John E. Monaco, MD

WENDY R. LEVINE GROSS

John E. Monaco, MD | John E. Monaco, Brandon Regional Hospital, Moondance to Eternity, Slim and Fit Kids

Pediatrician Relies on Family History When Diagnosing



John E. Monaco, MD, a pediatric intensivist and chairman of the pediatric department at Brandon Regional Hospital, faces many challenges as he routinely cares for his pint sized patients.

On any given case his biggest challenge is that rather than having one patient, he has a sick child and parents to contend with. With this in mind Monaco noted, "The most important aspect of caring for a sick child is the history I get from the family."

Because many of his patients are too young to speak and relate how they are feeling, he relies on information provided by family to arrive at a diagnosis. "I have to be patient enough to be a good listener, perceptive enough to ask the right questions and then combine this with my experience as a physician," said Monaco.

Often, Monaco's job is further complicated when parents' worries and fears prohibit them from being the best historians.

A graduate of the State University of New York at Buffalo's School of Medicine, Monaco knew from the outset that pediatrics was his chosen specialty. Attributing his love of children in part to his mom, a school teacher who taught second grade, Monaco indicated that had he not been accepted to medical school, his back up plan was to be a school teacher.

Upon graduation from medical school, Monaco did his residency at Orlando Regional Medical Center (now known as Arnold Palmer Children's Hospital) followed by a fellowship in pediatric critical care medicine at Shands Children's Hospital at the University of Florida, Gainesville.

Recalling his residency years, Monaco related how excited he was by "the human drama of taking care of sick babies." He added, "People who do this are amazing with commitment and talent and I started to think that this is where I wanted to be."

While doing his residency, Monaco was exposed to many professionals who impacted his professional life. However, the distinction of "greatest influence" is reserved for his wife Pamela, a former intensive care unit nurse.

According to Monaco, his wife has always been the one to see what it was about his personality that would be beneficial in helping him take care of hospitalized children and their families. In Monaco's words, "There were times during my fellowship which were grueling and I wanted to bag it and start a journey as a general pediatric doctor taking care of healthy kids." However, Pamela was always there with encouragement telling him "to stick it out."

When discussing his emotions vis a vis patients, Monaco admitted that, personally, he can't remain emotionally detached. "If I am emotionally detached how can I empathize with them enough to know what is going on with the patient and their families?" Rather, "I have to understand where my emotions are," said Monaco.

Monaco believes that "spiritual grounding" is a key element in helping him keep things in perspective. "We are scared of death but unfortunately bad things happen. You get to a point where the energy you get from attachment with one patient gives you more energy to move on to the next patient."

Admittedly, this is a lot easier for Monaco today than when he was a newbie practitioner in his 20s.

To help others understand this "energy," in 2006 Monaco co-authored Moondance to Eternity, a book detailing his "experiences with death and dying, and offering hope to those struggling to accept this difficult yet inevitable life transition."

While asthma and related respiratory illness are among the most frequently seen ailments in his Brandon practice, Monaco stressed that he is seeing an increasing number of young patients with "adult diseases" including type 2 diabetes, joint problems and gall bladder disease.

Driving home the seriousness of the obesity problem in youth, with tongue in cheek, Monaco talked about how the old adage "fat, fertile and 40" used in identifying patients prone to gall bladder disease has been changed to "fat, fertile and 14."

As a former "fat kid" Monaco knows the feeling of isolation and lack of self-esteem excess poundage during childhood can create. Combining his past experience with medical knowledge about the perils obesity can cause in children, Monaco was motivated to join forces with the late Judy Mazel, author of The New Beverly Hills Diet.

While offering solutions and strategies to deal with the epidemic of childhood obesity, their book, Slim and Fit Kids: Raising Healthy Children in a Fast Food World, published in 1999 stresses the importance of prevention through healthy diet and lifestyle.

In Slim and Fit, Monaco warns, "Unless something is done during childhood to prevent it, a fat kid will more than likely grow up to be a fat adult. According to statistics, if a child is overweight at the age of 6, he or she has a 25 percent chance of going on to become an overweight adult. If children remain fat until they are age 12, the chances of becoming a fat adult increase to 75 percent."

Today Monaco believes that we have to get our children moving. With school physical education programs a thing of the past, he encourages parents to have their children play outside after school. In addition, he stresses the importance of teaching youngsters to eat when they are hungry and stop once they feel full. In sum, he urges all to be careful in what they eat and to eat the right things.

When not tending to the needs of patients Monaco likes to walk, play tennis and spend time with his wife and two children.