St. Clair Hospital HouseCall_Vol V Issue 1

In Women’s Health CareOB-GYN surgeons Shannon H. McGranahan, M.D., and Stephanie S. Brown, M.D.

insideHeart Vest Saves Lives I Breast Care Center Offers 3D MammographyRenovations To First Floor Entrance And Lobby Complete I Ask The Doctor

HouseCall

VOLUME V ISSUE 1

Robotics Revolution

Volume V Issue 1 I HouseCall I 32 I HouseCall I Volume V Issue 1

PATIENT PROFILE

The women are among the first patients at

St. Clair Hospital to have gynecologic surgery

utilizing a breakthrough robotic technology

that is transforming the way that many

surgical procedures are performed.

The da Vinci Robotic Surgical System uses robotics and

computer technology to translate the real-time movements

of a surgeon’s hands into precise, micro-movements of

surgical instruments through tiny incisions. While the

da Vinci system uses robotics, it is not a robot. A robot

operates automatically, based on pre-set instructions.

With the da Vinci system, the surgeons are always in

control. The system cannot operate on its own. The

da Vinci represents a dramatic advance in surgical

science, making it possible for surgeons to perform

complex and delicate laparoscopic operations in the

safest and least invasive way possible. Robotic-assisted

surgery has numerous potential advantages for both the

surgeon and the patient, and is producing outstanding

clinical outcomes. At St. Clair, the system has been

in use since April 2011 for urologic surgery, and the

Hospital has gradually expanded its robotic-assisted

surgery program to include other surgical specialties,

including colorectal, general, thoracic and gynecologic.

Continued on page 4

Stephanie Brown, M.D. (left) and Shannon McGranahan, M.D. are using robotics technology in gynecologic procedures at St. Clair Hospital.

JUDITH GILLIAM, DEBRA CARSE AND AUDREY SMITH, ALL SOUTH HILLS RESIDENTS,

HAVE NEVER MET EACH OTHER, BUT THEY HAVE SEVERAL THINGS IN COMMON.

THEY ARE WOMEN WHO HAVE THE SHARED EXPERIENCE OF HAVING

UNDERGONE HYSTERECTOMY. THEY ARE ALSO MEDICAL PIONEERS.

ADVANCEDTECHNOLOGIES

Are Minimizing IncisionsAnd Speeding Recovery

For OB-GYN Surgery

Volume V Issue 1 I HouseCall I 32 I HouseCall I Volume V Issue 1

PAtient Profile

The women are among the first patients at

St. Clair Hospital to have gynecologic surgery

utilizing a breakthrough robotic technology

that is transforming the way that many

surgical procedures are performed.

The da Vinci Robotic Surgical System uses robotics and

computer technology to translate the real-time movements

of a surgeon’s hands into precise, micro-movements of

surgical instruments through tiny incisions. While the

da Vinci system uses robotics, it is not a robot. A robot

operates automatically, based on pre-set instructions.

With the da Vinci system, the surgeons are always in

control. The system cannot operate on its own. The

da Vinci represents a dramatic advance in surgical

science, making it possible for surgeons to perform

complex and delicate laparoscopic operations in the

safest and least invasive way possible. Robotic-assisted

surgery has numerous potential advantages for both the

surgeon and the patient, and is producing outstanding

clinical outcomes. At St. Clair, the system has been

in use since April 2011 for urologic surgery, and the

Hospital has gradually expanded its robotic-assisted

surgery program to include other surgical specialties,

including colorectal, general, thoracic and gynecologic.

Continued on page 4

Stephanie Brown, M.D. (left) and Shannon McGranahan, M.D. are using robotics technology in gynecologic procedures at St Clair Hospital.

Judith Gilliam, debra Carse and audrey smith, all south hills residents,

have never met eaCh other, but they have several thinGs in Common.

they are women who have the shared experienCe of havinG

underGone hystereCtomy. they are also mediCal pioneers.

ADVANCEDTECHNOLOGIES

Are Minimizing IncisionsAnd Speeding Recovery

For OB-GYN Surgery

the DoctorsThe application of da Vinci technology to gynecologic procedures

represents a clinical advancement that may dramatically change the

way that women experience hysterectomies and other surgeries. And,

according to the three St. Clair OB-GYNs — Stephanie Brown, M.D.,

Shannon McGranahan, M.D., and Sandor Mecs, M.D. — who perform

robotic-assisted gynecologic surgery, it can even be said that da Vinci

technology may revolutionize women’s health care.

Stephanie Brown, M.D., is an obstetrician-gynecologist who

performs robotic-assisted gynecologic surgery at St. Clair. She

describes the da Vinci system as a form of minimally invasive

surgery that improves upon conventional laparoscopy. The surgeon,

she explains, sits at a console that is in the operating room but

several feet away from the patient. Using hand and foot controls,

she manipulates a machine with four robotic arms that are positioned

over the patient. Three of the arms hold miniaturized surgical

instruments, such as a grasper or scissors, and one holds an

endoscopic camera. At the console, the surgeon looks through

lenses that give her a three-dimensional image and the capability

of magnification up to 10 times.

“The biggest advantage is that the da Vinci system enables the

surgeon to see so well,” Dr. Brown says. “You have extraordinary

visualization; you can zoom in and the three-dimensional camera

provides great depth perception. You can magnify and see the anatomy

so closely. The wristed instruments can get at angles in the pelvis that

you can’t otherwise achieve and the instruments move just like your

hands. It’s amazing.”

In addition to superior visualization, the da Vinci system provides

the surgeon with enhanced dexterity and increased precision.

Nevertheless, Dr. Brown acknowledges some initial skepticism.

“I was a skeptic at first. I didn’t like the idea of my hands not feeling

that tissue. As a surgeon, you feel it, respect it and know it. Especially

with tough cases, I felt that I had to be in there physically, feeling

the organs and arteries. With the robotic-assisted system, you are

not in direct physical contact with the patient, but what you gain in

visualization compensates.”

Dr. Brown says that some patients believe their surgery will be

performed by a robot. “When patients are first approached, some are

taken aback. I tell patients that I do the procedure with the assistance

of this instrument — it’s still laparoscopic surgery.”

Dr. Brown completed her comprehensive da Vinci training program

at an “epicenter” in Houston, Texas. An epicenter is a hospital where

there is a well-established da Vinci program with experienced surgeons

4 I HouseCall I Volume V Issue 1

Assistant

Video screen

Nurse

Surgeon uses open-surgeryhand movements, whichare precisely replicatedin the operative field bythe instruments

Surgeon at operative console

Anesthesiologist

Interchangeable instrumentswith EndoWrist™ technologysimultaneously followsurgeon’s hand andwrist movements

Volume V Issue 1 I HouseCall I 5

The surgeon uses hand controls on the da Vinci console tomanipulate the surgical instruments inside the patient.

“The biggest advantage is that the da Vinci system

enables the surgeon to see so well. … With the robotic-assisted system,

you are not in direct physicalcontact with the patient,

but what you gain in visualization compensates.

It’s amazing.”–Stephanie Brown, M.D.

An overhead view of the state-of-the-art da Vinci robotic surgical system.

the system provides surgeons with extraordinary visualization

and depth perception of the patient.

who offer their expertise to help other surgeons and surgical teams

master the technology. St. Clair has a special robotics surgical team,

which Dr. Brown calls “a well-oiled machine,” in a state-of-the-art

operating room that features wide-screen, high-definition monitors

and sophisticated equipment. Shannon McGranahan, M.D., Dr. Brown’s

partner in the OB-GYN group of Dr. Patricia Bulseco, M.D., PC, also

has completed da Vinci training at the Houston epicenter and the

two surgeons often operate together.

PAtient ProfileContinued from page 3

Continued on page 6

the PAtientsFor Canonsburg resident Judy Gilliam, having

a hysterectomy was a matter of trust. The

68-year old retiree, wife and grandmother had

known for several years that she might eventually

need the operation, due to an ovarian cyst and

uterine fibroids. Gilliam wasn’t worried — she

knew that hysterectomy was a common surgical

procedure. Still, she was surprised when

Dr. Brown made a request: was she open to

undergoing robotic-assisted hysterectomy?

Indeed she was. Judy never hesitated.

“Dr. Brown is my doctor and I have all the faith

in the world in her. She’s a good doctor and the

nicest person. She said we could do it the ‘old

way’ if I wanted, but that I was a good candidate

for the robotic-assisted surgery because I had

no scar tissue. I felt that if Dr. Brown said this

was safe and effective, then that was that. She

explained it all and prepared me for it.” My

need for surgery wasn’t urgent, so I waited for

her to finish her training. When she was ready,

I was ready.”

Judy had a hysterectomy, followed by an

uneventful and nearly pain-free recovery.

“I was surprised by how good I felt,” she says.

“Nothing hurt! Dr. Brown took such good care

of me and made me feel special. She even

admitted me to the Family Birth Center after

the operation, so that she could watch me more

closely. There I was, among all the mothers

and babies. I went home the next day, and did

not take a single pain medication after I was

discharged. I had no bleeding and no other

problems at all. I was able to resume my

normal activities quickly.”

Continued on page 8

“I was surprIsed by

how good I felt.

NothINg hurt! … I was able

to resume my Normal

actIvItIes quIckly.

I weNt home the Next day,

aNd dId Not take a sINgle

paIN medIcatIoN after

I was dIscharged.

”JUDY GILLIAM

da Vinci surgical patient Judy Gilliam had an uneventfuland nearly pain-free recovery.

6 I HouseCall I Volume V Issue 1 Volume V Issue 1 I HouseCall I 7


Robotic-assisted surgery is associated with

a lower rate of complications and reduced

length of stay. Patients have less post operative

pain, and subsequently less need for narcotic

pain medication, and they experience far less

bleeding. They require minimal post-operative

nursing care. Instead of 6- to 12-inch abdominal

incisions and scarring, they have five tiny

incisions that are more like punctures. Without

large wounds, patients are less likely to develop

an infection. Robotic-assisted surgery means

a shorter hospital admission ― usually one

night as opposed to three or four following

open abdominal surgery ― and a faster,

easier recovery. For patients, that’s the real

miracle of robotic-assisted surgery.

For Audrey Smith, a mother of three and

management consultant who lives in Mount

Lebanon, the decision to have robotic-assisted

surgery was more complicated. Smith was

planning a business trip to China when

Dr. McGranahan, her OB-GYN, informed her that

she had large fibroid tumors that necessitated

a hysterectomy. “I was quite anxious,” Smith

recalls. “I had had previous abdominal surgeries

and I knew what was involved; I was laid up for

six weeks with those surgeries and had a lot of

pain. I had this trip to China scheduled for four

weeks after the surgery, which could not be

canceled. I was worried; would I be recovered

enough to go? Plus, I was dealing with a lot of

emotions about having a hysterectomy.”

Pioneering technology

The da Vinci Robotic Surgical Systemis the result of a convergence ofpowerful forces: the science of medicine,

the art of surgery and the technology of thecomputer era, with a bit of science fiction in the mix, too.

The story of this breakthrough surgicaldevice originates in the Italian Renaissance,in the innovative mind of Leonardo da Vinci.da Vinci was undeniably a genius: a painter,sculptor, musician, architect, engineer, inventor and mathematician. He created arguably the most finely detailed andanatomically accurate drawings of thehuman body ever produced. da Vinci alsoloved machines and mechanics. He loved to study and improve existing machines,and designed everything from harmonicasto military tanks. In 1495, he developed the world’s first robot, a medieval knight in armor that could sit, stand, walk andturn its head.

More than four centuries later, in 1942,another creative thinker, Robert Heinlein,wrote a science fiction novel called Waldo,about a man too physically weak to care forhimself. He gained some independence byusing a device that enabled him to manipulatea mechanical arm. Inspired by the book,inventors began designing remotemanipulators, called Waldoes, and by 1950,these early robots were a reality. They were

used primarily to mobilize hazardousmaterials in unsafe environments, muchlike the bomb-detecting robots that policeuse today.

In the 1980s, advances in electronicsand computer technology further propelledthe development of robotics. At the sametime, surgeons were developing minimallyinvasive surgery techniques and in 1987,French surgeon Phillippe Mouret performedthe first laparoscopic gall bladder removal.Following that, there was explosive growthin laparoscopic technology and methods for simple surgical procedures.

The prototype for the da Vinci roboticsurgical system was created in the late 80sin an effort to improve military surgicalcapabilities for the U.S. Army. The DefenseAdvanced Research Projects Agency(DARPA) funded research to test thefeasibility of a remote surgery program foruse in the front lines of battle. The idea wasto substitute robots for human medics andsurgeons, to keep them out of harm’s way.The robotic medic concept never flourished,but the DARPA research advanced thedevelopment of surgical robotics. Anotherinfluence was the NASA-funded work ofscientists at the Jet Propulsion Laboratoryin Pasadena, Calif.

Intuitive Surgical was founded in 1995in Sunnyvale, Calif. and secured licenses

on the robotic technologies. The goal was to take these innovative concepts and turnthem into a marketable medical device thatallowed surgeons to operate intuitively. In conventional laparoscopic surgery, thesurgeon moves the instrument handles inthe direction that is opposite the way sheor he actually wishes to go — an approachthat surgeons describe as counter-intuitive.Within four years, in 1999, the firstda Vinci system was introduced and clearedby the FDA for laparoscopic surgery.

Intuitive Surgical, which is now theglobal leader in robotic-assisted, minimallyinvasive surgical technology, chose to call therobotic surgical system the “da Vinci” inhonor of the artist who created the first robot.With his apparently limitless capabilitiesand creativity, da Vinci blended art andscience in a singular way. His legacy hasendured for centuries and he continues toinspire futuristic thinkers, including thosewho developed the robotic surgical systemthat is transforming many surgical specialties.

Art, Science and ScienceFiction Merge in theda Vinci Surgical System

Debra Carse, 47, of Upper St. Clair, is a

married mother of two and a registered nurse.

As a nurse, she was aware of robotic-assisted

surgery and knew that St. Clair Hospital was

using a da Vinci system. She also knew

Dr. McGranahan well, as a colleague and

as her gynecologist. When Dr. McGranahan

suggested that she have a robotic-assisted,

hysterectomy to treat abnormal uterine bleeding

that had persisted for two years, Debra had

no doubt that this was the right option for her.

“Dr. McGranahan was excited about

robotic-assisted surgery for gynecology,

and everything went exactly as she told me

it would. Dr. Brown assisted her, so I had

the benefit of having both of them there.

Post-op, I had some discomfort from bloating,

but my pain was so minimal that I only took

Motrin.” Debra has exceptional appreciation

for the dramatic contrast between recovery

from open abdominal surgery and

robotic-assisted laparoscopy.

“Without an abdominal incision,

you’re able to move easily —

to stand and sit, to get in and

out of bed, to shower and

even to breathe normally.

All you have are five little

‘poke holes,’ where the

instruments were inserted.

Because there is so much

less manipulation of the

internal organs, you

experience less pain

and swelling. The most

difficult aspect of this

surgery is that you feel

so good, you forget that you had

surgery. When I lifted things, I felt

a pulling sensation that was like a

reminder — ‘oh, yeah, I just had a

hysterectomy, better slow down.’”

“the most dIffIcult

aspect of thIs surgery

Is that you feel so

good, you forget that

you had surgery.

”DEBRA CARSE

Continued on page 10

Debra Carse




Dr. McGranahan proposed having a robotic-

assisted hysterectomy, and Smith says that

her doctor’s confidence convinced her.

“Dr. McGranahan is fantastic. I went in feeling

so good about having this done, and it turned

out to be a great experience.” Smith echoes

Debra Carse and Judy Gilliam regarding her

recovery experience. “I was out of anesthesia

at 6 p.m. and up and walking at 8 p.m. That

first night I was sore, but able to get out of bed

by myself. I had the surgery on Thursday, went

home Friday and went to the movies on Sunday.

I was back at work one week later. My recovery

was so smooth.”

That smooth, rapid recovery is a bit of a

mixed blessing, says Dr. McGranahan. “Patients

rave about how quickly they rebound, but I have

learned to advise them to take it easy. Too much

activity can create complications; they can

strain or even separate the internal incisions.

Even though this approach has tremendous

advantages for patients, it is still surgery.

You have to rest and let your body heal.”

Audrey Smith went to China as planned,

and all has gone well. “I feel like I got myself

back, so fast. The physical healing helped my

emotional healing, and I’m glad that I did it.

Having this available to women is such a

positive development; I believe that when you

know you have this option, you’re more likely

to decide to have the surgery you need, rather

than delay it. It’s just awesome, especially

when compared to the conventional surgery.

It felt like a miracle to me.”

In the United States, 600,000 women

undergo hysterectomy every year, for a variety

of reasons: gynecologic cancer; endometriosis;

uterine fibroids; prolapsed uterus; and heavy

bleeding. There are four approaches to removing

the uterus: via a large open abdominal incision;

a vaginal incision; conventional laparoscopy;

or with robotics. Currently, 60 percent of

women who have hysterectomies have the

traditional open abdominal procedure, rather

than a minimally invasive one. The differences

are significant. Following the far more invasive

open abdominal procedure, recovery is

challenging and many women experience

significant pain, bleeding and fatigue. A woman

is unable to drive, shop, do housework, lift

things or return to work for six to eight weeks.

Still, some women need open abdominal

surgery because of the size of their organs or

medical complications such as obesity. Open

procedures, says Dr. McGranahan, do have the

advantage of giving a surgeon the entire range

of dexterity, but the da Vinci duplicates that.

“With the da Vinci, it’s like doing an open

procedure, in the sense that I have the same

wristed mobility, the same 3D visualization,

the same ability to make fine motor movements,”

she explains. “The da Vinci system is an extension

of the surgeon. It’s like doing an open procedure,

but through five very small incisions.”

A native of Upper St. Clair, Dr. Brown knew

since childhood that she wanted to become a

doctor and work at St. Clair Hospital. She

made her dream come true by graduating

from Denison University and then the University

of Louisville School of Medicine. She has two

children, ages 12 and 9, and enjoys the family-

friendly environment within the Patricia J.

Bulseco, M.D., PC, group. “With six doctors

in our group, we each get a day off during the

week, every week. I love OB GYN; I feel a special

connection with female patients, I love surgery,

and I love to deliver babies. Every time, it’s

the miracle of birth.”

Dr. McGranahan is a graduate of the

University of Pennsylvania who attended medical

school at Hahnemann University in Philadelphia

and completed her residency at West Penn

Hospital. She practiced there for seven years

before moving to her present position with the

Bulseco OB-GYN group four years ago. She is

married and the mother of two sons, ages 12

and 10, and lives in Sewickley. “I love what I do,”

“I had the surgery oN

thursday, weNt home

frIday aNd weNt to the

movIes oN suNday.

”AUDREY SMITH

she says. “I’m happy to wake up in the morning

and go to work.”

Dr. McGranahan envisions a future in

which robotic-assisted surgery becomes the

standard for hysterectomy, while abdominal

surgery becomes the exception. “We need to

endeavor to reverse those figures, so that

80 percent of women have minimally invasive,

robotic-assisted surgery. It should not be the

case in 2013 that the majority of women are

having the traditional open surgery. Our

mothers and grandmothers were having

hysterectomies done that way in their mid-40s,

mostly for heavy bleeding. Today we have

many other options for treating heavy bleeding,

so hysterectomy is not the automatic approach

to that. Still, women need hysterectomies for

other reasons, and as women become educated

about this, they will ask for this type of surgery.”

Dr. Brown agrees. “Robotic-assisted surgery

will eventually become the routine for GYN surgery.

Any case you’d normally do open, you should

consider doing robotically, unless the uterus is too

big. Robotic surgery allows for more dissection

than you’d be comfortable doing laparoscopically,

because you can see where the scars are.”

The implications for women’s health are

tremendous. The greatly reduced recovery

time and the quality of the recovery experience

mean that women get back to their normal

lives more quickly. This matters, not only on a

personal level for each woman, but even on a

broad social and economic level. Women are a

major presence in the workforce and their lives

are full. Judy Gilliam, Debra Carse and Audrey

Smith, as well as Drs. Brown and McGranahan,

are like most American women, juggling homes,

marriages, families, jobs, elder care and other

responsibilities. As Dr. McGranahan says,

“So much depends on women. Getting them

healthy and back to normal is a matter of

concern that extends beyond the individual

woman. The da Vinci technology is revolutionizing

women’s health care. And it should — women’s

health is critically important to families and

the community.” �

Benefits of Robotic-AssistedGynecologic Surgery

• 5 tiny poke holes versus a 6- to 12-inchincision with scarring

• Less pain and swelling

• 1-2 weeks versus 6 weeks to resumenormal activity post-op

• 1 night versus a 3-4 night hospital stay

• Less post-operative pain

• Less need for narcotic pain medications

• Reduced opportunity for infection

• Low rate of complications


STEPHANIE S. BROWN, M.D.

Dr. Brown specializes in obstetrics and gynecology. She earned hermedical degree at the University of Louisville School of Medicine andcompleted her residency at the Medical College of Ohio Hospital. Dr. Brown is board-certified by the American Board of Obstetrics andGynecology. She practices with the Patricia J. Bulseco, M.D., PC, group.

To contact Dr. Brown, please call 412.561.5666.

SHANNON H. McGRANAHAN, M.D.

Dr. McGranahan specializes in obstetrics and gynecology. She earnedher medical degree at Hahnemann University in Philadelphia andcompleted her residency at The Western Pennsylvania Hospital inBloomfield. Dr. McGranahan is board-certified by the AmericanBoard of Obstetrics and Gynecology. She practices with thePatricia J. Bulseco, M.D., PC, group.

To contact Dr. McGranahan, please call 412.561.5666.

“So much depends on women.Getting them healthy and back to normalis a matter of concern that extends beyond

the individual woman. Women’s healthis critically important to families

and the entire community.”–Shannon McGranahan, M.D.



Life SaverPortable LifeVest can help save lives

T hanks to a “vest,” two St. Clair Hospital patients who

were about to experience life-threatening heart attacks

were able to spend the recent holidays with their families.

But this was more than just an ordinary vest; it was the

LifeVest — the first wearable defibrillator manufactured by

Zoll Medical Corporation in Pittsburgh. Unlike a cardioverter

defibrillator, the LifeVest is worn outside the body rather than

implanted in the chest. It requires no bystander intervention.

Pittsburgh patient, Andrew Tichon, 61, was prescribed

the LifeVest following a diagnosis of ischemic and dilated

cardiomyopathy. After Andrew had been wearing the LifeVest

for about six months, he went to St. Clair Hospital to have open

heart surgery. Following his surgery, he continued to wear the

LifeVest during his recovery at an area rehabilitation facility.

Following rehabilitation, Andrew's heart began to beat out of

rhythm while he was at home. His LifeVest detected the life-

threatening arrhythmia and delivered a treatment shock.

His electrophysiologist, Puvalai M. Vijaykumar, M.D. said

had Andrew not been wearing the LifeVest, he probably would

not have survived that day.

Bridgeville resident Frank Ptaszynski, 59, another patient

of Dr. Vijaykumar, was also prescribed the LifeVest following

balloon angioplasty and stent insertion. While visiting St. Clair

Hospital for another unrelated medical condition, Frank passed

out after his heart lost its life-sustaining rhythm. As with Andrew,

the LifeVest delivered a treatment shock and helped Frank regain

consciousness. Moments later, his heart was restored to a

normal rhythm.

In both of these cases, the LifeVest came to the rescue. Once

fitted, the LifeVest continuously monitors a patient’s heart and, if

a life-threatening heart rhythm is detected, the device delivers a

treatment shock to restore normal heart rhythm. The device alerts

the patient prior to delivering a treatment shock by sounding an

alarm and releasing a conductive gel over the patient's chest.

According to Dr. Vijaykumar, the LifeVest is used for a wide

range of patient conditions, including following a heart attack,

before or after bypass surgery or stent placement, as well as

cardiomyopathy or congestive heart failure.

“We recommend the LifeVest to a patient who is at risk for

sudden cardiac arrest or who recently had a heart attack,” he

says. “Typically, we wait for 40 days following a myocardial infarction

(heart attack) before we can place an implantable cardioverter

defibrillator. Some patients may need to wait for 90 days. These

are people who have a dilated cardiomyopathy, patients who had

a recent balloon angioplasty or a stent placed, and people who had

coronary artery bypass surgery. During this waiting period, the

patient has to be protected from sudden cardiac arrest — and

the LifeVest protects them.”

Comfortable,lightweightgarment iswashableand can beworn all day,except whenbathing andshowering.

Dry, non-adhesivesensing electrodescontinuously monitorpatient’s heart.

This monitor is worn in a holsteraround the waist and from thesensing electrodes collects ECGdata that can be sent to a doctorvia modem.

If a life-threatening arrhythmia is detected,this alarm module alerts the patient with audible, visual and tactile alarms. A consciouspatient can prevent a shock by simultaneouslypressing two response buttons.

In the event of a life-threateningarrhythmia, these dry therapeuticelectrodes will automaticallydeploy conductive gel prior todelivering a shock.

Life-saving technoLogy


Electrophysiology

The LifeVest also allows physicians like

Dr. Vijaykumar time to assess patients' long-term

arrhythmic risk and make appropriate plans. Once

a patient gets shocked from a LifeVest, the patient

immediately receives an implanted defibrillator.

That waiting period goes away — they do not have

to wait for 40 or 90 days.

Since the LifeVest is lightweight and easy to

wear, Dr. Vijaykumar says it allows patients to

return to their normal activities of daily living, while having the peace of mind

that they are protected from sudden cardiac arrest. “It’s like any vest you may

wear with adjustable straps,” says Dr. Vijaykumar.

The LifeVest is non-invasive and consists of two main components ―

a garment and a monitor. The garment, worn under the clothing, detects

arrhythmias and delivers treatment shocks. The monitor is worn around

the waist or from a shoulder strap and continuously monitors the patient’s heart.

To date, the LifeVest has been prescribed to more than 75,000

patients nationwide. �

As an electrophysiologist, Puvalai Vijaykumar, M.D. can help

determine whether a patient is at high risk for sudden cardiac

arrest or cardiovascular disease. According to the Heart Rhythm

Foundation, electrophysiology, a subspecialty of cardiology,

is now the fastest growing of all the cardiovascular disciplines.

Electrophysiologists, like Dr. Vijaykumar, are cardiologists

who have additional training in the diagnosis and treatment of

abnormal heart rhythms. Dr. Vijaykumar and his staff evaluate

and treat patients who have a variety of cardiac arrhythmias

and abnormal heart rhythms.

Your heart sends out electrical signals throughout the

muscle, thereby acting as a natural pacemaker. These signals

will cause each of your heart’s four chambers to relax and

contract in a rhythmic pattern. If your heart could not send out

a signal, it would be a motionless pump.

“People can have a slow heart beat or a rapid heart beat,”

notes Dr. Vijaykumar. "As electrophysiologists, we evaluate their

abnormal heart rhythm and prescribe the appropriate treatment.

In some cases, we may need to insert a pacemaker or an

implantable cardioverter defibrillator; and in other cases, they

may need a procedure called a radio-frequency ablation.”

Dr. Vijaykumar and his staff routinely handle heart rhythm

problems in patients of all ages. They often work closely with

other cardiologists and specialists to achieve the best outcomes

for these complex cases. �

THE FASTEST GROWING CARDIOVASCULAR DISCIPLINE

PUVALAI M. VIJAYKUMAR, M.D.

Dr. Vijaykumar specializes in electrophysiology and cardiology at St. Clair Hospital. He earned his medical degree at Stanley Medical College andcompleted his medical training at Madras MedicalCollege, both in India. He completed an internship atCabrini Medical Center in Manhattan, and fellowshipsat Coney Island Hospital in Brooklyn and DeborahHeart and Lung Center in Browns Mills, New Jersey. Dr. Vijaykumar is board-certified in cardiology andelectrophysiology. He practices with PittsburghCardiac Electrophysiology Associates, P.C.

To contact Dr. Vijaykumar, please call 412.687.8838.

on average,

Lifevest is

saving one

life a day.

David DeCarlucci, MS, CES, Supervisor, Cardiac/Pulmonary Rehabilitation at St. Clair Hospital, demonstrates the LifeVest while exercising.


asK the DoctoR

BrIDGET K. BEIEr, D.O.

Ask the Doctor Q

A

Is there a relationship between diabetes and heart disease?

There is strong link between diabetes and heart

disease. People with both Type I and Type II diabetes

are at increased risk of developing and dying from

heart disease. If you have diabetes, you are twice as

likely as someone without diabetes to suffer a heart

attack or stroke. According to the National Institutes of

Health, about 65 percent of people with diabetes die

of a heart attack or stroke. Even at the time of diabetes

diagnosis, many diabetics already have overt heart

disease (past heart attack, peripheral vascular disease,

or EKG changes). Many patients with diabetes have

multiple risk factors for heart disease, including high

blood pressure, cholesterol abnormalities, and obesity.

The pathogenesis of heart disease in diabetics is

complex. In simple terms, high blood sugar levels over

time can lead to the buildup of fatty materials on the

insides of blood vessel walls. This in turn can cause

abnormal blood flow, leading

to increased chance of

clogging and hardening

of blood vessels.

Chronic inflammation

may also play

a role.

The good news is, there are many ways for diabetics

to reduce their risk of heart disease. Good blood sugar

control is important. The goal HgA1c (this test provides

an average of your blood sugars over the preceding

2- to 3-month period) for most patients with diabetes

is less than 7 percent. Aggressive control of high blood

pressure and high cholesterol are also vitally important.

A goal blood pressure for most people with diabetes

is less than 130/80. In regards to cholesterol, the LDL

(“bad cholesterol”) should be less than 100 in diabetics

without known heart disease. The target LDL in diabetics

who have already been diagnosed with heart disease

is less than 70. Fortunately, there are safe and effective

medications available to help people meet their blood

pressure and cholesterol targets.

Smoking cessation lowers cardiovascular risk

substantially. Additionally, a low dose daily aspirin may

be beneficial in diabetics at high risk for heart disease,

but is no longer recommended for low risk individuals.

Finally, lifestyle modifications can greatly reduce

the risk of heart disease in diabetics. Diet, exercise and

weight loss can make a big impact. Try to get at least

30 to 60 minutes of exercise most days of the week

and follow a diet that is low in saturated fats and salt. �

BRIDGET K. BEIER, D.O.

Dr. Beier specializes in endocrinology. She earned her medical degree atLake Erie College of Osteopathic Medicine and completed her residency at the University of Connecticut Health Care Center and a fellowship atVirginia Commonwealth University Health System. She is board-certified in internal medicine and endocrinology. She practices with Associates in Endocrinology, P.C.

To contact Dr. Beier, please call 412.942.2140.



Advanced Technologies at St. Clair Hospital’sNew Breast Care Center Enhance Mammography Screening

St. Clair Hospital’s new Breast Care Centerin Bethel Park is quickly gaining a stellarreputation among patients for a spa-like

ambience that offers them an environmentexuding comfort, convenience and beauty.

But patients are also praising the center’s advanced diagnostic imaging technology, particularly a new technology called 3D breast tomosynthesis. A recent study involving 3D breasttomosynthesis found a significant increase in cancerdetection rates, particularly for invasive cancers,and a simultaneous decrease in false-positive rateswith use of mammography, plus 3D tomosynthesis,when compared with mammography alone.

At the St. Clair Hospital Breast Care Center,3D breast tomosynthesis, which is FDA-approved,is often used in conjunction with traditional digital mammography as part of a woman’s annual screening mammogram to capture more breast images.

WHAT IS 3D BREAST TOMOSYNTHESIS?3D breast tomosynthesis uses high-powered computing to convert digital

breast images into a stack of very thin layers or “slices” ― building what is essentially a “3-dimensional mammogram.”

The 3D images allow doctors to examine breast tissue one layer at a time. Very low X-ray energy is used during the screening examination ― which takesabout 10 seconds to acquire ― so a patient’s radiation exposure is safely below the American College of Radiology (ACR) guidelines.

With 3D images, St. Clair Hospital diagnostic radiologists can see tissue detail in a way never before possible. Instead of viewing all of the complexities of a woman’s breast tissue in a flat 2D image, a radiologist can examine the tissue a millimeter at a time. Fine details are more clearly visible, no longer hidden by the tissue above and below.

When used together, 3D breast tomosynthesis and digital mammographyhave been proven to reduce “call-backs,” scenarios in which patients areasked to return for follow-up examinations to rule out any suspicious areas.The use of 3D tomosynthesis has proven particularly beneficial in womenwith dense breast tissue and has reduced the number of unnecessary invasivediagnostic procedures. �

The St. Clair Hospital Breast Care Center is on the Third Floor of the St. Clair HospitalOutpatient Center–Village Square, 2000 Oxford Drive, Bethel Park. To contact the center,please call 412.942.3177.

Diagnostic aDvances

“3D tomosynthesis has proven

particularly beneficial in women

with Dense breast tissue

anD has reDuceD the number

of unnecessary invasive

Diagnostic proceDures.

”

General & Patient Information Physician Referral Service Outpatient Center–Village Square Medical Imaging Scheduling 412.942.4000 412.942.6560 412.942.7100 412.942.8150

St.Clair Hospital1000 Bower Hill RoadPittsburgh, PA 15243www.stclair.org

is a publication of St. Clair Hospital. Articles are for informational purposes and arenot intended to serve as medical advice. Please consult your personal physician.

Follow us on twitter at: www.twitter.com/stclairhospitalHouseCall

In November, St. Clair Hospital formally

dedicated its newly renovated First Floor

Lobby and entryway to the Professional Office

Building, enhancements that have transformed

one of the most trafficked areas of the Hospital

from ordinary to extraordinary.

Much of the renovation was paid for through

a generous gift from the Hospital’s Auxiliary,

which closed out its 67-year history at the

Hospital with a $500,000 donation to the St. Clair

Hospital Foundation. Instrumental in the

Hospital’s founding in the early 1950s, the

Auxiliary donated more than $6 million to St. Clair

throughout the decades. In its honor, the First

Floor Lobby was renamed the “Auxiliary Lobby.”

And while the lobby’s facelift has enhanced

the aesthetics, it also has greatly improved how

patients and visitors navigate the building. The

entrance features a new covered, wide entryway

with automatic doors for patient drop-off or valet

service. Once inside, a new 45-inch electronic

touch-screen Directory makes finding a physician’s

office, Patient Registration, or even Café 4,

a simple, speedy process.

A short walk through the sun-drenched

glass atrium leads to a new art gallery featuring

original paintings and photography of local

artists for sale. Just past the art gallery is a

new Information Desk, where patients and

visitors can talk with a friendly customer

service representative or volunteer before

stepping onto nearby elevators or relaxing

on the brightly lit lobby’s many new couches

and chairs.

When exiting the Hospital or the Professional

Office Building through the Auxiliary Lobby,

patients and visitors have their choice of two

convenient Pay Stations for the Parking Garage’s

new ticket-based system. �

AuxiliAry lobby

Renovations Enhance Patient and Visitor Experience

St. Clair Hospital HouseCall_Vol V Issue 1

Documents

Transcript of St. Clair Hospital HouseCall_Vol V Issue 1