II,ISSUE ISSUE32 VOLUMEII, VOLUME
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IMPROVING MENTAL HEALTH
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ASK THE DOCTOR
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ER IN TOP 1% NATIONWIDE
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REACHING OUT TO HAITI
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NEW OPERATING ROOMS
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RADIAL CATHETERIZATION
Advanced Orthopedic Care REBUILDING A PATIENT’S OUTLOOK FOR THE FUTURE
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OUTPATIENT CENTER/MEDICAL OFFICE BUILDING TO OPEN IN PETERS
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t. Clair Hospital has purchased
property in Peters Township, along
Route 19, just south of Donaldson’s Cross
Roads, to construct a new medical office building and outpatient center. The new center will provide more medical office space for St. Clair physicians and make the Hospital’s services more convenient for its patients. Over the last few years, St. Clair has seen a marked increase in the number of patients from this area. More than 40 St.
A
fter working all day at his full-time job, Blaine “Darrin” Kuhn of Upper St. Clair had been putting
in five to six hours a night readying his new home for his
LEADING HAND AND UPPER EXTREMITY SPECIALIST CHRISTOPHER MANNING, M.D. EXAMINES HIS PATIENT, DARRIN KUHN.
wife and their young daughter. Good with his hands, Darrin was using an electric-powered miter saw to trim the
Clair physicians have offices in the Peters
hardwood floors he was installing on the second floor. That’s when it happened. He
Township area, one of the fastest growing
partially amputated his left thumb. His world had changed in an instant. “I was doing
communities in southwestern Pennsylvania.
some real thin shaving when the miter saw just kind of grabbed the piece of wood and
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Reaching Out to Improve Mental Health Psychiatrist Bruce A. Wright, M.D. believes the stigma long associated with “mental illness” has waned over the last decade or so, but says there are still hurdles preventing people from reaching out for what sometimes can be desperately needed help.
“M
any people simply believe that nothing can be
Dr. Wright says some studies show that up to 15 percent
done to treat the way they are feeling,” says Dr.
to 20 percent of the general adult population suffers an
Wright, Medical Director of Psychiatry in the Behavioral
episode of major depression at some point in their lives.
and Mental Health program at St. Clair Hospital.
(Women are twice as likely to experience an episode of
But that, he says, is far from the truth.
major depression as men.) He says those numbers reflect,
People suffering from mental illnesses today—whether mood disorders such as major depression, anxiety or panic disorders, or other psychiatric disorders—are being treated effectively and successfully with a combination of therapy and medication. And, says Dr. Wright, the goal in treating people with
“
People are realizing that
psychiatric illnesses are diseases,
”
not a sign of weakness. Bruce A. Wright, M.D.
mental illnesses is much like that of physicians who are treating patients with physical ailments. “Our aim is to
in part, the growing number of men and women who are
not just make people feel better. It is to bring about a
actively seeking treatment for mental illness after seeing
remission, where they feel completely better.”
that other people have been treated effectively for it,
Dr. Wright says he and the other board-certified psychiatrists, as well as the therapists at St. Clair, are
including celebrities. “People are realizing that psychiatric illnesses are
helping people every day return to lives free of despair
diseases, not a sign of weakness,” he says. “They know it’s
and worry.
not as simple as pulling yourself up by your bootstraps.”
He says the majority of men and women who are
Dr. Wright says St. Clair Hospital offers a continuum
treated at St. Clair are suffering from mood disorders,
of services for people in need of treatment. The Hospital’s
which include major depression and anxiety disorders,
26-bed inpatient unit is designed for adult patients who
in which people are unusually or overly anxious, or may
need treatment during the acute phase of their illness.
experience panic attacks.
Outpatient services include the Partial Hospitalization
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ASK THE
program and the Intensive Outpatient program. Both of these programs are designed as a possible alternative to an inpatient
DOCTOR
stay for adults with acute psychiatric illness or can be beneficial as a transition following an inpatient stay. The Hospital’s Mental Health Consultation-Liaison program provides comprehensive evaluation services for patients in St. Clair’s Emergency Room who are identified as needing psychiatric care or other crisis intervention. In addition, the Hospital facilitates two support groups in the community. For more information, please call St. Clair Hospital Behavioral and Mental Health Services at 412.942.4850.
A Patient’s Path to Recovery For Samantha (not her real name), her entrée into Behavioral and Mental Health Services at St. Clair Hospital was precipitated by a host of stress-inducing family issues, including a troubled marriage and, like so many other Baby Boomers, with having to care for elderly parents. “There were a lot of issues that I was dealing with at that particular time,” Samantha recalls of summer 2007 when a deep depression began to creep into her everyday life. The private clinical psychologist Samantha was seeing at the time suggested she enroll in the Partial Hospitalization program at St. Clair. “She felt that at that particular moment in time, I needed more intensive therapy than what I was going to be receiving from her in one, 45-minute session per week,” Samantha says. A teacher by profession, Samantha admits that she didn’t follow the same advice she gives her students, which is to immerse themselves in their studies in order to receive the most benefit. “At the time, I really didn’t get what I could have out of the Partial Hospitalization program, because I wasn’t fully embracing it.” In 2008, having been diagnosed with major clinical depression, she was treated in the Hospital’s inpatient unit, where she participated in a “much more structured program” before returning to the Partial Hospitalization program. Samantha credits the dedication and professionalism of the staff of
DR. CIVITARESE
Q:
I’m hearing a lot about electronic health records. What exactly are they and what are the advantages for patients?
A:
–Melissa, Robinson Township
An electronic health record (EHR) is a comprehensive electronic record of patient health information. EHR is a technology that can provide significant benefit to patients. Preferred Primary Care Physicians (PPCP), based at St. Clair Hospital, was one of the earliest adopters of EHR in Western Pennsylvania, and for more than six years, has seamlessly integrated office and hospital records in a computerized database. EHR allows physicians to: document and view comprehensive medical histories; order diagnostic testing and view the results; send electronic prescriptions to pharmacies; and view electronic alerts for potentially harmful drug interactions or allergies. There are even greater advantages for patients with chronic conditions such as diabetes. EHR provides physicians with sophisticated “decision support” tools based on clinical guidelines. For example, physicians can be alerted when patients are due for appointments or when lab results exceed desired levels. Additionally, EHR can connect the members of your health care “team.” Providers are able to electronically send and receive test results and other medical information as they consult with each other about your care. This puts the most accurate, current and confidential medical information at your provider’s fingertips. Finally, Internet-based tools connected to EHR allow patients to manage their own health information. Dr. Louis A. Civitarese is a physician at St. Clair Hospital and is a member of Preferred Primary Care Physicians (PPCP), with offices in Scott Township and McDonald. He received his medical degree from the Chicago College of Osteopathic Medicine. He is board-certified by the American Board of Family Practice. Dr. Civitarese has served on multiple committees for the national Certification Commission for Health Information Technology (CCHIT).
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A Patient’s Path to Recovery CONTINUED FROM PAGE 3
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made on my own without conferring with my psychiatrist.” But, she says, she found the Partial Hospitalization
both programs with helping her make great strides toward
program served as a “safety net” for her just when she
recovery. “I felt like I was treated like a human being and
needed it most. “I found I could rely on St. Clair Hospital
not just another patient in a hospital,” she says. “The
and the staff to welcome me back to the program and
staff in both the inpatient and the Partial Hospitalization
not ridicule or belittle me because I had a relapse and
program at St. Clair are dedicated to their profession and
had to come back to the program. That was heartwarming
very dedicated to their patients. They wanted us to make
to me that they did not make me feel that way.”
improvements and they encouraged us to do so.” Also key to making progress was developing a level of
Today, Samantha is seeing a private therapist outside the Hospital, but believes the veil of depression she was
trust between not just herself and staff, but other patients
living with has been lifted. “I am doing great. I feel the
during group therapy. “When I was in therapy, I
cognitive behavior therapy that I went through in the
wanted to be able to tell people what was going on so
Partial Hospitalization program has helped me to look
they could help me. But you had to develop a level of
at life and how to handle issues and stressors that arise in my life in a more positive and productive way.” She credits the good connections she made with other patients with helping her form a solid support mechanism to fall back on. Samantha agrees with Dr. Wright that the stigma long associated with mental illness is preventing people from getting help. “When it comes to dealing with mental health issues, the stigma of seeking out help needs to be removed,” she says. “Our society needs to realize that mental
DR. BRUCE WRIGHT (CENTER) CONFERS WITH BEHAVIORAL AND MENTAL HEALTH COLLEAGUES KIM FRITZ, R.N. AND ED WALSH, R.N. BRUCE A. WRIGHT, M.D. Dr. Wright is Chairman of the Department of Psychiatry at St. Clair Hospital. He is board-certified by the American Board of Psychiatry and Neurology in Psychiatry. He earned his medical degree from the University of Pittsburgh School of Medicine and completed his internship and residency at the University Health Center of Pittsburgh Western Psychiatric Institute & Clinic.
health is the same as physical health. If I had a broken bone, or diabetes, or had suffered a heart attack, I would not hesitate to seek out medical attention. But people don’t seek out medical attention for mental health issues because we have stereotyped people who do go for mental health or psychiatric help. But the
trust. And that was something I thought was definitely
mind is part of the body that needs to be taken care of,
developed at St. Clair,” Samantha says.
as well.” Based on her own experience, Samantha says,
A combination of therapy and medication was helping
“Don’t be afraid to reach out for help. There are so many
Samantha, but she suffered a relapse when she stopped
things that happen in our lives that we cannot handle on
taking the prescribed doses of medication. “I made a big
our own. We need to rely on others to help us through
mistake in going off my medication, a decision I had
those issues.”
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St. Clair Hospital’s Rankings Continue to Rise St. Clair Hospital’s ER is ranked among the top 1 percent of hospitals nationwide, according to Press Ganey, an independent health care research firm. The ranking is the result of input from ER patients who were surveyed about their experiences by Press Ganey. David Kish, executive director of Emergency Services and Patient Logistics at the Hospital, attributes the superior ranking to not only his staff, but all of the departments the ER interacts with on a daily basis. The top satisfaction rating is truly a result of BettER By Design.
Continuing to Reach Out to Haiti In a fundraising drive spearheaded by the St.Clair Hospital Center for Women & Children, the Hospital Auxiliary, and Volunteer Services, St. Clair Hospital employees and medical staff donated almost $17,000 to purchase child sponsorships (meals and schooling), live animals, rice, shade and fruit trees, medical supplies and more, for the people of earthquake-ravaged Haiti. St. Clair Pediatrician and Medical Director of the Hospital’s 24-hour pediatrics unit, Dayle Griffin, M.D., (pictured), recently spent two weeks in Haiti providing desperately needed medical care to children and adults and helping purchase the child sponsorships, animals and supplies. Dr. Griffin has been donating her medical expertise to the people of Haiti for more than a decade and is planning to return in June. For information on assisting in the relief efforts, visit www.friendsofhaiti.org.
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Orthopedic Care
Assessing The Damage
CONTINUED FROM PAGE 1
Because a thumb is responsible for an estimated 40 percent of
flipped the thumb of my left hand into the blade,” Darrin recalls
the function of the hand, losing one can drastically change a
matter-of-factly. “As soon as it happened, I grabbed my thumb,
person’s life, particularly for a man who uses his hands to make
which was only attached by skin. The saw blade had gone right
a living and to participate in hobbies like woodworking, which
up above the lower-most knuckle and up through the upper
require a high degree of manual dexterity.
knuckle, right to the nail bed. It looked like a pretty gory mess. A real gory mess.” Fortunately, Darrin did not panic and neither did his wife’s cousin who was helping him with the late-night home remodeling project. The cousin drove him to St. Clair Hospital’s Emergency Room. Along the way, Darrin just held on to his thumb, which
A thumb is responsible for an estimated 40 percent of the function of the hand. Losing one can drastically change a person’s life.
much to his surprise, was not bleeding all that much. Still, he fought to remain conscious so he could give driving directions to the cousin, who was from out-of-town. As soon as Darrin arrived at the ER, staff cleaned out the wound, started an IV, and gave him medication to dull the pain.
Fortunately for Darrin, the solution to this potentially lifechanging moment was on his way to the ER. The ER doctors had contacted renowned hand specialist Christopher M. Manning, M.D. at home. The South Hills resident got to the ER within minutes.
That’s when Darrin started to think about his future, a future
“I got a call that a patient had suffered a partial amputation of
that might include living without one of his thumbs, even though
his thumb,” Dr. Manning told HouseCall. “He had lost the majority
it was on the ‘righty’s’ non-dominant hand.
of the bone in the front part of his thumb. The good news was, there was a nerve and an artery and some skin that was left behind and it was likely that the thumb could be re-attached and saved.”
Saving The Thumb Despite Dr. Manning’s positive outlook, the damage the saw inflicted to the bone presented a formidable challenge. The loss of some bone meant that simply sewing the thumb back into place would, most likely, result in a shorter thumb. But he had an idea: Take a small piece of bone— maybe 3.5 to 4 centimeters in length—from Darrin’s pelvis and use it to graft the thumb, creating a long, stable post. He told Darrin he would know if he had incorporated the structural bone graft into the procedure as soon as Darrin woke up from surgery. “Dr. Manning said, ‘If it hurts to walk when you get out of surgery, you’ll know I did the bone graft,’” Darrin said, a slight smile crossing his face. Dr. Manning said putting Darrin’s thumb back together was actually “the easy part.” The hard part, he continued, was finding enough skin to cover the thumb. “I had to do a soft tissue flap, 6
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week in the Hospital. Of course, visiting co-workers from the CHRISTOPHER MANNING, M.D. is a leading hand and upper extremity specialist. He is board-certified by the American Board of Orthopaedic Surgery. He earned his medical degree at the University of Pittsburgh School of Medicine and completed his orthopedic residency and hand and upper extremity fellowship at the University of Pittsburgh Medical Center.
private environmental company he works for couldn’t resist ribbing him about his woodworking accident. “As a project manager and someone who supervises some jobs, I’m focused on worker safety,” Darrin said. “Yet, here I go whacking my thumb off at home.” Darrin said his rebuilt thumb was held together with pins that protruded from a cast he wore for months. Dr. Manning said the first two weeks following the surgery
where we borrowed skin from the back of his hand and rotated it
were crucial to its success, with the most important element
to cover the thumb. Then we closed the flap on the donor site on
being the healing of the skin flap. After that, it was just a matter
the back of his hand. That was the more difficult part of the
of waiting for the bone to heal.
procedure—soft tissue coverage. But he came through really well.” Dr. Manning said the procedure was probably not the most technically difficult of his career, which has included mending a host of serious hand injuries caused by saws, knives, wood splitters, and various industrial machinery. But, he added, Darrin’s case was “probably the most stressful.” That’s because it involved a thumb of a young man who has many more years of work ahead of him and needs two functioning thumbs. Had the thumb, which Dr. Manning describes as “the most important digit,” been completely amputated in the accident or had it been so badly damaged it could not have been saved, he still had a few options. “You can lengthen what’s left of the thumb over time. It’s called osteogenesis, in which you grow new bone over the course of a year. But that is a long time for someone who works like Darrin does. You can also rotate an index finger over, but that is done more often with children than adults. Or, you can use the big toe.”
DARRIN KUHN AT HOME WITH WIFE, MARLA, AND THEIR DAUGHTER, RAEGAN, 2 1/2.
That’s right. Dr. Manning said there are cases where
“Darrin actually got his motion back rather quickly,” Dr.
surgeons have removed patients’ big toes and reattached
Manning said. “Of course, we didn’t really expect a lot of motion
them to the hands to use as thumbs, another affirmation
because I fused the bone. But the thumb doesn’t really need a
of just how important it is to have two functioning thumbs.
lot of motion. You just need a strong, stable, painless post that you can use to grip and grab.”
A Time For Healing
Darrin estimated his thumb is already functioning at about
Following his surgery, Darrin had to stay off his feet for three
85 percent and he has no problems grasping or lifting heavy
to four days while his pelvis and his thumb began to heal. The
objects. He admits he tries to avoid using a sledgehammer at
35-year-old native of Tionesta, Forest County, spent almost a
work, as the vibrations tend to “shock” his thumb a bit. CONTINUED ON PAGE 12
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G r o w i n g
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Construction is Underway on Three New Operating Rooms
NOTED CARDIOVASCULAR SURGEON G. FREDERICK WOELFEL, M.D., (FAR RIGHT) AND HIS TEAM AT WORK IN THE OR.
n an effort to accommodate growing patient volume,
I
increase efficiency and productivity and, ultimately,
St. Clair Hospital is constructing three new operating
enhance patient comfort and safety. VEBH Architects
rooms, set to open in September at its primary campus
of Mt. Lebanon is the architect for the project. Massaro
in Mt. Lebanon. Currently, the Hospital performs more
Corporation of Pittsburgh is the primary contractor.
than 11,000 surgical cases a year. That volume is
Estimated cost for the entire project is more than
expected to increase in the future.
$6 million.
Each of the new ORs will be equipped with
The Hospital does not anticipate any interruption
state-of-the-art technology, including digital surgical
to the existing ORs during construction. Because the
equipment and flat panel monitors mounted to the ceiling
staging area for construction is near the entrance to the
via “booms,” which allow for easy access for OR medical
Emergency Department, the Hospital is offering free
staff while optimizing space and eliminating potential
valet parking service for patients and visitors to the
obstacles. The ORs’ integrated technology will feature
Emergency Room. Signage is posted near the ER
centralized, touch screen control of ergonomic medical
entrance to direct drivers to the valet service, which is
devices and environmental systems that, combined,
available 24/7.
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“Development of a new medical office building will better serve St. Clair-affiliated physicians already in this vicinity,” said Barry S. Zaiser, Senior Vice President of Strategic Development at St. Clair. “The site is conveniently located, which will make our clinical services more accessible to the increasing number of patients seeking the Hospital’s care.” The location formerly included a home improvement center and a dance studio. The project is expected to break ground later this year.
“
The site is conveniently
located, which will make our clinical services
”
more accessible...
–Barry S. Zaiser, Senior Vice President of Strategic Development, St.Clair Hospital
Aerial view of the planned outpatient center site.
The Hospital recently completed extensive renovations to patient and staff areas to brighten the space and improve access. Renovations include completely remodeled hallways and patient rooms on the Fifth Floor that now feature plenty of natural light and hardwood floors.
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Heart Patients Have Options for Catheterization
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“For a traditional heart cath through the femoral artery in the
patient undergoing a heart catheterization at St. Clair
groin, a patient often requires prolonged bed rest of 4 to 6 hours
Hospital now has the option of having the procedure
performed through the radial artery in the wrist instead of the
following the procedure, especially if the patient undergoes
traditional femoral artery in the groin.
angioplasty or stent placement,” Dr. Friedel says.
While entry through the femoral artery is still the most common
“With a radial cath, you can remove the tube, place a small
approach of the approximate 2,000 cardiac catheterizations
bandage on the artery, secure it with a special, adjustable
performed each year at St. Clair Hospital, Cardiologist Jeffrey M.
wristband, and the patient can literally walk off the table. There
Friedel, M.D. says a so-called “radial cath” through the underside
is no prolonged bed rest. This also holds true if the patient is on
of the wrist offers two major advantages.
long-term blood thinners, including Coumadin. Unlike traditional
Ascending aorta
Radial Catheterization: A Closer Look Axillary artery
Radial Catheterization Inserting a catheter through the radial artery in the arm appears to be linked to a lower rate of bleeding complications than the standard route through the groin.
Heart
1. After a local anesthetic, the cardiologist places a small needle into the radial artery of the wrist. This needle is smaller than those used for most routine bloodwork.
Brachial artery
2. A thin wire is then placed through the needle and into the artery,gaining “access” to the blood vessel. 3. Small tubes called catheters are then placed over the wire and up through the larger arteries of the arm and shoulder, and eventually into the aorta and heart arteries. Dye is then injected into the heart arteries and, if necessary, an angioplasty or stent procedure is performed.
Femoral Catheterization
Radial artery
The femoral artery presents a direct route to the heart. To a physican, it’s a straight stretch of freeway that can be navigated easily. Femoral catheterizations have been performed for more than 30 years.
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4. At the conclusion of the procedure, all the equipment is removed and a "zip band" is applied to the wrist. The patient is able to sit up in a chair, as subsequent bedrest is not required.
Guide Sheath
ARTERY Cross section of arm
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catheterizations via the femoral artery, you do not have to stop
alternative for patients with significant blockages in the larger
Coumadin several days prior to the procedure.”
arteries of the abdomen or lower legs.
The other advantage is safety. Dr. Friedel says several studies
Not every patient is a candidate for a radial cath, Dr. Friedel
that compared the two methods showed that a catheterization
says. The main prerequisite is good circulation in the wrist
through the wrist offers up to a 75 percent reduction in bleeding
arteries. A non-invasive test that takes seconds and is performed
risk. “The radial artery is smaller, and if you do have bleeding, it
at bedside can determine if a patient’s circulation is good enough
is much easier to control. The risk of blood vessel injury is also
for a radial cath.
less compared to the femoral approach.” Dr. Friedel says a catheterization through the femoral artery
Of the approximate 400 cardiac catheterizations he performs every year at St. Clair, Dr. Friedel says he does about 20 percent
is still a very safe procedure and is the preferred method of most
through the radial artery. His goal is to increase that rate to
cardiologists. In fact, today about 99 percent of the 1 million-plus
about 50 percent per year, approximately the same rate of radial
heart catheterizations done annually in the U.S. are performed
caths performed annually in Europe and Japan.
through the femoral artery. But, Dr. Friedel adds, that is due in large part to the fact
Other cardiologists performing radial caths at St. Clair are Drs. Mark K. Greathouse, Adil Waheed, and John P. Girod.
that most invasive cardiologists were trained to do cardiac catheterizations through the femoral artery and have become very proficient at that method. There is a significant learning curve for performing a radial cath, and it is not yet a standard part of every training program. What’s more, the original catheterization equipment was larger. “Simply put, the tubes were too big to place into a small artery in the wrist,” Dr. Friedel explains. “As the procedure evolved, all of our equipment has gotten smaller and now the tubes we use are only several millimeters in diameter and can easily fit into most radial arteries.” Dr. Friedel notes that, aside from the different access point into the body, femoral and radial caths are very similar. “The majority of the procedure is the same: injecting dye into the coronary arteries (to detect blockages and other abnormalities), doing an angioplasty (in which a small balloon is inflated inside the artery to re-open blockages) and placing stents (small mesh tubes used to keep the re-opened arteries from collapsing). Dr. Friedel, who has been doing radial caths since 2001, says the radial method is of particular benefit to patients with orthopedic limitations, including severe back, leg and knee pain—people who, in general, can’t lie flat for a prolonged period of time. It’s also more comfortable for obese patients or patients with
JEFFREY M. FRIEDEL, M.D. Cardiologist Dr. Jeffrey Friedel is board-certified in Interventional Cardiology, Cardiovascular Disease, Nuclear Cardiology, Internal Medicine and Cardiac Computerized Tomography (CT) Angiography. At St. Clair Hospital, he is Co-Director, Cardiac Catheterization Laboratory; Director, Cardiac Rehabilitation Department; serves on the Medical Executive Committee; and is a founding member of the Hospital’s renowned Door-To-Balloon team. Dr. Friedel earned his medical degree at Pennsylvania State University College of Medicine. He completed his internship and residency at Allegheny General Hospital and was awarded fellowships in Interventional Cardiology, Cardiology and Categorical Internal Medicine at Allegheny General Hospital.
significant lung problems. And, he says, it is an excellent 11
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ST. CLAIR HOSPITAL General & Patient Information 412.942.4000 Physician Referral Service 412.942.6560 Outpatient Center—Village Square 412.942.7100 www.stclair.org 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.
“ D r. M a n n i n g s ave d m e f ro m a l i fe t i m e o f c h a l l e n ge s .” DARRIN KUHN
Orthopedic Care
CONTINUED FROM PAGE 7
Downtown,” he said with a hearty laugh. Dr. Manning said Darrin’s case helps reinforce the message
Excellent Care Close to Home
that St. Clair not only offers exemplary service and care in its
He credits Dr. Manning with saving his thumb and helping him
new Emergency Room, but that “We provide excellent care for
avoid a lifetime of challenges that come with losing the hand’s
any type of orthopedic problem.”
most essential digit. Darrin also had high praise for the staff at St. Clair, who he described as “awesome.” He said that, on the night of the accident, some friends and
Darrin took some time off from putting in hardwood floors at his house, but surprisingly, has used the miter saw again since the accident. “I had to. I had to finish the house!” Still, he admits
relatives asked if he was going to transfer to a larger hospital
that the sight of the spinning saw in close proximity to his
to have surgery. Darrin said he replied that his confidence in
surgically repaired thumb makes him nervous. “My heart rate
Dr. Manning and the other medical staff convinced him that
goes up a bit when the miter saw comes out.”
St. Clair gave him the best shot at saving his thumb. And, oh, yeah, “The parking is much better than in Oakland or
To find an orthopedic doctor at St. Clair Hospital, visit www.stclair.org.