HouseCallVOLUME V ISSUE 2

inside New Physician Spotlight I Ask The Doctor: Low Testosterone Treatment In The Swing Of Things: Summer Swing Date Announced I In The Community

HouseCallVOLUME V ISSUE 2

Center of HealthcareThe New

Expanded Outpatient Center Debuts in Bethel ParkPage 2

South Park resident Tami Mikush was clinically dead for 45 minutes.St. Clair Hospital doctors, advanced technology, and her determination to live brought her back from the brink.

Her amazing storybegins on Page 10.

lifeRestoredto

The newly expanded St. Clair Hospital Outpatient Center at Village Square is a responseto patient desire to access healthcare services in a way that is convenient and efficient.

Outpatient CenterSt. Clair Hospital

atVillage Square-Bethel Park

2 I HouseCall I Volume V Issue 2

Continued GroWth

An artist’s rendering of the soon-to-open South Hills Cardiology Associates’ suite on the Third Floor.

ThE CrEATion oF A onE-STop ouTpATiEnT CEnTEr

AllowS pATiEnTS To hAvE TESTS, SEE A phySiCiAn, unDErgo ThErApy,

AnD EvEn EnJoy A SpECiAlTy CoFFEE. All unDEr onE rooF.

outpatient facility triples in size and makes accessing healthcare services

simple and convenient.

Extensive renovations at St. Clair Hospital

Outpatient Center–Village Square are nearing

full completion, but patients are already

enjoying a wealth of healthcare services

conveniently located on three floors, all

in one accessible, easy-to-navigate building across

Fort Couch Road from South Hills Village mall.

You'll find easy access to a wide range of healthcare

services and physicians, including lab, imaging and other

diagnostic services, occupational medicine, physical therapy,

breast care, pain management, diabetes care, and cardiac

testing, along with physicians in primary care, endocrinology,

ear/nose/throat, orthopedics, cardiology and more. And

coming soon: an urgent care center that will be open

every day of the year, including all major holidays.

Grouping these services allows patients to see a

number of physicians and obtain healthcare services

in one day, all under the same roof ― a response to

patient desire to access healthcare services in a way

that is convenient and efficient. Moreover, a new café

will soon be added to the Outpatient Center so patients

can enjoy a specialty coffee and a bite to eat in a warm,

inviting atmosphere.

What follows over the next six pages is a floor-by-floor

breakout of services at the Outpatient Center-Village Square

and corresponding contact information for each. We encourage

HouseCall readers to save this handy guide for future reference.

Meantime, welcome to the new St. Clair Hospital Outpatient

Center–Village Square. We look forward to taking care of you

and your family.

Volume V Issue 2 I HouseCall I 3

Continued on page 4

First FloorContinued GroWth

Continued from page 3

• X-ray• MRI• CT scan

4 I HouseCall I Volume V Issue 2

urGent Care valet ServiCerehabilitation ServiCeS

Café 4 at villaGe Square

CominG Soon!Patients and visitors to the Outpatient Center will be able to sip a cup

of specialty coffee and get a bite to eat at the Center’s soon-to-open

Café 4 at Village Square. The sit-down café will be offering some of

the same popular menu items as its namesake at the Hospital. In

addition to its famous coffee, those items will include danish and

bagels, baked goods, salads and sandwiches, nuts and dried fruits,

and more. A selection of bottled beverages suitable for breakfast

and lunch will also be available.

diaGnoStiC Center

Long considered the heart of the overall Outpatient Center, the

Diagnostic Center’s easy check-in service and comfortable, spacious

waiting area are a gateway to the Center’s many services, such as:

• Lab, which includes blood draws and specimen collection, and

• Imaging, which includes X-ray, CT, MRI, and more.

To contact the Diagnostic Center, please call 412.942.7100.

A

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BD

A B C D EdiaGnoStiC Center Café 4

BA

Volume V Issue 2 I HouseCall I 5

rehabilitation ServiCeS

PHYSICAL THERAPY

St. Clair Hospital’s Outpatient Physical Therapy Department, or PT,

has long been recognized for its highly skilled team of licensed

physical therapists. The newly renovated and greatly expanded

space at the Outpatient Center has allowed the installation of new

state-of-the-art equipment and the introduction of enhanced treatment

options for patients. Physical therapists use a variety of treatment

techniques, such as exercise; gait training; balance activities;

heat/cold modalities; electrical stimulation; traction; and tissue

mobilization/manual therapy techniques to aid patients.

OCCUPATIONAL THERAPY

With a personalized plan of care, patients are assisted in resuming

activities integral to participation in independent self-care, home

and work-related skills, and leisure activities.

SPEECH THERAPY

Utilizing comprehensive assessments and therapy materials,

the department’s team of specialized healthcare professionals

identifies and treats a variety of speech conditions and disorders.

To contact Rehabilitation Services, please call 412.942.7122.

urGent Care

CominG Soon!Today’s urgent care centers are designed to take care of patients who

become ill or are injured, but their conditions are not serious enough

to warrant a trip to an Emergency Room. St. Clair Hospital’s Urgent

Care center will be a brand new addition to the Outpatient Center,

and will offer on-demand care for minor injuries, colds and flu,

physical exams for after-school sports, and vaccinations.

The Urgent Care Center will be open 9 a.m. to 9 p.m., seven days a

week, 365 days a year and will be staffed by board-certified physicians.

Follow-up care will be coordinated with patients’ personal physicians.

Patients visiting the Center do not make appointments. They simply

walk in and ask to see a doctor.

free valet ServiCe

Free valet parking is available for patients of the Outpatient Center

and physician practices. Visitors to other building tenants may also

use valet parking for a nominal fee.

DC

E

6 I HouseCall I Volume V Issue 2

Continued GroWthContinued from page 5

Second Floor

diabeteSCenter

South hillS orthopaediCSurGery aSSoCiateS

preferred primaryCare phySiCianS, inC.

oCCupationalmediCine Center

D2

D1 aSSoCiateS in endoCrinoloGyD2A B C

A

C

E

B

South hillS orthopaediC SurGery aSSoCiateS

South Hills Orthopaedic Surgery Associates is home to a leading team

of surgeons who specialize in the care of the musculoskeletal system,

with emphasis on the spine, neck, shoulder, elbow, wrist, hand, hip,

knee, foot and ankle. Whether it is repairing a torn ACL (anterior

cruciate ligament) in the knee of an athlete, performing intricate hand

or shoulder surgery, or completing a joint replacement of a patient's hip,

the surgeons at South Hills Orthopaedic Associates are committed to

helping their patients regain motion and be more active without fear

of pain or further injury.

To contact South Hills Orthopaedic Surgery Associates, please call

412.283.0260 or 888.817.2019.

(left to right) Damon B. Combs, D.P.M., Brett C. Perricelli, M.D., Eric D. Nabors, M.D.,Derrick J. Fluhme, M.D., and Christopher M. Manning, M.D.

preferred primary Care phySiCianS, inC.

The office of Preferred Primary Care Physicians (PPCP) at Village

Square is staffed by board-certified physicians who specialize in

family practice. They provide primary care services with an emphasis

on wellness and preventative care.

To contact PPCP, please call 412.831.1522.

Kevin G. Kotar, D.O., (l) and John L. Bobby, D.O.

D1

South hillS entaSSoCiationE

A B

Volume V Issue 2 I HouseCall I 7

diabeteS Center

The Diabetes Center provides comprehensive, personalized diabetes

care and management, with diabetes educators and registered dietitians

in one convenient location. The Center’s highly trained staff is very

experienced in diabetes care and management, and assists patients

in managing their condition and understanding how it impacts their lives.

As part of its Empowerment Program, Center staff works with patients

and their primary care physicians to provide the comprehensive

education and support patients need to stay healthy and reduce the

risk of complications. Patients receive a personalized plan on blood

glucose monitoring, insulin administration, diabetes medications,

exercise strategies, meal planning, sick-day management, and more.

To contact the Diabetes Center, please call 412.942.2151.

aSSoCiateS in endoCrinoloGy

Associates in Endocrinology

specializes in the care of

diabetes, thyroid disease,

osteoporosis, hormonal

disorders and metabolism.

To contact Associates in

Endocrinology, please

call 412.942.2140.

South hillS ent aSSoCiation

The branch of medicine and surgery that specializes in the diagnosis

and treatment of disorders of the head and neck is called

Otolaryngology, but most people refer to it simply as ear, nose and

throat care. The physicians and audiologists at South Hills ENT

Association combine compassion, expertise and integrity in the care

of every patient. Services there include:

(left to right) David P. DeMarino, M.D., Stephen F. Wawrose, M.D., Brian R. Elford, M.D., and Paul Scolieri, M.D.

• Sleep apnea• Snoring• Otologic surgery• Vestibular disorders• Audiology• Hearing aid dispensing

• Head and neck surgical oncology

and reconstructive surgery

• Thyroid surgery

• Facial plastics

• Allergy

• Sinus surgery

To contact South Hills ENT Association, please call 412.831. 7570.

Bridget Beier, D.O., (l) and Camille Buonocore, M.D.Christopher G. Maropis, M.D. (r)

oCCupational mediCine Center

The Occupational Medicine Center is under the direction of an

experienced certified occupational medicine physician who promotes

and maintains the health of workers and provides client companies

with personalized, professional and cost-effective healthcare. The

Center also offers medical services for individuals traveling

overseas, including vaccinations and immunizations.

To contact Occupational Medicine, please call 412.942.7115.

C D1

D2

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8 I HouseCall I Volume V Issue 2

Third FloorContinued GroWth

Continued from page 7

evron endoCrinoloGyaSSoCiateS/robert t.JohnSton, m.d.

KeyStone pain ConSultantS, ltd.

South hillSCardioloGyaSSoCiateS

CardiaCdiaGnoStiCS

ConferenCeroom

breaSt CareCenter

A

CE

B

D

A B C D E F

F

CardiaC diaGnoStiCS

The new Cardiac Diagnostics Center offers patients a full

range of diagnostic testing, including EKG, holter monitoring,

echocardiology, stress testing, and nuclear cardiology.

To contact Cardiac Diagnostics, please call 412.942.7900.

evron endoCrinoloGy aSSoCiateS/robert t. JohnSton, m.d.

Endocrinologist Wayne A. Evron, M.D., and Internal Medicine Physician

Robert T. Johnston, M.D., share this suite. Dr. Evron specializes in the

care of diabetes, thyroid disease, hormonal disorders, hypertension

and osteoporosis. Dr. Johnston offers a full range of internal

medicine and primary care services.

Dr. Evron Dr. Johnston

To contact Dr. Evron,

please call 412.942.7295.

To contact Dr. Johnston,

please call 412.4 71.3061.

A B

Volume V Issue 2 I HouseCall I 9

breaSt Care Center

St. Clair Hospital launched a new era in women’s healthcare with the

October 2012 opening of its new, state-of-the-art Breast Care Center at

Village Square. Designed with a spa-like ambience, the Center offers

the most advanced diagnostic imaging technology in an environment

of comfort, convenience and beauty. The Center also features a new

technology called 3D breast tomosynthesis, which has been credited

in a recent study with a significant increase in cancer detection rates,

particularly for invasive cancers, and a simultaneous decrease in false-

positive rates, when used with traditional mammography. Patients also

have access to stereotactic biopsy, a procedure that uses a computer

and imaging to localize a tumor, or small calcifications, which can be

an early sign of breast cancer, and guide the removal of tissue for

examination by a pathologist.

To contact the Breast Care

Center, please call

412.942.3177.

additional St. Clair hoSpital phySiCianS at villaGe Square are:

Family Practice: John E. Popovich, M.D.

To contact Dr. Popovich, please call 412.854.5491.

Hematology/Oncology: Louis Pietragallo, M.D.; Robert Volkin, M.D.;Ronald Fierro, M.D.; Vincent Reyes, M.D.; Robert Vanderweele, M.D.

To contact any of the above physicians, please call 412.831.1320.

Internal Medicine: Joel D. Warshaw, M.D.

To contact Dr. Warshaw, please call 412.833.2233.

Rheumatology: David J. Helfrich, M.D.

To contact Dr. Helfrich, please call 412.854.3491.

DSouth hillS CardioloGy aSSoCiateS

This seven-physician practice offers a wealth of services that focus

on the diagnosis and treatment of conditions and diseases involving

the heart and vascular system at large. In addition to providing an

array of diagnostic testing, the cardiologists are available 24 hours

a day, seven days a week to provide scheduled and emergency

cardiac care. The highly trained cardiologists also offer patients

undergoing heart catheterizations the option of having a “cath”

performed through the radial artery in the wrist instead of the

traditional femoral artery in the groin, a procedure that offers several

advantages, including less bleeding and faster recovery time.

To contact South Hills Cardiology Associates, please call 412.851.0279.

(left to right) Mark K. Greathouse, M.D., John P. Girod, D.O., Robert N. Shogry, M.D.,James H. MacDougall, M.D., Harshad R. Mehta, M.D., and Jeffrey M. Friedel, M.D.

Not pictured, Jeffrey C. Liu, M.D.

Dr. Rivero

Sherri H. Chafin, M.D., and Raye J. Budway, M.D.

D

EKeyStone pain ConSultantS, ltd.

Staffed by Jorge N. Rivero, M.D., who specializes

in pharmacologic and interventional management

of pain, Keystone offers a host of acute and chronic

pain services designed to support and speed

healing and relieve suffering. Chronic back pain

sufferers, for example, may benefit from epidural

steroid injections, facet joint injections, neurolytic

blocks, spinal cord stimulators and intrathecal

drug delivery system implants. All patients must be referred by their

primary care physician, oncologist, or another medical doctor.

To contact Keystone Pain Consultants, LTD., please call 412.942.5786.

C

10 I HouseCall I Volume V Issue 2

patient profile

FROM DEATH TO

Tami Mikush is given a second chance at life after a

heart attack throws her heart out of normal rhythm.

life

Volume V Issue 2 I HouseCall I 11

Continued on page 12

Tamara “Tami” Mikush

(pronounced Mick-ish)

remembers that fateful Friday

night in late October 2012

like it was yesterday.

But only the first part of the night.

Because later that night … she was

clinically dead.

For 45 minutes.

“I was getting ready for bed around

11 p.m. As soon as I got into bed, I felt

something was wrong; something wasn’t

right. It was almost like a panic attack. I felt

sweaty and I could feel my heart beating.”

Tami, 53, says she got out of bed and

sipped on a glass of water in an attempt to

calm herself down. When that failed, she

woke her husband. “I think we need to call

an ambulance,” she told him.

Seconds later, she felt her left arm

go numb.

Paramedics arrived and told her she

was having a heart attack.

The ambulance crew rushed her to the

Emergency Room (ER) at St. Clair Hospital.

As she was being transferred from the

ambulance stretcher to a bed in the ER, Tami

says, “My heart stopped.”

Her doctors told her later that her heart

had stopped its normal rhythm and instead

was in “ventricular fibrillation” (V-fib) in

which it was quivering and no longer sending

oxygen-rich blood to her heart, brain and

other vital organs.

ER staff quickly used an electrical

device known as a defibrillator to restore

her trembling heart to its normal rhythm.

They then transported Tami to the

adjoining Catheterization Lab where

Interventional Cardiologist James W.

Marcucci, M.D., was preparing to insert

a thin wire through her femoral artery

into her heart to clear the suspected

blockage that caused the heart attack

and the V-fib.

“When I got to the Cath Lab, apparently

my heart stopped again,” Tami relates in a

calm, strong voice while relaxing in the living

room of her South Park home.

Dr. Marcucci remembers Tami crying

out, “Please don’t let me die,” just as she

began to lose consciousness.

As in the ER, Tami’s heart had gone into

V-fib. But unlike the first time, an electrical

shock to her heart did not restore it to its

natural rhythm.

Dr. Marcucci and Cath Lab staff declared

a Code Blue and immediately began Cardio

Pulmonary Resuscitation (CPR) to manually

provide oxygen to the heart, brain and other

vital organs until normal heart and pulmonary

function could be restored.

Within seconds, some 10 to 12 people

were in the room, all part of St. Clair

Hospital’s CPR team. In between chest

compressions, the team shocked Tami’s

heart. Again and again.

They worked feverishly on Tami for

more than 20 minutes, alternating between

electrical shocks and CPR. Still, her heart

would not return to a normal rhythm.

Dr. Marcucci was bound and determined

to not let Tami die, so he and the staff

continued CPR and shocking her heart for

another 25 minutes. They also administered

intravenous amiodarone and lidocane, both

powerful anti-rhythm drugs, and vasopressin,

which stimulates contraction of muscles of

capillaries and arteries.

It was the 25th shock, and what was

probably going to be the final shock that

Tami would receive, that restarted her

heart and returned it to a normal rhythm.

inTervenTional cardiologisT

James w. marcucci, m.d.,

remembers Tami crying ouT,

“please don’T leT me die,”

JusT as she began To lapse

in and ouT of consciousness.

“The docTors and The

enTire sTaff aT The

hospiTal were wonderful

To me and my family.

i feel blessed for

everyThing each and

every one of Them

did in making sure i

had a greaT recovery.

”TAMI MIKUSH

12 I HouseCall I Volume V Issue 2

patient profileContinued from page 11

In fact, Tami believes she remembers feeling

the sensation of that last shock to her heart.

Dr. Marcucci then proceeded with the

emergency catheterization, which revealed

that Tami’s dominant right artery was 100

percent blocked. Dr. Marcucci performed

a balloon angioplasty to restore blood flow

through the artery.

Tami’s chest was black and blue and

what she would later describe as very sore,

but, amazingly, she did not suffer any broken

ribs, despite 45 minutes of continuous

CPR, a nod to the skill and dexterity of the

CPR team.

Following her catheterization, Tami

was taken to the Hospital’s Cardiovascular

Surgical Unit (CVSU), where, still critically

ill, she was placed on a ventilator and had

a temporary pacemaker and intra-aortic

balloon pump inserted to support her blood

pressure. She also was placed in a medically

induced coma. CVSU doctors pumped

refrigerated intravenous fluids through her

veins and also placed cooling blankets

underneath and on top of her to keep her body

temperature at approximately 92 degrees

for 24 hours. (Normal body temperature is

98.6). The cooling blankets are body-sized

plastic coverings filled with extremely cold

water that is supplied by a portable pump.

The chilling effect of the cold fluids and the

cooling blankets is designed to lower a

patient’s body temperature, reducing brain

swelling and the formation of dangerous

chemicals that result from inflammation.

It also preserves other vital organs.

As her husband and family, which includes

two adult daughters, gathered at Tami’s

bedside, staff in the CVSU prepared them for

the worst. Given her heart attack and the fact

she was “clinically dead” for 45 minutes in

the Cath Lab, it was possible Tami would die,

or, she would be severely impaired mentally

and physically because of the suspected lack

of oxygenated blood to her brain.

iT was The 25Th shock,

and whaT was probably

going To be The final shock

ThaT Tami would receive,

ThaT resTarTed her hearT

and reTurned iT To

a normal rhyThm.

dr. marcucci

acknowledges …

ThaT in 30 years

of pracTicing

cardiology, he

has never seen

a paTienT be

clinically dead

for 45 minuTes and

noT suffer

any ill effecTs.

James W. Marcucci, M.D.

But 12 days later, Tami was discharged

from the Hospital with no neurological or other

impairment. She recognized everyone and

could talk, walk, and eat without assistance.

She believes it is a miracle that she

survived and did so in full possession of all

her faculties. “I’m still here because there

is a purpose for me in this world,” Tami

says. “It wasn’t my time.” And, she adds,

“I was lucky Dr. Marcucci shocked me one

more time.”

Dr. Marcucci largely credits Tami’s

miraculous recovery to the efforts of the CPR

team, who kept precious blood coursing

through her arteries, and the organ-

preserving cooling blanket.

He acknowledges, though, that in 30 years

of practicing cardiology, he has never seen

a patient be clinically dead for 45 minutes

and not suffer any ill effects.

Before she left the Hospital, Tami was

fitted with a Zoll LifeVest, a wearable

defibrillator that is designed to detect any

abnormal heart rhythms and then deliver

a treatment shock if necessary. She had to

wear the LifeVest 24 hours a day. The only

time she could take it off was for showering

or bathing, and then, she had to have a family

member nearby in the event of another

heart-related emergency.

The LifeVest, which was featured in

a previous issue of HouseCall, is often used

by patients until they are fitted with an

implantable cardioverter defibrillator by

an electrophysiologist.

(Editor’s note: Tami’s cardioverter

defibrillator was implanted by St. Clair

Hospital Electrophysiologist/Cardiologist

Puvalai M. Vijaykumar, M.D., in March.)

About four weeks following the October

heart attack, Tami began to experience

chest pains and returned to St. Clair’s Cath

Lab, where Dr. Marcucci cleared two more

blockages in her heart and placed stents in

two arteries to prop them open and ensure

good blood flow.

Tami’s heart attack in October was

actually her second. She suffered her first

attack in 1990, an event that resulted in a

14-day hospital stay.

She readily admits that years of smoking

about a pack of cigarettes a day likely

contributed to both heart attacks. She had

smoked for about 10 years until her first

heart attack in 1990. She then stopped

smoking for 11 years, before resuming the

habit about 12 years ago, smoking right up

until the night of the second attack. She had

no serious health problems between the

two attacks. “I have not started to smoke

again,” says Tami, “and very desperately

am hoping that I never do again.”

Tami says she is very grateful for the care

she received at St. Clair Hospital. “The doctors

and the entire staff at the Hospital were

wonderful to me and my family. I feel blessed

for everything each and every one of them

did in making sure I had a great recovery.”

Feeling better each day, Tami has

returned to work, part-time for now, in the

office of a South Hills podiatrist.

One of the requirements for her job as

a medical receptionist there: being certified

in CPR. As she heads to the kitchen to

prepare lunch for her husband and one of

her daughters, Tami smiles when she offers,

“I definitely feel everyone should be trained

in CPR.” n

Volume V Issue 2 I HouseCall I 13

JAMES W. MARCUCCI, M.D.

Dr. Marcucci specializes in interventional cardiology at St. Clair Hospital. Heearned his medical degree at the University of Pittsburgh School of Medicineand completed an internship at Temple University Hospital, an internal medicineresidency at UPMC Mercy Hospital of Pittsburgh, and a cardiology fellowshipat George Washington University Hospital. Dr. Marcucci is board-certified ininterventional cardiology and cardiovascular disease by the American Boardof Internal Medicine. He practices with US Heart and Vascular, P.C.

To contact Dr. Marcucci, please call 412.429.8840.

PUVALAI M. VIJAYKUMAR, M.D.

Dr. Vijaykumar specializes in electrophysiology and cardiology at St. ClairHospital. He earned his medical degree at Stanley Medical College andcompleted his medical training at Madras Medical College, both in India.He completed an internship at Cabrini Medical Center in Manhattan, andfellowships at Coney Island Hospital in Brooklyn and Deborah Heart andLung Center in Browns Mills, New Jersey. Dr. Vijaykumar is board-certifiedin cardiology and electrophysiology. He practices with Pittsburgh CardiacElectrophysiology Associates, P.C.

To contact Dr. Vijaykumar, please call 412.687.8838.

Twelve days laTer, Tami was

discharged from The hospiTal

wiTh no neurological or oTher

impairmenT. she recognized

everyone and could walk, Talk,

and eaT wiThouT assisTance.

aSK the doCtor

ArnoLD­j.­SHoLDEr,­M.D.­

CAMiLLE­M.­BUonoCorE,­M.D.

Ask the Doctor

Q

A

i keep hearing the term “low T” being bandied about.

what is it and should i be concerned?

The­phrase­“Low­T’­has­become­part­of­the­

American­lexicon,­thanks­to­a­wealth­of­TV­and­

print­advertisements­for­medications­to­treat­low

testosterone­in­men.­Having­Low­T­is­something

that­can­be­a­significant­problem­for­men.­Low

testosterone­could­place­a­man­at­a­higher­risk­for

developing­illnesses­such­as­diabetes,­osteoporosis

and­heart disease,­as­well­as­causing­lack­of­energy

and­low­libido.­

Testosterone­is­the­hormone­created

by­men’s­testicles­that­give­them­male

characteristics,­both­physical­and

emotional.­At­the­low­end­of­normal,

men’s­total­testosterone­count

is­about­300,­while­the­high­end

is­around­900.­

“Men­in­their­20s

through­40s­may­have

a­normal­range­of

around­500,”

notes­Arnold J. Sholder, M.D.,­a­urological­surgeon­at

St.­Clair­Hospital­who­practices­with­Sholder­&­Bordeau

Urologic­Associates.­“As­men­age,­there­is­a­gradual

decline­in­testosterone,­so­many­men­in­their­70s

and­80s­will­have­a­level­at­the­low­range­of­normal

or­slightly­below.”

A­primary­reason­that­men’s­testosterone­levels

decline­as­they­age­is­because­their­testicles­are­not

as­active­in­producing­testosterone.­According­to

Dr.­Sholder,­95­percent­of­the­testosterone­comes

from­the­testicles­and­about­5­percent­comes­from

the­adrenal­glands,­which­are­located­above­the

kidneys.­Dr.­Sholder­stresses­that­it’s­normal­for

men’s­testosterone­to­decline­as­they­get­older­and,

for­the­most­part,­it­is­nothing­to­be­too

concerned­about­—­as­long­as­a­man’s

testosterone­level­remains­in­the­range

for­his­age­group.­

Dr.­Sholder­and­St.­Clair­Hospital

Endocrinologist­Camille M. Buonocore,

M.D., say­they­are­seeing­a­growing

number­of­patients­seeking­answers

about­Low­T,­many­of­them­prompted

to­call­after­seeing­the­ubiquitous

advertisements.

The­doctors­say­a­simple­blood­test

is­used to­determine­testosterone­levels.

Typically,­the­best­time­to­have­blood

drawn­for­testosterone levels­is­early

morning.­

The­most­common­symptoms

of­low­testosterone­are­a­lack

of­energy­and­a­lack­of­interest

in­sex.­

When­a­younger­man­is

displaying­these­symptoms,

a­testosterone­level

should­be­done,­says

Arnold J. Sholder, M.D., with Robin Pavlik, Medical Assistant

14 I HouseCall I Volume V Issue 2

Volume V Issue 2 I HouseCall I 15

CAMILLE M. BUONOCORE, M.D.

Dr. Buonocore specializes in endocrinology. Sheearned her medical degree at State University ofNew York College of Medicine and completed her internship, residency and a fellowship at the University of Pittsburgh. Dr. Buonocore is board-certified in endocrinology, diabetes and metabolismby the American Board of Internal Medicine. Shepractices with Associates in Endocrinology, P.C.

To contact Dr. Buonocore, please call 412.942.2140.

Dr.­Sholder,­since­this­could­be­a­sign­of­low­testosterone.

For­a­patient­in­his­80s,­it’s­just­a­normal­part­of­aging.­­

Sometimes,­the­symptoms­of­low­testosterone­can be

confused­with­suffering­from­stress­at­work­or­home, being

overworked,­or­just­not­getting­enough­rest.­

Dr.­Buonocore,­whose­Low­T­patients­range­in­age­from

30­to­70,­says­she­believes­testosterone­levels­are­declining

earlier­in­men­due­to­the­rising­incidence­of­obesity.­She

notes­that­testosterone­levels­in­obese­patients­often

improve­with­weight­loss.­

Drs.­Buonocore­and­Sholder­say­there­are­many­treatments

available­for­men­suffering­from­Low­T.­Following­a­prostate

exam­and­PSA­level­to­rule­out­any­other­problems,­some

urologists­and­endocrinologists­will­recommend­an

inter-muscular­shot­every­two­weeks.­There­is­also­a

pellet­that­is­implanted­under­the­skin­and­slowly

releases­testosterone.

Drs.­Sholder­and­Buonocore­often­opt­for­one­of­four

topical­gels­that­are­applied­to­the­skin­on­a­daily­basis­and

can­be­quite­effective.­

“The­gels­work­so­well­that­to­be­given­a­shot­or­an­injection

really­doesn’t­make­a­lot­of­sense­when­you­can­just­apply­a

gel­after­your­shower­every­morning,”­says­Dr.­Sholder.

“Men­who­truly­have­low­testosterone­levels­are­the­ones

who­can­truly­benefit­from­testosterone­supplementation.”

Following­supplementation,­with­restoration­of­normal

testosterone­levels,­men­usually­have­more­energy,­more

interest­in­sex,­gain­more­muscle­mass,­and­even­lose­body

fat,­according­to­research­by­the­American­Endocrine­Society.­

A­controversy­about­testosterone­supplementation

occurs­in­men­with­borderline­low­levels­of­testosterone­and

in­elderly­men­who­have­physiological­low­testosterone

based­on­their­age.­

“Although­the­decline­in­testosterone­with­age­may­have

several­adverse­consequences,­the­impact­of­testosterone

replacement­in­older­men­with­low­normal­serum­testosterone

remains­unclear,”­says­Dr.­Sholder.­“The­Committee­of­the

institute­of­Medicine­of­the­national­Academy­of­Sciences

reviewed­available­studies­and­concluded­that­no­beneficial

effects­of­administering­testosterone­have­been­well

established­in­this­age­group.”

However,­men­who­have­significantly­low­levels­of

testosterone­definitely­do­benefit­from­testosterone

supplementation.­

“i­see­elderly­men­who­are­using­testosterone

supplementation­who­have­borderline­low­levels,­which­is

normal­for­their­age­group,”­says­Dr.­Sholder.­“The­problem

with­supplementation­in­these­elderly­men­is­that­there­are­a

host­of­other­problems­that­could­arise.­For­example,­if­you

have­sleep­apnea,­it­can­make­it­worse.­Men­with­an­enlarged

prostate­can­have­prostatic­growth­and­an­increase­in

urinary­symptoms.­if­a­man­has­undiagnosed­prostate

cancer,­there­is­a­risk­that­they­could­be­feeding­testosterone

to­the­cancer,­which­makes­prostate­cancer­grow.”

For­patients­undergoing­testosterone­supplementation,

Drs.­Sholder­and­Buonocore­say­they­test­their­patients’

testosterone­levels,­liver­function­and­blood­count,­and

monitor­them­for­any­urinary­problems.­n

TesTosTerone supplemenTaTion can be

of greaT benefiT for men wiTh low T and

significanT sympToms. reTurning The

TesTosTerone level To The normal range

can resulT in a noTiceable increase in

energy and resToraTion of normal libido.

iT can also pose hazards for older men

wiTh low normal TesTosTerone levels

who have minimal chance of benefiTing

from a higher TesTosTerone level.

ARNOLD J. SHOLDER, M.D.

Dr. Sholder specializes in urological surgery. He earned his medical degree at the University of Illinois College of Medicine and completed hisinternship, residency and fellowship at NorthwesternUniversity-affiliated hospitals in Chicago.Dr. Sholder is board-certified by the AmericanBoard of Urology. He practices with Sholder &Bordeau Urologic Associates.

To contact Dr. Sholder, please call 412.572.6194.

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.

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WAYNE A. EVRON, M.D., a 10-timePittsburgh Magazine “Top Doctor” who has been elected by his peers forinclusion in “Best Doctors in America”for 14 years, specializes in the careof diabetes, thyroid disease, hormonaldisorders, hypertension and osteoporosis. He earned his medicaldegree at the University of PennsylvaniaSchool of Medicine, completed aninternal medicine internship at theUniversity of Florida-Shands Hospital,and an internal medicine residency,and endocrine and metabolismfellowship at UPMC-PresbyterianHospital. Dr. Evron is board-certified

in internal medicine and endocrinology by the American Board of Medicine.Previously, he served as Medical Director of the Joslin Diabetes Center atThe Western Pennsylvania Hospital, and as Clinical Assistant Professorfor the Temple University School of Medicine.

To contact Dr. Evron, please call 412.942.7295.

New PhysicianSPOTLIGHTENDOCRINOLOGIST WAYNE A. EVRON, M.D.

­­Summer­Swingt o b e n e f i t S t . C l a i r h o S p i t a l

Friday, July 19 – Benefit Dinner – St. Clair Country Club

Food Station Dining l Cocktails l Silent Auction l Entertainment

Save thedate forthe 16tha n n u a l

For more information regarding reservations, sponsorships, or underwriting opportunities,please contact St. Clair Hospital Foundation at 412.942.2465 or schfoundation@stclair.org,or visit us online at www.stclair.org/82/foundation. Thank you!

In the Communitys part of its commitment to the community, St. Clair Hospital is supporting area community organizations.The Hospital highlights the good works of these non-profit

partners in HouseCall. In this issue, we feature Pittsburgh ActionAgainst Rape.

The Pittsburgh Action Against Rape (PAAR) mission is to respond,advocate and educate to end sexual violence through counselingvictims and their families and supporting them through the medicaland legal systems. PAAR is one of the oldest, and largest rape crisiscenters in the country. Additionally, PAAR remains the only organization in Allegheny County dedicated exclusively to victimsof sexual violence.

PAAR has a 24-hour freeand confidential hotline foranyone who needs help:1.866.END.RAPE. To learnmore about PAAR, please visithttp://paar.net.