podiatry. what is it?

a quick end of shift selfie with Dr. Heidi Godoy!

I was first introduced to the field of podiatry through Dr. Heidi Godoy’s presentation to our AMSA club a couple weeks ago. One of the things she said that stood out to me was: “a lot of people do not understand the importance of our feet – they help us walk and move.” Thus, I emailed Dr. Godoy and asked if I could spend a day shadowing her in her office, to which she immediately agreed! Fun fact: Dr. Godoy is a TCNJ alum!

Dr. Heidi Godoy, DPM, practices at the Alps Family Foot & Ankle, which is a family (and women) run practice composed of Dr. Heidi Godoy and Dr. Johanna Godoy (and previously their mother, Dr Irma Godoy) – girl bosses!

When I first entered the office, Dr. Godoy handed me a white coat (rather casually) and I remember hesitating to take it from her for a quick second because that’s the coat that so many pre-meds hope to wear one day. To be able to wear a white coat, enter a patient’s room, and just be on the other side of medicine was such an insanely wholesome feeling.

Dr. Godoy is simply amazing! Her energy is just so positive and inspiring. Our conversations were fun, educational, and easy. She taught me to not put so much pressure on myself. Everything will work out. Relax.

She also truly is such a boss. Along with handling the clinical side of medicine, she also (rather effortlessly) handled the administrative duties. She was answering patient phone calls, retrieving materials from the storage unit, scribing her charts, responding to emails, and so much more. What a queen.

This shadowing experience taught me more than I thought it would, hence why I wanted to wrap it all up into one blog post so I have a place to refer to this experience.

There are a diverse group of patients that come to a podiatrist. In the 5 hours that I spent at the office, I saw Dr. Godoy interact with patients with all sorts of different conditions that affect the entire lower legs. I’ll recall some patient interactions below and reflect briefly on what their complaint, diagnosis, and treatment plan was (note: the patients are named with letters of the alphabet to abide by HIPAA rules).

  • Patient “A”

Our first patient was an elderly person, who presented with Athlete’s foot and some left foot toenail discoloration. This patient came in with the intention of just getting their toenails trimmed. However, once Dr. Godoy saw the patient’s feet, she recognized that Patient “A” had Athlete’s foot. Luckily, Athlete’s Foot is not a serious condition and is very much treatable. The patient was instructed to apply an anti-fungal cream and ensure that they were wearing shoes that weren’t so tight-fitting.

Afterwards, Dr. Godoy explained to me that some of the older patients come in to get their toenails cut because they are physically unable to do so themselves. This also enables the doctors to examine their feet to ensure that there isn’t any sort of infection or problem with the feet. Watching Dr. Godoy interact with people like Patient “A” was very humbling because it showed me that medicine is not always about the ‘life-changing, cancer-curing’ treatments. Medicine is also about making the ‘everyday’ things more accessible to every single person.

  • Patient “B”

Patient “B” was another adorable older person, who appeared to have mildly painful pressure calluses at the bottom of her foot. It was during this patient interaction that Dr. Godoy taught me about the two pulses that are present in the lower legs. One is called the dorsalis pedis (DP) pulse, which is palpable at the top (or dorsum) aspect of the foot. The posterior tibial pulse is palpable at the intersection between the ankles and heels. Dr. Godoy explained that the latter type of pulse diminishes over time with age due to a lower amount of blood reaching that area (Patient “B” had strong DP pulses, so there appeared to be no concern).

  • Patient “C”

This patient was the first pediatric patient I saw at the office (Dr. Heidi Godoy is also specialized in pediatric podiatry)! Patient “C” came in as a ‘post-op’ and received an XR at the office. This was cool to watch because as a scribe, I only go into patient rooms with the physicians during the initial consultation. I don’t get to see the patients follow through on the orders placed by the physicians. Therefore, being able to see this patient receive an X-Ray was intriguing as I was able to piece together everything from my scribe job. It was also interesting to see the patient get scanned in the office and have the results pop up immediately on the screen. Dr. Godoy pointed out that the area that looks mildly indented is where the patient sustained a trauma injury and fractured that area.

I also learned that toenail fungus is a rather common result of trauma. This patient suffered from a foot injury and as a result came to the office with an obvious fungal infection around the area of trauma.

  • Patient “D”

Patient “D” presented with a fungal toenail infection – their entire big toe was discolored. The patient explained that they get a pedicure regularly and has never seen something like this before. Dr. Godoy explained that nail salons are the main places where people can acquire such fungal infections (wild!).

Nail salons do not sterilize their materials enough (they usually just drop them in some alcohol). Since fungus loves to travel in areas that are moist, dark, and metal, nail salons provide the perfect environment for fungus to grow. Thus, when one gets a gel manicure, the fungus loves to thrive in the darkness under the gel on our toes. *irky*

The cool part about this patient interaction was that I watched Dr. Godoy literally cut off the entire fungal toenail! Not gonna lie, that was a bit difficult to watch because nails, in general, just freak me out. However, the process of actually removing an entire toenail to treat this condition was awesome!

Dr. Godoy then proceeded to explain to the patient that there are usually two forms of treatment for fungal infections: (1) an oral pill or (2) a topical ointment. The patient ended up choosing the topical ointment. Dr. Godoy further explained the process of applying that ointment: it must be applied from the nail bed and cover the entire nail in order to ensure that any residual fungus is being killed.

  • Patient “E”

Patient “E” also presented with a toenail infection. The difference between “E”‘s fungal infection versus “D”‘s was that Patient “E”‘s toenail was not discolored – the nail was just growing thicker. I had no idea that thicker growing toenails could also be a sign of a fungal infection!

Dr. Godoy explained that the treatment for this infection would involve softening the nail first to allow for the antifungal ointment to be able to reach the fungal infection.

Before prescribing the ointment, Dr. Godoy checked the patient’s insurance company. Based on the insurance company, Dr. Godoy offered the patient a different antifungal ointment, which has essentially the same effects as the usually prescribed one. The only reason why Formula 7 (i.e. the antifungal offered to those who do not have insurance that covers Jublia) was the better option for this patient was because it is a lot less cheaper. This showed me that it is crucial that doctors are not single-minded. If multiple patients present with the same symptoms, treatments must be tailored to not only their own somatic needs, but also financial needs.

  • Patient “F”

Patient “F” presented with an ingrown toenail. Dr. Godoy had to perform a partial nail avulsion to treat this patient’s ingrown toenail. She needed to anesthetize the area, for which she mixed a short-acting anesthetic (i.e. lidocaine) and a long-acting anesthetic in the injection. She then proceeded to use a cold spray before injecting the patient’s toe with the anesthetics. Cold sprays are used before the injection to “provide transient anesthesia via evaporation-induced skin cooling, which reduces pain. Results from studies of earlier vapocoolant sprays indicated that they reduced pain due to vaccine injection in children and adults.” Dr. Godoy then injected the patient with the anesthetics. She took a sterilized metal tool and was able to maneuver inside the toe and very elegantly scooped the entire ingrown toenail out. EPIC!

  • Patient “G”

Patient “G,” who has a history of uncontrolled diabetes, presented with a ‘pins and needles’ feeling in their foot. This patient was the perfect example of someone who had fallen through the cracks of the American medical system. They explained how after selling their business, they could no longer afford insurance. Thus, for almost a decade, their health practically deteriorated due to their unfortunate financial constraint.

Upon Dr. Godoy’s examination, it was seen that the patient’s condition is more so a neurological problem than a podiatry related condition. Along with diabetes, the patient explained to Dr. Godoy that they also have history of chronic back pain. Dr. Godoy replied that back pain can also be related to foot pain.

This patient interaction taught me two main things:

(1) Everything in the body is connected to everything in the body. Pain in one area can result in pain in the other area.

(2) Health is often put on the backburner for those who cannot afford to consult a doctor until their conditions become unbearable. How can this situation be better handled so that people are not afraid to go to a doctor during the early stages of their pain/conditions?

  • Patient “H”

Patient “H” presented with heel pain. With a quick examination, Dr. Godoy was able to diagnose the patient with plantar fasciitis. Plantar fasciitis “occurs when the plantar fascia, a strong band of tissue that supports the arch of your foot, becomes irritated and inflamed.” A common sign of this condition (along with heel pain) is having a tight calf.

There were 2 parts to the treatment plan:

  1. Dr. Godoy administered an injection consisting of a corticosteroid (e.g. an anti-inflammatory), short-acting anesthetic (e.g. lidocaine), and a long-acting anesthetic.
  2. The patient was then provided a “Night” splint to help stretch out the calf and release the pressure placed on the heel.

Conclusion

I am ecstatic that I was able to connect with Dr. Godoy and learn some details about podiatry. More than the actual diagnosis and medical part of the learning process, this experience taught me that I have to be open-minded when entering the field of medicine. It sounds so trivial, but I don’t think this is emphasized enough for pre-med students. A lot of us who want to enter the medical field already have this pre-set idea of what medicine ‘looks’ like. However, we do not realize that medicine is so much greater than what we know – it encompasses fields and people from all sorts of different backgrounds.

Note to self: Be open to learning and exploring. Thankful I got to do just that with Dr. Godoy 🙂

An Interesting Debate Over ‘Purpose’

The other day a doctor I was working with said to me:

“Many people don’t know what their purpose is, so they make their work their purpose.”

This stuck with me.

I thought anyone’s purpose would be embedded within their work because, at least for those of us who are privileged enough, they will choose to enter a profession that brings them the utmost joy and value. Becoming a surgeon has been my ‘purpose’ for over a decade, and that’s because I believe that this profession will enable me to build on my strongly held values, such as service and compassion.

However, when a doctor said that to me, I was forced to stop and reflect. If work isn’t my purpose, then what is? How do I find it?

The doctor was talking about how we, as students, should not take academics as seriously as we do being premeds and even as we grow older. This is because he believes that work should never engulf one’s entire life.

I agree with this wholeheartedly, however, I have a slight problem. I can’t even envision myself as having any other purpose. I don’t want my purpose to be limited to family, friends, or any one sector of my life. I want it to be more, and being a medical professional fulfils that desire for me.

Because I was so deep in confusion over what my purpose would be if I can’t rely on my future profession, I googled how we can find out our purposes.

According to Richard Leider, who is “a nationally-ranked coach and purpose expert…the equation for purpose is G + P + V = P.” (gifts passions values = purpose)

Let’s break this up.

Gifts

I’m not sure what my gifts are yet, but I’m sure I’ll discover them as I progress further.

Passions

My passions are deeply rooted in service, specifically in helping & advocating for children and mental health rights. I am also passionate about the performing arts. As a dancer and someone who grew up watching way too many Telugu/Hindi movies, I believe the performing arts has the ability to change one’s perspective on various occurrences within our world.

Values

This one is tough to reflect on as I have never actually sat down and thought about them.

Using the list from this website, I would say that these are my current values that I hold very dear to me:

  • family-orientedness
  • leadership
  • service
  • self-actualization

Purpose

Combining all three of these aspects, I would ideally find my purpose. However, we know that discovering what we truly want in life is not as simple as cracking down on an equation. I feel like our purpose can only be found by either experiencing a lot in life or by having a life-changing experience.

And maybe we don’t need to settle with having just one purpose. Maybe we’ll have more than one purpose and that’s okay. Maybe we won’t discover our purpose(s) until we take our final breaths and that’s okay too. And maybe one’s profession does become their purpose, while for others it’s just something that they’re passionate about but it’s not their true calling. It’s our life and we get to shape it in whatever we want to.

Starting Over.

This month I started something over again.

In February 2021, I started a new job as an Emergency Department medical scribe. I love medicine – specifically, surgery. Thus, I wanted to do something that would give me exposure to such a breathtaking field.

The hospital I worked at at that time was draining, to say the least. Providers were seeing nearly 30 patients every day, meaning I had to write almost 30 patient charts every time. Every one in that hospital was severely burnt out and didn’t know how to cope with the overwhelming amount of pressure. My shifts ruined my very disciplined and rigid routines as I would work 3pm-1am, 9pm-7am, 11am-11pm, etc. My sleep schedule, eating schedule, working schedule – everything – was altered. I began to internalize every comment or attituded remark made by the people working in that hospital.

This experience honestly affected my perception of medicine and I decided to leave the job once in-person classes began.

Here I am, a year later. I am now, once again, trained to be an Emergency Department medical scribe and I now work at a different hospital.

I started over.

I was terrified in the beginning when I first entered this new hospital because what if this hospital is the same as the previous one? What if it’s not the providers, it’s me? What if I am not made for the rigors of medicine?

Fortunately, this hospital was vastly different. People were still burnt out (as this is a major problem in the healthcare field), but they do not project their inner feelings onto those around them. It’s crucial to note that it was totally okay for the previous hospital’s providers to express their dissatisfaction with their job and life, in general. However, I was unable to disassociate from such statements and vibes of the hospital.

The point is, I was scared to start over. I was scared to train all over again for a job I was already experienced in. I was scared to interact and cultivate relationships with new people. I was scared of change.

Change is good. Change teaches us new things. Change gives us new perspectives. Change must be welcomed more.

Why the Physician Mental Health Questionnaire is Ineffective for Adolescents

Whether it be for a sick visit or an annual check-up, my doctor’s office always has me fill out a “Mental Health Questionnaire.” The questionnaire essentially consists of numerous statements with a scoring criteria. For example, one statement could be written as “feeling nervous, anxious, or on edge” and the right hand columns will have a 0 for “not at all,” 1 for “several days,” 2 for “more than half the days,” and 3 for “nearly every day.” As I circle a number for each statement, I arrive at the end where I am required to tally up the numbers and give myself a score. 

This questionnaire has been a recent requirement, which I appreciate as it shows that mental health is becoming more of a priority in medicine. However, there are a couple drawbacks to this that I feel defeats the whole purpose of having pediatric patients fill this out. 

For starters, minors are accompanied by their parents for these doctor visits. Therefore, parents are sitting next to them when children fill out these questionnaires. It can sometimes be uncomfortable and hard to honestly answer the questions because there’s a high probability that our parents are looking over our shoulders to see what we’re writing down. This automatically skews the answers and deems the questionnaire ineffective. 

The other major con of this questionnaire is that most doctors don’t even look at it or mention it during the visit. Out of all the years I’ve been required to fill this out, only one doctor took the time to send my mom out of the room and talk to me about my answers. The rest of the physicians didn’t even look at my responses.

What does this convey to pediatric patients? 

When the physicians didn’t even bother to take a few minutes to check in with how I was doing mentally, it conveyed to me that getting my ears, eyes, heart, and the rest of my body was more important to them than understanding the way I was feeling mentally. 

It also showed me that physicians may not be taught medicine from a holistic standpoint. Especially in the U.S, medicine is more about analyzing a patient’s somatic symptoms and arriving at a diagnosis for further treatment. Therefore, physicians are likely to overlook symptoms of depression, anxiety, suicidal tendencies, bipolar disorder, etc. because they are so focused on the issues of the physical body.  

The questionnaire was a great starting point to prioritize mental health in medicine. However, it is now time to step it up a notch. This could be done by requiring doctors to take time out of the visit to have conversations about mental health. This, not only will help children who recognize that they are mentally struggling, but will also raise awareness for the children who are not aware of mental health and mental illnesses.