by Vannhi Huynh.
Dr. Nicholas Pagano is a podiatrist who specializes in pediatrics. He is a member of the American College of Foot and Ankle Pediatrics and professor of Pediatric Orthopedics at Temple University School of Podiatric Medicine. Despite his busy schedule, he graciously took time to introduce us to his specialty. Here is his take on pediatric podiatry!
Q1: How did you begin your specialty in pediatric podiatry?
A: I began my specialty during my residency shadowing an orthopedic pediatric surgeon by the name of Dr. Claude Scott. He would come to the hospital at 10 PM to do clubfoot castings on NICU patients. I would wait around after hours just so that I could help and assist him. Then, I was lucky enough to meet my first mentor in podiatry, Dr. Phil Bresnahan, who is one of the top pediatric podiatrists in the country. He mentored me and my love for this focus grew.
Q2: Have you always been interested in treating the pediatric population?
A: I’ve always known that I had a connection with children through my younger years of coaching and knowing how it can affect so many family members when their children are sick.
Q3: How often do you treat children in your practice?
A: I am lucky to see a fair number of children in my practice.
Q4: What are some of the challenges to treating children in comparison to adults?
A: In order to properly treat a child, you need to have a good parent or a support network to work as your compliance officers. I remember being a child and having doctors’ orders, and not being the best at following through them. That is why a family is so critical to getting proper treatment.
Q5: What are some of the pros to treating children vs adults?
A: Children heal at a much faster rate than adults. They are growing and optimizing their health; their bodies have not yet undergone the same gradual damage that adults have. It’s so rewarding to take care of children for that fact alone.
Q6: What are some of the adverse effects of performing an invasive procedure on a young patient?
A: You have to keep in mind that when you are going to perform an invasive procedure on a child, you are going to be affecting them for the rest of their lives. You need to make sure that you are doing the right thing at the right time for that patient. You need to make sure that expectations and postoperative care and plan are followed closely for the best results. Oftentimes, the expectations are not properly managed and there can be disappointment and frustration with both the patient and the parents as well.
Q7: How old was the youngest patient that you’ve operated on? Do you think the surgical procedure might have affected their growth in any way? Did you achieve the desired results?
A: The youngest patient I have operated on would have to be my Achilles tendon releases for clubfoot patients; this usually occurs before the first year of life. The recovery rate in children is much faster than that of adults, especially with fractures. A lot of times they are healed at half of the time that’s needed for the average adult to heal. In regard to whether the surgical procedure affected their growth, avoiding fusions of bones and affecting their growth plates should prevent you from interfering with their growth. In those younger surgical patients, the immediate desired results were achieved but it is important to follow your pediatric surgical patients for an extended period of time. Multiple years are required, even if it is just a short annual checkup visit. The parents appreciate the follow-up as well to make sure everything is going well.
Q8: We learned that the statute of limitations for medical malpractice is much longer with children. How does this affect your practice, if at all?
A: You cannot practice scared. You have to depend on your training and maintain your knowledge and skills when performing medicine. Some will find the statute of limitations to be quite daunting and will avoid caring for pediatric patients. It is a shame because this is a population that requires the expert care that we in the pediatric field, are equipped to do. As long as you are doing the best in your knowledge for the patient with the correct intentions, you should not think about the statute of limitations for medical malpractice as something that would keep you from delivering proper care for a child in any situation. I really think to myself if it were my child, what I would do, and go forward with that decision.
Q9: To the best of my knowledge, not many residency programs really specialize in pediatric podiatry. How did you acquire the knowledge and skills to specialize in pediatric podiatry?
A: We talked about Claude Scott and Phil Bresnahan but education after you graduate and your residency, is essential. Reading on a daily basis about pediatric topics is necessary. I am a member of the American College of Foot and Ankle Pediatrics. They offer an incredible conference on a yearly basis. You need to continue to advance your knowledge after you graduate.
Q10: Do you see a high demand for pediatric podiatrists in comparison to general podiatry?
A: Absolutely. Especially at this time, focus on sports has become an epidemic and children are getting pushed way too hard before they grow properly. This has led to more pediatric sports injuries. This is slowly becoming the focus of my practice with regard to my pediatric patients.
Q11: What advice would you give to podiatric students who aspire to work with children?
A: If you find something that you love, study it. Seek out opportunities to provide care for children, even if that requires volunteering, going on missions, shadowing in an office of someone that focuses on pediatrics, going to conferences, reading periodicals and always working to grow your knowledge. The beauty of podiatry is you continue to learn.
by Vannhi Huynh.
School: Temple University School of Podiatric Medicine
Special Edition, Interview
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