Warming Up to Wound Care: Nico’s Story

Nico’s birth was full of surprises for his mom Jennifer. The biggest one being that he was a boy, when all along she had been expecting a daughter. That wasn’t the only unexpected realization. He lacked a fully-formed tibia (the bone that connects the knee and ankle), was missing his left thumb, and had several structural heart disease defects, none of which had been diagnosed prenatally.

Unexpected heart defects

Nico was diagnosed with unbalanced AV Canal (AVC), Anomalous Pulmonary Venous Connection (APVC), and Ventricular Septal Defect (VSD) due to the underdevelopment and abnormal formation of his heart and major blood vessels. Jennifer learned early on that her son’s heart conditions were treatable with a series of open heart surgeries and/or cardiac catheterization procedures.

The day after he was born, Nico was transported to CHOC Children’s. He underwent his first heart surgery when he was only three days old, under the care of Dr. Richard Gates, a CHOC Children’s pediatric cardiothoracic surgeon and co-director of the CHOC Children’s Heart Institute. Nico’s second heart surgery happened before his first birthday, and he’ll have a third heart surgery later this year.

nico-today
Nico, who is today a happy pre-K student, has already endured several surgeries.

“Despite Nico’s significant heart condition, he has responded well to each surgery, becoming stronger right before our eyes,” says Dr. Gates. “I look forward to his final surgery which should allow him to continue to be active and happy.”

Jennifer knew that someday Nico would need to have his leg amputated below the knee, Since Nico’s tibia bone connecting his knee and ankle wasn’t fully formed, it meant his ankle didn’t have the support it needed. Her original plan was to have that surgery performed at another facility closer to their home, when she was told they weren’t comfortable operating on his leg due to his heart conditions. Soon after, she and Nico were at CHOC meeting an orthopaedic specialist to discuss a prosthetic for his leg.

“I didn’t know what we were going to do, but during his prosthetic appointment, we learned CHOC would be comfortable performing his surgery, and could schedule it for just a few weeks later! I was thrilled we could do it earlier because I don’t want him to get to a point later on in life when he remembered or missed when he had more of a leg,” Jennifer recalls.

Shortly before his third birthday, Nico underwent surgery to amputate his leg below the knee under the care of Dr. Francois Lalonde, a CHOC Children’s pediatric orthopaedic surgeon.

nico-toy-after-wound-care
In addition to stocking our holiday toy store, donations that pour into our annual holiday toy drive bring joy to patients year round. After one wound care appointment, Nico is surprised with a new toy for being so brave.

After spending just one night in the hospital ―including a checkup with his cardiologist, Dr. Nafiz Kiciman, to make sure his heart looked alright after surgery― Nico was discharged.

“Nico is a brave and courageous young boy with an easy-going personality,” says Dr. Lalonde. “He has demonstrated great resilience and coping skills following surgery and wound care, and is already adapting well following the amputation of his left ankle.”

His doctors told his mom he should take it easy for a few days, but as soon as his cast was removed, he was quickly back to his old habits of climbing on furniture and jumping on pillows.

“I never want my son to have the mentality that he is limited,” Jennifer says. “Kids can sense if their parent is worried or scared, and I didn’t want him to feel like that. He’s too young to feel anxious on his own, so I made sure I didn’t bubble wrap him and let him play like his normal self.”

The importance of pediatric specialists for wound care therapy

The week after surgery, Nico and his mom started coming back to CHOC a few times per week for wound care, where specially-trained pediatric physical therapists would clean and rebandage his leg. In between those appointments, Jennifer cared for the wound at home.

“At his first appointment, he saw a new person walking into the room with all these supplies he had never seen before, and it was a lot for him to take in. He covered his eyes and wiggled around during the appointment,” Jennifer recalls.

To make Nico feel at ease, his physical therapist Sandy started letting him help her care for his wound.

nico-before-and-after-wound-care
Left: Nico was naturally apprehensive during his first wound care appointment, before he realized it didn’t hurt and could even be fun. Right: Nico during a subsequent wound care appointment, where he was rewarded for his bravery with a larger-than-life Mickey Mouse balloon.

“I wanted to be honest with him about what they’re going to do at this appointment, but frame it in a positive way so he knows it’s for his own good and he doesn’t have to be scared. It’s important to explain things in a way that he will understand,” Sandy says. “If you’re honest with the child, they’ll start to trust you. If you say, “this won’t hurt” and it hurts, then you’ve lost their trust.”

Once Nico was involved, he immediately understood that he didn’t have to be scared of wound care, and that it could even be fun.

Now, when Sandy finishes one step, he grabs the next supply that she’ll need. He almost sees it as a game. “Ok Nico, we’re done with this part. What part is next?” Sandy says to him.

nico-during-wound-care-appointment
To help calm Nico’s fears during wound care, his pediatric physical therapist involved him in the process.

These days, before each appointment, when Jennifer asks Nico if he wants to go see Sandy, he squeals and claps with delight.

“I tell him, “Let’s go see Sandy! She’s going to clean your owie and make it feel better.” My positive mentality was contagious for him. I was excited, so he was excited,” Jennifer says. “If the kid sees the parents squeamish during wound care or sees a worried expression on their face, then the kid will be apprehensive. Whenever we come to wound care appointments I make sure I speak to him in a very upbeat, positive way so he feels like physical therapy is fun and not something to be scared of, which helps him to relax. Positive energy is contagious.”

Continuity of care has also helped Nico feel more comfortable.

“It has helped him to have the same one or two physical therapists each time, so it’s a familiar face.”

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Nico’s Star Wars-themed prosthetic.

Once Nico’s leg was fully healed from surgery, he resumed physical therapy, was fitted for a prosthetic, and started walking. In between all of that, he continues to love anything Star Wars, playing Ninja Turtles, coloring and attending pre-Kindergarten classes.

Read FAQs about pediatric wound care at CHOC

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Meet Dr. Francois Lalonde

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Francois Lalonde, a board certified pediatric orthopaedic surgeon.

Dr. Francis Lalonde
Meet Dr. Francois Lalonde, a board certified pediatric orthopaedic surgeon at CHOC Children’s.

Q: What is your education and training?

A: I attended medical school at University of Toronto School of Medicine. I completed my orthopaedic surgery residency at the University of Ottowa, and a pediatric internship at Montreal Children’s Hospital/McGill University. I completed a pediatric orthopaedic surgery fellowship at both Children’s Hospital of Eastern Ontario/University of Ottawa, and San Diego Children’s Hospital and Health Center/University of California San Diego.

Q: What are your current administrative appointments?

A: I am president of the CHOC Orange medical staff; medical director of the hip program, CHOC Orthopaedic Institute, member of the CHOC board; and president of Adult & Pediatric Orthopaedic Surgery medical group.

Q: How long have you been on staff at CHOC?

A: 11 years.

Q: What are your special clinical interests?

A: My clinical interests include infant, child, adolescent and young adult hip conditions (DDH, Perthes, SCFE, impingement); pediatric fractures and musculoskeletal injuries; pediatric foot conditions and reconstructive surgery; general pediatric orthopaedic conditions; limb lengthening; surgical treatment of bone deformity in osteogenesis imperfecta; and cerebral palsy.

Q: What are your most common diagnoses?

A: We see a variety of conditions, including forearm and elbow fractures; developmental dislocation of the hip in infants; Perthes disease; slipped capital femoral epiphysis (SCFE) condition of the hip; joint, extremity pain in children, adolescents (overuse, growth related); idiopathic adolescent scoliosis; among others.

Q: Are you working on any current research?

A: Yes, on Legg-Calve-Perthes research. We are looking at our five year experience with patients treated with open hip adductor lengthening, range of motion, nighttime orthosis and limited weight bearing protocol. Our patients have maintained femoral head sphericity and containment with congruent hip joint with very limited surgery. Many patients have been back to sports without any symptoms.

Q: What are some new programs or developments within your specialty?

A: Orthopaedic surgeons are better able to diagnose hip impingement based on radiographic and imaging assessment and depending on severity of underlying findings or condition, treat this condition with arthroscopy or surgical hip dislocation with femoral head/neck osteochondroplasty and/or acetabular rim trimming. In doing so, we are better able to differ the onset of premature degenerative changes (arthritis) of the hip.

Advanced hip joint preservation surgical techniques such as the Ganz periacetabular ostetomy and relative femoral neck lengthening have emerged to treat the sequelae of developmental dysplasia of the hip and other childhood conditions. In the appropriate setting, these surgical techniques are able to relieve hip pain and significantly delay or prevent the onset of premature degenerative changes (arthritis) of the hip.

A modular magnetic intramedullary nail (Precise nail) is now available to allow orthopaedic surgeons to lengthen the femur or tibia by up to 8 cm in patients with moderate or large limb length inequality. This internal device is being better tolerated by patients with less soft tissue irritation.

In addition, for several years now, the Fassier-Duval telescoping intramedullary nail has been used at CHOC to correct severe deformities of the femur and/or tibia in patients with osteogenesis imperfecta. This modular implant which is anchored at the top and bottom telescopes as the bone grows and has helped avoid multiple revision surgeries in childhood due to migration of the implant and refracture.

Q: What would you most like community providers to know about your division at CHOC?

A: Our division covers the entire spectrum of subspecialties in pediatric orthopaedics (fractures, upper extremity, spine, hip, lower extremity, sports medicine, foot/ankle, bone tumours, neurosmuscular conditions – cerebral palsy, spina bifida, muscle disease, osteogenesis imperfecta, brachial plexus injury, concussion). We have three offices in Orange, Irvine and Mission Viejo, in addition to the CHOC Clinic. We try to see our referral patients promptly, and are accessible by phone for questions from physicians.

Q: What inspires you most about the care being delivered at CHOC?

A: I’m inspired by the expertise, drive and dedication of our physicians, nurses and support staff, as well as our state-of-the-art facility, the wide range of subspecialists within pediatrics, the emphasis on patient safety and experience, and the emphasis on delivering high-level quality care to our patients.

Q: Why did you decide to become an orthopaedic surgeon? 

A: I decided to become a doctor as a teenager. I had a part-time job as a lifeguard at local pools and beaches in Ottawa, Canada, in which I was required to take first aid courses, and that piqued my interest. Later, while attending university, I worked as a children’s swim instructor and gained interest in pediatrics and pediatric orthopaedics. I became interested in orthopaedic surgery as a medical student during a pediatric orthopaedic surgery rotation when I was exposed to a great role model.

In addition, my uncle, who is an obstetrician and gynecologist, was an early role model. I often listened to him talk about his work and schedule during the summer. I used to spend the entire summer at my parents’ cottage in the Laurentians in Quebec, Canada. My uncle’s cottage was right next door. I liked the diversity of his daily routine. His days were busy either seeing patients in his office for initial consultation or follow-up, or performing surgeries or delivering babies.

Q: If you weren’t a physician, what would you be and why?

A: I would have become a marine biologist. I became interested in this field by watching documentaries, taking biology classes, and by scuba diving.

Q: What are your hobbies/interests outside of work?

A: I enjoy playing ice hockey, as well as watching or attending all sports events.

Q: What have you learned from your patients?

A: I have learned that making funny noises when I examine babies’ hips really distracts them and elicits a smile and lets me conduct my exam more effectively and reliably. With older kids, I have learned how challenging it is to treat great athletes, who present with joint or extremity pain often from overuse, and they can find it difficult to commit to a period of rest, which is often necessary to allow for recovery.

Q: What was the funniest thing a patient told you? 

A: One of my patients keeps asking me, “Where is your gold tie?” The first time he met me I was wearing a gold tie. Every time he sees me now, he asks me about my gold tie. I keep asking him to call me the day before so that I can wear it on the day he comes but he keeps forgetting to call.

Watch a short video to learn more on Legg-Calvé-Perthes disease

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    Jennifer was diagnosed with scoliosis at 8 years old. After several lifestyle modifications and dedication to wearing a back brace, she was able to avoid scoliosis surgery.
  • Warming Up to Wound Care: Nico’s Story
    Nico’s birth was full of surprises for his mom Jennifer. The biggest one being that he was a boy, when all along she had been expecting a daughter. That wasn’t ...
  • Meet Dr. Kelly Davis
    Dr. Kelly Davis specializes in sports injuries, injury prevention, concussion management and advanced musculoskeletal ultrasound medicine for children, adolescents and young adults. Among the most common diagnoses she sees include ...

Enjoy a Safe Time on the Slopes

Photo courtesy of office.microsoft.com

With abundant snow on our local mountain tops, many families will be hitting the slopes this season!  To ensure you and your family have a fun and safe time, check out the following tips recommended by Dr. Francois D. Lalonde, orthopaedic surgeon at CHOC Children’s:

  • Stretch:  Proper conditioning can minimize the risk of injury and optimize performance. Make sure your family is warmed up. This can be as simple as walking, marching in one place, or doing a few jumping jacks.
  • Use proper safety gear:  The lack of proper gear is a common factor in sports injuries. Make sure your children use a helmet, wrist and elbow guards, knee pads, goggles, boots, and the appropriate snowboard or skis.
  • Dress appropriately:  Make sure your family is wearing the right amount of layers to match the weather and each person’s activity level. Wear a hat or helmet liner and gloves. Also, be sure to wear sun protection, even on cloudy days!
  • Get proper instruction: Take a lesson from a qualified instructor before you hit the slopes. Ensure that your children know how to properly use the equipment.
  • Follow the rules:  Children should be supervised at all times. Make sure your family understands and obeys posted warning signs. Avoid icy slopes. Do not go off-trail.
  • Ski or snowboard with a friend:  Pre-arrange a meeting place in case you get separated. Use walkie-talkies if possible. Make sure your children have the name and phone number of your hotel.
  • Take a break:  Lots of energy is being used while gliding through the slopes. Take a moment to rest. While resting, make sure you have something to eat or drink.

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