VOLUME IV ISSUE 3
HouseCall
Visionary care inside
The Fine Art Of Plastic Surgery I Educating Patients Living With Diabetes I Ask The Doctor St. Clair Hospital Ranked Among 100 Top Hospitals In The Nation I Physical Therapy Expansion
Volume IV Issue 2 I HouseCall I 2
Patient Profile
Providing Better Vision for a
Better Quality of Life 2 I HouseCall I Volume IV Issue 3
refining focus
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s a retired optometrist, Dr. Robert Nungesser knows eyes better than most people. He also understands the unique visual challenges people living with cataracts face on a daily basis. Not only did he often treat patients who suffered from cataracts, but he also developed them himself as he got older. As a result, he began to experience decreased vision, which made it especially more troublesome for him to drive at night when he would see “halos” around approaching headlights. The 81-year-old Scott Township resident knew where to turn for help. For years, he had referred cataract patients for surgery to James P. Mondzelewski, M.D., founder of GlaucomaCataract Consultants, located near the main campus of St. Clair Hospital. Dr. Mondzelewski determined that Dr. Nungesser was an excellent candidate for the Crystalens, an FDA-approved intraocular (IOL) lens, that Dr. Mondzelewski offers his patients. IOLs are always used in cataract surgery because they replace the eyes’ natural lenses, which are removed during surgery. However, the Crystalens offers better vision at multiple distances than other IOLs because Unlike Dr. Nungesser, 34-year-old Matthew it is able to shift position with the action of Jobson is not an optometrist. However, since eye muscles as a person focuses. third grade, he was used to seeing one every year According to Dr. Mondzelewski, the Crystalens because of his poor eyesight. The St. Clairsville, is designed with hinges on each side. These allow Ohio resident, who works as a pharmacist in the optic, which is the central portion of the lens a hospital in Wheeling, had -12 diopters of used for viewing, to flex back and forth as a patient nearsightedness vision in each of his eyes — changes focus on images meaning that, without in his or her line of sight. glasses, he could barely “The Crystalens gives see objects right in front This was a very some cataract patients uncomplicaTed procedure, of him. He didn’t like a better ability to focus,” so i was noT apprehensive wearing glasses much he says.“It also allows and contact lenses only abouT iT. also, if patients to be free of dried his eyes out after dr. mondzelewski is glasses the majority performing your surgery, extended wear. of the time.” While most nearyou’re in greaT hands. Dr. Nungesser had sighted patients would his surgery in February elect for LASIK surgery of this year at the Mt. to improve their vision, EYE SURGERY PATIENT DR. ROBERT NUNGESSER Lebanon Surgical Center Jobson was not a good in the St. Clair Hospital Professional Office candidate because of his extreme nearsightedBuilding. Today, his distance vision is sharper ness. During a LASIK consultation with another and he can now drive at night with no problems. surgeon, he learned about a relatively new “This was a very uncomplicated procedure, vision correction solution called the Implantable so I was not apprehensive about it,” he says. Collamer Lens (ICL), also known as the “Also, if Dr. Mondzelewski is performing your “Implantable Contact Lens.” Dr. Mondzelewski surgery, you’re in great hands.” is one of the few eye surgeons in the region
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IOL surgery patient Dr. Robert Nungesser, a retired optometrist from Scott Township.
performing this procedure. Through research, Jobson discovered Dr. Mondzelewski and was delighted to learn that he was located a relatively short drive away from his home in Ohio. The ICL is a refractive lens that can correct vision up to -15 diopters of nearsightedness, making Jobson a near-perfect candidate. During surgery, this lens is implanted behind the iris and in front of the natural crystalline lens. Dr. Mondzelewski stresses that unlike LASIK eye surgery, the ICL procedure does not permanently alter the shape of the cornea — and it is also a fully reversible procedure. In fact, he says that it is more similar to cataract surgery. The surgery itself is performed on an outpatient basis, and only takes about 15 minutes per eye. As in cataract surgery, patients undergoing an ICL procedure have one eye done at a time, with about two weeks between procedures. Recovery time is only about two days per eye. “The ICL procedure also provides clearer imaging than LASIK,” Dr. Mondzelewski says. “A small, 2.5-millimeter incision is made in the eye, along with two other smaller one-millimeter incisions. The lens is then folded and implanted Continued on page 5
At left: Eye Surgeon James P. Mondzelewski, M.D. peers through a surgical microscope in an operating room at St. Clair Hospital’s Mt. Lebanon Surgical Center. Cover: St. Clair Hospital Surgical Technician Kelly Trevelline, right, assists Dr. Mondzelewski during a recent cataract surgery at the Center. Volume IV Issue 3 I HouseCall I 3
Unlike LASIK eye surgery, the ICL procedure does not permanently alter the shape of the cornea — and it is also a fully reversible procedure. It is more similar to cataract surgery. The surgery itself is performed on an outpatient basis, and only takes about 15 minutes per eye.
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iT’s been simply amazing To noT have To worry abouT wearing glasses or conTacT lenses. i highly recommend The icl procedure. iT’s very safe and i’m very happy wiTh my resulTs.
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ICL SURGERY PATIENT MATTHEW JOBSON
Dr. Mondzelewski performs eye surgery at the Mt. Lebanon Surgical Center at St. Clair Hospital.
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Patient Profile Continued from page 3
ICL surgery patient Matthew Jobson on the job in the Pharmacy Department at a Wheeling, W. Va. hospital.
in the eye, and then unfolded and placed in the proper position in the eye. The incisions are self-sealing, so no stitches are necessary.” While the surgery is performed with relative ease, the preparation for surgery is critical, says Dr. Mondzelewski. The lens has to be carefully sized and custom-fitted for each eye. This pre-operation is typically done at Glaucoma-Cataract Consultants about two weeks prior to surgery. It usually takes about three visits to properly size a new implantable lens. Jobson admits having been a little nervous prior to his eye surgery back in September, but he was also confident that he would be fine under Dr. Mondzelewski’s care. “He was experienced in doing this procedure and he was also very easy to talk to,” he says. “He inspired confidence in me that I would receive good treatment under his care.”
Today, Jobson is enjoying 20-20 vision and, for the first time in his life, he doesn’t need corrective lenses. “It’s been simply amazing to not have to worry about wearing glasses or contact lenses,” he says. “If you want to do something that will improve your quality of life and your vision, then I highly recommend the ICL procedure. It’s very safe and I’m very happy with my results.” In addition to the Crystalens and ICL procedures, Glaucoma-Cataract Consultants
also specializes in glaucoma and suture-less, patch-less cataract surgery. “It’s been an intimate relationship between our practice and St. Clair Hospital,” says Dr. Mondzelewski. “We find it very advantageous to be located near the hospital campus. We have provided quality surgical eye care utilizing their very excellent operating rooms and outpatient surgical centers.” n
JAMES P. MONDZELEWSKI, M.D. Dr. Mondzelewski specializes in ophthalmology. He earned his medical degree at The Ohio State University School of Medicine and completed his residency in ophthalmology and a fellowship at Eye and Ear Hospital, Pittsburgh. Dr. Mondzelewski is board-certified by the American Board of Ophthalmology. He practices with Glaucoma-Cataract Consultants, Inc. To contact Dr. Mondzelewski, please call 412.572.6121.
Volume IV Issue 3 I HouseCall I 5
Patient Profile
the fine art of
Plastic surgery
Plastic surgery patient Rebecca Fuscardo touches up a 5‘ x 15‘ mural of The Last Supper that she painted on the dining room wall of a client in Steubenville, Ohio. 6 I HouseCall I Volume IV Issue 3
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icture the hands of an accomplished artist. Now consider the creative process, the focus and passion that the artist brings to her work and expresses through her hands — hands through which a vision becomes substance, beauty is awakened, and the spirit within is expressed. Simona V. Pautler, M.D. brings such an artistic spirit to her work as one of the Pittsburgh region’s pre-eminent reconstructive and cosmetic plastic surgeons. She is an artist, literally and figuratively, and she uses the tools and technology of state-ofthe-art plastic surgery at St. Clair Hospital to shape, restore, renew, and transform bodies and faces. Since her childhood, Dr. Pautler has been drawing and sculpting, exploring and expressing a natural artistic talent that has taken her, happily, from the studio to the surgical suite. “I never needed to take an art class when I was growing up,” she says. “I was able to draw or sculpt anything. In medical school, I realized that I could transfer my artistic talent to plastic surgery. I think of plastic surgery as an elevated art form. It changes the quality of people’s lives. Being a plastic surgeon enables me to express myself through my hands.” Dr. Pautler, whose primary office is in McMurray, performs a variety of surgical procedures at nearby St. Clair Hospital. She emphasizes natural results and specializes in tummy tucks, breast augmentation or reduction, face lifts, liposuction, brow lifts, and eye and nose plastic surgery. She also offers a range of skin care treatments and services. “The goal is always improvement, not perfection,” Dr. Pautler notes. Once the domain of celebrities, plastic surgery is increasingly sought by “ordinary” people who want to improve their appearance, correct flaws, and feel better about themselves. The perception of plastic surgery among the public is changing, Dr. Pautler acknowledges. She credits reality TV shows such as “Extreme Makeover” to opening the eyes of the American public to the possibilities of plastic surgery and to making it more acceptable. “People are less secretive about having plastic surgery; they’re no longer embarrassed to talk about it.” Her patients come from all corners of the region. “My patients are not from affluent neighborhoods; they are regular people and the majority are women. Many are working mothers. Plastic surgery is not just for the rich and famous; it’s for anyone who wants it.”
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i never needed To Take an arT class when i was growing up. i was able To draw or sculpT anyThing. in medical school, i realized ThaT i could Transfer my arTisTic TalenT To plasTic surgery. i Think of plasTic surgery as an elevaTed arT form. iT changes The qualiTy of people’s lives.
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PLASTIC SURGEON SIMONA V. PAUTLER, M.D.
the truck Driver It’s 8 a.m. on a weekday in Downtown Pittsburgh and Diann Taylor is on the job, driving a pickup truck to deliver heavy equipment, tools, and propane tanks to major construction sites around the city. The Bethel Park native has been driving a truck for Century Steel Erectors for more than 20 years, helping to build the region’s bridges and buildings. She loves the job. The only downside to it is the long periods of sitting, but Taylor compensates by leading an active lifestyle and exercising vigorously on a regular basis. Regularly joined by her boyfriend, Scott, she enjoys taking her three dogs for daily walks on the trails near her Burgettstown home. It’s a happy life, and the 49-year-old mother of one son was satisfied — with one exception. “I was uncomfortable with my flabby, muffin-top belly,” she reveals. “I’m not overweight and I work out a lot, but I looked awful in a bathing suit. My belly didn’t fit the rest of me ― the way I live or who I am. Continued on page 8
Forty-nine-year-old Diann Taylor says that since her surgery, she feels like her body fits who she is — a woman who is active on the job, and off.
Volume IV Issue 3 I HouseCall I 7
Patient Profile Continued from page 7
I tried laser and other treatments, but they didn’t work because I had scar tissue from a C-section. I decided to try liposuction and my sister told me about an excellent plastic surgeon — Dr. Simona Pautler.” Taylor made an appointment for a liposuction consultation with Dr. Pautler, but learned that it would not solve her problem. “Dr. Pautler gently explained to me that I needed a tummy tuck, because liposuction would not get rid of my excess skin. I loved her honesty and the fact that she spent time with me, explaining things. I told her to schedule the surgery, and she told me to bring my favorite bikini bottom to the hospital, so she could determine where to make the incision.” Taylor underwent the procedure, formally known as abdominoplasty, in late November at St. Clair Hospital, and she is thrilled with the results. “My stomach is flat, with a beautiful contour. I dropped
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down two sizes and lost four inches at my waistline. This isn’t weight loss surgery, but I look like I’ve lost weight. I haven’t looked this good since I was a teenager.” Abdominoplasty gives the abdomen a more youthful shape, with flatter, tauter skin and a firmer look to the navel. Most often, patients who undergo a tummy tuck have loose skin, stretch marks, and abdominal bulging in the lower abdomen, secondary to weight fluctuation or pregnancy. Exercise and diet have no effect on tightening the loose, saggy skin. The incision is placed lower than a C-section scar, from hipbone to hipbone. Most bikini bottoms will cover the scar. “In plastic surgery, there are no shortcuts; you can’t get anything done without a scar,” Dr. Pautler explains, “although we try to place scars in concealed places. It takes a few months to see the final result.” A tummy tuck can be combined with liposuction from the waist and “muffin-top” region and is sometimes performed along with a
i didn’T expecT The changes on The inside. i feel beTTer abouT myself; i’m more confidenT. PLASTIC SURGERY PATIENT DIANN TAYLOR
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Diann Taylor at a job site in Oakland for Century Steel Erectors.
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tubal ligation, hernia repair, or hysterectomy. Breast surgery to enhance or reduce the breasts can be done at the same time to give the entire torso a renewed appearance and tone. A tummy tuck procedure is major surgery, done under general anesthesia, and an overnight admission is recommended, although not essential. The post-operative course can be challenging for the first week or two, until the swelling subsides and drains are removed. “It wasn’t a walk in the park,” recalls Taylor, “but it was absolutely worth it. I slept in a recliner at first, and walked in a hunched-over position, but I was back to doing office work in two weeks. Thanks to the quality of Dr. Pautler’s work, my scar is already gone; there is no evidence of what I had done, and as long as I don’t gain weight, my belly will remain flat. I can tie my shoes and shave my legs again!” Her enthusiasm extends to St. Clair Hospital and especially to the nursing staff who cared for her. “The nurses gave me excellent care; the Hospital is great and even the food was good. I had my surgery during Thanksgiving week and Dr. Pautler called me on Thanksgiving Day to ask how I was doing. That’s how caring she is.” Most surprising to Taylor is the psychological impact of the procedure. “I didn’t expect the changes on the inside,” she says. “I feel better about myself; I’m more confident. I know I look good in my clothes.”
the artist Rebecca Fuscardo is a patient of Dr. Pautler with a different story. She is a 45-year-old professional artist, a wife, and a mother of three who lives in Weirton, W. Va. She is a powerhouse of a woman, constantly engaged in multiple art projects that showcase her versatile talent. Known primarily for painting murals in churches, schools, homes, and businesses, Fuscardo also does artistic painting on cars and motorcycles, and more recently began doing decorative concrete work, carving and painting it for outdoor kitchens and patios. Fuscardo radiates so much energy, joy, and optimism that it’s hard to imagine that, not so long ago, she was profoundly depressed. In her home state, Fuscardo had experienced a botched abdominal hysterectomy that left her mutilated and in pain. With severe abdominal scarring and a crooked, displaced navel, she found it difficult to work and manage her life. Her scars were so thick and protrusive that they showed through her shirts and caused pain when anything, even fabric, came into contact with them. Her physically demanding work often entails climbing on ladders and getting on her hands and knees, and the condition of her abdomen made this uncomfortable. “It seemed impossible to me that this could ever be fixed. I saw several doctors who had nothing to offer me. I was resigned to living with the scars and the pain for the rest of my life. I became depressed; I cried and felt self-conscious. My belly was disgusting, all scarred and puckered. I had to wear big loose clothes. My kids said my belly looked like Mr. Yuk.” Fortunately, she saw a new gynecologist, who referred her to Dr. Pautler. “I was thrilled when I met Dr. Pautler,” says Fuscardo. “She spent an hour with me in my consultation and
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The surgery far exceeded my expecTaTions. i can acTually wear a Two-piece baThing suiT. now, i am ready for anyThing. i would do iT again Tomorrow.
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PLASTIC SURGERY PATIENT REBECCA FUSCARDO
was so concerned for me. I loved everything about her; she’s warm and caring and even her office has an aura of happiness and positivity. Most importantly, Dr. Pautler gave me hope.” Dr. Pautler gave Rebecca Fuscardo more than hope ― she gave her a new torso and a transformed body image. She performed a tummy tuck and included liposuction in order to get additional skin to pull and tighten. The procedure totally reshaped Rebecca’s torso, giving her a beautiful flat tummy and a “new” navel ― in the right place. “I look like I’ve had a breast lift, too, because pulling the muscles and skin tightly together elevated my breasts. The surgery far exceeded my expectations ― I can actually wear a two-piece bathing suit.” Fuscardo says she feels reborn. “Now, I am ready for anything. I would do it again tomorrow. Dr. Pautler transformed me ― my body and my life. I am back to being my old self, but even better, and I feel like nothing can stop me. A friend said, ‘Your personality is back and everyone wants to be around you now.’ My primary care doctor told me she has never seen me look better or healthier.” Continued on page 10 Volume IV Issue 3 I HouseCall I 9
Patient Profile Continued from page 9
“Plastic surgery completely changed her. It was remarkable,” Dr. Pautler says. However, such dramatic change is not the norm, she cautions. “You have to have realistic expectations for plastic surgery. Some people want perfection and expect their whole lives to change. I can’t deliver that. Most people are happy with improvement.” For women ― and men ― who are considering a tummy tuck, Dr. Pautler has some sage advice. “The best patients are those who have sound expectations, are in good overall health, and have a stable support system. Non-smokers are the best candidates; smokers have an impaired ability to clear infections and heal; their wounds tend to be weak and to separate more easily.
“A tummy tuck gives you improved core strength, and that’s important. You need a strong abdomen for everything you do. The procedure is safe; complications are rare, but potential ones include bleeding, infection, delayed wound healing, and prolonged swelling. Very rarely, a blood clot might develop in the leg as a result of decreased mobility, but I get my patients out of bed quickly to prevent that. I tell them, ‘Take a few weeks to lie low, but don’t become bedridden.’ Some patients choose to go home right after surgery, but I prefer that they stay for one night at St. Clair so we can manage their progress. They’re well cared for; the nurses are there to attend to them and monitor them. I think it’s hard on family members when the patient goes right home after surgery. “Cosmetic surgery is not reimbursed by third party payors, but reconstructive surgery is. If you need cosmetic surgery due to complications from an accident or cancer, it may be covered.” Dr. Pautler finds great satisfaction in seeing her patients at their post-operative office visits. “That’s the best moment, when they come in and I see how happy they are and how good they look. That seals the deal. I have moments when I think, ‘I could be home with my kids instead of doing this,’ but when I realize how much this means to the patients, I know I’m doing something good. For me, being a plastic surgeon is both artistic and gratifying.” n
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i have momenTs when i Think, ‘i could be home wiTh my kids insTead of doing This,’ buT when i realize how much This means To The paTienTs, i know i’m doing someThing good.
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SIMONA V. PAUTLER, M.D.
SIMONA V. PAUTLER, M.D. Dr. Pautler specializes in plastic surgery. She earned her medical degree at Columbia University in New York City and completed her professional training at Columbia Presbyterian Medical Center, Yale New Haven Hospital in Connecticut, and Dartmouth Hitchcock Medical Center in New Hampshire. She is board-certified by the American Board of Plastic Surgery. Her primary office is in McMurray. To contact Dr. Pautler, please call 724.969.0930.
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healthY choices Kris Kessler of Bethel Park walks near her home every day as part of an exercise plan to ward off type 2 diabetes.
THE DIABETES CENTER:
Educating Patients Living with Diabetes
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hen Kris Kessler went in for her annual physical exam last November, the Bethel Park resident was surprised to discover that her blood sugar levels were slightly elevated. Her primary care physician, M. Sabina Daroski, M.D. of Fatigati/Nalin Associates, was concerned that she could develop type 2 diabetes, and asked her to come back in three months for further tests. Kessler, who is 54 years old and works as an administrative assistant and controller for a local construction company, did not experience any symptoms to indicate she had diabetes. However, because of her family history, she knew that she was at higher risk for developing it. As a result, Kessler returned in late January for more blood work and received her results in early February. Her hemoglobin A1c test — which is an important blood test that reflects blood sugar levels over the past 2 to 3 months — was at 6.3 percent. Dr. Daroski wanted to see it at 6.0 percent. Kessler’s blood sugar level was at 126; Dr. Daroski wanted to see it under 120. “Diabetes is a common and complex condition. We really ask a lot of patients in terms of taking control of their medical life, because it is something that no single professional, no matter how accomplished, can manage independently,” says Dr. Daroski. “Simply put, no doctor can do anything significant to treat a patient’s diabetes without the full support of the patient. A pill simply won’t do the trick. Proper exercise, eating habits, and other factors that only the patient controls are as, or more, important than any ‘medical’ intervention.”
Due to her age and hereditary factors, Kessler was placed on a watch list for type 2 diabetes, meaning she had to get on the right track with her diet and begin to exercise more. “I had a choice to get started on medication to control my blood sugar,” says Kessler. “But my physician said I could get my blood sugar levels down with proper eating and exercise, so I chose that route.” Dr. Daroski referred Kessler to the St. Clair Hospital Diabetes Center, which is located at the Hospital’s Outpatient Center at Village Square in Bethel Park. At the center, patients with diabetes, or who are at risk for diabetes, meet with Certified Diabetes Educators and Registered Dietitians, who help them learn about diabetes, and work with them to develop strategies for managing it. For Dr. Daroski, the Diabetes Center is crucial in teaching patients just diagnosed with diabetes the basics of their condition and its management. “My experience with the Diabetes Center has been universally positive. Patients enjoy the classes and one-on-one instruction,” says Dr. Daroski. “They come away from the center recharged and empowered.” She adds that patients who are ‘old pros’ about their diabetes learn new and more detailed information about the condition, and get useful tips and reminders about management. The program is recognized by the American Diabetes Association for meeting the National Standards for Diabetes Self-Management Education. Any physician managing a patient with diabetes can refer them to the education program, which has been in operation since 2003. They see about 700 patients each year. Continued on page 12
Volume IV Issue 3 I HouseCall I 11
healthY choices Continued from page 11
Kris Kessler enjoys a healthful lunch..
“Our approach is very individualized,” says Beth Ann Coonrod, Ph.D., a Certified Diabetes Educator and the coordinator of the diabetes education program.“We meet with patients on a one-on-one basis and in group classes. Over several visits, we help them develop management plans that fit with their lifestyles.” Coonrod views the program’s role as a partnership with the primary care physician. “Besides teaching, we can provide a lot of assistance with their patients’ blood sugar management — not just because of our clinical expertise, but also because of the time we can spend assessing patients’ circumstances and strategizing with them.” She adds, “Understanding patients’ lifestyles, schedules, and personal goals is a critical part of that assessment and an essential component of helping patients develop action plans that they believe are doable. That takes time.” An appointment with a Certified Diabetes Educator or a Registered Dietitian typically lasts between 1 to 11⁄2 hours, a luxury not afforded to physicians.
ST. CLA I R HOSPI TA L’ S D I A BETES C EN TER OFFERS C OM PREHEN SI VE CA RE Statistically speaking, diabetes is on the rise, not only in the U.S., but across Southwestern Pennsylvania. People with diabetes need the expertise of not only their primary care physicians, but endocrinologists, dietitians, and nurse educators to help them manage their conditions and better understand how diabetes impacts their lives. St. Clair Hospital’s Diabetes Center provides all of this expertise in one, convenient location ― St. Clair Hospital’s Outpatient Center at Village Square in Bethel Park.
Of course, there is so much for a patient to learn about diabetes, more than anyone can absorb in one sit-down appointment. So, the Diabetes Center also offers group classes split between two sessions. Coonrod notes that these classes are instructional and educational, and not a “sit-in-a-circle-and-share” type of class. Kessler found both the individual appointments and the group classes extremely beneficial. During her meetings with the educators and dietitian, Kessler learned more about diabetes, what it does to your body, why you get it, and the recommended diet to help you combat it. “The sessions were enormously helpful and they were wonderful, well-educated people,” she says. “They did a wonderful job and explained everything in layman’s terms.” Specifically, they discussed Kessler’s lifestyle and eating habits. One reason why Kessler’s blood sugar levels were high was because she ate too many carbohydrates at meals. “I learned that there are two main things you need to look at when you’re trying to control your blood sugar: carb intake and serving size,” says Kessler.
CAMILLE M. BUONOCORE, M.D. Dr. Buonocore specializes in endocrinology. She earned her medical degree at State University of New York at Buffalo and completed her internship, residency and a fellowship at the University of Pittsburgh Medical Center. Dr. Buonocore is board-certified by the American Board of Internal Medicine. She practices with Associates in Endocrinology, P.C.
As part of the center’s Empowerment Program, staff works with pre-diabetic and diabetic patients, along with their primary care physicians, to provide the comprehensive education and support they need to stay healthy and reduce the risk of complications.
To contact Dr. Buonocore, please call 412.942.2140.
The center’s highly trained, compassionate staff meets with patients individually to develop personalized plans to manage their respective medical needs.
Dr. Beier specializes in endocrinology. She earned her medical degree at Lake Erie College of Osteopathic Medicine and completed her internship and residency at the University of Connecticut Health Center and a fellowship at Virginia Commonwealth University Health System. Dr. Beier is board-certified by the American Board of Internal Medicine. She practices with Associates in Endocrinology, P.C.
This customized plan includes:
• Blood Glucose Monitoring • Diabetes Medications • Meal Planning
• Insulin Administration • Exercise Strategies • Sick-Day Management
The staff of the St. Clair Hospital Diabetes Center includes Medical Director Camille Buonocore, M.D., endocrinologist Bridget Beier, D.O., as well as a team of nurse educators and dietitians who work with patients each day. For more information, please call 412.942.2151.
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BRIDGET K. BEIER, D.O.
To contact Dr. Beier, please call 412.942.2140.
The recommended diabetes meal plan should be naturally rich in nutrients and low in fat and calories. Kessler was delighted to learn that she could still eat her favorite foods, but in moderation. Additionally, she could snack during the day, before lunch and dinner, and before going to bed. In addition to eating better, Kessler has been walking 30 minutes every day, either outside or on a treadmill if the weather is bad. By following this plan, Kessler has been able to lose weight and keep her blood sugar level down. More importantly, it hasn’t been a struggle to follow her new eating and exercise plan, because the clinicians at the Diabetes Center worked with her to come up with a plan that takes her personal preferences into account.
Diet and exercise can reduce by 57% the risk of progressing from pre-diabetes to diabetes. “You can find foods that you like to eat and just need to count carbs,” she says. “When you count carbs, you can’t believe how much your portion sizes shrink.” Kessler also found the group classes, taught by Coonrod, extremely helpful. “Knowledge is a powerful thing,” says Kessler. Coonrod says that patients need to meet one-on-one with an educator before attending the group education sessions, so that their individual needs are sure to be addressed. “Some content applies to everyone, but other information needs to be highly tailored to the individual,” she says. “Sometimes people are hesitant to meet with someone to focus on their diabetes management. For example, they might be concerned about seeing a dietitian because they think they will be told that they should not eat certain foods that they enjoy. Like Kris, when meeting with the dietitian they discover they can still enjoy eating foods they like. I often see patients walking out of their appointments very happy, because they learned that they have a lot more options than they had thought. Our center is a tremendous resource for people to take advantage of.” Another reason people may shy away from getting help with their diabetes management is because they believe that they will be judged on their blood sugar
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remember ThaT you have a life To live and ThaT managing your diabeTes, raTher Than ignoring iT, is The besT way To enjoy ThaT life.
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M. SABINA DAROSKI, M.D.
readings. That belief can come from their thinking that they must be doing something wrong. Unfortunately, that belief often stems from the fact that they have been judged. That will never happen at the St. Clair Hospital Diabetes Center. “When people meet with us, they often discover that they weren’t doing something wrong,” says Coonrod. “Many are surprised to learn that high blood sugar levels aren’t always due to how they are eating.” Kessler strongly urges other patients who are at risk for developing diabetes, or those who may be living with diabetes, to go through this education process. “If you’re diabetic and you have no clue how to sustain yourself and control this disease, then you’re just putting one bad foot in front of the other,” she says. “You need to understand what’s wrong with you and how you can fix it. The only way to do that is through education. If you understand what’s wrong with you, you can take steps to fix it.” Dr. Daroski agrees. “Educate yourself!” she says. “Look online at the ADA website, diabetes.org, and at the National Institutes of Health site at diabetes.niddk.nih.gov. Talk to your health care professional at length. Talk to diabetes educators. Look at cures advertised on TV with a healthy dose
of skepticism. Above all, remember that you have a life to live and that managing your diabetes, rather than ignoring it, is the best way to enjoy that life.” Coonrod adds that the earlier people get involved in managing their diabetes, the more advantage they have in controlling it. “What Kris did was great,” she says. “She was proactive and just took the bull by the horns and came in to learn what could be helpful for her diabetes management.” Coonrod is quick to note, however, that it is never too late to get involved or to renew involvement. “Naturally, there can be a lot of ‘falling off the horse.’ We can help people with getting back on.” She adds that yearly follow-up appointments can be very beneficial. In addition to diabetes education, the Diabetes Center has a Wellness Group that meets every other month to discuss topics such as stress management, eye care, foot care, and conditions that are more common in individuals who have diabetes, for example, sleep apnea. These sessions are free and open to the public. n For more information about the Diabetes Center and the services it provides, please call 412.942.2151.
M. SABINA DAROSKI, M.D., FACP Dr. Daroski, who is Chair of the Department of Medicine at St. Clair Hospital, specializes in internal and geriatric medicine. She earned her medical degree at Northeastern Ohio College of Medicine and completed her residency in internal medicine at Mercy Hospital of Pittsburgh. Dr. Daroski is board-certified by the American Board of Internal Medicine. She practices with Fatigati/Nalin Associates and is based out of the Mt. Lebanon office. To contact Dr. Daroski, please call 412.343.1770.
Volume IV Issue 3 I HouseCall I 13
ask the Doctor
Ask the Doctor MATTHEW G. PESACRETA, M.D.
Q A
I have been diagnosed with chronic kidney disease (CKD). What exactly does that mean and what do I need to do?
CKD is a condition in which the kidneys are damaged,
CKD have a higher risk of cardiovascular disease,
for any number of reasons, and can no longer function
such as heart attacks, heart failure and stroke, and
properly. CKD is detected through a blood test to
death at an earlier age, as compared to populations
estimate the kidney function, and/or a urine test to
without CKD. Fluid and electrolyte balance, waste
assess for the presence of protein in the urine. Most
removal, acid-base balance, bone health, and the
people do not have any symptoms at the time of
regulation of anemia are a few of the important roles
diagnosis and are surprised to learn they have CKD.
the kidneys play in maintaining our overall health.
In the United States, more than 20 million people have CKD, with more women than men affected.
As CKD progresses, these issues often need close attention to maintain optimal health. A common question asked is, “What can I take or
CKD is staged from 1 (mildest form) to 5 (most severe) based on degree of kidney damage. The two
do to ‘improve’ my kidney function?” Unfortunately,
main causes are diabetes and hypertension
CKD is often irreversible and progressive over time,
(high blood pressure), but there are
but there are several ways to slow the progression.
several other causes. Other conditions
Prevention and treatment of the risk factors for CKD
might play a role in the progression
is paramount to therapy. This often starts with a visit
of CKD, namely obesity and high
to a primary care physician to assess for the presence
cholesterol. The risk of CKD also
of CKD. For patients with high blood pressure,
increases with age, as we all lose
maintaining a blood pressure less than 130/80 is
approximately 1 percent of kidney
optimal. This will often include a low sodium diet,
function every year after age 40. When patients first hear of CKD, their first concern often is kidney dialysis. There are approximately 300,000 people on dialysis in the United
in addition to prescribed medications. Diabetics should try to keep their A1C (glucose) less than 7 percent, and an overall healthful lifestyle is strongly encouraged. This includes exercising several days a week and not smoking.
States, but many people with CKD do not progress to end stage renal disease (ESRD). With
Depending on the severity of CKD, your primary care physician may refer you to a nephrologist, a physician with specialized training in medical kidney disease. n
that said, patients with
MATTHEW G. PESACRETA, M.D. Dr. Pesacreta specializes in nephrology. He earned his medical degree at the University of Pittsburgh School of Medicine and completed his residency and fellowships in nephrology and geriatrics at the University of Pittsburgh Medical Center. Dr. Pesacreta is board-certified in nephrology and geriatrics by the American Board of Internal Medicine. He practices with Teredesai, McCann & Associates, P.C. To contact Dr. Pesacreta, please call 412.572.6129.
14 I HouseCall I Volume IV Issue 3
continueD growth
new outPatient Pt DePartment at village square
STRETCHES t. Clair Hospital’s Outpatient Physical Therapy Department has long been recognized for its highly skilled team of licensed physical therapists, therapist assistants and support staff who collaborate to provide compassionate, personalized care for a wide-range of needs. Now, due to continued growth, the center has opened a newly renovated and greatly expanded space at the Hospital’s Outpatient Center at Village Square. Physical Therapists began treating patients in the new, patient-friendly space in May, according to Director of Orthopedics Bob Kovatch, MPT, MBA. “Our goal remains the same: returning patients to their previous level of functioning by decreasing pain, and restoring loss of motion and strength,” Kovatch says. “Now the facility better matches the quality of care. The openness of the new therapy clinic has greatly enhanced patient flow and has created an atmosphere pleasing for patients and employees alike. Having the additional room has allowed us to add new equipment, enabling us to offer enhanced treatment options for patients. Also, we’ve increased the number of individual exam rooms and added several curtained areas, providing increased patient privacy.” Bob adds: “We’re very happy to now have a dedicated suite for therapy services, while still being in close proximity to other supporting services, such as Laboratory, Imaging, and Occupational Medicine, all of which are in the same building and provide ‘one-stop’ health care services for our patients.” n
its caPaBilities
S
fast facts on the new outPatient PhYsical theraPY DePartment at st. clair hosPital outPatient center at village square • Patients are treated by qualified licensed Physical Therapists (PT) and Physical Therapist Assistants (PTA), with support provided by a PT aide.
• The combined years of experience among current Outpatient PT/PTA staff is 75 years.
• PTs use a variety of treatment techniques, such as exercise; gait (walking) training; balance activities; heat/cold modalities; electrical stimulation; traction; and tissue mobilization/manual therapy techniques.
• Each patient is given a thorough evaluation by a PT, who then sets up a treatment program based on the particular needs of the individual.
• Patient education is a key component of Outpatient PT and is incorporated in patients’ treatment programs. Patients are given explanations of their particular diagnoses, as well as the treatment modalities and expected results. Much emphasis is spent educating patients on their individualized home exercise program, as well as preventative measures for future issues.
• The PTs treat a multitude of diagnoses in patients, including youth/young adults with sports related injuries.
• The Outpatient PT Department works closely with the Occupational Medicine Department on work-related injuries, pre-employment screenings, and work capacity evaluations.
• Specialty areas of the Outpatient PT Department include Vestibular Rehab and Pilates program.
• Hours of operation of the Outpatient PT Department are 7:30 a.m. to 7:30 p.m. Mondays through Thursdays; 7:30 a.m. to 5 p.m. Fridays.
• The Hospital offers a free Courtesy Van service for patients who are having difficulty arranging transportation to Outpatient PT.
• Services are by appointment only. A valid prescription from a physician is required to make an appointment. Most insurances are accepted. To contact Outpatient PT, please call 412.942.7122.
Volume IV Issue 3 I HouseCall I 15
St.Clair Hospital 1000 Bower Hill Road Pittsburgh, PA 15243 www.stclair.org
General & Patient Information 412.942.4000
HouseCall
Physician Referral Service 412.942.6560
Outpatient Center – Village Square 412.942.7100
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.
RANKED AMONG THE 100 TOP IN THE NATION.
Thomson Reuters has named St. Clair Hospital one of the nation’s 100 Top Hospitals. The prestigious award was based on an analysis of St. Clair’s patient safety, clinical outcomes, patient satisfaction and clinical efficiency, all key indicators of performance excellence. Since 1993, Thomson Reuters has used independent objective research to identify the nation’s 100 Top Hospitals. Hospitals do not apply or pay for this honor, or pay to promote their award. Only a handful of hospitals, such as Mayo Clinic, Beth Israel Deaconess (a Harvard Medical School teaching affiliate), Northwestern University Hospital and Vanderbilt University Medical Center, have been perennial winners of the award.
Medical Imaging Scheduling 412.942.8150
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OSPITALS
Thomson Reuters estimates that if all U.S. hospitals performed at the level of the 100 Top Hospitals: • More than 186,000 lives could be saved; • Approximately 56,000 additional patients would be complication-free; and • More than $4.3 billion could be saved. St. Clair salutes its talented and caring physicians, employees and volunteers for delivering this superior care through state-of-the-art technologies and advanced processes.