VOLUME II, ISSUE 2

I N S I D E T H I S I S S U E

ASK THE DOCTOR

da VINCI Si SURGERY PATIENT PROFILE

ST. CLAIR’S OUTPATIENT LOCATIONS

ER RANKED AMONG BEST IN U.S.

COMMUNITY OUTREACH

SUMMER SWING

ST. CLAIR DOCTORS RECEIVE TOP RATINGS

CONTINUED ON PAGE 7

VOLUME III, ISSUE 2

Surgeons at St. Clair Hospital are now using state-of-the-art robotic technology,

the da Vinci Si, to provide the benefits of minimally invasive surgery to a

growing number of patients.

Named after the famous Italian engineer, mathematician and scientist Leonardo

da Vinci, the da Vinci System uses the most advanced technology to enable surgeons

to perform delicate and complex operations through a few tiny incisions with

increased vision, precision, dexterity and control.

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4

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8

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Raye J. Budway, M.D., a 2011

Pittsburgh Magazine “Top Doctor”,

relocated her practice to St. Clair in April.

Dr. Budway specializes in general and

breast surgery and will lead St. Clair’s

Breast Care Center.

As a participating surgeon in the recent

National Surgical Adjuvant Breast and

Bowel Project’s (NSABP) clinical trials, her

work has contributed to changes in the

treatment protocols for breast cancer—a

disease which affects more than 200,000

women each year. The NSABP, which is

supported by the National Cancer Institute,

has published studies that have led to the

establishment of lumpectomy with radiation

over radical mastectomy as the standard

surgical treatment for breast cancer, and

DRS. ARTHUR THOMAS and KEVIN BORDEAU are among a growinggroup of surgeons at St. Clair Hospital using the da Vinci Si, theworld’s most advanced robotic-assisted surgery system.

CONTINUED ON PAGE 2

Next generation surgery using the da Vinci Si

LEADING TEC NOLOGY

CONTINUED GROWTNew surgeon bolsters St. Clair’sbreast surgery program

shorter hospital stay, and quicker recovery and return to everyday

life. And, in men who have their prostates partially or fully

removed, robotic-assisted surgery also can mean a faster

return to urinary continence, lower rates of urinary pain, and

sustainable erections.

From the surgeon’s perspective, the benefits of robotic-

assisted surgery start with the ability to see inside the human

body at 10 times magnification. Moreover, the da Vinci Si’s “endo

wrists” enable the surgeon to sew sutures more precisely than by

hand. “Robotic-assisted surgery is more beneficial over traditional

laparoscopic surgery in anything that requires sewing,” Dr. Thomas

says.

Dr. Bordeau says a key to the success of the robotic-assisted

program at St. Clair is the operating room personnel who have

undergone extensive training with the da Vinci Si system.

Several teams have been trained.

Dr. Bordeau says those teams, and he and the other surgeons

performing robotic-assisted surgery, will benefit from having “the

newest and best system and the added advantage of learning

from the best practices.”

Y o u n g b a s e b a l l a n d s o f t b a l l p i t c h e r s a r e s u f f e r i n g

2

Arthur D. Thomas, M.D. earned his medical degree at the University ofPennsylvania School of Medicine and completed a residency in urologyat the Hospital of the University of Pennsylvania. Dr. Thomas is boardcertified by the American Board of Urology and practices as part of TheCenter for Urologic Care, P.C.

Kevin P. Bordeau, M.D. earned his medical degree at Tufts UniversitySchool of Medicine in Boston and completed a residency in urology atthe Eastern Virginia Medical School. Dr. Bordeau is board certified bythe American Board of Urology and practices as part of Sholder & BordeauUrologic Associates.

LEADING TEC NOLOGYCONTINUED FROM PAGE 1

The da Vinci is currently being used at St. Clair for urology

procedures, such as prostatectomies (removal of the prostate

gland, most often due to cancer), but the system is also designed

for gynecology, cardiothoracic, head and neck and general

surgery procedures. Gynecological surgeons at St. Clair are

expected to be the next users of the new system.

The da Vinci Si consists of four interactive robotic arms that

are controlled by a surgeon who is seated at a console in the

operating room. Three of the arms are for tools, such as a

grasper and scissors, the fourth holds an endoscopic camera

with two lenses that give the surgeon a 3-D image (at 10 times

magnification) during the procedure. The system seamlessly

translates the surgeon’s hand, wrist and finger movements into

precise, real-time movements of surgical instruments. Every

surgical maneuver is under the direct control of the surgeon.

Repeated safety checks prevent any independent movement

of the instruments or robotic arms.

St. Clair urological surgeons, Arthur D. Thomas, M.D. and

Kevin P. Bordeau, M.D., both of whom have years of experience

with the da Vinci system, completed the Hospital’s first robotic-

assisted surgeries in April, performing radical prostatectomies

on area men suffering from prostate cancer.

Dr. Thomas says that in the last two years, robotic-assisted

laparoscopic radical prostatectomies have become the No. 1

treatment choice for localized prostate cancer, supplanting open

surgery and various radiation options. The benefits of this

minimally invasive surgery include less pain and blood loss, a

Please see Patient Profile on Page 4.

m o r e i n j u r i e s f r o m o v e r u s e a n d i m p r o p e r t e c h n i q u e .

Q:I’m hearing more stories of youngbaseball and softball pitchers sufferingshoulder and elbow injuries. What is causing this jump in injuries?

A: Travel and instructional teams have recently becomepopular in baseball and softball. In addition to their school

and summer teams, some boys and girls are playing more

baseball and softball than ever. More play may result in

better performance. But for some, more play means more

injuries, especially at the shoulder and elbow.

Pitch count is very important. Most professional starting

pitchers throw only 100 balls a game, then rest for five days.

But some Little Leaguers throw many more, especially if they

are the “best” pitchers on their respective teams. And while the

windmill pitch used in softball may be somewhat safer than

the overhead baseball pitch, I am seeing more girls with injuries

after pitching several games in a week.

Many don’t know that pitching effectiveness comes from

pitch placement and variation in pitch speed as much as simply

“bringing the heat.” Effective starting pitchers in the big

leagues rarely throw as hard as they can. Pitching mechanics

are also very important to minimizing injury and several hours

with a good pitching instructor is often time well spent in

effectiveness and in avoiding or limiting injury.

Throwing a ball causes huge forces at the shoulder and

elbow that can easily cause injury. Anterior instability is the

ball of the shoulder sliding out the front from its normal

position. It can occur when the shoulder is placed beyond the

limit of its normal range of motion. This may occur when a ball

player “reaches back” to throw really hard. Throwers with

anterior instability will report pain and sometimes a sensation

ASK THE DOCTOR

of the shoulder

sliding out.

Achy pain that

persists for

several hours

or days after

throwing is

common. The

medial collateral

ligament (MCL)

of the elbow

can also be

injured from

throwing. This

ligament is on the inside of the elbow and injury initially results

in pain with hard throws. Pitch velocity is lost. A pop with

immediate sharp pain is felt on the inside of the elbow if the

MCL tears. Fortunately, this is uncommon and most patients

have mild shoulder and elbow injuries. Then, a proper

rehabilitation program and rest for a few weeks to a few

months is often effective as first

treatment. If this does not

work, their evaluation by

an orthopedic surgeon

with expertise in shoulder

and elbow problems is the

next best step.

3

DR. PATRICK MCMAHON

Please see Dr. McMahon’sbiography on Page 8.

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rST. CLAIR HOSPITALMT. LEBANON1000 Bower Hill RoadPittsburgh, PA 15243

ST. CLAIR HOSPITALOUTPATIENT CENTERVILLAGE SQUARE2000 Oxford DriveBethel Park, PA 15102

ST. CLAIR HOSPITALMRI CENTER (WIDE B350 Broughton RoadBethel Park, PA 15102FOUR CONVENIENT LOCATIONS

St. Clair Hospital is committed to offering exceptional, high quality outpatient health care services in fourconvenient locations. Highly skilled teams of board-certified physicians, registered nurses, physical

therapists, technologists and technicians collaborate to provide compassionate, personalized care for a widerange of outpatient medical services. The accompanying chart lists the wealth of available services at theHospital’s main campus in Mt. Lebanon, as well as at three satellite facilities in surrounding communities.

St. Clair Hospital OUTPATIENT SERVICES

The field of robotics not only fueled Ron Obremski’s passion for teaching, it also may have saved his life. Ron, 57, is a retired welding and robotics

teacher from McKeesport Area High School and the proud father of twodaughters. And thanks to physicians from The Center for Urologic Care atSt. Clair Hospital, he’s also a prostate cancer survivor.

To combat prostate cancer, surgeons at St. Clair Hospital have a new sophisticated tool among their arsenal—the da Vinci Si (Please see main storyon Page 1) which provides the benefits of robotic-assisted, minimally invasivesurgery to prostate cancer patients like Ron. In April, the North Huntingdonresident became the first patient to undergo a robotic-assisted radicalprostatectomy at St. Clair Hospital.

A sudden spike in Ron’s PSA (prostate-specific antigen) levels from 15 to 24caused his primary care physician to refer him to The Center for Urologic Carein early January. The first step in the process was to undergo a biopsy.

“This process was a real shock to me,” Ron admits. Two weeks later at hisnext appointment, Ron learned that the biopsy came back positive for prostatecancer. “It felt like a punch in the face,” he recalls.

Based on Ron’sbiopsy pathology, PSAnumbers, relativelyyoung age and overallgood health, he wasadvised to have hisprostate removed.

A bone scan and CT scan were next.

“These processes were necessary to tell if the cancer was spreading,”he says. “After receiving an IV, I reported to the Radiology Department wherethey gave me a drink which tasted like a soapy Gatorade. It took an hour for thedrink to be absorbed into my system, at which point I was inserted into acylindrical device that looked like a time travel machine.”

The CT scan only took about 15 minutes. A bone scan took about an hour.A week later, the test results confirmed that the cancer hadn’t spread, butsurgery was still necessary. Prostate cancer is one of the few cancers where

Robotic-Assisted SurgeryPATIENT PROFILE: Ron Obremski

T h e b e n e f i t s o f r o b o t i c - a s s i s t e d s u r g e r y i n c l u d e

da Vinci Si patient, RON OBREMSKI

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St. Clair HospitalOutpatient LabChartiers Valley Shopping Center

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ST. CLAIR HOSPITALOUTPATIENT LABCHARTIERS VALLEY SHOPPING CENTER1025 Washington PikeBridgeville, PA 15017

GENERAL INFORMATION: 412.942.4000MEDICAL IMAGING SCHEDULING: 412.942.8150

WWW.STCLAIR.ORG

patients can choose their treatment options. Ron conducted extensive researchonline, including through YouTube, but still wanted other opinions.

“Knowing that my PSA was unusually high, I knew I was headed for surgery,”he says.“I chose the da Vinci Si. Part of my program at McKeesport Area HighSchool involved robotics so I had an understanding of the process. The mainpart of any robot is the end effector—what’s on the end of the robot. Most arewhat’s called pick and place. The end effectors on the da Vinci Si are small laparoscopic arms that perform the operation while being guided by the doctorseveral feet away.”

The da Vinci Si System uses the most advanced technology to enable surgeons to perform delicate and complex operations through a few tinyincisions with increased vision, precision, dexterity and control.

It consists of four interactive robotic arms that are controlled by asurgeon who is positioned at a console in the operating room. Three of thearms are for tools, such as a grasper and scissors; the fourth holds anendoscopic camera with two lenses that give the surgeon a 3-D image at 10times magnification during the procedure. The system seamlessly translatesthe surgeon’s hand, wrist and finger movements into precise, real-timemovements of surgical instruments. Every surgical maneuver is under thedirect control of the surgeon.

With the da Vinci System, patients have less pain and blood loss, a shorter hospital stay, and quicker recovery and return to everyday life,compared to traditional open surgery.

Ron met with St. Clair urological surgeon, Arthur D. Thomas, M.D., who performed the operation.

“He was great,” says Ron. “He gave me all the details about my surgery andlet me know that I would be the first patient at St. Clair on the new da Vinci Si.”

Today, Ron is doing great. He’s back to enjoying some of his hobbies suchas fishing and working in his yard. “Here it is, a little over three weeks aftersurgery, and although I’m still supposed to take it easy, I feel like I can doalmost all of my normal activities,” Ron says. “Five days after the surgery,I was up out of bed, feeling healthy. I only had to use the catheter for aweek, and the scarring is very minimal. All in all my recuperation has beenjust wonderful.” Even throughout this entire ordeal, it didn’t take longfor the teacher in Ron to emerge. He remained focused by chroniclingthis experience for the benefit of educating others. He kept an onlinejournal detailing his experiences from the time he was diagnosed throughhis recovery.

“I’m doing this so that this might help someone else, to ease theirfears, just as I had with the uncertainty of the process,” he says.

Appreciative of the surgeon who skillfully performed the robotic-assisted, minimally invasive surgery, Ron is also grateful to his friendsand family who helped him get through this experience.

“Some men find this embarrassing and keep it to themselves, which isa mistake, because of the power of the support that you will receive frompeople closest to you,” he says.

St. Clair Hospital offers a free transportation service to patientshaving difficulty accessing health services at our facilities. Thisneed-based service can be arranged by calling 412.942.6157.Please call at least 24 hours in advance of your appointment.

COURTESY VAN SERVICE

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a q u i c k e r r e c o v e r y a n d r e t u r n t o e v e r y d a y l i f e .

S t . C l a i r H o s p i t a l i s p a r t n e r i n g w i t h n o n - p r o f i t o r g a n i z a t i o n s

6

On May 5th, St. Clair Hospital sponsored a Wellness Day at South

Hills Interfaith Ministries (SHIM), a non-profit social service agency

that meets the needs of individuals and families in the South Hills who are

struggling to make ends meet.

Nurses and other clinical staff from the Hospital conducted a host of

free health screenings, including glucose, cholesterol, body mass index,

blood pressure, and carbon monoxide levels, while Antonio M. Riccelli, M.D.

and Robert J. Pagano, M.D. staffed an “Ask The Doctor” table to help educate

families and distribute important health care information. Hospital

representatives also talked to participants about quitting smoking and

healthful eating habits to avoid or combat diabetes.

ER Consistently Among Nation’s Best

St. Clair Hospital’s Emergency Room (ER) is ranked among the top ERs in the country for patient

satisfaction, according to Press Ganey, an independent national research firm. In fact, March 31 marked a

two-year period in which St. Clair has consistently been ranked above the 98th percentile in patient

satisfaction, an achievement that has earned it the No.1 ranking in the nation.

Press Ganey’s research indicates patients are particularly impressed with how fast they are taken to an

exam room and seen by one of our physicians, all of whom are board certified in emergency medicine.

Patients also cite the compassion of St. Clair’s doctors, nurses and other health care providers, as well

as the amenities, including valet parking.

COMMUNITY OUTREAC

s u c h a s S H I M a s p a r t o f o u r c o m m i t m e n t t o l o c a l c o m m u n i t i e s .

7

was the first to demonstrate the preventive effects of the drug

Tamoxifen in breast cancer.

Recently, NSABP studies revealed that more aggressive

breast surgery, including removal of lymph node tissue, was no

longer necessary for successful surgical outcomes in breast

cancer patients.

"Surgeons historically observed the rules of Halstedian theory

(named after Dr. William Halsted, who performed the first radical

mastectomy early in the

20th century) which said

that the more tissue you

remove, the better the

patient outcome would

be,” explains Dr. Budway.

“The thinking then was

that cancer first spread

locally, then systemically.

In the 1970s, Dr. Bernard

Fisher of Pittsburgh

launched the theory that

breast cancer is a

systemic disease, right

from the start,” she

continues. (Note: Dr.

Fisher was the principal

author of a study published in 1993 by The New England Journal

of Medicine that showed a form of breast cancer, intraductal

carcinoma, which had often been treated by full mastectomies,

could safely be treated less invasively with lumpectomy and

radiation therapy.) “Now, the results of this new NSABP study

indicate that removing much less of the lymphatic tissue

results in better surgical outcomes. It’s a choice. With a

mastectomy, you don’t need radiation afterwards; but with

a lumpectomy, you need radiation.”

As a surgeon, Dr. Budway is a proponent of a less invasive

surgical approach to breast cancer, and sees herself as an

educator and partner in her patient’s treatment. One of her most

important roles, she says, is to guide her patients through the

unfamiliar and often upending journey of breast cancer diagnosis

and surgery, step by step. “I am there to help them through the

process of understanding the treatment options before them.

There is so much information that you have to help them get

through. It’s one decision at a time.”

A Pittsburgh native and former director of the surgical breast

disease program and surgical ICU at The Western Pennsylvania

Hospital, Dr. Budway attended medical school at Hahnemann

University College of Medicine in Philadelphia. Although her

interest in medicine was rooted in childhood, she pursued a

bachelor’s degree in chemical engineering from Grove City College

as a career backup plan, she says. (Her father was an engineer.)

One of Dr. Budway’s patients, a mother of five, recently

expressed gratitude for the doctor’s thorough, compassionate

approach during her cancer diagnosis and surgery. “I was a deer

in the headlights. I was just in a great big fog,” she told Dr. Budway in

a follow-up visit. “But you gave me the baby steps I needed. Now,

I have a friend who’s been diagnosed with cancer, and I’m able to

help her get through those baby steps, too.”

Dr. Budway's office is in the St. Clair Hospital Professional

Office Building. Her telephone number is 412.942.5600.

CONTINUED GROWTCONTINUED FROM PAGE 1

I am there to help them

through the process of understanding

the treatment options before them.

It’s one decision at a time.”

“Raye J. Budway, M.D.

RAYE J. BUDWAY, M.D.

Please see Dr. Budway’s biography on Page 8.

ST. CLAIR HOSPITAL1000 Bower Hill RoadPittsburgh, PA 15243

ST. CLAIR HOSPITALGeneral & Patient Information 412.942.4000

Physician Referral Service 412.942.6560

Outpatient Center—Village Square 412.942.7100

Medical Imaging Scheduling 412.942.8150

www.stclair.org

Followuson twitter at: www.twitter.com/stclairhospital

HouseCall is a publication of St. Clair Hospital. Articles are for

informational purposes and are not intended to serve as medical

advice. Please consult your personal physician.

VOLUME II, ISSUE 2

Raye J. Budway, M.D. earnedher medical degree atHahnemann University inPhiladelphia. She completedher residency training ingeneral surgery at The WesternPennsylvania Hospital andadditional training in surgicalcritical care at the Universityof Pittsburgh Medical Center.She served as the Site SurgicalClerkship Program Director forTemple University Medical School,Site Program Director for theAllegheny General HospitalGeneral Surgery Residencyprogram and Director of theSurgical Breast Disease Programand Surgical Intensive Care atTheWestern Pennsylvania Hospital.She is board certified in surgicalcritical care and general surgery.She is a Fellow of the AmericanCollege of Surgeons and serveson the Fellowship's Commissionon Cancer.

Join us for the14th ANNUAL

Friday, July 155:30 p.m. ‘til the dancing endsCocktails, Dinner, Silent Auctionand Entertainment

Hilton Garden Inn, Southpointe$125 per person

Monday, July 18—Golf ClassicValley Brook Country ClubRegistration 10:00 a.m.,Shotgun start at noon

$700 per person(price includes two ticketsto Friday night dinner)

CONGRATULATIONS to St. Clair Hospital’s ‘Top Doctors’

Benefiting St. Clair Hospital’s newest Cardiac Catheterization Lab.

Jay A. Lutins, M.D. earned hismedical degree at the MedicalCollege of Virginia. He completedhis residency training in urologyat the University of PittsburghMedical Center and he is boardcertified by the American Boardof Urology.

Patrick G. Reilly, M.D.earned his medical degree at theRoyal College of Surgeons inDublin, Ireland, and completedhis residency in internalmedicine at Mercy Hospital ofPittsburgh. Dr. Reilly completeda fellowship in critical caremedicine at the University ofPittsburgh Medical Center.He is board certified bythe American Boardof Internal Medicine.

Donald M. Whiting, M.D.earned his medical degree atJefferson Medical Collegein Philadelphia and completedhis graduate training in generalsurgery at Geisinger MedicalCenter in Danville, Pa., and inneurosurgery at the ClevelandClinic. Dr. Whiting also completeda fellowship in neurotrauma at Allegheny General Hospital. He isboard certified by the AmericanBoard of Neurological Surgery.

Patrick J. McMahon, M.D.earned his medical degree atTemple University School ofMedicine in Philadelphia andcompleted his residencyin orthopaedic surgery at theUniversity of Pittsburgh MedicalCenter. He also completedfellowships at UPMC andKerlan-Jobe Orthopaedic Clinicin Los Angeles. Dr. McMahon isboard certified by the AmericanBoard of Orthopaedic Surgery.

To contact one of these “Top Doctors” or anyof the more than 500 exceptional physicianson our staff, please visit www.stclair.org.