VOLUME VIII ISSUE 1
HouseCall From diagnosis to emergency intervention, advanced treatment and techniques, to preventive care, St. Clair Hospital is a nationally recognized leader in cardiac care.
inside
Healthcare Costs Made Transparent I A Comprehensive Program For Preventing Patient Falls Community Outreach I Donor Spotlight I Ask The Doctor VII Issue 4 I HouseCall I 2 St. Clair Ranked #1 In Western Pennsylvania For OverallVolume Hospital Care
HEARTSTRONG
ST. CLAIR HOSPITAL IS
TAKING YOUR CARE
to heart ONE IN FOUR ADULTS HAS SOME DEGREE OF CORONARY ARTERY DISEASE
2 I HouseCall I Volume VIII Issue 1
610,000
735,000
PEOPLE DIE EACH YEAR FROM HEART DISEASE
ADULT AMERICANS WILL HAVE A HEART ATTACK ANNUALLY
F
OR DECADES, ST. CLAIR HOSPITAL HAS CARED FOR THE HEARTS OF PITTSBURGH RESIDENTS. EVERY DAY AT ST. CLAIR, HEART ATTACKS ARE HALTED, DAMAGED HEARTS ARE REPAIRED, ARTERIES ARE RE-OPENED, HEART RHYTHMS ARE STABILIZED — AND LIVES ARE SAVED AND RENEWED. THROUGH THE
YEARS, ST. CLAIR’S CARDIAC CARE SERVICES HAVE EXPANDED IN SIZE AND SCOPE AND CONTINUE TO EVOLVE, BRINGING EVERY AVAILABLE RESOURCE, HUMAN AND TECHNOLOGICAL, TO THE CARE OF PATIENTS.
IN THIS ISSUE OF HOUSECALL, readers will get a look at a sampling
Meantime, fellow St. Clair cardiologist Ryan W. Zuzek, M.D. is
of the many heart-related procedures offered at the Heart Center,
also using cardiac stents to treat patients with so-called left main
through the words of a few of the 2,000-plus heart-related patients
coronary artery disease, the most complex and challenging type and
who are treated each year by the Hospital’s outstanding cardiologists,
one that requires extensive planning, measurement and clinical
three of whom are featured in the following pages.
precision. Thanks to Dr. Zuzek and his expertise, patient Mark Bowman of Bethel Park is back to playing golf, doting on his first grandchild,
We begin with patient Zenon “Zen” Piotrowski, whose chest
and making plans to walk his youngest daughter down the aisle.
pain and shortness of breath on a recent business trip led him to the Cardiac Catheterization Lab of St. Clair cardiologist Jeffrey M.
And St. Clair cardiologist Jeffrey C. Liu, M.D., known for his
Friedel, M.D., who made the Upper St. Clair resident part of medical
masterful work in repairing problems with the heart’s electrical
history when he placed the region’s first Synergy cardiac stent in
conduction system, such as atrial fibrillation, is “fixing” AFib patients
Zen, preventing a near certain heart attack and restoring the business
like Brian McCay of Upper St. Clair and Kate Fagan, also of Upper
executive to good health.
St. Clair, in the Hospital’s sophisticated Cardiac Electrophysiology Lab. Continued on page 4
♥ ST. CLAIR HOSPITAL IS RANKED
#1 IN WESTERN PA FOR CORONARY BYPASS SURGERY
ST. CLAIR RANKS ST. CLAIR HOSPITAL WAS AWARDED THE REGION’S ONLY
‘A’ GRADE IN PATIENT SAFETY
1ST IN THE REGION IN DOOR-TO-BALLOON TIME ... AND IS AMONG THE BEST-PERFORMING HOSPITALS IN THE NATION
Volume VIII Issue 1 I HouseCall I 3
HEARTSTRONG Continued from page 3
Jeffrey M. Friedel, M.D.
ZEN, SYNERGY AND HEALING Zenon “Zen” Piotrowski made several trips to Las
I seemed okay. He referred me to cardiologist Jeffrey
Vegas in 2015, but two were especially significant. The
M. Friedel, M.D., who thought my history and diagnostic
first, late last year, was a business trip, one of many
tests suggested coronary artery disease. I had a stress
made by this busy sales executive for IBM Corporation.
test at the Heart Center at St. Clair Hospital. I failed it.
Zen was en route to a conference center, walking a fairly
Next, I had cardiac ultrasound and an EKG, and Dr. Friedel
hefty distance on a warm day, and arrived to find that
said I needed a cardiac catheterization and that he might
the long, long escalators he needed to take to his third
be able to take care of the problem then, with stents.
level destination were out of order. Disheartened but
The other possibility was that I might need coronary artery
determined, the 59-year-old Upper St. Clair resident
bypass surgery. I’m a non-smoker, I’m active and I love
and hiking enthusiast began the steep climb, and by the
the outdoors, but I have stress because I travel so
time he reached the top, he experienced some alarming
much and I’m overweight. Those things were probably
and unfamiliar sensations: a tightness in his chest,
contributing factors.”
accompanied by shortness of breath. It didn’t last long,
According to Dr. Friedel, a board-certified cardiologist
perhaps 90 seconds in all. But Zen was well aware of
with South Hills Cardiology Associates and the chief of
the implications of his symptoms.
the Division of Cardiology at St. Clair, Zen’s clinical
It happened a second time, in a similar manner, a few
presentation was classic. “It was very suspicious for
days later. “When I came home, I called my primary care
coronary artery disease at the outset. As soon as Zen
physician, internist Richard Gobao, M.D., in Scott Township,
exercised, he had chest pain and EKG changes — findings
and asked to see him right away. He examined me and
that are very concerning for a heart blockage. The symptoms
said that my blood pressure was a bit high, but otherwise
went away when he rested. I set things in motion for him to have a cardiac catheterization and instructed him to take it easy. I put him on aspirin, nitroglycerine and metoprolol, a beta blocker.” Coronary artery disease refers to the narrowing of the blood vessels that supply the heart muscle with blood and oxygen. The condition can be treated with an open-chest surgical procedure known as a coronary artery bypass graft, or CABG, commonly referred to as a bypass, in which blood vessels from other parts of the body are grafted onto the heart to replace the blocked arteries. Since the early ‘90s, cardiologists have also been performing a minimally invasive procedure, percutaneous coronary intervention,
Jeffrey M. Friedel, M.D., Chief of Cardiology, says St. Clair was the first hospital in the region to make the new Synergy stent available to patients.
4 I HouseCall I Volume VIII Issue 1
or PCI, to treat coronary artery disease in selected patients, and placing stents in the diseased arteries.
Not just any stent Zen became the first person in western
Stents are tiny, hollow, flexible mesh devices that are
Pennsylvania to receive a new kind of stent that had
placed within the narrowed coronary arteries. Simply
recently been approved for use by the FDA. Known as
stated, a stent holds the artery open and allows blood
the Synergy stent and developed by Boston Scientific,
to flow more freely.
it is a bio-absorbable polymer drug-eluting stent
Zen’s cardiac catheterization took place in St. Clair’s
(BP-DES) and is the only such stent in use in the
state-of-the-art Cardiac Catheterization Lab. “Patients
nation. Groundbreaking in its design and utility, it
are usually sedated but awake for the procedure,
is a paradigm changer that promises faster healing,
which is typically painless,” says Dr. Friedel. “I give
fewer complications and better outcomes.
my patients medication to take the edge off and help
Dr. Friedel says that St. Clair was the first
them relax. I used the right radial artery, near the
hospital in the region to make the new stent
wrist, as the insertion site for the catheter, instead
available to patients. “The BP-DES is the third
of the femoral site. It’s my preference: it’s a smaller
generation of coronary artery stents. The first
artery and there is a lower risk of bleeding. It’s a
generation was the bare metal stent,
better choice for the patient’s comfort, plus they
followed by the drug-eluting stent,
can walk immediately afterwards.”
which delivered a time-release
The cardiac cath revealed that Zen had three
Zenon “Zen” Piotrowski
medication. There were problems
critical blockages; the third vessel had a collateral
with both of those stents, which
vessel, which Dr. Friedel explains is the heart’s own
led to the engineering of the
natural bypass. “With multiple blockages, you
Synergy stent. It’s a major
consider bypass surgery, depending on the nature of
improvement.”
the blockages and their location within the coronary arteries. Zen’s blockages were very localized, making him a good candidate for placement of the stent.”
Continued on page 6
“
I was talking with Dr. Friedel during the procedure … right after, I felt good enough that I wanted to go right home.
”
ZENON “ZEN” PIOTROWSKI, PATIENT
Volume VIII Issue 1 I HouseCall I 5
HEARTSTRONG Continued from page 5
The original bare metal stents provided healing, but the resultant
reliably. These stents reduce the amount of time the patient has
scar tissue led too often to re-stenosis (re-narrowing) of the coronary
to stay on medications; with the faster healing, you don’t always need
artery. According to Dr. Friedel, who has worked with both previous
long-term blood thinners.”
models of stents, the healing that took place was too much of a good
The Synergy stent is a significant technological advance for
thing: “It was a hyperactive kind of healing, similar to a keloid.”
cardiology. Composed of platinum chromium, it is a miniscule device,
As many as one-third of patients developed re-stenosis from the scar
but its architecture provides great strength and capability. Intricately
tissue. That problem seemed to be solved by the development of the
carved by ultra-precise laser-cutting technology, its mesh is very thin
second generation stent, the drug-eluting stent, which included a
and finely detailed in a scaffold pattern, composed of bridges and
scar-preventing medication imbedded within a polymer coating.
struts that render it flexible, expandable and very strong. The BP-DES
The drug, everolimus, is delivered gradually and prevents re-stenosis,
model is coated on one side only with the absorbable polymer —
while the polymer coating remains on the stent. But in some patients,
a significant difference from the drug-eluting stent, which was entirely
the polymer acted as an irritant, and long-term exposure to the polymer
coated. The coating is a mere four microns thick — by comparison,
produced inflammation, which delayed healing and sometimes led
a human hair is 70 microns. The polymer breaks down after the drug
to serious complications, including blood clots.
has been delivered and is fully absorbed in three months.
“This latest stent provides the best of both worlds — it includes a
For Zen, who had two stents placed by Dr. Friedel, the beauty of
medication which prevents scarring and a polymer that is gradually
the Synergy stent is in the renewed health and vitality it has given him:
absorbed by the body and eventually disappears, so the risk of inflam-
“I’m amazed by this entire experience. I was nervous about having the
mation from long-term polymer exposure is eliminated,” Dr. Friedel
cardiac catheterization and stent placement, especially when I learned
says. “It allows the coronary artery to heal more quickly and more
that I would be awake for it. Dr. Friedel gives great explanations and
THE NEW SYNERGY STENT The Synergy stent is a significant technological advance for cardiology. Composed of platinum chromium, it is a miniscule device, but its architecture provides great strength and capability. Intricately carved by ultra-precise, laser-cutting technology, its mesh is very thin and finely detailed in a scaffold pattern, composed of bridges and struts that render it flexible, expandable and very strong. Dr. Friedel explains the intricacies of the new Synergy stent.
THIN, INTRICATELY CARVED MESH
STRONG AND FLEXIBLE
PLATINUM CHROMIUM COMPOSITION
6 I HouseCall I Volume VIII Issue 1
BIO-ABSORBABLE POLYMER DRUG-ELUTING COATING
tells you what to expect, and that lessened the
“
anxiety a lot. I was talking with Dr. Friedel during the procedure, and I’m still surprised by how comfortable I felt throughout it. The
Dr. Friedel has been
care was excellent, and felt very personal.
awesome and
Right after, I felt good enough that I wanted to go right home.”
St. Clair Hospital
Zen felt well enough to make another
gave me an excellent
trip to Las Vegas at Thanksgiving to visit his mother, who had been ill. “Without these
experience ...
stents, I would have had to go through the
I am very grateful.
entire bypass ordeal, and I would not have been well enough to travel, to see my
”
mother,” he says. “Dr. Friedel cleared me to make the trip. I feel very good now; I’m on aspirin, a beta blocker and a blood thinner, and I might be able to get off the blood thinner
ZENON “ZEN” PIOTROWSKI, PATIENT
soon. At my follow-up appointment with Dr. Friedel, my blood pressure was 117/78. I love spending time with my family: my wife, Donna, and our two sons, Stefan, 30, and John, 27. I know I’m fortunate; my own father died at age 49 of a heart attack. Dr. Friedel has been awesome and St. Clair Hospital gave me an excellent experience. I’m again enjoying the outdoors; I love sports, especially University of Michigan sports, and I love walking my German shepherd. I am very grateful.” Dr. Friedel is equally pleased with Zen’s progress. “Zen was an ideal candidate for the Synergy stent, and the stent conformed nicely to the bends in his coronary arteries. It went
Heart patient Zenon ”Zen” Piotrowski is back to playing fetch with his full-bred German Shepherd, Onya, 8.
very well. He was wise to see his primary care doctor quickly when he had symptoms, and to get a referral to our cardiology practice.
JEFFREY FRIEDEL, M.D.
At St. Clair, we have the most advanced tools
Dr. Friedel earned his medical degree at the Pennsylvania State University College of Medicine and completed his internal medicine residency at Allegheny General Hospital. He also completed fellowships in cardiology and interventional cardiology at Allegheny General Hospital. He is board-certified by the American Board of Internal Medicine in cardiovascular diseases and interventional cardiology and board-certified by the American Board of Nuclear Cardiology. Dr. Friedel practices with South Hills Cardiology Associates, a division of St. Clair Medical Services.
to diagnose and treat heart disease, including the most cutting-edge coronary artery stent. If you have symptoms, as Zen did, don’t hesitate to come to the Emergency Room at St. Clair, so we can make a diagnosis and begin treatment.”
To contact Dr. Friedel, please call 412.942.7900. Continued on page 8
Volume VIII Issue 1 I HouseCall I 7
HEARTSTRONG Continued from page 7
Ryan W. Zuzek, M.D.
A CHALLENGING CONDITION
“
In its infinite wisdom, the human body vigilantly
St. Clair Hospital. According to Dr. Zuzek, treatment for
protects its most vital organ, the heart. Shielded by the
coronary artery disease keeps improving, and St. Clair
armor of the sternum and rib cage, the heart carries out
Hospital is on the cutting edge of the latest breakthroughs
its ceaseless work, nurturing every tissue in every organ
in technologies and approaches to treatment. This
system. It’s the toughest and hardest working muscle
includes the treatment of left main coronary artery
in the body, and it requires some special sustenance of
disease, the most complex and challenging type. Left
its own. That is provided by the coronary arteries, the
main coronary artery disease is treated at St. Clair by
network of blood vessels that supply the heart muscle with
Dr. Zuzek and other interventional cardiologists with
The coronary arteries are
percutaneous coronary intervention, or PCI ― the
delicate-looking vessels
arteries through small incisions in the groin or the wrist.
ARTERY DISEASE KEEPS
that snake across the
This includes balloon angioplasty and the placement of
IMPROVING, AND ST. CLAIR IS
outer surface of the
stents, all of which take place in St. Clair’s Cardiac
heart. Like long, thin
Catheterization Lab.
richly oxygenated blood.
TREATMENT FOR CORONARY
ON THE CUTTING EDGE OF
fingers, they appear to
THE LATEST BREAKTHROUGHS
cup the heart and gently
IN TECHNOLOGIES AND
hold it. Their fragile
APPROACHES TO TREATMENT.
”
RYAN W. ZUZEK, M.D., INTERVENTIONAL CARDIOLOGIST, ST. CLAIR HOSPITAL
non-surgical, minimally invasive treatment of coronary
A patient in dire need It was about one year ago, on a Sunday night, when
appearance belies their
Mark Bowman, 56, sat down after dinner to watch a
significance: they are
Steelers game at his home in Bethel Park, and suffered
the heart’s own personal
a massive heart attack. As a pharmaceutical sales
circulatory system, as
representative who specializes in cholesterol-lowering
vital to the heart as the
drugs, Mark knew enough about heart disease to
heart is to the body.
immediately recognize that the “incredible pain” in
Taken together, the
his chest and upper arms was a heart attack. He took
three coronary arteries are merely inches in length — but
some aspirin, laid down on the floor and instructed
they are some of the most critically important inches in
his wife to call 911. Then he waited. And prayed.
the entire body. If there are deposits of plaque within a
When the paramedics arrived, Mark was unconscious
coronary artery or one of its branches,it may become
and going in and out of ventricular tachycardia, an
stenotic (narrow) or even occluded (closed), reducing the
abnormal heart rhythm that can be fatal. He was taken
flow of blood to the heart, a condition called ischemia.
the short distance to St. Clair Hospital’s Emergency
Ischemia causes the chest pain known as angina and can
Department, where clinicians awaited his arrival. In the
be clinically catastrophic; if the ischemia is not reversed,
Cardiac Catheterization Lab, in cardiogenic shock with
the affected tissue is starved of oxygen and dies. That is
his heart failing, he was placed in the care of Dr. Zuzek,
essentially what happens in a myocardial infarction,
who diagnosed a 100 percent occlusion of the left main
more commonly known as a heart attack.
coronary artery, leaving the two major arteries on
Treating coronary artery disease by maintaining or
the left side of his heart without any blood flow. The
restoring the flow of blood through the coronary arteries
blockage was initially treated with balloon angioplasty
to the heart muscle is the clinical focus of Ryan W. Zuzek,
to resume some blood flow and help stabilize him.
M.D., a highly credentialed interventional cardiologist at
Because of the high risk of operative mortality Continued on page 10
8 I HouseCall I Volume VIII Issue 1
Erin Maclay, an exercise specialist in St. Clair Hospital’s Cardiac/Pulmonary Rehabilitation Department, checks the blood pressure of heart patient Mark Bowman before he begins exercising.
Volume VIII Issue 1 I HouseCall I 9
HEARTSTRONG Continued from page 8
Dr. Zuzek, left, in St. Clair’s state-of-the-art Cardiac Catheterization Lab.
associated with his condition, Mark was not
Mark is looking forward to playing golf this
I heard tremendous things about it, and it
a candidate for cardiac surgery. So, Dr. Zuzek
spring. To build his strength and tolerance for
was exactly the place I needed to go.”
placed a stent (a small mesh tube designed to
activity, Mark attends the Cardiac/Pulmonary
hold open a blocked coronary artery) in Mark’s
Rehabilitation program at St. Clair three
and he is looking forward to next fall, when
left main coronary artery, extending into the
times a week. He says it has been a godsend.
he will walk his youngest daughter down
left anterior descending, and positioned an
“Cardiac rehab has benefitted me greatly.
the aisle at her wedding.
intra-aortic balloon pump to help keep his
I chose St. Clair’s rehab program because
He is excited to be a first-time grandfather,
blood pressure stabilized. The stent propped open the vessel, allowing blood to flow again to Mark’s severely injured heart muscle. Dr. Zuzek knew that, given the extent of the
RYAN W. ZUZEK, M.D.
damage, the situation was grave. “Mark had
Dr. Zuzek earned his medical degree at the National University of Ireland in Galway. His postgraduate training includes an internal medicine residency at the Cleveland Clinic, where he was later an attending physician. He completed cardiology and interventional cardiology fellowships at Brown University hospitals in Providence, R.I. Dr. Zuzek is board certified in internal medicine, general cardiology, interventional, and nuclear cardiology. He practices with US Heart and Vascular, P.C.
an acute left main occlusion and a massive myocardial infarction,” Dr. Zuzek says. “I have only seen this a few times, and he is the only patient I have seen who survived that kind of severe event. He was in critical condition.” Today, thanks to Dr. Zuzek’s skills and Mark’s dogged determination to recover,
10 I HouseCall I Volume VIII Issue 1
To contact Dr. Zuzek, please call 412.429.8840.
CORONARY ARTERY DISEASE:
The Evolution of Treatment Dr. Zuzek’s treatment of Mark’s heart disease
national standards. In fact, St. Clair ranks first
Re-stenosis is a complex physiologic process,
is a prime example of how treatment of coronary
in the Pittsburgh region in its door-to-balloon
involving many elements, and it was found that
artery disease has evolved substantially in the
time rate and is among the best-performing
the obstructive tissue in the bare metal stents
last half-century, and it continues to progress.
hospitals in the nation in this metric. This proce-
was fibrous; it was not composed of plaque.
The 1970s were a time of game-changing
dure, and the CABG procedure, saved thousands
It was the result of the body’s inflammatory
progress, when cardiac surgeons began restoring
of lives and prevented countless first and second
response to the presence of a foreign body.
blood flow to ischemic heart muscle by replacing
heart attacks.
But, blockage is blockage, no matter what the
diseased coronary arteries with blood vessels
The next breakthrough came with the
grafted from other parts of the body. This proce-
development of stents, the tiny hollow tubes
composition.” In 2003, a third generation of stents was
dure, called coronary artery bypass graft or
that are placed in coronary arteries to hold them
introduced, with dramatic results. Drug-eluting
CABG, is an open-chest surgical procedure and
open. This alternative procedure, however, was
stents are made of metal and are coated with a
was the standard of care until the ‘90s, when
problematic, as re-stenosis (renarrowing) of the
polymer that contains and elutes (delivers)
balloon angioplasty was developed. Balloon
artery was common within just six to nine
timed-release drugs to the walls of the
angioplasty, the insertion and inflation of a
months. In the late ‘90s a significant advance-
coronary artery, which tricks the body into
balloon-like device, enabled cardiologists to
ment was achieved with the advent of bare
thinking that the stent is not a foreign presence.
re-establish blood flow to the heart muscle
metal stents made of chromium, titanium or
“The effect is cytosuppressive, meaning that
without surgery. St. Clair’s door-to-balloon time
cobalt. “Bare metal stents inhibited re-stenosis,”
the cells don’t proliferate,” Dr. Zuzek says.
— the period of time from arrival in the Emer-
Dr. Zuzek explains. “They were better than
“Just as chemotherapy drugs inhibit the
gency Room (ER) to completion of artery-opening
balloons but still 35 percent of patients would
growth of cancer cells, drug-eluting stents
balloon angioplasty — is consistently above
return with another narrowing within that stent.
inhibit the development of fibrous tissue in the Continued on page 12
BALLOON ANGIOPLASTY WITH STENT
THE HUMAN HEART
PULMONARY ARTERY
LEFT MAIN CORONARY ARTERY
2
1
Build-up of cholesterol, partially blocking blood flow through the artery.
Stent with balloon inserted into the partially blocked artery.
LEFT MARGINAL ARTERY RIGHT CORONARY ARTERY DIAGONAL ARTERIES
RIGHT MARGINAL ARTERY
3
4
Balloon inflated to expand the stent.
Balloon removed, leaving the expanded stent.
Volume VIII Issue 1 I HouseCall I 11
HEARTSTRONG Continued from page 11
CORONARY ARTERY DISEASE:
The Evolution of Treatment (continued) stent. These are much better stents, far less
new drug-eluting stents, the left main is now
ment, as it demands absolute clinical
likely to develop stenosis. They represent
an acceptable site for stenting in select
precision. Patients are admitted to the
the most important development since the
patients. Drug-eluting stents are producing
Cardiac Care Unit after the procedure and
advent of balloon angioplasty. Drug-eluting
excellent outcomes that are similar to out-
may remain hospitalized for several days.
stents have greatly reduced the incidence of
comes achieved with open-heart surgery.
Patients who have stents in their coronary
re-narrowing, from 35 percent to just 5-8
They’ve become more popular as a viable
arteries have an increased risk of developing
percent, and have saved many lives.”
option as the technology and equipment have
blood clots and are consequently placed on
improved.”
anti-clotting therapy for a year or more.
The left main coronary artery is unique and presents special challenges for cardi-
Drug-eluting stents are not for everyone,
“Dual anti-platelet therapy means a combi-
ologists. “The left main is like the trunk of a
however, and are not a replacement for CABG
nation of aspirin plus another anti-clotting
tree,” explains Dr. Zuzek; “It’s wider and
for those who truly need it. For patients who
medication, such as Plavix, to prevent stent
shorter than the other coronary arteries
are relatively healthy, CABG is still recom-
thrombosis,” Dr. Zuzek says. In addition,
and branches off into two tributaries. These
mended and remains the gold standard. Drug-
patients must make lifestyle choices to
arteries supply 80 percent of the blood to
eluting stents represent a major advancement
prevent coronary artery disease. “That means
the heart. Fortunately a blockage at this site
for patients who have unprotected left main
no smoking; taking your medicine exactly
has not been treated ― and are unable to
as prescribed; exercising four times per week and following a heart-healthy diet.”
have the CABG surgery because they have
Coronary artery disease is the most
is not a common event, as the left main is the largest of the coronary arteries, but it is associated with high mortality.”
disease ― advanced left main stenosis that
Traditionally, the treatment of left main
existing co-morbid conditions, such as
common form of heart disease in the U.S.,
disease has been CABG surgery. “A blockage
chronic obstructive pulmonary disease or
according to the Centers for Disease
of 50 to 60 percent in the left main coronary
COPD, that make them poor candidates for
Control and Prevention, claiming 610,000
artery always resulted in a recommendation
such an extensive surgical procedure. Others
lives annually. One in four adult Americans
for CABG,” says Dr. Zuzek. “It has been the
may simply prefer not to undergo the bypass
have some degree of coronary artery
preferred approach, really the only approach,
surgery. For these patients, drug-eluting
disease, and 735,000 of them will have
to revascularize the left main coronary
stents are an option.
a heart attack. For most, it will be their
artery and restore perfusion to the heart.
The placement of a drug-eluting stent in
The left main was considered a ‘no-fly zone’
the left main is a complex procedure that
first ― and the heart attack itself may be
for stenting. But with the availability of the
requires extensive planning and measure-
happened with Dr. Zuzek’s patient, Mark.
ACCORDING TO THE NATIONAL HEART, BLOOD AND LUNG INSTITUTE
An 82% reduction in heart risk is possible
12 I HouseCall I Volume VIII Issue 1
their first symptom of heart disease, as
When you do these four simple things:
AVOID SMOKING
STAY PHYSICALLY ACTIVE
EAT A BALANCED DIET
MAINTAIN A HEALTHY WEIGHT
Jeffrey C. Liu, M.D.
RESTORING RHYTHM Shortly after joining St. Clair Hospital’s highly regarded cardiology program, board-certified cardiac electrophysiologist Jeffrey C. Liu, M.D. helped to expand the Hospital’s Cardiac Electrophysiology program and to develop a fully equipped, state-of-the-art, comprehensive Cardiac Electrophysiology Lab for the treatment of cardiac rhythm disorders, or arrhythmias — abnormal patterns in the heartbeat that are the result of problems in the heart’s electrical conduction system. Cardiac electrophysiology is a subspecialty within cardiology, and Dr. Liu is one of relatively few cardiac electrophysiologists in the region. Dr. Liu specializes in complex cardiac ablation; at St. Clair, he performs one of the most advanced forms of ablation, cardiac cryoballoon ablation, which was developed specifically to treat atrial fibrillation, a common arrhythmia. Cryoballoon ablation is a truly cutting-edge medical technology, Dr. Liu says, and the Cardiac Electrophysiology Lab at St. Clair is generating excellent outcomes with this and other procedures. Most importantly, cryoballoon ablation is changing the lives of patients, restoring not only their normal heart rhythms, but also their quality of life. Continued on page 14
NORMAL
Jeffrey C. Liu, M.D.
ATRIAL FIBRILLATION
This medical illustration of a patient’s EKG shows a normal heart rhythm and one in atrial fibrillation.
Volume VIII Issue 1 I HouseCall I 13
HEARTSTRONG Continued from page 13
Relieving the burden of AFib Upper St. Clair resident Brian McCay recently dug an
Dr. Robert Shogry of South Hills Cardiology Associates,
eight-foot by five-foot ditch, and the 51-year-old contractor
(a division of St. Clair Medical Services). I spent two days
could not have been happier. Earlier this year, that kind of
on a Holter monitor; I had a stress test; and I had a cardiac
strenuous work would have been impossible for him. Atrial
catheterization, which showed that my heart was basically
fibrillation had made his life miserable, rendering him
healthy. Dr. Shogry recommended that I see an electro-
breathless and exhausted.
physiologist. Dr. Liu tried several medications, but they
“My heart was beating so fast, as high as 170, and it kept
didn’t help. I had to either live with atrial fibrillation or get
getting progressively worse,” Brian recalls. “In the beginning,
the cryoballoon procedure done. I knew I couldn’t continue
I had episodes about once a month; soon though, they were
to live the way I was.” Dr. Liu says that atrial fibrillation is
happening once a week, and then it became daily. I couldn’t
different for everyone, and for some people, it can be disabling.
breathe or climb stairs; I was exhausted. All I could manage
Brian had a rapid progression of disease, and his episodes
to do was work and sleep.“ Unfortunately, Brian experienced a phenomenon that is
all too common for people with atrial fibrillation ― difficulty
in getting the condition diagnosed. Due to its usually
were severe enough that he felt like he might die. “Some people with atrial fibrillation can’t feel it, while others are very symptomatic, as Brian was. He had a lot of palpitations and he felt so poorly,” Dr. Liu says. “He had no energy. When people
paroxysmal or spasmodic nature, episodes may not coincide
are very symptomatic, we try medication first. Sometimes
with visits to the doctor or the emergency room. Often,
they are very effective, but they had the opposite effect on
patients are told that they are having panic attacks and may
Brian and actually made him worse. This is not unheard of,
go for years without an accurate diagnosis ― and treatment.
“I never had an episode when I was in my PCP’s office.
He told me to go right to the ER when it happened the next
as these medications are designed to alter electrical activity in the heart. We can’t always predict what they will do.” Dr. Liu talked with Brian about the cryoballoon ablation
time,” Brian says. “I did that several times, and finally the
procedure, explaining the procedure in detail. “I offered Brian
diagnosis was confirmed by an EKG and I was referred to
the ablation procedure in order to decrease the burden of
WHAT IS CRYOBALLOON ATRIAL ABLATION? In many patients atrial fibrillation is triggered
DISORGANIZED ELECTRICAL SIGNALS
by abnormal electrical impulses firing from the pulmonary vein. Cryoballoon ablation is a procedure in which a balloon within the catheter is inflated and filled with an extremely cold gas that slightly “wounds” a specific, targeted area of tissue in the heart. The wound creates a scar that acts as a barrier, blocking the abnormal electrical signals that trigger atrial fibrillation.
14 I HouseCall I Volume VIII Issue 1
CATHETER
ABLATES AT THE POINT OF BALLOON CONTACT
Dr. Liu uses a sophisticated, high-tech mapping system to perform cryoballoon ablation at St. Clair.
atrial fibrillation for him. That’s what it is intended to do.
For those patients who experience paroxysmal
He is young to have the condition. I never twist any arms;
atrial fibrillation, Dr. Liu says, cryoballoon ablation has
I explain the options to the patient. Atrial fibrillation or
a success rate of approximately 80 percent; for those
“
Afib is not life threatening, but many people find the
who are in atrial fibrillation all the time, the rate is
VILLAGE TO DO
symptoms unbearable and they want to have this done.
about 60 percent.
A CRYOBALLOON
This is a safe procedure; people do well with it.” Cardiac cryoballoon ablation utilizes intense cold to
IT TAKES A
Brian had the procedure at St. Clair and spent two
ABLATION. LOTS
days in the Hospital. Although the cryoballoon ablation
target and destroy a precisely pinpointed area of tissue
itself only takes a few hours, extensive and meticulous
OF VERY SKILLED
in the heart muscle to create a controlled scar to block
advance preparation is required because of the need for
PEOPLE AND
aberrant electrical signals that trigger episodes of atrial
absolute precision. “It takes a village to do a cryoballoon
fibrillation, thus restoring a normal heart rhythm. Regular
ablation,” Dr. Liu says. “Lots of very skilled people and
A LOT OF VERY
cardiac ablation burns or cauterizes the tissue to create
a lot of very special tools play a part. A special cardiac
SPECIAL TOOLS
a scar, while cryoballoon ablation uses freezing technology.
CT scan is done first in Medical Imaging. It gives
PLAY A PART.
During the procedure, a thin pliable catheter is threaded
awesome, high quality pictures — a 3D reconstruction
through the large femoral vein in the leg and up into the
of the veins and what we’re working on. This is
”
heart through a trans-septal puncture. A balloon within
meticulously made and very helpful. We take the
the catheter is inflated and filled with a cold gas that
raw data, process it and incorporate it into a mapping
slightly “wounds” the tissue in order to create a scar.
system. It literally gives me a road map of the patient’s
The tissue is targeted so specifically that the surrounding,
heart ahead of the procedure. As a result, I know exactly
healthy tissue is unaffected.
where I’m going. In addition, we use intracardiac
“Cryoballoon ablation is safer and faster than the old
JEFFREY C. LIU, M.D., ELECTROPHYSIOLOGIST, ST. CLAIR HOSPITAL
echocardiography, which provides high quality pictures
targeted burn technique; it’s easier on the patient,” says
of cardiac structures in real time. We create a scar
Dr. Liu. “It all adds up to a better experience for properly
to isolate the four blood vessels, the pulmonary veins
selected patients.”
that feed blood into the left atrium.” Continued on page 16 Volume VIII Issue 1 I HouseCall I 15
HEART STRONG Continued from page 15
“
This was life-changing for me. My quality of life is vastly improved. My experience with Dr. Liu and his whole practice was excellent; his skill is matched by his compassion.
”
KATE FAGAN, PATIENT
Special technology freezes out AFib “It feels like a crazy bird is loose inside your chest, wildly flapping around. It’s not painful but
wasn’t disabling for me; I kept working, although
it feels awful. You can’t relax or sleep and you
it wasn’t easy to be in court with my heart racing.
can’t get anything done because it’s so distracting.
Finally, I was put on a different monitor that
You can’t think; you can hear it and feel it. It’s
I wore for two weeks. On the basis of the data
very disruptive.”
from that monitor, I was referred to Jeffrey
That is attorney Kate Fagan’s vivid description
Friedel, M.D. of South Hills Cardiology Associates.
of how atrial fibrillation can feel. For Kate,
Dr. Friedel explained to me that I was in atrial
the condition began with occasional episodes
fibrillation.”
of rapid and irregular heartbeats. Her journey
Kate, 64, is a civil trial attorney with Wayman,
to diagnosis mirrors that of Dr. Liu’s patient,
Irvin & McAuley, LLC in Three Gateway Center.
Brian McCay. “I went to my primary care physician,
She is also an eight-year survivor of breast
who ordered a Holter monitor for me to wear,”
cancer, with a lot of first-hand experience in
Kate says. “It showed nothing, but the episodes
the healthcare system. Initially, her atrial
continued and increased in both frequency and
fibrillation was treated with medication. It worked
duration. They were becoming more and more
for a while, but then her episodes returned and
Kate Fagan, patient
16 I HouseCall I Volume VIII Issue 1
unpleasant, although I never passed out. It
worsened. She was referred to Dr. Liu. “Dr. Liu spent a lot of time with me and gave me the opportunity to ask a lot of questions. He was
Cardiovascular screening saves lives
never pushy about having this done. He explained
Cardiovascular disease remains the number one killer of adults
to me what he could do, and told me to think it
in this country. But more important than treating someone with
over. I did a lot of reading and learned as much
a heart attack, is to prevent it from ever happening in the first
as I could about it. I felt that I understood it very well. When my episodes worsened, I knew it was what I wanted to do. I had great confidence in
place. Fortunately, today, medicine has advanced capabilities to identify those who are at greatest risk of dying from a heart attack. Many people have no cardiovascular symptoms, but carry with them an increased risk of heart disease. These include patients with no medical problems, but a strong family history of cardiovascular
Dr. Liu and his team, and I knew I could count
disease. Other patients at risk include diabetics, smokers, those with high blood pressure
on St. Clair Hospital.”
or high cholesterol, sedentary individuals, and people who are overweight.
Kate had cryoballoon ablation done in early November. “The procedure took four hours, and when I woke up, Dr. Liu was right there,” she says. “He told me it had gone perfectly. I had no need for pain medication afterwards. At first, I did have a few episodes of atrial fibrillation, but I was prepared that this might happen so I didn’t panic. Those episodes were far shorter and less intense — and they’re completely gone now. “This was life-changing for me. My quality of life is vastly improved. My experience with Dr. Liu and his whole practice was excellent; his skill is
FOR THOSE WHO MIGHT BE AT RISK FOR HEART DISEASE ST. CLAIR HOSPITAL OFFERS THE FOLLOWING PREVENTIVE SERVICES: ♥ A comprehensive exam by a cardiologist to assess overall cardiovascular risk.
♥ Cardiac CAT scans.
♥ Analysis of cholesterol and abnormalities of the blood known to be markers of heart disease.
♥ Echocardiograms.
♥ A Calcium Score — a noninvasive way to measure plaque in the arteries of the heart. This has been shown to be a powerful predictor of cardiovascular events including heart attack and stroke.
♥ Stress testing. ♥ Cardiac catheterization. ♥ Fitness evaluations — including a comprehensive cardiac rehabilitation program. ♥ Nutritional counseling with an emphasis on heart healthy diets.
matched by his compassion.” “Cryoballoon ablation is cutting edge, and it distinguishes St. Clair Hospital,” says Dr. Liu. “These procedures have a firm endpoint. I see how the patients do in the long term, and that leads to a better understanding of what we can accomplish. We’re able to get many people off medication and that alone is an incentive to have the procedure. The patients are pleased and doing well. It’s life changing for them, and that’s rewarding for me. It’s a winner in every way.” ■
JEFFREY C. LIU, M.D. Dr. Liu earned his medical degree at Jefferson Medical College, Philadelphia. He completed a residency in internal medicine at the University of Maryland Medical Center, served as Chief Resident at the Baltimore VA Medical Center, and completed a fellowship in Cardiovascular Medicine and a fellowship in Cardiac Electrophysiology at UPMC. Dr. Liu is board-certified in cardiovascular diseases, cardiology, cardiac electrophysiology and internal medicine by the American Board of Internal Medicine. He practices with South Hills Cardiology Associates, a division of St. Clair Medical Services. To contact Dr. Liu, please call 412.942.7900.
Volume VIII Issue 1 I HouseCall I 17
HEALTHCARE PRICE TRANSPARENCY
EALTHCARE COSTS MADE
18 I HouseCall I Volume VIII Issue 1
ST. CLAIR LAUNCHES A VALUABLE NEW ONLINE FINANCIAL TOOL FOR PATIENTS
S
t. Clair Hospital recently launched a new online tool that promises to further help patients have the best possible healthcare experience. Called
Patient Estimates, it is a cost transparency tool that
patients may freely access on the Hospital’s website, www.stclair.org, in order to learn what their estimated out-of-pocket costs will be for services at the Hospital or its Outpatient Centers prior to the delivery of those services. St. Clair is the first hospital in the region to offer this new cost estimate service, which — given today’s higher deductibles and co-payments — makes St. Clair’s new service especially valuable and meaningful. “St. Clair Hospital is committed to being a leader in high-value healthcare,” says Richard C. Chesnos, Senior Vice President & Chief Financial Officer. “In addition to our award-winning patient safety and clinical outcomes, and nation-leading patient satisfaction, St. Clair provides very cost-effective services, and we want our patients to feel secure knowing, upfront, how much their care will cost them.” Continued on page 20
Volume VIII Issue 1 I HouseCall I 19
HEALTHCARE PRICE TRANSPARENCY Continued from page 19
Patient Estimates is a product developed by Experian Health. Patient Estimates is not a list of charges, but an interactive, user-friendly tool that provides information that is highly specific to the individual. It is simple to use and convenient, accessible 24/7, and available to all. A patient simply visits the Hospital website, www.stclair.org, and selects the option “Financial Tools” on the home page. After selecting the Patient Estimates block on the landing page, a patient then enters their insurance information, selects one of the listed clinical services, and chooses the specific diagnostic test, procedure or treatment. The tool then provides a customized estimate of what their out-of-pocket costs are likely to be. Traditionally, patients have not had access to cost information. Nearly always, a patient only learns about out-of-pocket costs weeks after a procedure or test via their Explanation of Benefits (EOB). Patient Estimates provides the EOB before services are delivered. St. Clair’s financial services staff conducted research to determine which clinical services to include. They range from delivery room costs to lab tests and imaging studies. “We chose over 100 of the most frequently ordered services, in 15 categories,” says Rick. “People can come to the website to learn what their financial responsibility will be for that test or procedure. Our tool gives you true out-of-pocket costs, whether you have insurance or not.” Cost transparency is a growing trend in healthcare. Driven in part by higher deductibles and the Internet, consumers in 2016 are far better informed about their health, quality care and healthcare costs. “Today’s healthcare consumers are educated and informed,” says Rick. “They’re thinking as consumers and demanding more. They want the information so that they can manage their healthcare budget and make the best choices for their circumstances and needs.” ■
20 I HouseCall I Volume VIII Issue 1
NEWSWORTHY The Pittsburgh Tribune-Review and Pittsburgh Post-Gazette published Op-Ed pieces saluting St. Clair’s new Patient Estimates tool just days after its unveiling.
Reprinted with permission.
Copyright Š, Pittsburgh Post-Gazette, 2016, all rights reserved. Reprinted with permission.
Volume VIII Issue 1 I HouseCall I 21
QUALITY & PATIENT SAFETY
ST. CLAIR SAFETY INITIATIVE
Preventing Patient Falls FALLING IS ONE OF THE LEADING CAUSES OF INJURIES TO HOSPITALIZED PATIENTS. It is the most common adverse event reported by hospitals, according to the Institute for Healthcare Improvement, and half of all hospital falls result in injury. Falls are not always unavoidable, however, and a strong fall prevention program is an essential element of quality care at any hospital. At St. Clair Hospital, patient safety is a priority, and an important effort that is being formally recognized by such renowned national organizations as the Leapfrog Group, which recently awarded St. Clair the region’s only ‘A’ grade in patient safety.
S
t. Clair has implemented a vigorous and comprehensive
There are two major aspects of risk, Joan says. “We look at fall
fall prevention program that is producing outstanding
risk and harm risk as two separate issues. Does the patient
results. At St. Clair, vulnerable patients are protected
have a history of falls? Is the patient at greater risk for a fall
by an extensive system of well-defined and well-executed initiatives that have resulted in a fall rate that is well below the national average, and is continuing to improve. Joan Massella, R.N., M.Ed., M.B.A., Administrative Vice President & Chief Nursing Officer at St. Clair, says that a fall is formally defined as “an unplanned and unexpected descent to the floor.” Not all falls are traumatic, she
because of pre-existing conditions? Does the patient use an assistive device like a cane or walker? Those issues raise the risk of falling. The risk of harm to the patient from a fall increases when there is advanced age, bone disease, such as osteoporosis, the use of anticoagulant therapy (blood thinners) or recent major surgery.” In a hospital environment, there are numerous factors that raise the risk of falling. Contributing factors for patients include: cognitive changes secondary to illness or the side effects of medication; muscle weakness and fatigue;
explains, and not all falls lead to injury.
disorientation in an unfamiliar environment; changes in gait,
But when injuries do occur, she says, they
balance or posture; and sensory changes, including pain.
can be severe: “Falls can result in fractures, especially hip
Something as simple as not wearing shoes or being unable to locate one’s eyeglasses can contribute to a fall. In many
fractures and head
instances, the interplay of multiple factors results in a fall.
injuries. A fall can also cause
While not all of these factors are modifiable, awareness of
a patient to be fearful and
them leads to careful monitoring and interventions that
more tentative about their
mitigate risk and help prevent falls.
daily routine, which can
Fall prevention is primarily the responsibility of nursing
tend to make a person
and at St. Clair, the nursing staff meets the challenge of
more reclusive. A fall can
fall prevention with diligence and determination, utilizing
change a life; it can be
a multifaceted approach that both reduces the risk of falling
the beginning of a cascade
and minimizes the risk of harm from falls. From adherence,
of complications and lead
to the most time-honored fundamentals of nursing practice,
to immobility as well as
to use of evidence-based guidelines and national best
to a loss of independence
practice interventions, to the utilization of high-tech safety
and reduced quality
equipment and electronic monitoring, St. Clair nurses
of life.”
view fall prevention as imperative. Continued on page 24
Joan Massella, R.N., M.Ed., M.B.A., Administrative Vice President & Chief Nursing Officer, St. Clair Hospital 22 I HouseCall I Volume VIII Issue 1
Patients wearing red socks are deemed at risk of falling and are carefully monitored and attended to around the clock.
“
At St. Clair, the staff pays enormous attention to quality care and patient safety. ELIZABETH PITTMAN, VICE PRESIDENT OF OPERATIONS, ST. CLAIR HOSPITAL
”
Volume VIII Issue 1 I HouseCall I 23
QUALITY & PATIENT SAFETY Continued from page 22
Barbara Girod, B.S.N., M.B.A., R.N., Director of Nursing Quality at St. Clair, says nursing interventions at the
The presence of family members can be highly beneficial in fall prevention, and the nursing staff welcomes them.
Hospital are both universal and individualized. “At St. Clair,
“Families provide essential information to the staff, information
we apply universal precautions and safeguards for every
the patient may not share,” Barb explains.
patient, including call bells, a uncluttered floor and adequate
Nursing, in
lighting. We set up the patient environment to minimize risk.
large part, centers
A key preventive step is the initial assessment of the patient,
on communication
to identify risk factors, using a standardized risk-assessment
and analysis of
form. Other interventions are visual cues: red ID bands
risk. Hand-off communication
information to all staff that the patient is a fall risk.”
at shift changes
FALLS PER 10,000 PATIENT DAYS 2.75 1.96
ST CLAIR HOSPITAL
NATIONAL AVERAGE
235 200 _ 172
and red non-slip socks that immediately provide visual “We use protective devices,
includes fall- and
164
150 _
137 120
100 _
such as a slip guard on the chair
harm-risk information
to prevent sliding,” Barb adds.
for patients who are
“For frail patients with arthritic hips,
transferred about the
osteoporosis or a body mass index
Hospital for testing or treatment. St. Clair
(BMI) below 20, we have padded hip
staff performs approximately 300 audits
protectors: high tech pads, which
each week using a software program
50 FY ’11
cushion the hips in case of a fall.
called Qualaris. Data are entered into
Low beds, eight inches from the floor,
an electronic dashboard, from which
are an option. We also have “landing
the team can monitor trends and
mats” — soft pads placed next to
identify opportunities for improvement.
the bed, to provide a cushioned surface on which to fall.”
’12
Qualaris furnishes the nursing department
Technology plays a key role in fall prevention at St. Clair.
with a summary that reveals
The Hospital has a video monitoring system in place to keep
trends and allows comparison
a constant eye on selected patients whose risk is especially
to previous years.
high. A pilot program demonstrated that staff can respond
A multidisciplinary fall
very quickly when they are alerted that a patient is about to fall
prevention committee meets
or is in a precarious situation that may lead to a fall. Although
monthly; they review every
every patient room has camera capabilities, the monitoring
fall event, identify all the
system is used selectively and only with the consent of the
contributing elements, and
patient and family.
make recommendations.
“
RED ID BANDS AND RED NON-SLIP SOCKS IMMEDIATELY PROVIDE VISUAL INFORMATION TO ALL STAFF THAT THE PATIENT IS A FALL RISK.
”
BARBARA GIROD, B.S.N., M.B.A., R.N., DIRECTOR OF NURSING QUALITY, ST. CLAIR HOSPITAL
24 I HouseCall I Volume VII Issue 4
ST. CLAIR ACUTE INPATIENT FALLS
250 _
Barbara Girod, B.S.N., M.B.A., R.N.
’13
’14
’15
Since 2012, when St. Clair began to track falls, the fall rate at the Hospital has dropped.
metrics
per 10,000 patient days, which compares very
used by the
favorably with the national rate of 2.75 falls
“We measure by patient days, in accordance
Leapfrog
per 10,000 patient days, as tracked by NDNQI,”
with the system used by the National
Group, a
Elizabeth says. “Our fall prevention program
Database of Nursing Quality Indicators
national organization that focuses on patient
is quite effective. It is actually preventing
F (NDNQI),” says Joan. “We compare quite
safety. St. Clair has consistently had an
as many as five falls per month.”
favorably with the national rate.”
‘A’ rating from Leapfrog.
Elizabeth Pittman, Vice President of
Zero falls, says Elizabeth, is the ultimate,
The fall prevention team drives efforts
though formidable, goal. “At St. Clair, the
Operations at St. Clair, says that fall rates are
with data collection, data analysis, bench-
staff pays enormous attention to quality care
considered a significant quality indicator by
marking and trending. “For fiscal year 2015,
and patient safety. They truly care about the
the entire healthcare industry and are publicly
St. Clair had 152 falls in 776,500 patient
well-being of all those in our care and they
reported. Hospital fall rate is one of the
days. This gives St. Clair a fall rate of 1.96
are doing an outstanding job.” ■
PREVENTING FALLS
Falls are usually caused by a combination of several risk factors, including problems with balance, slow reflexes, poor eyesight and medications.
STEP STEP
Patients who fall while in the hospital have a 60 percent higher likelihood of falling at home. To help prevent falls at home, St. Clair Hospital provides patients and families with the following fall prevention guidelines at discharge.
BY
PROTECT YOURSELF
MAKE YOUR HOME SAFE Use grab bars and non-slip adhesive strips or a mat in the shower or tub.
Ensure proper lighting, especially on stairs.
Review your medications with your doctor. Some drugs can make you drowsy, dizzy and unsteady. If dizzy or lightheaded, sit down until your head clears, then get up slowly.
Have your sight and hearing tested.
Consider a bench or stool in the shower and an elevated toilet seat.
Perform regular exercise to improve strength, flexibility and balance. First verify with your doctor that exercise is okay.
Keep electrical and telephone cords out of pathways.
Use a cane or walker when walking, if you have been advised to use one or both. Wear nonslip, low-heeled shoes or slippers. Avoid walking in stocking feet.
Remove clutter.
Remove throw rugs or runners that can be a tripping hazard.
Always use handrails on stairs.
Never stand on a chair to reach things.
Volume VII Issue 4 I HouseCall I 25
IN THE COMMUNITY
COMMUNITY OUTREAC YOUTH MENTORING Karen Alberts, R.N. (top photo, far right), of St. Clair Hospital's Sipe Infusion Center, explains to high school-aged students with the Bethel Park-based human services organization SHIM (South Hills Interfaith Movement) one of her duties at the infusion center during a recent job shadowing/career night at the Hospital. More than 15 students from SHIM — all of whom are refugees — spoke with professionals in Pharmacy, Occupational Therapy, Medical Records, Medical Imaging and Nursing during the event. ■
DONOR SPOTLIG
T
Jennifer A. Totten, M.D.
GRANT TO FUND COURTESY TRANSPORTATION Venard Campbell (third from left), Pre-Hospital Coordinator at St. Clair Hospital, accepts a $1,000 grant from Joseph King, (second from left) President of the Mt. Lebanon Community Endowment to support the Hospital’s Courtesy Van Transportation Program. The program, funded entirely with generous donations from the community, shuttles individuals who do not have access to transportation to their medical appointments. Pictured with Venard and Joseph and one of the Foundation-sponsored Courtesy vans are, left to right: Audrey Bode, Executive Director of the Endowment; Mike Blehar, a Board Member of the Endowment; Rick Lerach, Vice President of the Endowment, and Kristen Beattie, Manager, Organizational Advancement, St. Clair Hospital Foundation. ■
26 I HouseCall I Volume VIII Issue 1
Volume VIII Issue 1 I HouseCall I 26
ASK THE DOCTOR
Ask the Doctor JENNIFER A. TOTTEN, M.D.
Q A
I have been having abdominal pain and indigestion. Could I have irritable bowel syndrome? What is the treatment? Irritable bowel syndrome (IBS) is a very common
doctor. By working with your physician, you can
gastrointestinal disorder. Up to 20 percent of Americans
determine if you have specific symptom triggers, such
have symptoms consistent with IBS. In fact, IBS is the
as stress, lifestyle habits or specific foods that exacerbate
most common diagnosis seen in gastroenterology practices.
your symptoms. Then, eliminate or attempt to minimize
Women are twice as likely to be diagnosed with IBS
those triggers.
as men. Patients with IBS often suffer from diarrhea,
Certain foods, such as milk-containing products, legumes and cruciferous vegetables, may aggravate IBS
constipation, or alternating diarrhea and constipation.
symptoms in certain patients by promoting gas and
Abdominal pain must also accompany these bowel changes
bloating. It is reasonable to eliminate these foods
for a patient to be diagnosed with IBS. Other symptoms
for two weeks to see if your symptoms improve.
seen with IBS include bloating, gas and belching. There is not one specific diagnostic test for IBS,
There are several medications available to control IBS symptoms and specific therapies targeted to the individual
however, there are formal criteria that physicians use for
symptoms. Pharmacologic treatment strategies include
diagnosis. After taking a medical history and performing
medications for constipation and diarrhea,
a physical exam, your doctor may recommend certain
probiotics, low-dose anti-depressants,
tests to exclude other gastrointestinal conditions as well.
antispasmodics and certain
In order to establish a diagnosis, patients must have
antibiotics.
recurrent abdominal pain and/or discomfort for at least
It is also important to eat
three days per month during the last three months. The
a balanced diet, drink plenty
symptom onset must have been six months or more prior
of water and to exercise
to the diagnosis, and patients must have at least two of
regularly to help keep your
the following three symptoms: symptom improvement
digestive tract regulated.
with a bowel movement; onset associated with a change
The goal is to establish a
in stool frequency; or onset associated with a change in
lifestyle plan that gives you
stool appearance or form.
maximum control over
Although IBS is thought to be a chronic disorder,
your symptoms. â–
there are many options available for treatment. First and foremost is to establish a good relationship with your
Jennifer A. Totten, M.D.
JENNIFER A. TOTTEN, M.D. Dr. Totten specializes in gastroenterology. She earned her medical degree at the University of Rochester School of Medicine. Dr. Totten completed her residency in internal medicine at the University of Pittsburgh Medical Center, and a fellowship in gastroenterology at Allegheny General Hospital. She is board-certified in internal medicine and gastroenterology by the American Board of Internal Medicine. Dr. Totten practices with Southwest Gastroenterology Associates. To contact Dr. Totten, please call 724.941.3020.
Volume VIII Issue 1 I HouseCall I 27
1000 Bower Hill Road Pittsburgh, PA 15243 www.stclair.org
General & Patient Information: 412.942.4000 | Physician Referral Service: 412.942.6560 | Medical Imaging Scheduling: 412.942.8150 Outpatient Center–Village Square: 412.942.7100 | Urgent Care–Village Square: 412.942.8800 | Outpatient Center–Peters Township: 412.942.8400
MAKE SURE ST. CLAIR HOSPITAL IS IN YOUR HEALTH INSURANCE NETWORK.
St. Clair participates with every major insurer in almost every product. That means ST. CLAIR IS AN IN-NETWORK PROVIDER for these insurers and products. And, if you have a health insurance product (like a high-deductible health plan) that requires you to share in the cost of paying for services, you’ll be pleased to know that ST. CLAIR IS OFTEN THE LOWEST COST PROVIDER. For more information, please call Customer Service at 412.344.3408 to speak to a St. Clair representative. For a complete list of insurers currently contracted with St. Clair to provide IN-NETWORK services to their members, please visit WWW.STCLAIR.ORG.
1 in Western Pennsylvania for Overall Hospital Care
#
National accolades for St. Clair Hospital’s quality continue. The latest to recognize St. Clair as a national leader in patient safety and quality is Comparion Medical Analytics, one of the nation’s largest privately held healthcare information services companies. Using its proprietary CareChex® quality rating system, Comparion rates St. Clair #1 in western Pennsylvania and in the top 2 percent in the country for “Overall Hospital Care.” Comparion also rates St. Clair as best in the region for eight different specialties.
ST. CLAIR HOSPITAL IS RANKED #1 IN WESTERN PENNSYLVANIA FOR: General Surgery
Coronary Bypass Surgery
Orthopedic Care
Overall Surgical Care
Overall Hospital Care
Gastrointestinal Care
Cancer Care
Neurological Care
Major Bowel Procedures
HouseCall
is a publication of St. Clair Hospital. Articles are for informational purposes and are not intended to serve as medical advice. Please consult your personal physician.
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