Theme: Plenary Session
James Atchison, D.O.
Chair of PM&R
Mayo Clinic Jacksonville
Jacksonville, Florida
Disclosed no relevant financial relationships.
Mihir Joshi, MD (he/him/his)
Interventional Pain Physician
Riverside Healthcare
Chicago, Illinois
Disclosed no relevant financial relationships.
Kelsey Lau, DO
Resident Physician
University of Texas Southwestern Medical School PM&R Program
Dallas, Texas
Disclosed no relevant financial relationships.
Alexandre Lavigne, MD
Resident
Department of Physical Medicine and Rehabilitation, University of Montreal
Montreal, Quebec, Canada
Disclosed no relevant financial relationships.
Zainab Shirazi, MD
Resident Physician (PGY3)
New York Presbyterian Hospital (Columbia and Cornell) PM&R Program
New York, New York
Disclosed no relevant financial relationships.
Yunna Sinskey (she/her/hers)
PGY-4 Chief Resident Physician
Mary Free Bed Rehabilitation Hospital, Michigan
Disclosed no relevant financial relationships.
Steven Flanagan, MD
Chair of Rehabilitation Medicine
New York University Langone Health
New York, New York
Disclosed no relevant financial relationships.
Exercise & Medicine: A Physiatrist's Patient Story
James Atchison, DO, FAAPMR
Life takes a lot of twists and turns and how you respond to them will determine your ultimate happiness. One day you're in the middle of your career as a physiatrist and the next day you're a patient in the oncology center. This talk is about the story of how a physiatrist takes the knowledge and training that we have to help themselves and others with cancer. It will reinforce the principles and value of what we do as physiatrists to help people recover from devastating problems. In 2011, at age of 56, I was diagnosed with Multiple Myeloma. I had always been a regular exerciser before this and after chemotherapy treatment, was in remission and returned to exercise. I remained healthy and highly functional in my PM&R career until 2020. As the rest of the world was learning to deal with COVID, I was back in the oncology clinic and was diagnosed with Acute Lymphocytic Leukemia. During this time, my exercise tolerance was declining, which was part of how I knew things weren't right. I entered the hospital in July 2020, and started walking laps around the unit with mask in place, and hanging onto the chemotherapy IV pole. At first I was good for 4-5 miles per day, but then the chemo hit and this got much harder. So based on physiatric principles, I started walking shorter distances more frequently to try to keep up the distances. Much of my time in the hallway was spent talking to other patients and encouraging them to follow the same pattern. What I learned was that as opposed to what we do in rehab hospitals with getting people up and out of bed and dressed in the mornings and having therapies in the morning and afternoon, this does not happen in acute hospitals. People have to learn to do this on their own! Over the next 8 months, I was in and out of the hospital enough that it felt more like home than my house. When home, I could walk repeated short distances in the house and do yoga, squats and climb stairs while heading to clinic/lab appointments and infusion therapies. Back at the hospital, it was possible to do all of these, but function gets harder with loss of balance, cognitive decline, and fatigue. Emotional control also becomes more difficult due to the chemotherapy. As we know, the exercise can help all these things, and the primary oncology team was amazed at how my dedication to exercise contributed to my recovery and positive outcome. So we have to keep moving our PM&R principles for team management with the patient as the center/leader of the team forward and empower patients in our acute hospitals to do more activity and exercise while combining this with the most up-to-date medical treatments for each diagnosis. This will help emphasize the ""Exercise is Medicine"", but that often is going to be the best ""exercise & Medicine"" that will be needed for best treatment/outcomes.
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
Mihir Joshi, MD, FAAPMR
I did my fellowship from July 2020 to June 2021, basically square in the middle of the COVID-19 epidemic in the US. Every fellow in that class, including me, was nervous about job prospects because we were hearing over and over that even large institutions were freezing new hires, and some small practices had to rescind offers or shutter entirely. Entering the job market in this situation was daunting, to say the least. And yet, I was being inundated with advice from my faculty and private practice doctors about contract negotiating, finding a "good" practice, and making sure in every way possible that my first job was as close to perfect as possible. So, in an environment of scarcity, I did an agonizing amount of job screening, more interviews than anyone in my class, and significant hand-wringing about contracts, negotiating, terms, and practice environments. Ultimately I went for a small private practice thinking that it would be the right fit in the right location. Shortly after joining, it became apparent that either I had not asked the right questions or that I had been misled about the nature of the practice, and I had an existential crisis about working in a deeply unfulfilling job doing what I had hoped not to do, or quitting and restarting the whole job hunt with zero existing prospects. I put in my notice on my tenth day of work, and after significant soul searching and interviewing combined with what I had learned from my first go at this, I ended up with 3 wonderful job offers and ended up going with one that was better in some areas and a compromise in some others. I am now doing more meaningful and fulfilling work, and even got a pay bump out of it. When I told this story to several friends of mine, I believe it empowered them to consider finding other opportunities, and a few of them have done just that. You have worked too hard for too long, and you're a great doctor with needed skills. Life is too short for you to stay in a job that doesn't fulfill you, or adequately compensate you, or makes you sacrifice things you don't want to.
What MORE can You do to Make an Impact?
Kelsey Lau, DO
What does it mean to you to live a remarkable life? To live a life full of impactful moments? I was deeply inspired while watching an IMG Academy Ted talk in 2015. I came across Kat's video online. Kat spoke about her drive to play Division 1 soccer at USF, her travels in Bolivia and her sudden illness which led to a diagnosis of myasthenia gravis and a brain aneurysm. As I listened to her story, I felt a deep amount of respect and admiration for her. Throughout all of her challenges and setbacks, she started the non profit called IamMore, which allows kids, teens and young adults with a chronic illness or physical disability to pursue their passion in life instead of being defined by their diagnosis. She ended her Ted talk by asking one poignant question: "What is more important, the quantity of years or the quality in those years that you possess?" I was astounded with how she navigated a new diagnosis of neuromuscular disease and yet had the energy and wherewithal to develop a non profit. Her desire to live a courageous, fulfilling life was contagious and I felt like I had to do more with my life. I was so inspired that I decided to email her days later, asking how I could get involved. She lived in Florida and I was in Oregon. I was a stranger reaching out, asking her to instill trust in me to carry out her mission in the Pacific Northwest as an 'IamMore parachute'. A good friend of mine and I started the PNW branch in 2016! We held community events, facilitated individual sponsorships and coordinated silent auctions! Memorable moments include watching a 15 year old girl with epilepsy participate in equine therapy and days later get to meet her favorite artist, Katy Perry. Another IamMore participant loved to read and we contacted her favorite author who autographed her favorite book! Another was able to get back stage pass to the Oregon Zoo and feed the animals! After starting residency, I partnered with a few co-residents to begin a new chapter of IamMore in Texas! We have made a small but powerful impact on the Dallas community with group events. Kat continues to be an inspiration. Most recently, she played in Spain representing the USA Women's Para National Team and won Inaugural 2022 IFCPF World Cup! Can we just stop and think about this for a second, she's playing soccer at THE most competitive level with myasthenia gravis. I tell this story not so much on my behalf but to share her story and how she has impacted me to aspire to more, to demand more from myself and more from others. To set higher expectations and to make a powerful positive impact on the lives around me. So I challenge each of YOU, what more can you do to make a positive impact on the lives of those around you?
Building a Mobile App for Rehabilitation Purposes in this High-tech Era
Alexandre Lavigne, MD
At the beginning of my residency, I started building a research project to measure the changes in the structure of the Achilles tendon with quantitative ultrasound for patients affected by Achilles tendinopathy during and after a 12-week eccentric strengthening protocol. I needed to follow the symptoms closely to see if it correlates with the ultrasound changes, so I decided to create a mobile app that participants would use at home to enter research data. I created an account on Upwork, which is a website where people who want to create a mobile app can find freelancer programmers to help them. On my Upwork account, I wrote down a brief summary of the app I wanted to create, and several programmers sent me offers to work with me. The Upwork website lets you see the previous projects of these programmers and their resume. Thus, I hired a programmer that had a trustworthy resume. He lived in China, so when we were doing Zoom meetings, I had to wake up at 1:00am in order to synch my work schedule with his. I designed my mobile app on PowerPoint slides with as many details as possible to help my programmer to build the mobile app. Firstly, participants were able to read on their app the instructions on how to use the app, and how to perform the Alfredson's eccentric strengthening exercise. I hired a video producer to film an example of how to perform the given exercise and uploaded that video on the mobile app so that participants could watch it at any time on their phone. Secondly, participants were able to enter multiple data related to their Achilles tendinopathy rehabilitation. They would check a box each time they completed their eccentric strengthening exercise, for a total of 14 times per week (twice daily). They indicated every day if they took Acetaminophen and Ibuprofen (and the number of tablets per day) as those molecules could influence their pain score. Participants also indicated every week their pain score (according to the Visual Analog Scale) at rest, in the daily living and during physical activity, and they entered their weekly minutes of physical activity with impact (i.e. running/jumping sports) and without impact (i.e. swimming, cycling). Then, at the end of the week, the participants would submit their data, and those data would be sent automatically to an online dashboard. When I would log in to that dashboard, I would be able to access all the data that were submitted by the participants. The mobile app was used by research participants between August 2021 and June 2022. It allowed me to understand the patients' pain trend as they go through an Achilles tendinopathy treatment, since pain is a dynamic parameter and cannot be solely assessed with punctual data. The mobile app also allowed me to keep track of potential rehabilitation determinants such as treatment compliance, analgesic medication, and mechanical stress quantification. The results of this project were submitted for a research presentation at the AAPM&R 2022.
The Words I Never Said: Re-humanizing the Patient Narrative through Awareness & Gratitude
Zainab Shirazi, MD
I will start by engaging the attendees in an interactive exercise] Show of hands, how many of us have been thanked by a patient? I want you to imagine a piece of string. Now I want you to take that string, and tie an imaginary knot for every patient that has thanked you. Hold onto that string, we'll come back to it after I tell you about 3 of my most memorable 'thank you's. [I will then illustrate 3 experiences for the audience to envision] 1) Nico: 10 year old with cerebral palsy who was unable to rock climb due to severe spasticity. I met him while volunteering with an Adaptive Climbing group. Despite numerous previous attempts, Nico had never reached the giant red bell at the top of the climbing wall. I was his designated side climber, guiding his legs as we ascended the wall together until he triumphantly rang the red bell and exclaimed "I can't believe I did it - thank you!". 2) Rachel - 17 year old who suffered a traumatic SCI after her car slid off a cliff, resulting in complete quadriplegia. She was devastated, and every day her family sat at her bedside trying to console her as she cried. As a medical student trying not to get in anyone's way, I would sit and talk to her for hours. She cried for weeks, and then one day I walked into her room and she wasn't crying - she was staring at a post-it note on the wall that read "I am not what happened to me. I am who I choose to become". 3) Andrea - 26 year old with recent above knee amputation due to lupus complications. I was the resident taking care of her on the inpatient rehab unit. Weeks went by, but not a single family member visited her. She had no emotional support, so she frequently asked me to sit with her and distract her from her new condition. I was no longer a medical student trying to pass time, but even as a busy resident I would sit at her bedside, showing her pictures of paralympic athletes and telling stories about their amazing accomplishments. On her discharge day, she said "thank you for helping me believe in myself". These are the 3 thank you's I remember most. I remember Nico's red bell. I remember Rachel's yellow post-it that read "I am not what happened to me. I am who I choose to become". And I still carry the bracelet Andrea made for me (show audience). Three patients with vastly different stories, but they have 1 thing in common: 1 thing I would go back and do differently, 1 regret I have: I never said thank you. Remember that string I asked you to hold onto? Now imagine your other hand holds a second string, but each knot represents a patient you have thanked. Which string has more knots? [I will conclude by emphasizing the impact our patients have on us and elaborating on the take-home points below
Residency Interrupted: Returning Back to Residency After Almost Dying
Yunna Sinskey, MD
In August 2020, I went from being a PGY-3 resident to being a cancer patient. Like many other residents, I came to Michigan alone for residency and the closest family I had was my sister who lived 2300-miles away. I took a LOA from residency and stayed with my sister. At the time, the cancer was thought to be stage-1 and I was to return to residency in 3-months. This dream of bouncing back to residency simply remained a dream as my post-surgical pathology report showed cancer cells in my lymph node requiring chemotherapy. I suffered a post-surgical complication causing ischemic bowel and my long journey of 11-month LOA ended with a total of 4-month hospitalization, 5 surgeries, and 4-moths of NPO on TPN. My residency was extremely supportive throughout this journey, and I felt the family-like culture of PM&R even more, when a physiatrist at the hospital I was staying at came to visit me with a flower signed by her entire department. I was truly proud to be a part of the field of PM&R. Despite all the support, returning to work was difficult. The first day back at work, I woke up at 4 AM and cried the entire morning. I was engulfed in fear, but I knew if I didn't show up that day, it would only be harder the next time. My prolonged hospitalization took a toll on my body and although I was better than my previous 2-person max-assist days, I was still underweight and had no endurance. Due to the removal of my rectum, I had to go to the bathroom about 20-30 times a day so I would starve myself to prevent from needing to go to the bathroom. Also, all the emotional trauma I suppressed surfaced at the most inconvenient and unexpected places. I almost had a strange nostalgic feeling about my cancer treatment times as the decisions were so simple: life or death. Now I was back to the complexity of life and I no longer was sure of what I wanted. I spoke with my program director about quitting and he asked me to continue just a little longer. Now it has been exactly 12-months since I have returned and I am grateful that I had people who encouraged me to stay. Although difficult, I am now confidently able to say that I am thankful that I survived, which was not always the case. My countless nights filled with anxiety, numerous anger-filled counselling sessions, and tears I shed hiding in the bathrooms at work now finally feel worth it. For those who are currently suffering through life-threatening illness during medical training, I want you to know that you are now alone. I am here to tell you that although it is not easy, it is possible to continue with your medical training. I still have moments of struggles, but it has become easier, just as it gets easier to endure the waves as you get deeper in the ocean.