Thank you for joining us in person and virtually at the 2022 AAPMNR annual assembly. We're thrilled you could be here to take away new information in our field, connect with friends and colleagues, celebrate during physiatry day, discover new research, and reinvigorate your passion for our specialty. Thank you to our program planning committee, faculty, and attendees who helped make this the best annual meeting for PMNR. Just like immunication and planning the next, we can't wait to make more memories at next year's annual assembly. We'll be gathering in New Orleans in person again and virtually. We can't wait to see you all there. Stay tuned to aapmr.org slash assembly for the latest updates. We need your expertise to help shape our 2023 assembly. What makes this meeting so valuable is our diverse backgrounds and skill sets. We want you to spotlight those by submitting a session proposal and or research abstract. Visit aapmr.org slash 2023 to learn more about submitting. See you next year. Good morning everyone. Please welcome your 2023 AAPMNR president, Dr. Stephen Flanagan. Good morning everybody and happy Sunday. Thanks for joining us here today and really for this entire week. As I look back on this assembly, I really remain excited that we were able to have a hybrid conference. Seeing you all here, sharing the event with our colleagues online, absolutely terrific. The knowledge-sharing during educational sessions, the connections you've made in person and those online, and the little catch-up moments that you squeeze in between those events just to say hi to a colleague that we haven't been able to do in three years. All of these activities help to make PMNR's biggest event for the year an event to remember and indeed it was. But now on to the main event. This year the Program Planning Committee had the difficult task of choosing our FizTalk presenters. We received incredible submissions this year and we hope that that continues well into the future. So for those of you here today and online, think about what you might want to share with us next year during the FizTalks in New Orleans. Over the course of the next 90 minutes you're going to hear from six physiatrists and we ask that you listen to each of their presentations carefully because near the end of this session we're going to ask you to vote. You're going to vote by scanning a QR code on the screen using your cell phone just like you're at a restaurant where they don't have menus anymore and I'll provide directions for you later during the sessions and how you go about that. Please also note that these presentations are the personal stories of each speaker. All of the statements and opinions expressed do not necessarily reflect the opinion of the AAPMNR. Okay, so we're going to be going in alphabetical order. So first up we have Dr. James Atchison who is presenting exercise in medicine a physiatrist patient story. Dr. Atchison, welcome to the podium. Well I'm glad he reminded me that my opinion doesn't matter or mean I'm representing the AAPMNR here but I will say good morning and I'm going to start real quick with something we all learned yesterday which is for those of you out there who may be visually impaired I'm a six foot two inch white male. I have my hair back so that will be noticeable in some of the slides that are gone but I learned yesterday that something powerful that we've never seen at those sessions before so I want to thank Dr. O for teaching us all something yesterday about that. This is my story about being a physiatrist and a cancer patient and I'm happy to say I've beat cancer twice now and we're going to talk about that story. We're going to talk about that and the journey and how I felt it was important and what I know as a physiatrist on this on this journey as we went through it and and talk about all the special things that happened to me. So 2011 I was at work University of Florida DJ happened to be gone so he didn't help me get my MRI scan when I came down to the problem but you know he helped me when I got back but started having back pain which is kind of funny for a spine guy right and it didn't get better with exercise. This is about exercise in medicine and I was exercising then but it really didn't help. We got to study myeloma in 2011 that wasn't a real good disease to have there weren't a lot of good things yet but I would tell you this story is about a lucky guy. I'm a lucky guy. I had remission chemotherapy, maintenance chemotherapy. I went back to work. I went back to exercising. I felt very good. I even came back to the AAPMNR meetings just as an aside so everything was going along well and I became more of an advocate of exercises medicine and this was before that term was copyrighted so please don't once again the AAPMNR and copyrights you know how things go with that but so but that's where I started talking more and as a physiatrist I was out talking the talk trying to promote this but mostly it was literature research. You know I was talking about what I'd read and studied and done things with. I will say that you know not everybody followed the principles. This is the hotel where I was speaking and somebody came to the treadmill with a little extra support from their sonships but you know it's good. They were thinking maybe exercise would work well. So fast forward I was still on chemo and maintenance chemo but doing well and in 2020 when the rest of you were starting to learn about COVID and learn how to do virtual visits I was not feeling very well. I started having symptoms again. Back pain, night sweats, things. Myeloma could be back. It's been ten years. That's about the range for it most of the time but it didn't look like that and so on to the rest of the imaging, PET scans. Those of you aren't used to looking at a PET scan you can kind of see the distal forearm and the distal leg where you don't see the bones. That's what a PET scan is supposed to look like. All those bones that we see are not good things to see on a PET scan from there. So my bone marrow biopsy this time it's leukemia. So ALL. ALL in a 65 year old is not a real good prognosis and so my friend oncologist called me that night and said this is ALL and I remember sitting there and I'm sure my wife does also with him giving us the news and he said you know you need to be in the hospital in the morning. We're gonna start treatment immediately. I said well wait a minute you know I got a schedule tomorrow. I got patients on the schedule. He goes no you don't understand. I was very naive. This is not this is not wait and see. This is get in the hospital in the morning. We're gonna we're gonna we're gonna have to start giving you the real deal this time from there. So anyway I listened. I went to the hospital, checked in. I'm a PM&R doc. What do I do? I start I start building a team right. We got in the hospital, the nurses, everybody. You see my family there most of whom are here today and they've experienced this and and lived through it also and I can't thank them enough but but with a team we know in PM&R things get better with a team and I was lucky. I still have my team from Mayo that works with me. I had my team from Shirley Ryan Ability Lab that was still involved with me from there. Even had PM&R team which is kind of interesting because COVID's going on and my son was starting med school at The Ohio State University and so on the white coat ceremony which was done virtually, which would never have been done virtually other than COVID, I got to attend from my hospital room and lo and behold part of the speakers are the president of the OSU Medical Alumni Association Dr. Deborah Vennessy and the Associate Dean for Medical Education Dr. Dan Clinchot who is a physiatrist and trained with us at The Ohio State University also. So COVID interestingly helped me get through my two years of treatment and it's probably not too many people in the world that say COVID was a good thing for them. Well we move on from I've always talked the talk exercises medicine and I've kind of walked the walk because I was an exerciser but now it's real. You know this is the real deal. Am I going to do it? Am I going to walk the walk? And I did. We started walking on the unit. Interestingly I didn't realize an IV pole is an assistive device but it is because when you got balance problems it helps you get through that. You see my other assistive device there on the other side with that. Once again notice everybody's got a mask on, right? We're on the unit in the middle of COVID having chemotherapy, waiting for a bone marrow transplant with masks on. But it was fascinating because the hospital was safer. There was less infection in the hospital during COVID and the worst problem for a person in my situation is infection. You'll notice one thing I'm wearing the shirt from the hospital today not just because I ran out of clothes but the idea is we learned and my wife's a rehab nurse we met it at Ohio State but people don't come out of the room because they don't get dressed and they don't get dressed because they have a lot of problems. They have like pick lines in but if you have a shirt that opens up you can get to your pick lines or you can get to your central line, right? And so we started talking to people about what do you do to get dressed and get yourself out of the room, right? We can go up, we can go down, we can change all those things around. I had never thought about how we do it in the rehab hospital. We get them dressed every day. They become people. What we do is right and so we started trying to help people on the unit do those things besides walking, stretching, you know, it's chemo. Some days I could do it, some days I couldn't, some days I had more energy but I was trying to walk the walk in addition to talking the talk. A lot of chemo done by the end of the year. Who knew as an aside that the mustache grows back before the hair on your head, right? So just just in case you're ever in this situation, once again my team and masked up because we had to stay without infection and the only other good piece was during COVID nobody went to the stadium, right? We all had cutouts so I got to go to every Ohio State game and my cutout was sitting in the stadium during COVID. Yeah, good news on that. November wasn't quite as good though from the standpoint that we came home from clinic one day my wife and I and we're we're talking and all of a sudden she said I can't understand you. All garbled. Well, we all in the room know that's unfortunately probably going to be a stroke. So she immediately checked my right side and I still had strength there and said we're going back to the hospital but as a good rehab nurse would do she made me pee first because she knew I'd have trouble doing that eventually so you know but I was having a stroke so I got to learn more about the NIH stroke scale than I ever thought I wanted to know. If you can name those six items you're having a good day today. Try to tell the story on the other side which I never quite did figure out but I couldn't tell it at first but I will tell you I believe TPA works because I couldn't name any of those objects when I got to the ED and two hours later after the TPA I could name all six objects and so once again I'm an extremely lucky guy. I've avoided another major problem and we all take care of stroke and I have for years and I'm just so blessed that TPA had that effect. Next on the agenda is bone marrow transplant so that's got some risks with it too. We decided we'd have a little pre-party. My daughter was home from school at UF because they're all on virtual school at this time right so we had a we had a party before we went in for the bone marrow transplant because we wanted to try and celebrate early and it's all about this. It's hard to see on the slide but that little bag of cells is what this is all about. This is what changes a person's life when they have a bone marrow transplant and you you know you think bone marrow transplant and it's got everything. It's this bag of cells and thankfully people donate and we appreciate that tremendously. Be the match is a special place. Any of you with your families want to get registered would be a great idea. Once again not endorsed by AAPMNR in any sense so you know but I would support be the match as much as we can. The first part of getting out of the unit when you have zero white count is it has to come up to at least point one or point two and then they want to get you out of the unit when you can and we all know that's a big time and it's important and the first step after it is getting out of the unit. The second step is the first hundred days. This is where most people die and so we were very cautious and I was blessed with my team again. This is my mother-in-law and my sister-in-law who was a kindergarten teacher and she decided she would torture my mother-in-law make her draw things for me every day so we had the team working through there but once again signs were different and we got through that. COVID is still going on and I had no infections. It was such a blessing and nobody else is probably going to stand up here and tell you that same thing. I beat the hundred days. I'm starting to talk with my oncologist about what do I do next. He said well in good oncology PM&R interactions you probably know more about this than I do right so so he kind of let me go. He did forget to tell me that while I'm on tacrolimus I'm not supposed to drive because it's got cognitive effects so that's my medical pearl today but I was hoping and thinking I could go be a physiatrist again so that day came November a year ago. You can see my little lunchbox which those of you worked with me in the past know I've carried that lunchbox for 30 years going to work and the problem was I forgot when I parked I had to go up the stairs to get to my office right so I had to start practicing the scares again and walking the walk while I'm talking the talk but I'm lucky I made it back and part of the story is what did I learn as a physiatrist in this time frame. First of all I hope it never happens to you but if it does act like a physiatrist. We know so much more about how to recover and do things to get back on our feet and be functional than any other group and so you need to act like that whether you have this or not start acting more like a physiatrist all the time. Teams are important. Help people build a team, use your teams, empower your teams, make your teams talk the talk, walk the walk, do the things that we want to do to make everybody better. This was important to me and we tried to keep building teams with all the other people on the units. Talk the talk. You know we go to a lot of meetings and we sit there and all the specialties that are high powered we consider them and we listen to them and then we often don't say what we think is important. Talk the talk. Be the nuisance. Put your hand up. Excuse me? Excuse me? What about exercise? What about function? What about return to their quality of life? We sometimes are quiet as a specialty. We need to talk the talk more and then walk the walk. One of the things I do like about our specialty is most people believe in exercise. Many people actually do it themselves but they are promoting it all the time. This is such an important part of what we do in PM&R that everybody in the world needs whether they've been sick or not. We can talk about preventative exercise versus you know recovery exercise, things like that. But the biggest thing I learned on the unit was get people up, get them dressed, get them in the hallway, make them think they're people again and not just patients. And think about in your training if you're not doing inpatient now. What have we done for all the years that I've been in this specialty? In the rehab hospital you get up in the morning and your PT and your OT and your nurses come by and they get them dressed and they help them get dressed and then they go to breakfast and then they start to have a schedule and they live a life. We've been doing it right for all these years. I didn't even appreciate how much so. I'd like to thank one of my mentors who taught me a lot of this, Dr. Ernie Johnson. Many of you know him and unfortunately some of you might not from there. Keep in mind he would disagree with my use of the term physiatrist as he always wanted it to be physiatrist. And we even still have some t-shirts. I was trying to find my slide with the t-shirts on it. But really the take-home message is it's no mystery, right? What we do is what we do but we just don't do it enough. We don't tell people enough but this is what a physiatrist does. And I'm still the luckiest guy in the world because I have such a wonderful wife and I can't thank her enough for all the support during this. But this is a story that does have a happy ending and I appreciate all that and I appreciate being back at the Academy meeting this year. Thank you very much. Thank you so much, Dr. Atchison, for that story. Our next speaker is Dr. Mihir Joshi who will be presenting the best laid plans how to extensively negotiate your first job contract, have it not work out anyways, leave within a year, and land on your feet anyway. Welcome Dr. Joshi to the podium. Thank you Dr. Flanagan and thank you to everybody who was able to make it this morning early on a Sunday, on our last day of the annual meeting. And of course, thank you to everybody who's tuning in virtually. My name is Mihir Joshi. I'm a first year practicing attending, just finishing fellowship last summer. And I'm gonna be telling a story, my story, about, well, trying, failing, trying again, failing again, trying again, and with the help of friends and community and a touch of grace and gratitude, eventually succeeding. So I have no relevant disclosures. And what I wanna start with is the summer and fall of 2020. We all remember it very well. COVID-19 is affecting the entire country. It's affecting health systems everywhere, large and small. And that's when I graduated residency and got into fellowship. And in speaking with previous year's fellows, we got really kind of concerning stories from them about fellows who had found jobs in 2019 and in early 2020. And due to the financial pressures caused by COVID, smaller practices had to rescind their offers. There were practices that unfortunately had to close, furloughing their employees, larger institutions, even state-run institutions, having to go on hiring freezes, no longer being able to hire the individuals that they had made the offers to. So that was kind of the, I guess, pre-job market that I had entered into. And that was, of course, very concerning for a lot of us. As I'm sure most of you remember, your fellowship year is about three months of learning how to actually do what it is that you're sub-specializing in, followed by three months of furiously trying to find a job, and then six months of actually trying to master that you tried to sub-specialize in. So here's what I was told by my faculty, by other fellows that I had talked to who had come in previous years. Try to go to as many places as you can. Go to different practice environments, go to different parts of the country, try academics, try private practice, try community hospitals, consider the VA. And the point was that there's not one perfect fit for everybody, and you kind of want to find the place that works best for you. And this was kind of pre-COVID advice, where it was a lot easier to travel, it was a lot easier to set up these kinds of meetings, and it was a lot easier to see the practices in person. The other thing that I was told, and people didn't say it enough is that, or I mean, people couldn't say it enough, was that partnership, equity in a practice was a must. You want to go to a place where you feel valued, that you're invested in the outcomes of the practice, and you're made an equal voice in the room. And kind of consequent to that was don't get exploited. Don't go to a place that doesn't value you, that doesn't really let you practice the way that you feel is appropriate, that doesn't give you a voice in the room when discussing new procedures, new processes. And the most important advice, the one that seemed to keep coming up, no matter who I spoke with, was not to wait. And this was, I think, the most COVID or 2020, 21 relevant advice that everyone seemed to want to give, which was that there weren't a lot of practices that were in a strong enough financial position to want to hire a new graduate. So if you found one that seemed to be a good fit, you should just jump on top of it and be happy that there is something. So having taken all of that advice on board, I interviewed at several places. I was fortunate to have the capacity to travel and to be able to interview in a variety of different settings. And I landed on a job that I thought was a good fit, that I thought served the kind of practice environment that I wanted to see, had the patient population that I wanted to work with, and allowed me to do the kind of work that I wanted to do. Turns out most of that was not quite right. And I think most of that falls on me, probably, not asking the right questions. And that's a learning point, right? Like every time you negotiate an interview, you're gonna learn a little bit more about what it is that you want from your work and from your career and from your family and work balance. So it ended up not being a good fit. And then I was confronted with one of two possibilities. I try to stick it out and make it work, or I decide to pull the cord and try to find a different landing spot. I opted for the second, quitting my job without any prospects lined up. And of course, that was terrifying because you're a new graduate, you've got student loans, you just moved to a new place, and now you're re-hunting for a job, having thought that you had kind of negotiated and settled that part of your life, at least. And I started looking, and I was very fortunate that thanks to societies like this, and thanks to the friends that I had made through residency, fellowship, meeting people at these meetings, I had a strong network that I could go to. And I started talking to people about where they were, how did they like where they were at, were there opportunities there? And that led to three fantastic job offers. This is in the fall of 21. A year prior, I couldn't have gotten these three offers. Or maybe if I could have, I didn't think myself capable of that. So ended up with three good offers, ended up taking the one I liked, and I'm in a much better place now, and I'm happy for that. But I don't think any of that could have been possible without that first unfortunate failure. So this is my advice to anyone who is early in their career, or is in training right now, looking to negotiate their first job contract, or make a move for a new job in their future. Do your due diligence, do what you can. Ultimately, understand that despite your best efforts, there may be things that come up in your work that are not gonna be exactly as you envision them. And sometimes that's okay. Like, small things can be lived with. And you kind of have to make that decision of where your boundaries are, what is it that you need to have, what is it that you want to have, and what is it that you can kind of go with or without in your professional life. The other thing that I would really encourage you guys to think about is not to feel rushed. And this was something that I touched on at the earlier part of this presentation, which was that there was a big feeling of urgency in my fellowship year because of what we had learned about the financial status of the practices, and just this pressure to find a place that would take you and could support you. And I would say that that contributed maybe more than other factors to what happened to me. So I would recommend to you guys, wait for the one that really clicks for you. And you'll know it when you feel it and when you see it. There is a great job out there for every one of us that gives us the fulfillment that we want, gives us the recognition that we want, allows us to work with patients in the way that we want. And it's there. So don't feel like you have to rush into the first thing that's offered to you. This next piece actually has been discussed a few times at some of the early career panels at this meeting, which is that most people don't end up staying at their first job. Obviously, I'm a little bit more dramatic of an example, but a lot of doctors across specialties will leave within the first few years of starting their first job. And that's only natural. You're gonna learn a lot about who you are and what it is that you want from your professional life in those first few years. And you may find that where you are currently is not the right fit for what it is that you want for that next step of your career, and that's okay. It is okay to, after some amount of time, if you feel like it's not a good fit, to try to find something that's a better situation for you. And this last point, I would encourage you all not to undervalue, and it's that being happy in your career, being happy with where you are, being spiritually and morally content with the type of work that you're doing has a value. It's worth trading money for, and ultimately, your own moral success, your own ethical well-doing and well-being will gift you further profits down the road. So I encourage you not to try to compromise on anything that you feel is a red line. You know, understand where your ethics are, understand what matters to you, and there is a job out there for everybody that allows you to be the best version of yourself. And I mean, if you have any questions, that's my LinkedIn, that's my Twitter. I'm sitting right over there. I'm happy to talk to anybody afterwards. Thank you all for your time. Thank you. Good morning. So my name is Kelsey Lau, and I am a PGY4, UT Southwestern in Dallas, Texas. And I am so grateful and excited to be here to share this story. So I would like to start with a question. What does it mean to live a remarkable life, a life full of impactful moments? I think we've all been the person here at the top of the mountain watching as others climb. And we've all, you know, been the person still trying to reach the summit. So as I give this presentation today, I want you to think about the people that have made an impact on your lives. Both Kat and I are IMG Academy alumni and having played soccer there at different times. So I was deeply inspired when I listened to Kat give a TED talk at IMG Academy online in 2015. She spoke about her experience playing Division I soccer, which we both did, and then traveling to Bolivia to play soccer as well. And then she had this sudden illness which ultimately led to a diagnosis of myasthenia gravis and a brain aneurysm. So as I listened to her story, I felt so deeply inspired. I felt this admiration and and this amount of respect for her because throughout all her challenges and setbacks she was able to start a non-profit called I Am More, which I'll talk about in a moment. So Kat ended her TED talk by asking one very poignant question. What is more important? The quantity of years or the quality in those years that you possess? And this to me, I was blown away with how she was navigating this new diagnosis of this neuromuscular condition and yet had the energy and the wherewithal to develop this non-profit at the same time. So as we know, myasthenia gravis is a neuromuscular condition. It weakens your muscles with activity and one would think that playing soccer would make this pretty difficult. I feel like a lot of people at that point would have said, let's shift my life to accommodate this diagnosis and and let it take over their life. But Kat did the exact opposite. She asked herself, how can I be better? How can I use this experience and make a difference for others going through this type of diagnosis? And that's ultimately how I am more was started in partnership with one of her closest friends at the time and a professional baseball player, John Ryan Murphy. So what is I am more? I am more allows kids, teens, and young adults with a physical disability or a chronic illness to pursue their passion in life and be more than their diagnosis. To me, I feel like it's essentially allowing the participant to see life through the lens of a child or a teenager instead of a patient. Kat's desire to live a courageous life was contagious and it pushed me to do more with mine. I was so inspired that I ended up emailing Kat a few days later after watching this TED talk online asking how I could get involved. So at that time she was in Florida and I was in Oregon in med school. I was essentially a stranger reaching out, asking her to instill trust in me to carry out her mission of I am more in the Pacific Northwest. Kat's desire to live a life full of positivity was contagious and it made me ask myself, what more can I do with mine to make an impact? So to give you an idea of what I am more is about, it offers a multitude of resources for patients and families that include passion classes, going to MLB games with Murph, adulting 101, which talks about how to budget, how to do taxes, how to build a resume, and how to get a job. Another really important resource that we offer is what's called an overcomer sponsorship, which is essentially where we create an individual experience for a child's passion and personality, empowering their identity to be more than their diagnosis. So while in med school, a good friend of mine, Andrea, and I started the Pacific Northwest branch of I am more. We're now called what's I am more parachutes and essentially we help facilitate overcomer sponsorships, we coordinate silent auctions, and we have held community events, which you can see here in these slides. These are some of the pictures that we've had from our early days of I am more in the Pacific Northwest. Zarek, some of you may recognize him. He's a former Timbers player. He was kind enough to organize a one-on-one session for one of our overcomers that love soccer. And it was through these experiences and in reflection, taking the time to really think about the impact we were making, that I realized the value and the impact ultimately that we had on these kids and their families. Hearing how supported the kids felt about making new friends, trying new things, and feeling confident enough to conquer their fears. Memorable moments for me include watching one of our 15 year old girls, Shelby, participate in equine therapy, learn how to take care of horses, and then days later get to meet her favorite artist, Katy Perry. These are all things that as an I am more parachute we organized. The Oregon Zoo was kind enough to provide a behind-the-scenes pass, so Shelby was able to learn how to feed the bears, feed the giraffes, and take care of elephants on a much more intimate level than a normal zoo visit would be. One of our other overcomers, Kirsten, she has three big passions in life. Baking, reading, and playing with her dog, Jolly. And knowing that she in particular struggled a little bit more with confidence, we tailored this experience to make it as positive a growth experience as possible. So she was able to have one-on-one time at a bakery with a professional chef. She learned how to make a gourmet cake. We contacted her favorite author, who sent her a personalized autograph book. And because of her love for Jolly, we purchased BarkBox, which further fostered the relationship she had with her dog. We couldn't do what we do with I am more without the funds, obviously. So fundraising is and it will continue to be an important part of our role of parachutes. Through organizing our silent auction fundraisers with the support at this time of three former Timbers players, we raised around $5,000 to bring more awareness to our community in the Pacific Northwest and the impact ultimately that's had on the kids and their families. So after starting residency in Dallas, I partnered with a few of my co-residents to begin a chapter in Dallas. We've made a small, I would say, but powerful impact through the pandemic and we've held events like outdoor movie nights, as you can see here. So I want to pause because for me at this point life comes full circle. Kat, to me, continues and will always be an inspiration. We both grew up with goals to play soccer at the highest level possible and her diagnosis of myasthenia gravis and a brain aneurysm did not derail her. Her drive and her thirst for life is just who she is at her core and it's how she has become so successful. So this past summer Kat played for the US Women's Paranational Soccer Team in Spain and won the World Cup. Let's stop and think about this for a moment. She's playing soccer at the most competitive level with myasthenia gravis. So I'm telling you this story not so much on my behalf, but to share her story and how she has made an impact on me. To aspire to more. To demand more from myself and more from the other people around me. To set higher expectations and to make a powerful positive impact. So I now ask myself, how can I be better? How can I work harder? When I challenge myself physically is when I personally feel the most alive. So I've hiked to the top of Mount St. Helens and I now run half marathons about every quarter. Professionally, I've taken on more responsibility becoming chief and continuing to work on my leadership skills. As you can see here, my two other co-chiefs are absolutely phenomenal human beings and I've found that it's really enjoying who you work with that makes the journey worth it. Kat and I have a very solid friendship based on trust, loyalty, and respect. She continues to ask more of me but honors my boundaries when I say I'm overwhelmed. And the picture that you see here is of me on island time and it's about taking that moment to stop, think, and reflect, which I don't think we do enough in medicine. When we do take this moment to stop, think, and reflect, it's in these moments that we find the most impact and how we can move forward and really challenge each other to be better, to ask more of ourselves and more from each other. My involvement with I Am More started in 2015 with one simple email reaching out asking how can I get involved. So in this moment I want to empower each of you. I challenge you, what more can you do to make an impact on the lives around you? Whether that means going and buying a stranger coffee, getting involved with your local nonprofit, or taking those few extra moments to tell your loved ones how much they mean to you. Go out and make that step forward today because as we all know in medicine all too well, this moment, this moment today is all we really have. Thank you. That music is so dramatic. Thank you very much Dr. Lau, that was really inspiring. Our next speaker is Dr. Alexander Levine who will be presenting Building a Mobile App for Rehabilitation Purposes in this High Tech Era. Welcome to the podium Dr. Levine. Good morning everyone. Thank you for being here this morning. So as Dr. Flanagan said, I'm Alex Levine. I'm a PM&R resident at the University of Montreal in Canada. I am very happy to give you a talk on how I build a mobile app for some of my research project in regards to rehabilitation. I have no disclosures beside the fact that my mobile app was in French since most of our mobile app users spoke French and some pictures in my slides contain French words but I'll make sure to translate what's important. I'd like to start off by giving you a little bit of background about myself. I'm a distance runner and many years ago I was running cross-country and track at the University of Kansas and during my time at KU I was studying biomechanical engineering. I've always been interested in trying to implement technology into the healthcare system and this is still true these years. Now fast forward to 2019 when I started my residency I was also passionate about sports medicine and wanted to do research on Achilles tendinopathy. I wanted my study to have really close follow-ups with participants and keep track of dynamic variables such as pain, treatment adherence, weekly running mileage, minutes of physical activity, etc. That's when my team and I had the idea to create a mobile app that would allow us to collect those data. The first step was to design the mobile app. Therefore I used PowerPoint slides to draw what my app would look like. I made extremely detailed slides. I put arrows to explain what each button meant as you can see on here on the screen. I had about 150 slides to describe the whole thing because I wanted to make sure that everything was super clear. Then the second step was to find a programmer and there were multiple options available. You either go see programmers at your university or find a private firm of programmers. So I decided to use the Upwork platform to find my programmer. It's almost like a social media, social network where freelancers advertise themselves and people with ideas hire them. On that platform I found a talented programmer who had a trustworthy resume and hired him. He was in China and had worked on numerous other mobile apps before. I was very excited to start working with him on this mobile app. However I didn't realize it would be complicated to sync our schedule together for Zoom meetings since he was in China. I actually had to connect on Zoom a few times around 2 a.m. so that we could chat during his work hours. It ended up working great except for my sleep. He programmed the codes so that my mobile app would do exactly what I wanted. Once he was done with that part we had to try the mobile app on several different smartphones. So I sent the beta version to my friends and family and told them to look for glitches so that when we would launch the mobile app for real there would be no technical issues. It was also checked by the computer technicians at our hospital to make sure there are no data leaks. When everything was ready we finally launched the app on the Apple Store and the Android platform. The steps to do so were pretty straightforward. So basically you follow the steps written on their respective websites and they just want to make sure your product is safe and follows all their requirements. So for example we had to send them the ethics review board approval and we had to create a password system so that only research participants would be allowed to use the mobile app with individual passwords. So now I would like to... I have a few pictures of the app I want to show you to give you examples of what we can do with such mobile apps. So on the menu page we wrote down instructions on how to use the app. We uploaded a video that showed how to perform the Achilles tendon eccentric strengthening exercises which was the intervention treatment in our study and participants could watch it as many times as they want. And then there was a section on the app where participants could enter their weekly data. There was a page for data about treatment adherence, a page for pain intensity and a page to quantify their minutes of physical activity. They would check a box each time they completed their exercises, so once every morning and once every evening. Here's the page where they entered their pain intensity according to the visual analog scale and here's the page where they entered their minutes of physical activity with and without impact, meaning if they were running or jumping. We needed to distinguish both because they don't have the same influence on Achilles tendonopathy. If participants had not checked a box in regard to their treatment adherence for two days in a row, our system would send them a text message as a reminder to do their exercises. After each week, participants had to submit their data by clicking on one particular button and their data would automatically appear in what I called my dashboard. From there I could upload the data in Excel and generate statistics. I am not here to talk to you about the results of this study but I have other interesting results to show you. We sent a post-trial survey to participants in order to better understand their satisfaction with the mobile app. The survey revealed that 100% of participants agreed or strongly agreed that the mobile app was simple and easy to use. 94% strongly agreed that the mobile app was more convenient than paper forms, online forms or answering emails. 83% agreed or strongly agreed that the mobile app helped them to stay motivated for their Achilles exercises and finally 72% strongly agreed that SMS reminders increased their exercise compliance. So now where do we go from here? Now that I have a mobile app programmed to collect data, I will be able to tweak it a little bit in order to use it for other circumstances. It'll be a great tool to collect data for other research projects and also for outpatient clinic follow-ups. This app should be useful for my future practice in sports medicine and regenerative medicine. In that particular field but also in many other fields it is so important to follow dynamic variables closely to assess how our patient's medical condition evolve. Nowadays patient reported outcomes are crucial. We need to understand the impact of what we do. For example a lot of providers are doing PRP injections and they inform patients about the outcomes from some some trials they read in journals. However there is so much variability in the types of PRPs being used so there is no way they all generate the same pain improvement. That's why I think it's crucial that you are aware of your own outcomes. Using such mobile apps will be a convenient way to do so since patients have their phones in their hands all the time almost 24-7. If you want to learn more about patient reported outcomes I invite you to check out this very interesting article on the NIH Collaboratory website. To conclude I would like to thank the team I worked with to create this mobile app Dr. Lamontagne, Dr. Gagnon and Mr. Hong Sipan. I hope this talk will inspire you guys to use technology at its full potential when you'll go home. Thank you very much for listening. Thank you so much Dr. Levine. So we have two presentations left. These have just been absolutely terrific and I'm glad that you're all here to help us pick a winner because man it is going to be tough and I don't want to be the one responsible. Our next session is Dr. Zainab Sirazi who will be presenting The Words I Never Said, Rehumanizing the Patient Narrative Through Awareness and Gratitude. Dr. Sirazi. All right. Good morning everyone. How's everyone doing? Made it to the end of the conference. I applaud you all. I'm Zainab Sirazi and I'm a PGY3 at New York Presbyterian Columbia Cornell and I just want to start by thanking you all for being here in person as well as those of you who are tuning in virtually. Today I really want to talk to you all about the relationships that we have with our patients and really my goal for this session is to bring us all into a state of reflection. So we're going to start with a little exercise. Show of hands. How many of us have been thanked by a patient? Most likely all of us. I want you to imagine that in your hand you have a piece of string. It can be any color you want, pick your favorite color, but in that string I want you to tie a knot for every patient who has thanked you. Now hold on to that string while I tell you about three of my most memorable patient thank-yous. The first is a story about a ten-year-old boy named Nico. Now Nico had cerebral palsy which resulted in severe spasticity in his lower extremities so this meant he wasn't able to rock climb on his own. I met Nico several years ago on my first day volunteering with an adaptive climbing group back in Chicago. I was assigned to be his designated side climber which meant I was responsible for guiding his legs as he pulled himself up rock by rock to the top of the climbing wall with a giant red bell at the top. Now despite numerous attempts Nico had never reached that red bell at the top until that day. On that day Nico and I slowly made our way up the wall rock by rock until finally he reached that giant red bell at the top and rang it with an overwhelming amount of excitement and joy and in that moment he turned to me and he said I can't believe I did it. Thank you. The second is a story of a 17-year-old girl named Rachel. Now Rachel's car had slid off of a cliff during a storm resulting in a cervical spinal cord injury with complete quadriplegia. She was devastated and every day her family would sit at her bedside and console her as she cried. At the time I was a medical student and I was just trying not to get in anyone's way so I spent hours sitting at Rachel's bedside and each day she opened up more and more. I learned that during the storm that caused her accident she had been driving home from a high school graduation party. I learned that she had planned on traveling across the country to pursue a career in early childhood education. After each conversation Rachel thanked me for spending so much time with her. Some days were better than others but every day I would walk into Rachel's room and find her crying until one day she wasn't. Instead I walked into Rachel's room and I found her staring at a large post-it note on the wall across from her hospital bed and the post-it note had scribbled writing on it that read I'm not what happened to me I am who I choose to become. The third and final story is one about a 26 year old woman named Andrea. Andrea had lupus complicated by severe recurrent joint infections ultimately resulting in a transfemoral amputation. I wasn't a medical student anymore this time I was the inpatient resident responsible for her care on the unit. I was just another busy resident running around like a chicken with its head cut off just trying to keep my head above water with the constant looming anxiety that something somewhere was happening to create a problem that I wouldn't be able to take care of. I remember the day that she was transferred to the unit. I stayed late to work on her transfer and go through the fat stack of papers containing her extensive medical history that detailed just how much Andrea had been through. But what that fat stack of papers didn't prepare me for was the weeks that went by without a single family member visiting. She had no emotional support and so I frequently sat with her. She asked me to distract her from her condition and during our time together I learned that she'd been a soccer player. In fact she actually put herself through college on a soccer scholarship. So I sat at Andrea's bedside and showed her pictures of Paralympic athletes telling her stories about their amazing accomplishments and each time I saw her demeanor get a little bit brighter. And on the day of her discharge Andrea handed me this. A bracelet that she had made during her inpatient stay and she looked at me and she said thank you for being the only one who challenged me to believe in myself. These are the three thank yous that I remember most. I remember Nico ringing his giant red bell. I remember the post-it note in Rachel's room with the inspirational words. And I still have the bracelet that Andrea gave to me. Three patients with vastly different stories but they have one thing in common. They all changed me. Remember that string that I asked you to hold on to? The one with a knot containing, well the one with a knot for every patient who has thanked you? Well now I want you to imagine that you have a different string and on that string I want you to imagine a knot for every patient you have been thankful for. Which string has more knots and are they even close? As physiatrists every day our patients challenge us and in doing so they inspire us. They change our perception of future patients. They change the way we practice medicine and over time they change us. As a resident who's worked on the front lines of the COVID pandemic I often find myself reflecting on the ambitious goals that I had as a medical student and the impact that I sought to make in the lives of my future patients. From the beginning of our medical training so many of us are instilled with this inherent need to find and fix problems. But we all eventually come to realize the reality of our own limitations. That there are some atrocities we can't reverse and some pains we can't extinguish including many of the debilitating injuries that we see in our patients every day. And yet we continue to try. Why? Why do we suffer through those sleepless call shifts, the interrupted family dinners, the dehydration and jitters that comes from having one too many cups of coffee? Well I can only speak for myself but I think we do it for that one look. And I think most of you know what look I'm talking about. That one look that makes you stop and think wow I actually made a difference. I think we do it because we can. I think we continue to try because maybe, just maybe, we will do enough to make a difference. We continue to try because in pain there is healing, in suffering there is empathy, and in times of discomfort there is adaptation and growth. We live in an ever-changing arena of political debate and societal discord. One in which time and time again we are called upon to raise our voice as physicians and advocate for our patient's best interests. But in the midst of all of this uncertainty one thing has remains constant. That the power of the patient narrative will always serve as the foundation of our role as physiatrists. At a time when burnout has become commonplace and suicide rates continue to rise, it is imperative that we continue to remind ourselves of the unparalleled gratification that exists in our relationships with our patients. Because our patients are always thanking us. And so maybe it's time we start thanking them. Because in the future, when I'm looking back and I'm thinking about the relationships that I had with my patients and the impact that they had on me, I don't want to overlook that. And I don't want thank you to become the words I never said. Thank you. to see after almost dying. Doctor, come on board. Good morning, everyone. My name is Yuna Sinski, and I am a chief resident at Mary Free Bed Rehabilitation Hospital. I am a 5'4 in height, curly long hair, Asian female, wearing a pink dress. I was too short to actually use the podium and look at the slide simultaneously, so I'm wearing a little microphone next to my face. And today, I wanted to share my journey, both being diagnosed and having treatment throughout my residency training. I'm going to go grab this real quick. All right, but before I share my struggles, let me tell you about who I was before all of cancer. I think just like many of us who go into physiatry, I was a young, energetic, happy, easygoing person who was so excited to be part of my Mary Free Bed residency because I had an attending who dressed up in a giant blowup dinosaur and greeted their patients. And I was allowed to dress up like Pikachu or a unicorn, and I would be able to go greet my patients and also congratulate their journey back home as well. However, one month into my PGY-3 year, I was diagnosed with stage 3 rectal cancer, and then my journey of cancer treatment began, just like Dr. Atchison in the height of COVID. It was so strange to go from the young COVID doctor, resident physician, to being a immunocompromised cancer patient. And my cancer treatment, unfortunately, was filled with complications. It was very unusual complications, too, that led me to four months of inpatient hospital stay, seven days in the ICU on a ventilator, five different major surgeries, eight months using an ostomy bag, four months of NPO and TPN, and on top of that, I lost 30% of my body weight, which caused me to be a two-person max assist, and I was using a bedpan, and maybe on my good days, I was using a bedside commode. But my journey with cancer treatment was still filled with multiple gifts, cards, text messages from my wonderful coworkers, and that included the CEO of our hospital, CMO of our hospital, my fellow residents, attending physicians, and nursing staff. Honestly, everybody was truly cheering for me to return back home to my residency. And finally, after two weeks later, I had my final surgery. I got to return home. My resident physician got a huge unicorn pinata and had a banner saying, welcome home. And our cancer rehabilitation doctor, who, Dr. Megan Smith, actually got into her unicorn outfit and came to my ice cream party. And as you can see, I was just so grateful and excited to be back home to my residency. However, I was still struggling mentally and physically. Honestly, once you remove your rectum after rectal cancer, you can no longer hold your bowel movements. And that forced me to go to the bathroom 20 to 30 times daily. I had to starve myself throughout the entire day because I didn't want to activate the gastrocolic reflex that we all know of. And once I returned home, I would actually find anything I could eat so I would keep my weight up. And after that, almost two, three hours daily, I would have to sit in the bathroom just to empty my bowels fully so I can go to work the next day. All of this wasn't easy, but I never really shared this with anybody at our hospital. And looking back, why would anybody know that I was going through such a difficult time? I looked fine. I looked fit, maybe even fitter than before because I lost body fat. I had all my hair because I didn't lose my hair from chemo. I wasn't strong enough to tolerate chemo at all. And I had so many scars in my abdomen because I had three emergent exploratory laparotomies, but all of those were hidden under my clothes. So to the world, honestly, I looked healthier than ever. About five weeks into my return back to residency, I was waiting for a patient to observe a spine injection. I see this girl, probably mid-30s, just like me, walking into the hospital C-suite, I mean, yeah, C-arm suite, in her hospital gown, just like me a few months ago when I was in the inpatient unit at UCSF. More importantly, not just the clothes, but I see something very familiar in her face that I recognize. And that was the facial expression of hopelessness. You see, when I was on TPN and PO four months in the hospital, nobody was able to really figure out what was wrong with me. And there was always this fear that I might never be able to eat again. And I might always be on TPN, which is not really something I would want to do. And I was on TPN, which is not really sustainable with life long-term. And that devastating period of my life taught me hopelessness. I learned it so well that I was able to recognize it in a complete stranger. And that was absolutely devastating to me. I remember that was a Friday night, Saturday came, Sunday came, I was completely impaired from PTSD and flashbacks. That was the first and last time, hopefully, that that ever, ever happened to me. Sunday morning, I actually decided to email the attending physician I'm working with that Monday. I stated what was going on and I said, hey, I might not be able to come on work Monday, but I will try my best. I wasn't able to make it to work on Monday, but I was able to make it on Tuesday. And I never missed a single day of work afterwards. But I learned that that attending actually complained to other attendings, stating that I didn't show up to work on Monday. And I don't know why, but whatever reason, that was the comment that broke the camel's back. Looking back, I think I was so devastated from that comment because I was already questioning myself of remaining a physician. How would I still be a physician when I couldn't even control my own bowel movements daily? Maybe the old person who really enjoyed dressing up in unicorn costumes and running around the hospital all the time was gone because in reality, I was so scared to put on the unicorn costume because I might not make it to the bathroom on time. I think the attending physician's comment was so piercing to me because it was something I feared so much. Maybe I wasn't suited to be a physician anymore, and maybe the old me was completely gone, and cancer consumed who I was. About eight weeks back to returning to residency, I made the decision that, you know what, I'm no longer suited for residency. Of course, how would I be suited for residency because all the things were going on? I was a completely different person now from all of it. So I went to my program director, Dr. Ball, who ironically also had a history of cancer, and I said, Dr. Ball, I am going to start my transition to quitting residency. He listened to me for a very, very long time, and he said, just give me six more months, and if you want to leave in six months, I will support you fully. And looking back, that was the best advice that anybody gave me after returning to residency. And here I am 16 months later. I'm a chief resident at our hospital. I dress up as a dinosaur trainer or a unicorn and greet my patients again, and I'm giving a phys talk here in front of all of you guys. And most importantly, I am in two years remission of my cancer. Oh, thank you. Yeah. But don't let me fool you. Don't let me being up here like this fool you at all. I am still struggling daily. My days are filled with tears and struggle. Honestly, every day I think about cancer recurrence. Every time I get a blood test, every time I get a CT scan, every time I just feel tired. Even when I was listening to Dr. Atchison's recurrence, I was thinking, oh my gosh, it dropped my heart completely. When I hang out with my friends after work, I have to carefully calculate the time and give myself a flushing enema. So I wouldn't have to go to the bathroom when I'm hanging out with them. And sometimes I get really excited about my future, my future job. And I also think about maybe I can get married to my significant other who stood by me through all of this. But then I get afraid. I get afraid that maybe I'm not gonna make it to my own graduation. Maybe I won't make it to my own wedding. Maybe I won't make it to my own wedding. See, unfortunately, when cancer treatment stops, that doesn't mean that your struggle ends then. And I am still fighting every day. But fortunately, the fight does get easier. So let me tell you, if you are somebody who is currently going through any major illness like cancer, mental or physical illness, and watching this talk, I want to tell you that my journey back to work wasn't easy at all, but it was possible. And it is possible for you too. You might be too sick to even be here right now. You might be watching this video in your hospital bed, but I want you to know that you are not alone. And the person who decided to come into medicine with such an excited heart still is in you. You might feel like you're completely gone. But remember, you were just forced to grow up a little bit faster than you wanted. Just like we grow up a little bit from being a child, just how we grow up when we get married or even have children of our own. You're just a little bit different. But remember, you are you, and that will never change. And for those who are currently going through cancer treatment and working or return back to work, of course it's really hard for you. You are going through something so difficult. Taking care of other people when you're barely surviving yourself is of course difficult. But I hope you can be better than I was. And I hope you can tell yourself that it's okay and practice self-compassion. Because yes, you are going through something extremely difficult. And for those who may know someone who returned back to the field of medicine after an event, friend, colleague, or family member, I hope you can extend out your empathy to them. They might look fine just like me, looking super healthy, long hair, running around with a giant smile on their face. But inside, they might be still struggling. So extend your empathy out. And more importantly, remember to give even more empathy for yourselves because we all need that. Lastly, I wanna share something so amazing that happened this week to me here at AAPMNR. It was a few days ago at the job fair right downstairs here, and I met this wonderful physician, Dr. Lisa Pascal, who apparently I met a year and a half ago. When I was really, really sick in the hospital, about two months in my hospital stay, there was a knock on my hospital door. The nurse was doing my wound changes in my abdomen, so I wasn't able to see her or to ever get to learn her name. But she left a beautiful flower and also a note just like this. Turns out, my mentor from medical school who lives in Vermont contacted a physiatrist in Northern California where I was getting my treatment, who then took time out of her busy day to cheer up a patient who was a physiatry resident in Michigan. I am honestly so proud and honored to be a part of such an amazing family just like this. Thank you so much for giving me the opportunity to speak today. I really hope we can continue to be cheerleaders, not just for our patients, but one for ourselves and also for each other. Thank you very much. Thank you. Thank you so very much, Dr. Szynski. These were truly, truly inspiring talks, really touching. So let's take a moment to just give a big round of applause to our Fizz Talk presenters. All right, now it's time for a bit of friendly competition, and it's not going to be easy. Using your cell phone, please scan the QR code shown right here on the screen and vote for your favorite presentation. The criteria that you choose are yours. While everybody is voting, I just want to take a moment and really express my gratitude for everybody being here online and in person for the last day of our annual assembly. As I kick off my presidential year, I'm really most excited about all the opportunities that lie ahead, not just for the academy, but for our members, physiatry, and the field of physical medicine and rehabilitation. You'll read in my first presidential editorial, which is a great read, in the physiatrist that this is a great time of challenge and opportunity for PM&R physicians. And I'm really looking forward to strengthening the vital work that we have embarked on in the academy to advance our field, because that's what we are about. Your efforts in championing the undeniable value physiatrists contribute to healthcare is essential to the success of BOLD, physical medicine and rehabilitation, and quite frankly, medicine in general. I encourage all of you to get involved with us. We have so many initiatives in motion to boldly advance the future of our specialty, and your insights are critical to making this process a great success. It's going to require a team effort, something that physiatrists excel at better than any other medical specialist, and I think we learned that even through all of these talks this morning. I'm confident that by all of us coming together, we can really advance physiatry and ensure that we continue to play a vital role in medicine. So as you're all voting, and I think we still have a few minutes left, just to tell you that over the course of the next year as your president, that I'm going to be committed to advancing our field, ensuring that everybody, our key stakeholders, the C-suite, the payers, our members, our patients, everybody that needs to know our referral sources, that we are committed, that physiatrists are essential, vital, and necessary to attain the triple aim of medicine, which we know is better population health, ensuring better patient experiences, and that it's all done more efficiently. So thank you for all of your support. I'm going to be asking you that over the course of the next year. And you folks vote quickly. It looks like the votes are in, and we have a winner. And the winner is Dr. Yuna Sinsky. Dr. Sinsky, please come to the stage and be recognized as the 2022 PhysTalk Awards winner. And a big thanks to all of our presenters. Congratulations, Dr. Sinsky, but really, congratulations to all of our presenters. Thank you all for attending the 2022 Annual Assembly. It's been a fantastic week, and I really hope to see you all next year at our 2023 Annual Assembly being held in New Orleans, I'm supposed to say, Louisiana, November 15th through the 19th. For those of you who are here in Baltimore, thank you so much for coming. Safe travels home. For those of you online, thank you so much for joining us, not only today, but all week. Have a great rest of your Sunday and the weekend, and thank you all for coming to Baltimore. See you next year in New Orleans.

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