Dr. Robert Kaslovsky was talking about pediatric pulmonology (his specialty) — and looking at his watch.
It was Wednesday morning, after all, and, more specifically, one of those Wednesdays when he is to be at Baystate Health’s outpatient facility on High Street in Springfield at 8:15 for the latest in a series of asthma clinics.
Springfield, it seems, has a rather high incidence of asthma — the eighth-highest in the country, according to the latest statistics — and the clinics were started last fall as a way to attack the problem head on, and bring needed care to an inner-city constituency that might have trouble traveling to see a doctor.
“So we bring the doctor to the patient,” said Kaslovsky, noting that he and other pediatric pulmonologists treat several children under the age of 18 every other Wednesday as part of one of many programs administered by Baystate’s department of Pediatric Pulmonary Medicine. There is also a cystic fibrosis clinic every Monday, where patients ranging from newborns to older adults, including one who recently turned 50 (a remarkable accomplishment for an individual with that affliction), receive treatment and counseling from a team of experts. There’s also a BPD (bronco pulmonary dysplacia) clinic each Tuesday for premature infants who have left the hospital but still need treatment for their lungs, and a monthly muscular dystrophy clinic as well.
The diversity of those programs and others, in addition to his regular patient workload, keeps Kaslovsky quite busy, but the sum of all these initiatives brings a host of rewards and satisfaction.
And for this, the latest installment of the Today’s Physician series, he talked to The Healthcare News about them.
Not Child’s Play
When asked why he chose to work almost exclusively with children, Kaslovsky replied jokingly, “I hate to say this, but they get better faster, and they don’t complain as much as adults.”
Elaborating, and getting more serious, he said that many adult afflictions are what he called self-inflicted — people abusing their bodies and not taking proper care of themselves — and that, when one works with children, he or she is largely isolated from that phenomenon. “And besides, it’s gratifying, and it’s fun.”
There are challenges to working with young people, however, he continued, noting, for example, that very young children can’t tell the doctor what’s wrong or articulate a problem as well as an adult. “So you have to rely on the parents,” he explained. “And you have to be a very good listener.”
Kaslovsky has mastered the nuances of his specialty over a nearly 30-year career in medicine that was sparked by an early interest in math and science, and helped along by a rare opportunity afforded him when he won an academic award his senior year in high school.
“It was a fellowship from the New York State Health Department that put me in a research laboratory with some PhDs for a summer,” he explained. “They were studying a very rare disease called severe combined immune deficiency syndrome, where both arms of the immune system — circulating antibodies and white blood cells — were knocked out, and one little girl who had this disease.
“Now, you would do a bone-marrow transplant and treat it, but this was 1972,” he continued, “so they put her in a big isolation room and tried a lot of things to treat it, mostly antibiotics. We developed a screening technique for this, and the whole process provided a spark for me to get into medicine.”
Indeed, after a number of summers working for the same physician who led his fellowship experience, Kaslovsky, who did undergraduate work at Union College, was inspired to apply to medical schools and eventually attend Albany Medical College. It was at that school’s medical center that he first conducted his residency and then his fellowship, and also developed his interest in pediatrics and, later, pulmonary medicine.
“Part of the training was in all the adult specialties, and while they were interesting, I never found anything where I said, ‘this is wonderful, this is great,’” he explained. “You have to catch the spark for something you want to do, and toward the end of my third year, I got to do two months of pediatrics. The people were nice, and the kids were great to work with. I really enjoyed it.”
As for his decision to focus on pulmonary care, he said it stems from work he did in the second year of his residency, specifically care provided to an individual with cystic fibrosis. “I got very interested in cystic fibrosis, which is part of what we do in pediatric pulmonary, and thought that would maybe be a great career.”
As it turned out, he was right.
Kaslovsky spent 18 years at the Children’s Hospital at Albany Medical Center, first as an assistant attending physician and then as an attending physician, before taking similar positions at the Charlston Area Medical Center in Charleston, W.V., starting in 2005. He came to Baystate last May to fill a vacant position leading the Pediatric Pulmonary Medicine unit.
Kaslovsky told The Healthcare News that he enjoys the depth and diversity of his practice, which makes every week, and every day, different from the one before.
And most of the time, he’s working as part of a team to provide a compendium of care that focuses on both the physical and mental aspects of various afflictions. He cited the cystic fibrosis clinic, one of the few operating in Western New England, as just one example.
“Patients come in about every three months, some more often if they’re sicker,” he explained. “We assess their health, we do pulmonary-function testing, check their nutrition and growth, and we encourage them and prescribe treatment that they need,” he explained. “And a big part of it is our social worker; no cystic-fibrosis clinic can exist without a social worker or psychologist, because there are many psychosocial problems — emotional, financial, non-compliance … you name it, we’ve seen it.”
There’s a different team for the BPD clinic, he continued, adding that it includes a dietician and occupational therapist, both of whom worked with the patients in the Neonatal Intensive Care Unit and are familiar with each case.
Work with his young patients varies, from that aforementioned focus on asthma and its growing prevalence in the City of Homes, to treatment of foreign body aspirations — when children experience blockage from swallowing everything from popcorn to peanuts to small toys.
Meanwhile, there is a steadily growing number of young patients with sleep apnea and related disorders that pediatric pulmonologists treat in conjunction with sleep specialists at Baystate. Such conditions certainly stem in part from an ongoing obesity problem plaguing large numbers of young people, said Kaslovsky.
“It’s becoming more and more recognized in children; not all snoring is problematic, but not all snoring is innocent,” he said, noting that there are several signs to warn parents that something may be wrong, including everything from heavy sweating during sleep to their children falling asleep at school because they failed to achieve proper sleep the night before.
And then, there’s allergy season, which is right around the corner, Kaslovsky said, noting that, as the trees start to bloom, people start to sneeze and experience breathing problems.
It is the role of the pediatric pulmonologist to help people suffering from any or several of these afflictions to breathe a little easier — in both a literal and figurative sense — and it is work that Kaslovsky finds rewarding on myriad levels.