St. Clair Hospital HouseCall Vol III Issue 2
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Transcript of St. Clair Hospital HouseCall Vol III Issue 2
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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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
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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.
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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
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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 .
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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.