Good morning! Happy Sunday everyone. Thanks for joining us here today and this entire week. As I look back on the assembly, I continue to be amazed at all of you. The knowledge shared during educational sessions, the connections you've made in person and those online, and the little catch-up moments you squeeze in between to say hi to a colleague. All of these activities help make PM&R's biggest event of the year an event to remember. And now on to the main event. This year, the Program Planning Committee had a difficult task of choosing our FizTalk presenters. We received incredible submissions this year and we hope that continues in the years to come. Over the course of the next 90 minutes, you will hear from six physiatrists. We ask that you listen to each of their presentations because near the end of the session, we're going to ask you to vote. I'll provide directions later in the session. Please also note these presentations are the personal stories of each speaker. All the statements and opinions expressed do not necessarily reflect the opinion of the AAPM&R. Okay, so first up we have Dr. Irene Astoriz, who is presenting Building a Scholarly Muscle, Hormesis and a Growth Mindset. Good morning. Building a scholarly muscle. Run, bike, swim. You probably are already thinking that I am a triathlete. Well, I've completed several half marathons and a full one as a race walker, not as a runner. I've not been back on a bike since 2015 after a nasty fall in Vancouver. Swim? I can swim. Only if my life depended on it. But as an academic physiatrist, I am expected to excel in three areas. Patient care, education, and research. The first two came naturally and easily for me. The last one I had to train hard for. Early in my academic career, my department chair encouraged me to pursue research seriously. She sponsored and mentored me, sent me to several of those grant writing workshops with the explicit expectation that I would become an independently funded investigator. With her coaching, mentoring, the support of her well-oiled administrative grants team, I submitted my first grant for federal funding. And guess what? It was funded. The first thing she said, congratulations. The next, don't get used to it. And she was right. My previous, my successful attempts were not successful. I subsequently moved to a different institution and did not have that same support and did not have that same mentoring. So I stopped. I told myself, been there, done that. I continue to participate in research, submitted smaller grants, and published. I was happy not to do any of the heavy lifting that came from investigator-initiated research. And as far as I was concerned, I have checked off that research box. And then a no-fo arrived. Not a UFO, but a notice of funding opportunity. And this was huge. Up to a million dollars for five years to support long COVID programs, both research and clinical. And we needed it. Our long COVID program needed it. Our patients needed it. The clinician's heart in me felt so compelled to pursue this. There was ample time to prepare for this. Had I not wasted, yes, wasted a fair amount of it, contending with two voices in my head. The first voice said, I'm not ready. Seriously? I mean, who am I to think I can do this? And with that, I started a quest to identify a research colleague within my institution with the creds. You know, the track record of successful funding and publication and a well-oiled grants administration team. I begged, I pleaded, I cajoled, I enticed several, but none had the same desire to do this on a tight timeline, except for one who insisted that I had to be a co-PI. And then there was the other voice that said, I can get ready. I can learn. I can grow into this. That was the voice of the growth mindset. And that voice prevailed. And with that, we were off to the races. There was this mad dash and this heavy lift to get this done. We ran through several things. I had to run furiously to long forgotten skills and documents, had to relearn technical writing, excavated my ERA commons number, updated my NIH biosketch, and everyone else on the team was running at a furious pace so that we could get to a competitive proposal that we could all be proud of. We cycled through multiple revisions at breakneck speed and swam through an ocean of ideas, references, concepts. And through this all, I violated every single rule, well, almost every single rule in my self-care book. I stayed up way past my bedtime just to keep track of writing timelines. I sat for hours on end without stretching. I multitasked, answered emails and texts way beyond office hours, all the time holding my breath and tensing my muscles more than I should. Stress? You bet. But we made it. After the grant was submitted, I told one of my research mentors that this was the hardest research task I have ever done. And she said, and I told her, I told her first I would take a long and good break. And she said, that's right, hormesis. I said, hmm, that's right, hormesis. So get ready, here comes the science slide. Derived from the Greek to excite, hormesis refers to a set of adaptive responses of biological systems to moderate environmental or self-imposed challenges in order to improve its functionality or to increase its tolerance to more severe challenges. Examples of hormetic stressors, caloric restriction, exercise, intermittent hypoxia, cold exposure. It is characterized as a biphasic dose response with a low dose stimulation and a high dose inhibition. There is a sweet spot within a hormetic zone where one sees the most benefit. And this is a function of either the duration or the intensity of the stressor. As physiatrists, we apply this principle when we use exercise for fitness and as medicine. We stress ourselves, we stress those muscles, we tear it down. But with recovery, it repairs and it is allowed to develop. Similarly, we challenge our brains and our minds with novel and difficult tasks in order for it to develop new neural circuits to grow and develop. At this point, most of you are already wondering, did they get funded? We didn't. But through this process, I got excellent mentoring from my co-PI, valuable feedback from high-level researchers. I honored my heart's desire as a clinician and listened to that wise voice of the growth mindset in my head. I learned. I grew. I built a stronger scholarly muscle ready to take on whatever comes next. Bring it. Thank you. Thank you very much, Dr. Astorias. Our next speaker is Dr. Paul Jett, who will be presenting Survivorship in the Face of a Neuroendocrine Tumor, the story of three physiatrists dealing with a rare disease. Good morning, everyone. In August 2017, I was diagnosed with neuroendocrine tumor. For those of you that are old enough, this was also called carcinoid, a rare cancer without expectation. Forty-five years old, didn't know if I was going to see my kids graduate high school, much less what the next day was going to bring. I want to share a story today with you about how I was able to connect with two other physiatrists who unfortunately have succumbed to this disease and how we shared a beautiful story of connectivity and built a relationship through a non-profit called the Healing Net Foundation. Many of you have seen my zebra belt throughout the week, my zebra bow tie gifted to me by the wife of Kevin Bailey, one of those who passed. I wear these proudly because our symbol for neuroendocrine tumor is the zebra. The zebra has the most unique coat of any animal. No two sets of stripes are the same, much like us as physiatrists, so proud of our community and our field and our specialty. It's been really awesome being here to reinvigorate those spirits, much of what Irene just shared. We're trained to think in medical school that when we hear hoofbeats, we think horses. But I want you to remember to think outside the box and remember the rare. We're all patients, we're all going through something. I could speak to you for hours about any of these concepts. My goal today in eight to ten minutes is to give you an overview of what this disease really looks like and what it's like to be a doctor full-time, managing a family and all the other stressors and issues and joys we have in life while dealing with a chronic disease. If you take nothing else away from my talk today, I hope you remember the names Kevin Bailey and Dave Hogarty. These were two awesome physiatrists with over 60 years cumulative training between, cumulative experience between the two of them. Kevin and I worked together 60 miles apart, knew of each other but weren't very close. Actually knew his wife a little bit better, she was the CEO of one of the local rehab hospitals. About six months or so after I was diagnosed, she reached out to me through social media and through that we connected over a mutual friend who was a neuroendocrine tumor specialist. I shared that I had been diagnosed and that learned that Kevin had also been diagnosed recently as well unfortunately. The four of us developed a very close kinship, my wife Karen and Kevin. We started to work together on a foundation called the Healing Net Foundation that I had gotten involved with as a cold call because I knew not where to turn when I was diagnosed with this rare cancer. My doctors didn't really know much about it and I reached out to other patients and I learned more through these other patients than I could have ever learned on my own or through my physicians. About six months after that I was reached out to again through social media through a friend of a friend and introduced to Dave Hogarty, a physiatrist in Goldsboro, North Carolina who also was diagnosed unfortunately with a high-grade cancer and through connectivity again he wanted to give back and see what he could do to help other patients to the very end. Both these guys fought the good fight and gave every ounce of their being to their patients and to other get into other people that were dealing with this disease. Next you're going to hear a video from their wives, Karen first and then Sunaya. Please listen. I can recall times that the three of them would get on the phone together and I was always Kevin's sidekick. You know I was usually on the phone with them but you know they would talk about their cancer, they would talk about where they were in their treatment, different type of treatments that they were going through and I think that they opened up to one another in ways that they felt comfortable doing you know not knowing each other extremely well. They knew the battles of trying to be a physician and trying to continue doing the thing that gives you a great joy while being sick and not feeling well and taking chemo and going through other treatments. Kevin's tumor was a bit more aggressive than Paul's. There were some things he talked about with Kevin that they could relate more to each other in some situations and certainly over the couple of years as different you know situations happened and we went through different procedures I think he was in contact with both of them sharing his experience and how it was going but I think one thing for sure for Dave just having both of those guys out there surviving, continuing to practice medicine, continuing to be in practice and doing the therapies and making it was a very important part of Dave's journey. So Dave passed away on December 31st, 2021 and Kevin on September 11, 2022. I just want you to forever remember these guys. They were very special people. My story, it's not about me today but just to share a little bit. I was diagnosed serendipitously after an unfortunate basketball injury which led to the retirement of my one of my favorite pastimes which was playing pickup basketball and developed internal bleeding after a routine game and being the good doctor that I am I slept on it overnight. Woke up the next morning took one step out of bed was sure I had appendicitis through a myriad of tests and procedures and two bowel preps within 10 days I had a right hemicolectomy and found that I had mid-grade neuroendocrine tumor with metastasis to the liver. I live each day to the fullest. I try to get the most out of every experience that I can. I focus so much on living in the present sometimes I have a hard time thinking about the future and that's something I continue to struggle with and to learn to develop. My family is great my wife Jeannie is here today with me. I have two daughters Polly and Essie and this picture is taken at my five-year surprise cancerversary party that I had thrown for me by my family last year. So I'm proud to say I'm six years in and hopefully have many more years but as you know tomorrow's promised to no one and we have to remember that we're all dealing with something even if you can't see it. A little bit about neuroendocrine cancer. It can attack anywhere. It's not as indolent as we once were told. One of the unusual things about our cancer is that, I like this slide because it illustrates it very well, by the time we're diagnosed, over two-thirds of us have metastasis, typically to the liver, which then produces the syndrome, the flushing, the diarrhea, the increased serotonin in our system that causes these nasty symptoms. For me, the biggest thing I deal with is fatigue, how I manage that day-to-day. I have to focus on my sleep, my hydration, nutrition. I have a few slides in here about some things I learned as serving in the patient advocate role. Cancer survivorship is something I think is very important to us as physiatrists. We're all living longer with cancer due to increased technology and medications and treatments. And through that, we have to deal with lots of other things. We have side effects to the medications, survivor guilt, psychosocial issues, huge financial burdens. Anxiety is a real thing. How do we deal with these things in our cancer rehab world? I like this slide as well because the five E's in a neuroendocrine patient are very important. Epinephrine, ethanol, exercise, emotions, and eating. All these things can trigger symptoms for us. So we have to be careful. It's easy for me not to try to code every day, so I try not to give myself epinephrine. Easy for me to give up beer or alcohol. But exercise, emotions, and eating, that's pretty tricky. And we could talk all day about that. This cancer is very heterogeneous, and it affects everyone differently. This is a busy slide, but this is preaching to the choir. We are trained as multidisciplinary doctors, and we always put the patient at the center of our care. We are designed for this. Just remember that we all have needs, values, and preferences, and I've shared a little bit of that with you today. This is just another definition that I like for patient-centered care. This is a study that was validated through the Neuroendocrine Tumor Society, as well as the Healing Net Foundation that just illustrates that point further. If you would like to check out the Healing Net Foundation, I'd really like for you to give them a like on social media. Here's a QR code if you'd like to take a picture of it. It'll be in your slides as well. I have some handouts if you'd like to learn more about it, but it's really a great organization. And lastly, I end with this slide. This is my family. I thank you for your time and attention. Thank you very much, Dr. Jett. Our next speaker is Dr. Aaron Kelly, who will be presenting, From Teacher to Student, What I Learned at 2023 Fourth Grade Career Day. Thank you for being here. This past year was my first year as an attending. I remember doing a peer-to-peer on New Year's Eve, and the fellow doc on the other line said, oh, I remember my first year. That was the hardest. For my fellow PM&R docs here today, I invite you to recall your first year out and why you keep doing what you're doing. And for those entering the field, imagine what you think it will be like. I'm a PM&R and palliative care doc at Thomas Jefferson in Philadelphia. I was staying on where I trained, and I was really excited to blend my training of rehab and palliative. I had a leg up from not having to adapt to a new culture. I knew I had a pretty good idea of what I was getting myself into, though. I'd be teaching medical students, PM&R residents, attending faculty and staff meetings. Initially, though, I had a fear of missing out on something that I would enjoy by committing to a focus in cancer rehab. So I decided I was going to try something new. I was going to say yes to pretty much anything that came my way. First available clinic, yes. SNF consults, yes. Oncology clinical trials, yes. So when a colleague forwarded an email to me that said, this would be a really good opportunity to get involved in the Philadelphia School District, I said yes. Seemed like they just needed someone in medicine in case kids had questions. Fast forward, we're about five months later, and I get an email saying, thank you for volunteering to speak at Career Day next week. There's another Erin Kelly at Jefferson now, so I was about to forward on the email, and then I saw Philadelphia School District. Sure enough, it was indeed intended for me. It was the opportunity that I apparently said yes to five months ago. I had a lot more on my plate, though, now. Deadlines of publications due next week. Plus, I don't even have kids. I always thought that it was the family members or the kids in the class who gave Career Day. And the movies always show you want the most exciting and dramatic story. Would they really want to hear from me, a PMNR doc, rather than a neurosurgeon or an OBGYN? In fellowship, though, we gave community lectures, and it was actually pretty fun because the people in the community asked questions that in medicine we wouldn't think to do. So I said yes, and I received a list of questions. Did my job require a high school, technical, or four-year degree? What kind of classes did I take to prepare? Then there were the working conditions. How many hours and days a week do you work? Do you work by yourself or with others? What kind of tools do I use, and could I bring them in? And then there were the general interest questions. What do you like about your job? What are some things you don't like about your job? What would you do if you didn't do what you do now? I didn't want to scare the kids, so how honest should I be about the hours or days a week that we work? I mean, we're four years out from intern year. It can't be as bad now, right? But I was told they're fourth graders, and they had computers and smart boards, so I do what we usually do in medicine. I made a PowerPoint. I have to say, I was pretty impressed with some of the images that I found, and I hoped it would deliver the message that it's a lot of schooling, but it's worth it if you like helping people getting back to what they love to do after a life-changing event. At the end of the presentation, I started taking questions. Turned out to be a lot of repeats, though, of things the kids missed and they needed to fill out on their sheets. After another round of repeats, I said, does anyone have any questions that aren't on the sheet? More hands raised, and it turned into the hardest interview I've had up until this point of my medical career. I'm going to share those questions with you in case they're as powerful to you as they were to me that day. First question. Do you remember your first patient? I was speechless, deer in headlights. You mean like this year, on my own, in the cancer rehab office, because I remember my first outpatient, or my first palliative care consult as a fellow, because, again, I was on my own. My mom, patient zero, who's the whole reason I got into medicine, but no, they wanted the very first. Unfortunately, I did not. What rotation was I even on? It was all a blur. But there were more hands to call on and questions to field. Next question. How many people have you helped? Again, speechless. You mean just this year out on my own? Go big or go home, ever. I like to think I help all my patients, is what I said. So I pulled out my phone calculator, ran some numbers from third year clinicals up until this point, figured it had to be at least 10,000. Really? Even I was impressed. How do you handle peer pressure when you're trying to save someone? Another great question. But the last hand that I called on. What do you do when someone is dying? Wow. That day, I left not as the teacher, but as the humbled learner. I mean, I just got schooled by fourth graders. How did they know to ask those difficult questions and knew what mattered most in fourth grade? I was never one to journal, but now I wish I had. Not only to look back on my first patient, but also remember those initial thoughts and raw emotions that transport us back in time, right into the moment. This past year was an interesting one. Clinical duties came naturally, but there was always more to learn between enhancing procedural skills, billing, work RVUs. It sometimes became overwhelming. But what allowed me to push through any feelings of burnout that crept up was social connectedness and the willingness to still learn. It was these social connections right here that sustained me, colleagues with new ideas, patients both past and present. The fourth graders at JW Catherine and Gloria Casares Elementary. But on that career day, I reflected back to patient zero, my mom, who passed away during medical school. We had this sign and then later a plate in our house growing up that served as a reminder that it's the little things that make the difference. And that's what I learned on career day that translates into practice. To be a good PM&R doc are the little things, remembering someone, helping someone, remaining calm under pressure, not putting extra pressure on ourselves, and just being present. At the end of the day, it's not as important if we reviewed every single specialist note that the patient has seen since we last saw them, or if we can recite off the top of our head all the side effects of a medication we can rarely prescribe. I argue the most important thing is what the person in front of us needs and how we can best treat them, no matter how much is on our plate. So whether it's your first day of a rotation, first years in attending, or you've been practicing for 30 years, I hope we can all still find opportunities to say yes, find this field as fulfilling as it was when we chose to enter it, and remember that it's truly the little things that matter and make the difference. Thank you. Thank you very much, Dr. Kelly. Our next speaker is Dr. Austin Scott, who will be presenting Adaptive Gaming and Physiatry, The Unrecognized Importance of Video Games. Hello everyone. Welcome to my PhysTalk, where today I'm going to be talking about adaptive video gaming and a model that I established in the city of Cincinnati. So to start, who am I? I am a fifth year in the combined pediatric rehab program at Cincinnati Children's that partners with the University of Cincinnati, and I love video games. And so as a gamer, one day in my third year of residency, I'm sitting there watching Twitch, and the person's doing a fundraiser for a charity called AbleGamers. And so I click the link, just kind of curious, what's going on? What do they do? And it turns out they provide equipment to people with physical disabilities so that everyone can play video games. And as I thought about it, I was like, this is at the core of physiatry. Why am I not incorporating my personal favorite hobby into helping the people that I work with every day? And so I send them an email saying, hey, I want to know more about this. How can I get involved? How can I bring this to Cincinnati? And within a few weeks, I'm talking to them, and they're saying, well, step one, you got to learn about what adaptive gaming is. And so I started doing my research, started watching YouTube videos, reading articles, learning about the Xbox Adaptive Controller, 3D printed models, the Hori Flex controller, the new coming out PS5 accessibility controller, modifications to controllers for one-handed players, companies like Warfighter Engage that make customized joysticks, customized buttons, companies like Evil Controllers that make customized controllers for one-handed players as well. And I was overwhelmed, as you probably are right now, with how many things are out there. And this is just scratching the surface of what's available to all these people. And so I told them, I have, like, this little bit of knowledge, but I don't know how to do this. I don't know what to do. And they said, we'll train you. So they were gracious enough to send $20,000 worth of consoles, games, equipment, controllers to Cincinnati Children's and to University of Cincinnati. And they set up training sessions for interested residents and occupational therapists and physical therapists who wanted to learn more. And so we get there one day, and we're sitting around some TVs and Xbox consoles at some of the most fun I've ever had in lectures, where we're learning how to use these different adaptive options and seeing how the buttons work, how the switches work, how placement matters and how that interacts with the video game that you're playing in time. And so we got to the point where I was comfortable with, all right, I kind of know how to set all this up. I know how it works. I know how people can be limited with their physical disabilities. What do I do now? Enter Dr. Victoria Heasley. She's a sports medicine physiatrist in Cincinnati who is currently on staff at University of Cincinnati. She has a passion for adaptive sports, and she founded a local nonprofit called the Bridge Adaptive Sports and Recreation in Cincinnati. And they do all kinds of adaptive recreational things like wheelchair basketball, skydiving, things like that. And she heard about what I was interested in and trying to do, and she said, we can help you. We have the population. This is something we're already doing. We can help organize things. We can help market it and get people to come so they know about this opportunity. And not only that, she had an adaptive sports clinic that she did once a month through UC. And after talking with her, we had the conversation of, why don't we also just have an adaptive gaming clinic? And so after talking with my program director, we were able to set it up that once a month I developed a half a day continuity clinic where I did adaptive gaming evaluations with an occupational therapist. And in that first visit, we had someone who played Nintendo Switch who had cerebral palsy. And all they could use was their left pointer finger. Otherwise they were limited by contractures and dystonia, and he would just lay the Joy-Cons just on the table and just try and press the buttons he could, but he would miss it. He would hit wrong buttons. He would hit them multiple times, and he was very frustrated. He just wanted to be able to play Pokemon. And so we were able to set him up with a Horiflex controller with all the buttons on the left side, so very accessible for him, and much larger so that he could, even with a little bit of less precision, still hit the exact button that he wanted to hit. And so here he is in the first time in clinic, being able to play Pokemon, feeling like he has full control of his character. And then this gets to the best part of the whole program, in my opinion, is at the end of the day, thanks to the generosity of these two non-profits, the AbleGamers Charity and the Bridge Adaptive Sports and Recreation, I can just give them this equipment free of cost. And the wonderful thing about that is a regular controller, if I was to go to Walmart, would be $30 to $40. This adaptive equipment can cost, on average, $300 to $400 to find a setup that works for someone. And if you need something customizable, it can get up to $1,000 very quickly, more than the cost of a console itself. And so being able to see their faces when you say, you get to take this home so you can play with your friends and family tonight, in my opinion, is the best part of the whole experience. And here are just a few quick snippets of our monthly people coming in. We see about two people a month over the last year and a half. And then one day, as we're doing this successful clinic, the president of the bridge calls me and says, hey, I need to tell you something else. I found us a new place that we can do these evaluations outside of the hospital. It's called Velocity Esports across the river. And it's an esports gaming bar that wants to help us. And so we go and visit them one day, and you walk in, and there's this arcade in the back. There's a bar with a restaurant. And then in the very back corner, there's an esports lounge where there's PCs, Xbox, PlayStation, a gamer's playground, really. And they said, we heard what you're doing. We want to give you this space once a month to do community activities and do these evaluations for people in Cincinnati and Kentucky. And so, in December of last year, we had our first Velocity Night, and we've been having one every month since, where it's a partnership between all three of these organizations, where we invite three to four families every month to come get these adaptive evaluations with various volunteers of physicians, residents, and therapists, and find what works for them. And we have the same deal at those nights as well, where if we find something that works, they get to take that equipment home that night. And not only that, we're trying to build a community, because there's so much space there. We also always encourage these people to come back the next month, because we want them to start socializing, finding other people that they can game with. And so, we have many families that come back every single month. There's always free food, socialization, and families can also play in the arcades. So, it's just a great event that we're trying to continue to build. And I will go through these quickly. This is just a small snippet of the around 40 or so people that we have had the opportunity to work with over the past year, and then next month will be the one-year celebration of our Velocity events. And then the question becomes, this is great, what's the next step? And so, we want to establish this in other cities. After talking to many people in the community, this is the first model like this in the country that we have been able to find, where there's a community event trying to incorporate not only the evaluations, but also everyone coming back and getting to know each other. And so, Velocity has other locations in Las Vegas and Chicago, and they said they would be more than happy to host there, but it doesn't even have to be at Velocity. It's wherever you can have a venue, have the consoles, and have someone willing and passionate enough to start something like this. And so, I'm in talks with the non-profits for my first attending job to actually have some protected time to help develop this program into a national program so that it's available across the country. And then we also want to get involved in eSports. We have multiple colleges in the local area that have eSport athletes that we want to have come volunteer their time, work with our gamers, have them nights where they can play together, and even get to the point where we have tournaments together, we have leagues together, weekly gaming nights. And then I want to end with one more story. This is Taylor. He is a former soccer coach who was out for a run one day and had a heart attack. And because of that, resulted with an anoxic brain injury, and had pretty severe limited function in his hands. And he just wanted to be able to play FIFA again because he's just a soccer fanatic. And so he came to our clinic, and after working a little bit, we were able to find a Logitech flight stick that works for his hand. And then on the left hand, he can press a single button, which is a mode in FIFA, so that he could start to play FIFA again with his father-in-law, with his father, and with his friends who used to play soccer with him. And Taylor, I have gotten to know very well over the past year because they're one of the families that come back every single month. And just something that warms my heart, one of those times that he came, he actually was able to play FIFA in front of Luciano Acosta, who is an MVP candidate for FC Cincinnati this year. And I was able to explain to him what adaptive video gaming looks like. And Taylor even won in a shootout as FC Cincinnati against Columbus Crew. It was a wonderful, wonderful moment. So, all that to say, I think this is the future of video gaming and our culture of xiatry. And I can't wait to see what new things develop and how this program continues to grow. Please reach out if anyone is interested. Thank you. Thank you, Dr. Scott. Our next speaker is Dr. Lisa Vargas-Croll, who will be presenting Pay It Forward, how the good that comes around can go around. Good morning, everyone. I have so enjoyed listening to my fellow speakers, and I'm just so grateful to be part of this event. So, thank you. So, in the brief period of time that I have with you today, I'd love to share a quick story. At 32, a number of life challenges were behind me. I had moved to a new country in my senior year of high school and somehow managed to navigate the American college application process. I had semi-successfully managed to hide my utter ignorance of American football, honestly still uncured to this day. Like many of you in this room, I had successfully graduated from medical school. Like many of you in this room, I had successfully completed four sometimes grueling years of residency. Each year, many more will join the ranks of those grizzled survivors. And like some of you in this room, I had made it through the toughest years of a military marriage. My husband, whom I met in medical school, was required to serve his Air Force commitment after our intern year. So, we spent three of our first four years of marriage living 500 miles apart and enduring his deployment to the Middle East. By the time we were 32, he had completed his military service and I had completed my residency, so we were at last in the same state again. True story. After we stopped flying back and forth to see each other, Continental Airlines, remember them, literally went out of business. So, for us, things were starting to look good, but there were new challenges on the horizon. My husband had now started his residency, I was a new attending, and we now had the first of two babies at the same time that he had a brutal call schedule. And further, I sensed that I was headed for a major career change. And just three weeks after I did leave private practice to start a new life in physician advising, I was diagnosed with thyroid carcinoma, which would require urgent surgery, and whose radioactive iodine treatment would require me to isolate and send my toddler away for weeks at a time. And while having a medical issue is just one list of life curveballs, it's probably not surprising that needing to separate from your young child for their own safety made that one feel like the most frightening. Lots of people have crazy things happen to them. But the reason I'm telling this story is because of what I saw when I looked back afterwards. My experiences during this period showed me the critical importance of a support network, which in Western culture can be difficult to build in adulthood. It will not shock anyone to hear that it took a village to help us to the other side. We were fortunate that our parents and my brother were able to take our two-year-old for the duration of each lengthy stage of my treatment. It's really her. We had to start both kids early. We had dedicated friends and past and present church communities that visited, called, and prayed for us. My husband's academic institution had an auxiliary program for residents that was a lifesaver. And most strikingly, as two physicians, we had the benefit of a huge number of medical school and residency colleagues and mentors who served as our brain trust. They could provide expertise, share referrals, and debunk myths. So when I came out of this period of my life, it was crystal clear to me that, given how much I had benefited from all of these things, I had to be part of that support network for others. But often, after coming out of a major inflection point, the memories of the specific ways that people helped us can start to fade as we return to normal life. That's common. I'd like to encourage each of us not to let that cognizance fade by sharing a mental picture. I came to see that support networks are comprised of four main facets. So let's talk a little about each of them and about how you and I personally could slot into each one. The first facet of a support network is physical assistance. And this comprises what are probably some of the most obvious things we think of when someone's going through a hard time. Providing childcare, dropping off meals, helping with house cleaning. And that auxiliary program at my husband's academic institution shone in this area. It had been created to provide social events for the spouses and children of residents. But for members who were going through medical treatment or having babies, they also rallied immediately to provide meals and rides. Let's ask ourselves, is there any area of our current lives where we could replicate such a community? If one already exists in your sphere of influence, incorporating some of these tasks into our own busy lives doesn't have to be difficult. I've personally found that cooking double or ordering double of a meal you're already assembling for your own family doesn't really take a lot of extra time. Picking up someone else's child to take them somewhere your child is already going doesn't really take a lot of extra effort. These kinds of practical assistance mean that this arm of support is one that almost anyone can participate in in one way or another. The next arm of support is financial assistance. How fortunate are most of us in this room that we don't face the threat of hunger or homelessness, but so many people are just one crisis away from exactly that. Donating money is relatively self-explanatory and fairly easy from a labor standpoint, so this arm of support, too, is one that almost anyone can participate in to some extent. The next arm of support is emotional assistance. There's quantifiable benefit to a phone call from a friend. The literature shows us that. Also, sending funny memes and cat videos are the reason the internet was invented. Sending gifts, showing up to visit, welcoming people into a faith community. The positive effects of these kinds of interactions can be what gets a struggling person through the day. But if we're not currently that struggling person, it can be so easy to let the busyness of life get in the way of providing that kind of support. I mean, we all know how it is. The alarm goes off at 6 a.m. This project isn't technically done in the legal sense. And the next thing you know, it's midnight, you're home from work, you have no idea what happened to the day, and you're drowning your stress acne in Nutella. Just me. But are there ways that we can incorporate some of these forms of emotional care into our day? There's no shame in scheduling texts or blocking out time for a call in our calendar. And in fact, this kind of behind-the-scenes effort translates into scaffolding for a support network far beyond what we may be able to see. So again, this arm of support is one that almost anyone can participate in. But when it comes to medical emergencies, the next arm of support might only be available to us as physicians. And that's intellectual expertise. When I was a patient, I had my eyes opened to the importance of access to reliable medical information. As a physician married to a physician, I benefited tremendously, and so do all of you, from a massive web of contacts that stretched across the country and internationally with a collective knowledge base that was staggering. If I was on a game show and had to phone a friend, I would run out of time before I could figure out which friend to call. I was so over-blessed with experts in my social circle, I would never be a millionaire. And I knew that that kind of access was not available to the average non-medical person. Now, attorneys can play that role in legal crises, teachers in educational dilemmas, and so on. My lawyer brother is the first person I'm calling from jail, even if he does try to change his number. But when it comes to medical emergencies, we are the ones with that responsibility. When I came out of cancer treatment, I was so moved by how my own clinical choices had been guided by my access to this brain trust that I spent ages thinking about how I could pay that forward. Eventually, with my close friend, I launched a health and parenting podcast with the goal of bringing some of that information to the public. And we used current events and questions that were frequently asked in our professional lives to shape each season's content. And because we also use listener feedback to guide the topics that we cover, it's been an incredibly rewarding experience that feels like a service to the greater community. Through the hard work of broadcasting for the past three and a half years, I felt like I have been paying it forward, some of that intellectual generosity that I received as a patient. And of course, podcasting is only one way we can share our expertise. When you write online articles for a lay audience, provide thoughtful commentary on social media, goodness knows we need it there, speak out against disinformation, I really believe that the steadfastness of experts today may be what saves society tomorrow. We all have challenges in life, of course. So when it's our turn for bad luck, we would all like to believe that there would be a network of some sort to catch us. So perhaps thinking about these four facets, physical, financial, emotional and intellectual, can help us hold up that network for others during their crises. And who knows, I like to think that each of our actions could be a tiny cog in the giant wheel of someone else's plan to keep paying it forward. As physicians, and not only as physicians, but as physiatrists who care deeply about returning our patients to their best lives, and as humans, it truly is creating the world we wish to see. Listen, if we can't have a world where chocolate cake improves our A1C, then a world where each of us serves as scaffolding in the wide, wide network of human love and support is, I'm convinced, the next best thing. Thank you. Thank you very much, Dr. Prywess. And let's take a moment and give a big round of applause for all our PhysTalk presenters. Now is the time for a bit of a friendly competition. Using your cell phone, please scan the QR code shown on the screen to vote for your favorite presentation. While everyone is voting, I wanted to take a moment and express my gratitude for everyone being here today and online for the last day of our annual assembly. As I kick off my presidential year, I'm most excited about the opportunities that lie ahead. As you'll read in my first presidential editorial on the physiatrists, this is a time of great challenge and opportunity for PM&R physicians everywhere. And I'm looking forward to strengthening the vital work we have embarked on to advance our field. Your efforts in championing the undeniable value physiatrists contribute to healthcare is essential to the success of PM&R. I encourage all of you to get involved with us. We have so many initiatives in motion to advance the future of our specialty, and your insights are critical in this process. It will require a team effort, something physiatrists excel at better than any other medical specialist. I'm confident that by all of us coming together, we can advance physiatry and ensure we continue to play a vital role in medicine. To that end, we are currently tabulating the votes. We'll announce the winner here shortly. Let's take one more moment and congratulate all of our presenters. I also want to acknowledge that this year's winner will receive a complimentary registration to next year's meeting in San Diego. Thank you. Where we will maybe have a few less bugs flying around the stage. And I also look forward to joining you on joining me on the USS Midway for our PM&R party. Should be a lot of fun. I also want to announce our plenary speaker will be Dr. Glaucum Fleckham. If you have not looked at that, go look him up. He is a healthcare comedian. We should have a good time with it. And we're also very proud to announce that the AAPM&R is partnering with the ABPM&R, the American Board, to allow you to present quality sessions, quality projects as posters to count for your Part 4 maintenance and certification. What a better excuse. Come present a poster of a quality project to get it to count while having a great time at the Midway in San Diego with close to 3,000 of your closest physiatry friends. Oh, I look forward to it. So it looks like the votes are in. And the winner is, drumroll, Dr. Aaron Kelly. So congratulations, Dr. Kelly. I very much look forward to seeing you in San Diego. Thank you, everyone, for attending the 2023 Annual Assembly. What a fantastic week it's been. And I look forward to seeing you in 2020-24 for our Annual Assembly. Again, November 6-10, San Diego, California, in-person and virtual meeting once again to present quality sessions. For those here in New Orleans, safe travels home. For those online, have a wonderful rest of your Sunday. Thank you.

AAPM&R

physiatrists

presentations

neuroendocrine tumor

adaptive gaming

support network

Dr. Aaron Kelly

plenary speakers

collaborations