Thank you, Brian. Good evening, everyone. I'm John Cianca. I'm the Medical Education Chair of the AAPMNR, and every once in a while, they let me pick a topic that we can talk about. And I decided I wanted to talk to Dr. Stan Herring, who's been primary in my career, and I suspect many of you as well. I'm going to take a couple of minutes to introduce him. Now, if it was up to Dr. Herring, he would probably have me introduce him as Stan Herring, MD from UW. I'm going to expand on that a little bit. He is in Seattle, Washington. He started his journey in higher education at the University of Texas in Austin, and then went on to Dallas and studied medicine at the University of Texas Southwest, and then ended up in Washington to do his residency in PMNR. He developed a practice in spine and sports, which he maintains today. He's board certified by AAPMNR, or excuse me, the American Board of PMNR and AANEM, and he serves on three departments, a professor in three departments at the University of Washington. He's internationally known as an expert in rehabilitation, biomechanics, spine, and in particular, concussion. He's also been the founding member, a founding member of the Physiatric Association of Spine and Sports Occupational Rehab, North American Spine Society, the organization now known as SIS, formerly ISIS, and also the American Medical Society for Sports Medicine. He's past president of the American College of Sports Medicine and the North American Spine Society. He serves on the board of the foundation of AAPMNR. He was a board member of Passover, and I think still currently with the American College of Sports Medicine, and he's numerous, has numerous board, editorial board positions with various journals. He himself has been published extensively, both journal articles, books, and book chapters, particularly in the areas of concussion, spine, and sports medicine. He's been team physician or consultant with many teams, both at the professional, college, and high school level. Some of his awards include the Distinguished Clinician for AAPMNR, the highest award given by AAPMNR, the Cruzan Award. He's given the Rosenthal Foundation Award and Lecture. He has received the Sports Medicine Citation Award from the American College of Sports Medicine. He's given the President's Lecture, as well as the John R. Sutton Lectures for ACSM, and the David Selby Award was given to him by the North American Spine Society. And finally, in terms of awards, he's given the Howe Memorial Lecture for the American Medical Society for Sports Medicine. I think, as part of our discussion tonight, I'm going to talk to Dr. Herring about his, him being a driving force behind the Zachary Leistat Law in Washington, as well as physiatry and sports medicine. And as his role as an international leader and mentor in the field of sports medicine and physiatry in general. I think it's not an exaggeration to say he's a giant in both of those fields, and he has an outsized sense of humility and a very, very dry sense of humor that I hope you get a sense of tonight. So it's my privilege to start this conversation with Dr. Herring, and I hope you all enjoy it as well. Good afternoon, or good evening, Stan, actually it's still late afternoon out there, I guess. It's five o'clock in rainy Seattle and John I really appreciate the kind introduction, even the parts that were true work. All right, Stan, let's get started. You know, I thought we could spend a few minutes if you tell us about how your career came into being and how it developed and maybe some of the milestones along the way. Thanks, John. And listen, first of all, as I look at the list of people who are listening in, I recognize some names and hope to meet others. So I'm grateful that you would find my story worthy of your time. I'm not sure it is, but I'll try to invent enough things to make it entertaining. My story, John, is one of having a wonderful brother who had significant immunologic disease, really quite disabling and watching him navigate that with grace and dignity. When my family was told he wouldn't amount to anything, he graduated college at 19 and has an extraordinary IQ and a successful career. So growing up as someone with a disability and that taught me that there's people in this world who are a lot more courageous than I'll ever be. And then going to college and getting hurt. And then those college days, University of Texas, there was required physical education class. So I was sent to the rehabilitation laboratory since I couldn't participate in that semester of physical education. And I met a fellow there by name of Professor Carl Klein, who was one of the founding members of ACSM and an extraordinary biomechanist and educator and exercise prescriber and biomechanist. And the gym where he was located was across the street from my dorm. And I just just fell in love with him and what he could teach me. And I just lived there and learned from him and asked him to be my advisor. So I got an early dose of the value of assessment, restoration of function and comprehensive rehabilitation with a seasoning of a family member who had shown strength from disability. So when I got to medical school, John, and the day I went on the wards, I realized no one was getting the patients out of bed to move them up and down the hall. I thought, you know, maybe there is a role here for what I had learned and been affected by early. And that kind of morphed itself into me falling more and more in the line of physiatry training. Bela Helm was the chair at Southwestern. So that was extraordinary. Like everything else in my life, I've stood on the shoulders of true giants. And that's kind of how I ended up following the path. Stan, I'm intrigued because I'm a little younger than you, but I had to kind of be introduced to physical medicine and rehabilitation. Where did that happen relative to your time with Dr. Klein and then going to UT Southwest? Professor Klein, you know, I have one of my most treasured possessions right behind me in my study is his book on knee rehabilitation, which he signed for me. He wrote it with Fred Allman, who's a sports doctor, and then it was published by the N.A.T.A. in the early 70s. So I got that, you know, that, John, that sort of rehab exercise part early. And when I got to medical school, I was so interested in the sort of biomechanical piece and the exercise piece that and Bela Helm was prominent. Right. So I sort of got to I took a PMNR rotation. I also took orthopedic surgery rotations, neurosurgery rotations, as many people on this Zoom have done. And I just I got to I liked the what I learned in rehab. And I also like the different disciplines that work together. And I've always liked the patient story. So even though I was a good student in medical school and there was a lot of sort of pressure for me to do internal medicine or other things. You know, I just said, you know, I really think I want to do this. And and it was by the time I graduated medical school that that's the path I want to take. It's very ironic to me because I actually had a college professor who was a, you know, botanist, really. And he I took a course, a couple of courses with him, one of which was the ecology of the Everglades. And after the trip that we made during one winter break, he gave me a textbook. I had no idea how he knew that somehow this would figure into my career, but it was a textbook on biomechanics and it had frame by frame images of athletes doing various things. And it really was my introduction to motion analysis. So it struck me that Dr. Klein had such an influence on you as well. It was extraordinary. By the time I was finished, I was teaching his rehab classes. You know, he taught me. I mean, he was John. He had he would go to the engineering department, the University of Washington and have braces built that can measure medial collateral ligament strain. And he would look at he was pronation supination and leg length relative inequality. He taught me all that. And the other thing he taught me was they the the athletic department would send him players to rehab. Because he had a special skill. And I saw those players being rehabbed and end up actually helping teach those classes, but also professors and other faculty members and staff members. He all doors led to him when there was a functional problem. And that was that was powerful medicine for me. Yeah, I think it's fair to say even at the orthopedic level at that time, sports medicine was just beginning to break ground. So as you really were on the very frontier of the whole movement. Right. Yeah, I think initially people were kind enough to tell me I was the father of sports medicine other time. I'm the grandfather of sports medicine. So I don't know if either is true, but I think both reflect my my length and that john that was over 40 years ago. Yeah. Yeah, I know. Okay, so let's fast forward where you're in Puget Sound you've started your practice, you know, you're, you're moving towards sports medicine you did a lot of work early on with spine. And you were became very prominent in the American College of Sports Medicine I remember that for when I was starting to go to that meeting. What was the environment like at the time that you began your career in sports. Medicine and sports medicine. Sure. The best thing that happened to me was that I was accepted to the residency here. And it was a traditional. I mean, this is referred to as the Department of Rehabilitation Medicine right and so the faculty that taught me I mean the, what I learned from stroke and spinal cord and brain injury and neuromuscular disease was so foundationally important to me. And so, what medicine was like when I was doing my residency was pretty traditional. I mean, there was no internet there was there were x rays there was no advanced imaging so it was, it was medicine that that many on this call will never experience but it was really bedside teaching and mentoring and having role models so I spent a lot of time, you know, clinical medicine and reading going to library and reading so that it was a more traditional, maybe not as enlightened period but there was, you know, there were still as there always has been there were giants you know I was trained by many of them I mean data turn layman and still often craft they were all here. Yeah, I used to say that the reason I chose this residency is that that way none of them could be my board examiner. I could hide from them. So I got that very strong foundation. And so even coming to the red, as with everything else in my life john I've seen the one a color outside the line so even coming to this residency I knew that I liked the physical Right, so I didn't even wasn't even focused on necessarily the traditional internal rehabilitation pathway although I embraced it for for the care and teaching and what I can learn, and the service. But even during my residency you know I would, there were some nascent pieces of sports medicine there was an early sports medicine clinic at at Husky Stadium and so I would on my, I would volunteer and go there on my own time, you know, and spend weekends with them trying to learn how to do coverage I just liked. There's issues of disability which is psychobiological and social issues and so I like that I like the learning, and so there were faculty here that were physically medicine focused I worked with them as well but you know, sports medicine what you're writing infancy I wasn't recognized as a specialty or a subspecialty there was no, there were no fellowships there was no CAQ. And so, john I never really went into it with the ad with any expectation of where it would take me except I just knew that that there was a body of knowledge that can be applied to people to help them improve the quality of their life. And what that didn't make a difference it was if it was on eight north and University Washington Hospital where the rehab ward was or the rehab outpatient clinics, or the orthopedic clinics or the nascent sports medicine Jim Garrick was here there was. This was an early home for people interested in sports medicine and I was a, you know, it's all about sacrifice when every minute I have that I wasn't doing something else I was there. You know, whatever I could do to help and certainly whatever I could do to learn so I wasn't I was a willing student I liked. It was just a perpetuation of what Professor Klein has started for me and fail the helm had encouraged in me and now it was being sort of realized or actualized through my residency training. And I was thinking about this because I think it's hard for everybody that's not as experienced perhaps as we are to understand that there was no pathway back then for sports me. So, finishing fellowship which in itself was pretty novel at the time I think I was the first musculoskeletal fellow here in Houston, and Bill Donovan, who was pretty renowned said to me, so john, you don't want to work in a hospital. And, and you are already out in practice so I mean what, how did you do, where did the gumption to start a practice outside of the inpatient walls begin and, and of course it wasn't about sports and it was about MSK and really spine. So, talk to me a little bit about that and where that came from. Yes, it's what it's what it's about now. I mean, you know, my, my interest in patient haven't changed I mean you can call it sports medicine but it was what it's the same as it was so you're right I finished, and you know Dr layman was a chair here and he brought me to his office and asked me which rehab position I was going to take in what hospital and I told him about doing sort of outpatient sports work and he looked at me so I hope you don't waste your career, which was a great sort of parting advice after after my internship and residency I just don't think he for the life and can understand why I would, you know, go that way, and I looked there were there wasn't much to choose from I went to the Academy meeting, and I went to the lectures and Mike Dillingham came and Mike was in Mike's North pictures he'd studied both and, you know, I don't have any original ideas in my life I've just sort of, you know, been a, I've been a quick adapter, and he gave a lecture which I thought was very interesting and had orthopedics and had rehab and exercise and he said you know this is what I do and we're looking to grow. So I walked up after meeting I really didn't have a job set up I said well I guess you're going to hire me then, because this is what I want to do. And that started a friendship and I you know went to packed up my bags and went to Palo Alto and, and Mike and the group started a small outpatient multidisciplinary practice right physiatry and orthopedic surgeon, there's an idea in the early 1980s. And I said okay. And they, they invented a little bit of a fellowship for me and they let me go for a month john and spend time with Stan James and his group I, you know, it was just it was it was this these are sort of the, the halcyon days of medicine we were all new at this right. And I worked hard I covered high school football two times a week to junior colleges, one division one college and eventually the 49ers every week. Because it was their opportunity was there. I'm surprised I didn't stadium food poisoning. And the, but you know it was it was such extraordinary opportunity and I you know I had privilege and I that was presented to me and I wasn't going to waste that and, you know, and I would go the OR still with Mike, you know, and look at and look and he would teach me operative anatomy and at that time, physical therapy was, you know, they were all of a sudden there were these things like manual therapy and there was just blooming right. And I would go to those courses. I said what is this that you're doing I don't understand this so I would go to physical therapy courses or go to their clinics and learn from them. We had the luxury of having a world renowned radiologist Dick Herzog who's still at age at HSS now. Dick was in Palo Alto and he decided to retire he was he was a GI radiologist but he decided he would learn musculoskeletal, and he came to our office and sat there and read images to us all day. And it was all just gifts, you know, I mean because you're right there was no structured curriculum so I just was the benefactor of opportunity that came my way and I was an enthusiastic recipient. And I tried hard I read a lot and I and I and I put in a lot of hours, none of which I regret. You and I have spoken in the past about sports medicine and what is it and I think we both agree that it's not a patient population it's a way of way of treating people and you know for you and I, it extends directly from our training and rehab and physiatry. What do you see these days in terms of, you know, how people are going about maintaining that kind of vision, if. Right, I think that certainly that it feels exploded and I once again I've been fortunate to kind of ride that crest you know when when you're early, you get to do a lot of things to start a lot of things you know if you're if you're willing. And so, you know, I. I think that sports medicine means different things to different people to me, and I think to you john. Yeah, sports medicine is to me, working with a multidisciplinary group to help someone identify their impairments limit their disability maximize their function improve the quality of life. Oh, I'm sorry that's the definition of physiatry. Right, so to me that's what it is. And you can do it a lot of different ways you can identify disease process process they have a cardiomyopathy or you can identify an injury that they have, or you can identify psychosocial factors and social factors that they have. So, it's the same principles to me, as it always has been. Find out who you're treating find out what their beliefs and values are be able to do a competent examination learn to listen and then get your team together and help them improve the quality of their life so I found was saying, you got to find the athlete and everybody. So yes, it's very exciting to take care of people who play sports and uniform, right. You know yesterday was a great day for me, let's see my first patient is getting all kinds of terrible advice she's being victimized again she's had everything cooked burned or ultrasound that you can no one's found out who she is so we kind of talked for a while about maybe there's hope and management my second patient is an avid dog breeder and we looked at her dogs and my dogs and then talked about how her dogs will keep her moving and then let me see the patient after that was a physician with issues but you know what, it's all the same to me so whoever they are and whatever they bring to the table the idea is to help them improve the quality of your life that to me is what physiatry is that's what sports medicine should be. No matter how no matter how you approach it. And, you know, I know maybe this sound that sounds trite or flippant but you know, it's not. I mean, my training, starting back with Professor Klein set me up to be what I what I wanted sports medicine to be which was helping people function, regardless of what they've got. Yeah, one of our colleagues carry read in Chicago has a very apt slogan on our web page it's because life is a sport. And, you know, that's essentially it I mean we help people move better. And I think that's where we come at it differently than other folks it's not about a set of symptoms or, you know, a structure that's not working it's about how it's all integrated or not. And, you know, john if I think if physiatry loses that that's that's a concern so I have made my career out of treating things that other specialties couldn't get better. Right, maybe complex pain spine issues. And so, the entree that opened door for me what they used to call me the other stuff guy. So, with teams or with organization will give the other stuff lecture to stand all that thoracic outlet and spine stuff and concussion stuff, because nobody on it's the other stuff. And I think physiatry makes its statement on fixing things that other specialty struggle to fix or connecting with patients on a different level. My only concern about our specialty is we not mortgage that you know a lot of people can examine a need but not a lot of people can put a knee exam and context of the person who has it and what it means to them, or vice versa, looking at why they got there in the first place. Thank you. Yeah, I mean you john you know this you live this I mean your, your, your whole career was run exercise and movement. So Stan you've been in a lot of organizations you've been leadership roles and a lot of organizations. I want to spend a couple minutes on password and how that came to be and what it's, you know what it still means, I think to our specialty since there's probably quite a few people don't even know what it was. But you know that was that formed when I was a fellow I you were a founding member and I joined shortly after that. It was a big deal then and it wasn't without its turmoil. But again, you know, change is hard and change for any specialty is hard and you have a traditional design tree learning tree and practice model which is fundamentally important to the health and welfare of the country but then young youngsters come in and they say yeah I kind of like the physical medicine piece and, and you you hunger to get concentrated information or learning or com or collegiality within your own specialty. While other organizations, many of which you've listed I was lucky enough to be part of, you know, a CSM and in a MSM and others. I think a lot of us felt that there needed to be something within our own Academy. I mean, our own Academy is Academy that protects our specialty and so I think the formation of password but people like you know john just one iteration older than you was the idea of trying to engage our membership within our specialty on areas that they found of emerging interest. And I think it was successful in that regard it certainly brought together a lot of bright minds and it gave young physiatrist a path so that they could once again the total look at sports medicine or musculoskeletal medicine for what it was. There are plenty of good musculoskeletal medicine long before password. I mean there are plenty of physiatrist you know I think of Ernie Johnson and others who were just geniuses George craft was that way. It was just us once again climbing on their back and just sending the ship in a little bit different direction. And now, over half of our specialty. Does that does musculoskeletal care and well, virtually everybody does but over half go into it as their primary area of specialization. Yeah. What about mass, how did that figure into your career and and that's the North American spine society for anybody that doesn't know what that is, and that was, that was pretty groundbreaking at the time to I mean physiatry moved in there pretty quickly once we started once the soul brothers all brothers started doing pushing out epidural steroid injections of cassette blocks and things of that sort, but how did, how did you interact with that crew with that. Lumbar spine was the organization right but it was membership only you had to be invited in and there were certain criteria and many people did not qualify or didn't like that sort of elitism. So there was a movement, kind of a nascent movement in the spine world about maybe starting a different society. And by that time in California. I was lucky enough to be working with orthopedic surgeons and neurosurgeons and physiatrists and you know and others and so the word came out that this organization was maybe going to, you know, I would be North American because me mostly Canadian and United States although it's become worldwide now, and actually Jeff, Jeff saw and I went to their first meet that organizational meeting in in San Francisco and they, there was a lot of conversation and introductions and then they asked how many people were orthopedic surgeons and neurosurgeons and we had to raise our hand and say we were physiatrist, and they so what are you doing here. And I said I thought there was a free lunch, you know, and so that was the beginning, you know, just once again sort of introducing the idea that maybe we did have a place at the table. And, you know, there are, I mean there are, there are great there were great leaders there for Cawley Willis and Don gun and these you know just these just giants. And they were receptive to what we did because you know what, listen, I was lucky john I said, I said a lot of impressive tables as a young man you all these people you want to have them autograph their book for you between courses at dinner. But the groups that I grew to respect the most. They didn't talk about their publications, or how big their office was or how many cars they own they talked about their patients. And that was really good modeling for me they were truly concerned and if you had something that they thought can help their patient be better they would they will let you in. But then you had to prove yourself. So, NASA was a good proving ground for physiatry in general. Took a while once again you know that to change minds but you know generations come and go and now, you know, NASA has a strong physiatric presence. There are physiatrist on every committee there physiatrist in the presidential line. And you know I was lucky enough to become president of NASA and I spent my whole year as president, not promoting physiatry, but promoting comprehensive spine care. So, once again, an opportunity presented itself I worked for it. But the privilege of being around people who truly were educationally gifted and had life experiences. I was all in. I mean I didn't miss a meeting and you know I was all in and whatever committee work they asked me to do I did and, you know, whatever lecture they asked for I was I was on board. American College of Sports Medicine been around a long time very broad coalition of professionals. You were involved in that certainly I think I'm curious, how did you get to be one of the founders at am SSM which I believe you're the only physiatrist, and everybody else was there. American College of Sports Medicine first once again, for those of you who have been to American College of Sports Medicine meeting the depth and breadth and areas covered I mean it's, it is, it is an intellectual candy store. I mean there are people walking down the hall who are the best exercise scientists in the world. And I love a CSM because everybody's name tag there's no initials after. You can't you can't you can't rest on your laurels. So you may be talking to someone you realize he's a Nobel Laureate. And I just loved I love that part so early on. I Karen Nielsen who is a primary care of internal medicine, early sports physician in Seattle dear friend of mine, Karen was involved in a CSM she said Maybe you could give a lecture we have this course in Breckenridge, and I said I think it was fine. And I said sure. And off I went and you know in that room. John Berg fell loud but it's just like the who's who at the back of the room. And I thought they were polite because they were listening to my lecture I think they were sizing me up more than listening to my lecture to see who this kid was. But I talked to you, you know who else was there john been Kibler. And it was over three hours later been and I was still sitting in a lecture hall talking. And I said, Ben, I'm the second smartest guy about rehab in this conversation. I met been through ACS and Margo took in a lot, you know, not just physiatrist but other discipline I ACS in was an easy match for me, because I still had that. Carl Klein want to learn the biomechanics part of me and the exercise physiology and john I had no formal training and exercise physiology but I was sure curious so to go to ACS him like you say I was lucky enough to get the john Sutton lecture, I knew john and I would listen to him talk about the physiology and climbing Mount Everest I mean it was, it's been a wonderful organization for me it's been almost 40 years I've been a member. I've been on the board. One of the things I'm the most proud of I guess is that for the last 25 years we've been able to have a multidisciplinary group that's pushed out the team position consensus paper. And that's that's a gift from ACS him. But in my involvement with ACS him as great as it was john that that whole issue that creeping issue of what are the ACS and members who are clinicians, where did they go to learn clinical medicine around musculoskeletal sports and ACS him did a lot of things that really didn't do that. And that was the genesis of the American Medical Society for sports medicine, the primary care doctors realize that they probably need another organization to teach you know how to examine the shoulder and, and how to how to order imaging and. And you're right, I was, I was, they did ask me as a physiatrist and they were all friends of mine and we'd done a lot together and including inventing the team physician course curricula and lots of time together in a lot of rooms. And so we thought that sports medicine wasn't owned by any specialty, but that people should come together, particularly since non-operative sports medicine was not so codified and have an organization where the clinical aspects of sports medicine is being discussed and that was the origin of AMSSM. And of course, that was about the time that fellowships started to bloom. You know, this was now late 80s, early 90s. And, you know, I remember vividly interviewing for his fellowships and most of them were either orthopedic sponsored or family medicine orthopedics. There was only two physiatry based fellowships, one at Mayo and one at Michigan State, which was sort of a combined EMG sports with gym or Mike, Andrew. And, you know, so our options weren't very broad at the time and you had to interact with the family medicine people, which was interesting to me because I think still to this day, there's a little bit of, who are you? Why are you here kind of look at things. But, you know, clearly when you're talking with Bergfeld and the other founders, I mean, that didn't, that wasn't part of the equation. So I'm curious where that came in and there was seeming to me a bit of resentment and or bias early on. Sure, of course there was. I mean, you know, doctors are interesting people. We were highly opinionated and sometimes we don't let the truth get in the way of what we're thinking. So everybody has their belief systems and their comfort zone. And, you know, Bergie and I are good friends. And when John first met me, he kind of looked me up and down and I proved to him though, that I knew what I was talking about. So I delivered when I was in the room to set up the team physician course. I volunteered for lectures. I did a job that impressed him and I showed him I knew what I wanted. I, you know, John, I think it's good for doctors to be in a space where they don't have entitlement or privilege, right? So sports medicine, we didn't inherit it. It wasn't ours by fiat, but it does make you, it's the same thing as being a team doctor. You're not the number one source there. You're not the number one and most important thing. So in those situations, you dedicate yourself to try to demonstrate your competency. And I think that that bridge building was helpful. Bergie's smart. I mean, Bergie's the one, he's the one who put John Lombardo to the Cleveland Clinic and had the first primary care sports medicine fellowship, right? And he understood that there were different ways to get people better. So you find people like that, Ben Kippers that way, many others are, and you work with them and then you show them what you can do. And you, listen, people consistently overestimate what they can accomplish in a year and they underestimate what they can accomplish in 10. I think that's a Bill Gates quote, but I think that's right. So, you just work with no expectation of anything except hoping that you're given an opportunity to demonstrate your skillset. So it's sure there was resistance and there was some hard feelings along the way, but for those who were enlightened, they found that the partnership among different disciplines was more than additive. Your practice reflects that, John, many people on this Zoom practice, it reflects that. And so there's always gonna be detractors and there's always gonna be people who say no, but I just was either too stubborn or too dumb to stop, or I just wanted it too much, not for the recognition as much as for the, I saw something that could clearly be better for patients. There was no question that our involvement improved patient outcome with neurological and musculoskeletal problems, no question. So, of course, now we have exercise as medicine, which to some of us isn't a new concept, but it was formative not so long ago. But let's switch gears a little bit and talk about how sports can be tragic too. And Zach Lystad, who you had the privilege of taking care of, I think you'd say, and you were formative in Zach's law and maybe take a few minutes and tell the audience about Zach and what happened and what came of it, which I think to me was one of the proudest moments I ever had as a physiatrist was seeing that presentation that you gave about Zach's law. Yeah, you saw courageous people on the stage and they weren't me. You saw Zach and his family, that's what you saw. And that's why it moved you so much. The courage and the fortitude of this family is absolutely awe-inspiring and it should generate gratitude in all of us for the privilege of trying to help them. So, Zach was 13 and he was playing football. He was clearly concussed, didn't know where he was going, kind of confused, and he wasn't taken out. And he played symptomatic and took a second blow. And if it wasn't for Harborview, he would have died, but he was saved with extraordinary loss, but no one understood his magical gift and his family's persistence. And he got better. When I met Zach, I was covering training camp at the Seahawks and there was a young boy with a feeding tube in and his father on the sideline. And of course, as a physiatrist, I just kind of walked over there, you know, and I introduced myself and I said, well, who are you folks? And Victor was his father and Zach, when he's just arthritic, voiced at times, he said, I'm Zach. And I said, well, what are you doing here, Zach? He says, I'm here to help people. How's that for an introduction? I said, really? He said, and his dad said, yeah, we just don't want this to ever happen to another kid again. That's all it took for me. And, you know, I was connected to the Seahawks and, you know, the GM had known Zach, and so we started talking and then Richard Adler was the attorney who knew them. And so, you know what, the Seahawks were in, we were in, the Washington State Athletic Training Association was in, even the CDC was in. And we said, you know what? This is an opportunity to do something that has a public health influence. And so in our mind, it was education. So we got tons of material from Kelly Sarmiento at the CDC. We co-branded it. We had a coach Holmgren write a letter to every coach in the state of Washington. We put all these educational materials together. My favorite saying was, you know, I crisscrossed the state of Washington raising awareness about concussion and raising my cholesterol. All these, you know, PTA potluck dinners and pregame, you know, barbecues and just trying to get the word out. You know what? And we made great strides with certain schools until a coach left or an administrator changed. And we realized that what we were doing was we were teaching individuals, but it wasn't sticky, right? And so Richard said, maybe we should legislate this. I said, legislate medical care? Who does that? He said, well, schools are rule driven. And if you make it a rule or a law, then they'll follow it because it fits in their rubric. It was such an extraordinary lesson about frame of reference. It wasn't what was important to us. It was important to them. So this started a process of us working with a team and a lobbyist. And we found the legislator in Zach's district and we got him excited about the idea. And we found a legislator from the other party and got her excited about this idea. And I learned how legislation works. And in a short time window with, once again, a lot of volunteer efforts in late nights, believe it or not, we were actually able to negotiate Zach's law, the Lysette law, with all the warts that come along with trying to get something passed. And I'm proud to announce that mostly due to Zach's testimony, the law passed unanimously in the state of Washington. And within four years, there was Lysette laws in all 50 states in the District of Columbia. And that was, the laws aren't perfect. They were not meant to be perfect. They were meant to be modified. Many states, over 20 now, have modified their laws many more than once. We wanted the law to be organic. The law doesn't solve all the problems, but it raised awareness, John, in a context that had meaning to schools. And there's been other examples now around cardiac laws and others that have followed that. So it was extraordinary work. And once again, for me, the new learning was over the top. I mean, I testified as a doctor and I said my piece, but that was the easy part of the work. So it was invigorating. Clearly to me, the thing I'm the most grateful and proud of in my professional career was to be able to have physiatry involved in actually advocating for someone with a brain injury on a national level and implementing policy change, which is now law. So my hero, listen, John, I have had a very privileged career. I've treated a lot of athletes and famous people and wealthy people. And you know what? I don't have very many heroes, but I got one. And that's Zach. Zach Leistad is a heroic figure to me, as is his family. So what a gift for me. You know, and in true physiatric fashion, there was a team that did it. And what was the, how many years did it take? It sounds like it actually moved along fairly quickly, but it was- We learned a lot. I mean, the legislative window in the state of Washington is small. We had like a hundred days once we decided we would give this a go to make it happen. And so as we sit now, I don't know, 18 or 20 states don't have seatbelt laws, several that may don't have motorcycle helmet laws. You know, there's all these things that states don't have, but within four years, we got it in all 50 states. Now having a limitless amount of support from organizations such as the NFL was helpful. They gave us all the resources we need, including finding people to testify in certain states and helping us hire lobbyists and giving us resources for outreach. And you know, it's amazing when the commissioner in the NFL calls a governor, the governor picks the phone up. So once again, just trading on the relationship piece of this, John, never asking for anything for yourself was key to this. It's the ultimate form of giving, right? I didn't, there was nothing in it for us. We didn't want anything. It didn't elevate our financial stature or professional relationship, but it was true service. It was invigorating. Yeah, kind of what we're supposed to do. I think so. Yeah. Stan, what's, you know, over the years, concussion's not a new issue, but how have you seen the approach and the management of concussion? What's changed and what's still left to do? You know, it's interesting, John, when we have a physiatry resident in our clinic, it takes them about a week to understand the sports concussion program because they have been trained in brain injury, right? If you have a doctor who's not a physiatrist and you bring them in, it takes a lot longer. So what's changed is the world's finally caught up to us. They understand that this is a complicated injury with psychological and biological and social implications, right? So the awareness piece, I think, should have elevated our specialty to demonstrate what we have learned. That's why I say the most important thing for me to be a concussion doctor now was the brain injury rotations I did as a resident. It was the foundational knowledge. And so there is more awareness. I think the treatment's better. I think the hype around concussion, unfortunately, has gotten to the point now where there's some catastrophizing. But once again, all attention is good attention when it comes to brain injury. Ironically, John, the door opened for funding for brain injury research had to come through concussion. So yes, I like the awareness. Yes, I like the appreciation of removing unnecessary head contact and taking every concussion seriously because a brain injury is always serious. I also hope that this attention allows people on this Zoom to take ownership of this topic. There's a very specific skillset that we need to offer, and there's not enough physiatrists who are doing, there's not a physiatrist doing brain injury at any level. But certainly if you're gonna think of yourself as a sports medicine physician, please don't abandon concussion and don't abandon low back pain. Don't abandon the stuff that sets us apart. Thank you. So what's it been like to be a team physician at all the levels that you've worked at? And how would you put that into the perspective of your career as a whole? It's been, listen, John, I've been to four Super Bowls. I've got Super Bowl rings. I mean, it's exciting. That's fun. I mean, I've been with, as you said, every level of team. It's fun. It is not exactly what people think it is. It is, you're not necessarily rewarded for your competency in those settings. And I've liked it. I've liked once again to be an ambassador for physiatry in those locker rooms. It brings privilege. You know, I've been to the White House. I've met presidents. I mean, it brings privilege. There's no question about that. And it also brings some notoriety. For example, John, the Lysette Laws were a lot easier for me because I was a Seahawk team physician and the Mariners team physician. It gave me, it opened doors for me that my academic bona fides would not. So it's great. I mean, it's fun. It takes a lot of time. It's not about you. John, I never strove for it, ever. I mean, I started with high school. I love taking care. I just love Friday night sports. I love, you know, covering wrestling matches. I just, you just, the organicity of it, right? You know, and what it means is seeing people unified. And I've liked all levels of it. I guess maybe the biggest compliment to me is that players who have retired still come to see me and they ask me about their families. And after a while of being a team physician, there are many people on this Zoom who are team physicians, you find out it's much less about the game and much more about the relationships. I mean, I retired from the Seahawks this year after 33 years. I mean, the games were fun. I don't, you know what I miss? Working with other physicians, the athletic trainers, the equipment room staff, the people that work in the organization. I mean, I was just as valuable to the organization because I could help take care of someone's cousin who needed to be hospitalized with a CVA or someone who had a question about chronic pain. You find yourself embracing that family of the organization in a way that other specialties often don't. That was as satisfying to me as game day. So we're at a point now early this year, earlier I should say this year, where we're starting to get some headwinds again about being team physicians and we're doing our best to try to make that right. But how do you see physiatry fitting into the world of sports medicine? And are we going to go through a similar process that we already did with the pushback we're getting from the NBA about being team physicians? Yeah, maybe to not discuss that specific issue in too much detail, because it's active and there's a lot of people involved in that. But in general, there's always going to be challenges. I mean, I spent my career sort of running into them. There'll be people who question anyone's capabilities or training who is not in the same discipline as they are. There will be people who think that they need to be, I mean, the biggest mistake that you can make as a physician, certainly as a team physician, is to try to own it all. That's a big mistake. The best thing I've ever done as a team physician is encourage players to get second opinions before they ask for them. And so I think that physiatry has a major role in what we're calling sports medicine. And I think that because we're musculoskeletal and neurological doctors, and that is a huge, orthopedic surgery is a big part of all, contact and collision sports, but the great majority of sports medicine is non-operative neurological and musculoskeletal injury. No one knows that better. No one knows how to diagnose and treat that better than we do. So I think that we're there in our ultrasound skills, or at least we use ultrasound as a tool and not as a substitute for an exam. So I think there's a big role for our specialty. I do think, John, that for people like you and the next generation behind you, the continued involvement in advocacy is necessary. I'm in the fourth quarter of my career. Some people say I'm in overtime. And so this soon will not be my fight, but you cannot, we will never be given the default ownership of sports medicine. And so because of that, I think you have to continue to advocate. You have to continue to show your skills. You have to continue to be a good partner. Don't whine, don't complain, be patient, work hard, sacrifice, don't ask for things too soon. The quality of the work speaks for itself. But this is not, listen, if you want to be a sports medicine doctor, it's not nine to five, it never will be. So you have to want to do that part of it. I don't think every physiatrist who wants to call herself or himself a sports doctor needs to cover teams necessarily, but you need to be open to advocating for young people and families who need to be more physically active and also who need to understand their musculoskeletal neurological system better. So no, we're in. I mean, I don't think we go away. I think this dust up like many others will be settled and a new generation will come along. I mean, John, compared to when I started, things are looking pretty good. That's true. That's a good perspective. So Stan, we're going to get ready to close up soon. I want to invite people if they have questions to start posting them. So let me conclude my questions to you, Stan, by asking what in your career has given you the most satisfaction? What are you most proud of? I think I have an idea, but I'd love to hear it from you. It's interesting to give these perspective lectures because it forces you to reflect upon your own life. I'm proud I remember what I ate for breakfast this morning, John. That's a start. I think the thing I'm the most proud of is the effect that I've had on my patients, right? That they believe in me and trust me. The non-historic visits in the exam rooms. That's the thing I'm the most proud of is that we've been able to work as a team to help people improve the quality of their life. I'm proud that musculoskeletal and sports medicine has risen within our own specialty. It become more recognized. I'm proud that our physical medicine and sports medicine is known outside of physiatry, as we were just talking about. You know, that we have a seat at the table and we just have to keep earning it. And so I think those are probably the most sustaining professional accomplishments. You're right, John. Listen, I am proud every time I give a named lecture, particularly a memorial lecture. That's very flattering, right? And you're proud to get those awards. It's so unexpected to me. When I got the email telling me that I was going to be given the Frank Kruzan Lifetime Achievement Award, John, I read that email as though they were asking me who I would nominate. It was so far from my mind that I would even be a candidate. I didn't even understand the email. I was typing in names. Wow, this is a good person to think about. I had to reread the email. So I'm proud of those things, but the more sustaining is what's done for the patient and what's done for the specialty. And I'm also proud of the friendships. I love to teach, as many people on this phone. So I guess I'm proud of the fact that if I've been in some lecture hall somewhere and someone's listened to me and it gave them one idea, I'm proud of that too. I think these are the same things you're proud of. I think these must be the same things that everybody on this Zoom is proud of if they think about it. I mean, yeah, listen, I have a lot of hardware and trophies and Super Bowl rings. That's all fun stuff, but that's not the juice, John. That's not it. Yeah, I think you told me the other day you're not done yet, so. I don't think, I hope not, unless people start telling me I am. I start wandering down the hall with soup stains on my time. Maybe somebody will give me a cookie and send me home. I'm still trying to push a little bit more. So listen, everyone, we got about five to six minutes. I'd like to, again, invite anybody who has a question or a thought about our conversation tonight to please feel free to ask. You can put it up in the chat and we'll get it posted or get you to elaborate on it on the question. Dan, anything else you want to say while we're waiting for questions? No, I just want to thank everybody for sticking in here and listening to an old man rattle on about his career. But yeah, if there's anything I didn't answer or a topic I didn't cover that has relevance to you, please ask me now. I mean, I'd like to help. So if there's something else you want to talk about or something you want me to sort of speak to in more detail, please ask me. I know it's always hard to break the ice here. We didn't talk about this earlier, but now you've got a, it's a multidisciplinary sports medicine clinic at UW, and I think it's in the stadium, is it not? Right, we have actually four locations, five locations now, and one in the stadium and one at Harborview, and one, I mean, we're all over town. And it is, you know, we're working closely with our primary care and orthopedic colleagues, but we're also- It's pretty novel in itself. I think so, in a good way. And building those bonds, you know, and John, we are so intricately involved with that. I think that if there's any success that comes out of the program, it's because those were working relationships, but we're also very, you know, like physiatrists. I mean, we know a good sleep doctor and we know a good psychiatrist. It's no different than anybody else's. It's all that relationship building and advocating for your patients. And so I like where, I feel proud to be back at the University of Washington. I guess that's one thing I'm proud of, is I'm finishing my career where I started, so I'm proud of that too. Very nice. Well, looks like we've, Brian, do you have anything that I don't see? No. Okay. Well, John, that means this was really good or really bad. Oh yeah, something just came through. Okay. That is the ever so clever Dr. Stander, Chris. It is so good to see your name. So Chris is a perfect example. Chris, we begged Chris to come back, Stu, and not to join us. He did. He was very kind not to explain to us. He was a lot smarter than we were. He just kind of let us rattle on and quietly made us better. And- I've heard him speak. It's intimidating. It is. He's read a book. And so Chris, and a personal loss, but he went to Pittsburgh where look what he's done. He is changing the face of evidence-based medicine around the spine. So Chris, we still could put a candle for you in the window, but I'm very happy that you're making a difference and please let us hire your next fellow, okay? Thank you, Dr. Vennessy, Madam former president. Yes. I know. If I would have known that you were on the call, I would have maybe won a better tie. Well, Stan, thank you very, very much. I guess we have one other question here. We got a couple coming in. Okay. Mostly saying thank you. Oh, Monique asks, when being a team physician, were you pressured by the team owner or coach to return players to play before the player was ready? Very good question. Everybody goes through this as a team physician. What's your take on it, Stan? Monique, that never happened. It was all, everybody held hands and we sang a lot together and had long lunches. It couldn't go forward, no. Not only was I pressured by those people, and most of the pressure comes from the players. I mean, the players are highly motivated to return to play. So when you become a team doctor, at any level, frankly, the first thing you need to do is write your resignation letter. You have to decide what you're not gonna do. And if you get asked to do it, you have to be prepared to walk away. If you're a team physician, you cannot need the job. You cannot need it for your career, your personal advancement. You cannot need the job. And so, yes, there's pressure, but you early on establish what your role is. You are not the player's friends. I don't hang out with them. You don't take selfies with them. You don't go to their parties. You're not the coach's friend either, really. You're in an interesting place where your professionalism is all you have. Everybody's richer than you, bigger than you, faster than you, more famous than you. And so you cannot mortgage your medical position. So you need to establish early on what your role is and how you'll respect them, but they need to respect you. So the pressure is different. It's always there. It's not as overt as it used to be, but you really, once again, at the professional level, some of the biggest pressure is from the players because they realize that their position is perishable. And so it's just all about walking in. It's like setting up a rehab plan with your patient. You have to plan for what your relationship's gonna be and you have to stick to it. And it's not always, people say, oh, it must be fun to be a team physician. It's always interesting. And it's sometimes fun. So Stan, our last question from Dr. Hubbell, what do you think the biggest difference is between taking care of professional athletes versus college athletes? Sue, it's so nice to see you and also nice to see you not expose me because she was a residency ahead of me. So she knows I really don't know anything. So I do appreciate you keeping that on the quiet. Sue, the difference is narrowing with college athletes now having, sort of being able to have their own brand and advertise and be paid. So elite college sports, particularly in certain conferences is not too much different than professional sports in terms of player motivation and the pressure the players are under. However, when you get to professional sports, every player on the field is the best at every play. And you'll see very talented college athletes be drafted. And after a couple of days, you just want to say to them, you should go home now before you get hurt. Because the level of performance is, it is physical literacy in an unbelievable fashion. So professional sports, every player is the best. No one takes any plays off. And there's no masquerading that there's anything but the sport in front of you. They're not student athletes, they're athletes. However, at some colleges, the pressure is similar. And so it's, I think the level of skill, the temptations, Sue, are so much, I mean, there's so much money and so much privilege and so much power for professional athletes. It's a hard, I can't imagine if I was given those opportunities what I would have turned out like. So I think that that is a bit of a difference. Although once again, high profile college athletes, and also the loyalty is different. I mean, if you go to the University of Washington, you're a Husky football player. If you play for the Seahawks, you're a Seahawk until you're a free agent. And then maybe you're a Seahawk or maybe you go who pays you better. So there's the business of it's a bit different. But you know what? The injuries are similar. The forces are not too much difference and the demands are increasingly similar. It's just, I think the stage is bigger for professional sports. And those of you on this Zoom would do the same thing. Maybe I'm saying that correctly, maybe I'm not, but there's nothing like covering professional sports in terms of just the theater, the show of it all. It's quite extraordinary. I mean, I don't know, Sue, I don't know when you go to work, but is there a military flyover before you go into your office, right? I mean, do you go in the locker room and snoop dogs in there? I mean, it's just such a different world, you know? It's just such a, and the expectations for performance are so unforgiving. It's just amazing. Well, Stan, thank you again. This has been a real fun time for me and a privilege and I think everybody enjoyed it and I hope you did as well. Thank you. Listen, I appreciate it. And for those, I would like to thank, I recognize some names and I, you know, there's so many people, I feel like, you know, that used to play music, John, that rolled me off for getting an Academy Award here. But I think of the friendships, you know, Chris and Stu and all the physiatrists and the associated staff and the office staff that I've had the privilege of working with. That's the, to me, the things I would like to offer is there's no way you do this on your own. There's no way you do it without making a lot of mistakes. So I appreciate everybody on this Zoom and I also appreciate the people that I've been lucky enough to interact with for the last 40 plus years. Well, by the looks of the Zoom or the chat, everybody appreciates you as well, Stan. Thank you very much. Have a good night and hope to see you soon. Take care, everybody. I really appreciate the evening.

Dr. Stan Herring

sports medicine

physiatry

residency in PMNR

American Academy of Physical Medicine and Rehabilitation

team physician

Zach's Law

concussion management protocols

changes in sports medicine

impact on patients