st. clair hospital housecall_volume 5 issue 2
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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
C
E
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.
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