Amanda Wilde (Host): Foot and ankle surgery is crucial to address a variety of conditions and injuries that don't heal well with other treatments. Next, we'll talk about this area of medicine and get to know a top surgeon who's joined the St. Clair Health team.

A look at foot and ankle surgery on this episode of Curating Care, a podcast brought to you by St. Clair Health, expert care from people who care. I'm Amanda Wilde. And joining me is Dr. Robert Mendicino, orthopedic surgeon here at St. Clair Health. Dr. Mendicino, it is great to have you here.

Dr Robert Mendicino: Well, thanks for having me.

Host: Let's start with a bit about your background. What inspired you to go in this area of Medicine and become a foot and ankle surgeon?

Dr Robert Mendicino: Well, I was born and raised in western Pennsylvania, outside of a little town called Vandergrift. My father was an x-ray tech and went to college in night school. He became an administrator. My mother was an OR tech. So, I really didn't know anything else but healthcare, because around the dining room table, that's what we talked about. I have an older brother that went to the University of Pittsburgh. He's four years older than me. He went into pre-medicine.

In the '70s and the '80s, in major newspapers around the United States, they had the top 10 professions to go into for the '90s and beyond. And foot and ankle surgery, a doctor of Podiatric Medicine, was one of the top ones every year, especially if you did a Foot and Ankle Residency in Surgery. So, that's one of the reasons why I picked it.

Host: Can you share some insights into the training you received?

Dr Robert Mendicino: After school, we do a residency in Surgery. I was trained by some top foot and ankle surgeons in Chicago. My residency director was the President of the College of Foot and Ankle Surgeons and really drove me into research and publications and lecturing. And that's what I've done throughout my career.

Host: And now, you've just moved from Columbus to Pittsburgh. What motivated that decision?

Dr Robert Mendicino: Well, I originally practiced in Pittsburgh for nearly 20 years. I was at West Penn hospital. In fact, my parents met there. I jokingly say I may have been conceived there and I was born there. So, I came back and worked there for nearly 20 years. And there was a big change right around 2010 to 2012, and the health system was struggling. They closed our emergency room where I got a lot of my business. They stopped our admissions. So, many of us moved either out of the city or to other health systems. Many of the doctors even came out here. I chose to leave. And, in the last year or two in our health system out in Columbus they were making some changes. And my wife was interested in coming back here for a couple reasons. We have two children that are in the Pittsburgh area. My daughter is a professional ballerina with Pittsburgh Ballet. And my son's now an attorney in Indiana. So, it's a good reason to move back.

Host: Well, congratulations. Your kids sound very successful in what they're doing. And it's fun to move back to a place that you have so much history with. What are you most looking forward to in this new chapter of your career?

Dr Robert Mendicino: Well, getting back to what I did here, I mean, I really enjoyed Western Pennsylvania, not only treated the patients in Western Pennsylvania, including the St. Clair area, but I had a regional and national referral base here, and I'd like to get back to that. Plus, I'm always into education, research, and publications, and it's something we want to bring to St. Clair at a higher level.

Host: So, real positive impact on and for the community. Are there any challenges or opportunities you foresee that are unique to this region compared to where you've worked previously?

Dr Robert Mendicino: Challenges, no. I think that uniqueness where I came back to is St. Clair is a standalone hospital. I've worked in three major big healthcare systems. And when you want to move a process forward or come up with some idea, you'd have to take it through a hospital health system, like the one I was in had 17 hospitals. So when you made a decision, that decision had to go to 17 CEOs and then a higher level here. I can take it to the fourth floor. They can give you an up and down and they can move fairly quickly to address issues for patients or service lines.

Host: And that's way more resonant with you as a doctor.

Dr Robert Mendicino: Absolutely.

Host: Let's talk about your professional focus and specialties. What are the most common foot and ankle conditions you treat? Because I know there's countless almost numbers of foot and ankle conditions.

Dr Robert Mendicino: Well, I do, I jokingly say, from birth till death. I guess on kids, club feet, pediatric flat foot issues. You know, when you get in your 20s to 50s or whatever, a variety of things, such as broken ankles, torn ligaments and tendons, and bunion surgeries and things like that. And then, in the elderly, things where they're aging and arthritides, and maybe previous surgeries or traumatic events that are now getting worse. So, it's a variety of things that be managed, at least I do. But I really manage reconstructive-type things.

Host: And is that your specialty or focus?

Dr Robert Mendicino: When I can be, I mean, not every patient is going to come in with a major reconstructive procedure. So, I do the basic things, but where I specialize in and spend a lot of time in my career is looking at unique deformities or problems, and then address those for the people in the community.

Host: And what are some of the latest advancements in foot and ankle surgery that have happened over the course of your career?

Dr Robert Mendicino: Well, I think we've seen big improvements in implants, not just joint replacements, like an ankle joint replacement, but implants, meaning plates and screws. They've become lower profile, less irritating, stronger, tendon and ligament anchors and reconstruction type materials. So, what we're seeing is improvement of designs of equipment. And we're seeing more and more minimally invasive type surgical procedures.

Host: Yeah, we're seeing that in a lot of areas, which really improves recovery time and, of course, quality of life. You've talked a little about this already, but I'd like to hear how you approach patient care, especially when dealing with foot and ankle issues.

Dr Robert Mendicino: Well, the big thing I think, for me, when I get a patient that comes in, especially with a unique issue, is educating them. I talk to them as if it's a family member. I need to find out a lot about them, their home living situation. Do they have steps? Do they have support at home? I'll work them up much more than maybe some others so I can get a better outcome.

And as an example, say, I have somebody that needs not to walk on this for whatever it is for one month, three months, or four months, I need to find out they have the ability to do that. So, I send them to physical therapy preoperatively. And if they don't pass, we work on that before we do the surgery. We look at other things like medical issues. I check their vitamin D to make sure the vitamin D is elevated because large part of our population is vitamin D insufficient or deficient. If they use tobacco products, try to educate them on quitting or stopping at least during the time that they're having surgery to get them a better outcome.

Host: And then, you're with that patient, you already said from birth to death. Are you with the patient from consultation to recovery?

Dr Robert Mendicino: Yes. I see the patients for consultation. I see them on every post-operative visit. I'm available 24 hours for telephone calls. And as we're going through the post-operative course, I make sure they understand through communication if there's any issues, how we address them, how much longer it's going to take to heal. If they need physical therapy, what that physical therapy is going to be. And then once they're healed, if they have any issues, they're more than welcome to come back.

Host: Do you find there are one or two most important factors to ensure successful outcomes for your patients?

Dr Robert Mendicino: I think a thorough consultation and discussion with the patient. And I have them repeat back to me what I've said, so they understand. You know, if I tell them you can't walk on this for six to eight weeks, even on the day of surgery, I go back in and I ask them the same questions over. And if they don't pass those questions, we go back over it again, because the communication and understanding is the most important part of any surgery.

Host: Do you have advice or thoughts for aspiring surgeons who are interested in Foot and Ankle Surgery as a specialty?

Dr Robert Mendicino: Well, I have trained well over a hundred residents in my career. And as an example, you're inspired by your teacher. So, my teacher was a president of the College of Foot and Ankle Surgeons. I'm a past president of our College of Foot and Ankle Surgeons. And over the last 20 years, four of my past residents are past presidents of the College of Foot and Ankle Surgeons. So, you are who taught you. And if you want to come into this specialty, I think you need to put the time and effort into it, but it's not just eight to five. It's reading, it's understanding literature, understanding complications, and it's just being a part of the community.

Host: As you said, in your case, you're available 24/7 to your patients. That's a huge commitment. What are your goals for your first year here at St. Clair Health?

Dr Robert Mendicino: I came back to help build the existing Foot and Ankle service. It's very good here already. I want to bring in some of the things I've done in the past and provide it to our subspecialty. I really want to get into some research and outcome studies here so we can show an improvement of care for patients in the area. It's already good. All we can do is make it better.

Host: Well, we don't want to have to ever see you, Dr. Mendicino. But when we do, it is nice to know that someone like you is there to make it all better. Thank you for this interview. And welcome to St. Clair. Our community is lucky to have you.

Dr Robert Mendicino: Well, thank you very much.

Host: I know Pittsburgh is a big sports City. So, can I ask you, is it Penguins, Steelers, or Pirates for you?

Dr Robert Mendicino: Penguins first, Steelers second, Pirates third.

Host: Excellent. Thank you again.

Dr Robert Mendicino: Sure.

Host: That was Dr. Robert Mendicino, foot and ankle surgeon at St. Clair Health. To schedule an appointment with Dr. Mendicino, call 412-942-7262 or visit stclair.org. If you found this podcast helpful, please share it on your social media and check out our entire podcast library for topics of interest to you. This is Curating Care, a podcast from St. Clair Health.