WEBVTT 00:00:00.189 --> 00:00:02.170 You're listening to the PT Pinecast, 00:00:02.270 --> 00:00:04.312 where smart people in healthcare come to 00:00:04.352 --> 00:00:05.174 make noise. 00:00:05.554 --> 00:00:06.455 Here's your host, Jimmy McKay. 00:00:06.514 --> 00:00:07.556 All right. 00:00:11.159 --> 00:00:12.580 It's a new, I should say new, 00:00:12.641 --> 00:00:13.942 it felt new a couple of years ago 00:00:13.961 --> 00:00:14.903 when we were talking about it, 00:00:14.983 --> 00:00:17.085 but this is a PT specialty that's gaining 00:00:17.125 --> 00:00:17.585 momentum. 00:00:18.426 --> 00:00:19.187 And it's about time. 00:00:19.608 --> 00:00:20.468 It's the newest thing. 00:00:20.487 --> 00:00:21.248 It's been around for a while. 00:00:21.989 --> 00:00:24.091 While millions of people are living with 00:00:24.451 --> 00:00:25.852 or beyond cancer, 00:00:25.891 --> 00:00:28.974 far too few know that physical therapy can 00:00:28.993 --> 00:00:31.015 be a game changer in their recovery, 00:00:31.094 --> 00:00:31.856 in their function, 00:00:31.916 --> 00:00:33.256 and in their quality of life. 00:00:34.176 --> 00:00:36.359 But today we've got a little CSM preview 00:00:36.378 --> 00:00:38.981 like we've been doing that isn't waiting 00:00:39.381 --> 00:00:40.203 for the referral. 00:00:40.323 --> 00:00:42.844 They're building the case for why every PT 00:00:42.884 --> 00:00:43.545 program, 00:00:43.686 --> 00:00:46.328 every clinic and every physical therapist 00:00:46.968 --> 00:00:48.710 needs to step up and meet the needs 00:00:49.109 --> 00:00:49.951 of this population. 00:00:50.210 --> 00:00:53.072 From classrooms to clinics to social 00:00:53.091 --> 00:00:55.712 feeds, conferences and clinical practice, 00:00:56.152 --> 00:00:58.953 these guests today are helping change the 00:00:59.012 --> 00:00:59.493 narrative. 00:00:59.612 --> 00:01:02.274 So let's welcome Amanda and Scott to the 00:01:02.314 --> 00:01:02.594 show. 00:01:02.634 --> 00:01:03.173 And Steve, 00:01:03.213 --> 00:01:05.414 Steve's here in spirit is what we'll say. 00:01:05.453 --> 00:01:06.515 Steve's been on the show before. 00:01:07.295 --> 00:01:08.775 Amanda, Scott's been on the show before, 00:01:08.814 --> 00:01:09.734 so I'm going to say welcome for the 00:01:09.775 --> 00:01:10.956 first time here to you, Amanda. 00:01:10.975 --> 00:01:12.676 Thank you. 00:01:13.108 --> 00:01:15.590 And you're in the Lone Star State of 00:01:15.629 --> 00:01:15.930 Texas. 00:01:16.870 --> 00:01:17.290 Real quick, 00:01:17.331 --> 00:01:19.052 what's your superhero backstory, 00:01:19.352 --> 00:01:21.453 just to give the audience of context about 00:01:21.513 --> 00:01:22.533 you and your career? 00:01:23.072 --> 00:01:26.375 Okay, so I went to, 00:01:26.655 --> 00:01:27.674 as Scott likes to say, 00:01:27.754 --> 00:01:29.536 the greatest physical therapy program in 00:01:29.756 --> 00:01:32.397 all the land in Ithaca, New York. 00:01:32.778 --> 00:01:33.197 It's gorgeous. 00:01:33.218 --> 00:01:33.938 I'm very proud. 00:01:34.298 --> 00:01:35.019 Oh yeah, it's gorgeous. 00:01:35.058 --> 00:01:35.698 Not this time of year. 00:01:36.308 --> 00:01:36.909 go over the summer, 00:01:36.929 --> 00:01:39.350 especially if you like wineries and 00:01:39.450 --> 00:01:40.010 waterfalls. 00:01:41.632 --> 00:01:44.936 But so I went there and everybody goes 00:01:44.975 --> 00:01:46.236 into PT school, 00:01:46.617 --> 00:01:50.000 maybe thinking athletics or some grand big 00:01:50.019 --> 00:01:53.862 picture with no inkling of oncology care. 00:01:54.823 --> 00:01:58.126 I graduated even in twenty twenty two. 00:01:58.387 --> 00:02:00.688 And so that's relatively recently and 00:02:00.808 --> 00:02:02.131 still didn't really know much, 00:02:02.411 --> 00:02:03.391 especially when I went in. 00:02:04.045 --> 00:02:07.227 So then over COVID they did a really 00:02:07.266 --> 00:02:08.768 good job of like keeping us engaged. 00:02:08.828 --> 00:02:10.909 They did some speaker series of the 00:02:10.969 --> 00:02:15.372 different specialties in physical therapy. 00:02:15.393 --> 00:02:19.915 So then in enters Scott on zoom does 00:02:19.936 --> 00:02:22.057 a great job explaining, you know, 00:02:22.138 --> 00:02:23.479 about oncology care. 00:02:23.538 --> 00:02:24.780 And I'm like, wow, 00:02:24.819 --> 00:02:27.401 that's a really cool niche kind of fills 00:02:27.442 --> 00:02:29.143 my little like nerdy void. 00:02:31.026 --> 00:02:31.706 And he said, oh, 00:02:31.727 --> 00:02:33.707 if anybody wants to come shadow me up 00:02:33.788 --> 00:02:35.568 in Connecticut, I'm like, okay, 00:02:35.588 --> 00:02:36.908 that's not too far from New Jersey where 00:02:36.949 --> 00:02:37.270 I'm from. 00:02:37.750 --> 00:02:40.031 So I went to go shadow him at 00:02:40.070 --> 00:02:41.752 least twice, uh, 00:02:41.912 --> 00:02:43.412 once in a survivorship program and then 00:02:43.491 --> 00:02:44.772 once in just a clinic day. 00:02:45.393 --> 00:02:46.913 And that was it for me. 00:02:47.234 --> 00:02:48.875 I just decided that that's what I wanted 00:02:48.914 --> 00:02:49.495 to pursue. 00:02:49.615 --> 00:02:52.056 So I worked, um, 00:02:52.116 --> 00:02:54.437 in the New York area after college was 00:02:54.477 --> 00:02:56.457 like kind of starting more of like their 00:02:56.478 --> 00:02:57.377 oncology program there. 00:02:57.397 --> 00:02:58.878 They had a really great like breast 00:02:58.959 --> 00:02:59.399 program. 00:03:00.199 --> 00:03:02.221 but nothing really coming from medical 00:03:02.281 --> 00:03:03.001 oncology. 00:03:03.721 --> 00:03:05.662 So I was a big advocate for that 00:03:05.722 --> 00:03:07.462 there and then moved down to Dallas, 00:03:07.502 --> 00:03:09.644 Texas, started working at UT Southwestern, 00:03:09.683 --> 00:03:12.044 which has an amazing oncology rehab 00:03:12.085 --> 00:03:12.604 program. 00:03:13.064 --> 00:03:14.284 We have like a physical medicine 00:03:14.305 --> 00:03:15.346 rehabilitation doctor. 00:03:15.746 --> 00:03:17.907 So been doing a lot of that here. 00:03:18.699 --> 00:03:20.721 power of story scott we've had you on 00:03:20.741 --> 00:03:22.401 the show before but i'm smart enough to 00:03:22.442 --> 00:03:24.522 know podcasting is like radio just because 00:03:24.543 --> 00:03:26.924 you told a story a couple years ago 00:03:26.943 --> 00:03:28.444 doesn't mean the same people are listening 00:03:28.504 --> 00:03:30.746 right now so how's that number one my 00:03:30.786 --> 00:03:32.646 first question is how'd that make you feel 00:03:33.046 --> 00:03:35.207 that you jump on just a zoom call 00:03:35.268 --> 00:03:38.389 right with ithaca right great program go 00:03:38.430 --> 00:03:41.270 bombers uh and then someone that story 00:03:41.371 --> 00:03:41.951 lands 00:03:43.066 --> 00:03:44.548 That's number one, but number two, 00:03:44.568 --> 00:03:45.449 they took a step. 00:03:45.868 --> 00:03:46.569 They liked it more. 00:03:46.590 --> 00:03:47.591 They took another step. 00:03:48.070 --> 00:03:49.332 So first I want you to do this, 00:03:49.393 --> 00:03:50.294 talk about that. 00:03:50.935 --> 00:03:51.876 And then I want you to tell the 00:03:51.955 --> 00:03:53.798 audience who may not have any idea who 00:03:53.837 --> 00:03:53.997 you are, 00:03:54.018 --> 00:03:54.878 even though you've been on the show 00:03:54.899 --> 00:03:55.158 before, 00:03:55.498 --> 00:03:57.681 what that story or a quick snapshot of 00:03:57.701 --> 00:03:58.543 what that story was. 00:04:01.092 --> 00:04:01.413 Yeah. 00:04:02.373 --> 00:04:05.295 I do think being a clinician, 00:04:05.355 --> 00:04:07.538 being a PT now for a long time, 00:04:07.598 --> 00:04:09.340 I do feel that it's my obligation to 00:04:09.360 --> 00:04:11.121 give back to the students. 00:04:11.181 --> 00:04:14.024 I realized that being an oncology physical 00:04:14.063 --> 00:04:15.705 therapist, like Amanda said, 00:04:16.505 --> 00:04:18.127 It is kind of a niche thing, 00:04:18.367 --> 00:04:19.928 even though there are twenty million 00:04:19.968 --> 00:04:21.709 cancer survivors living in the United 00:04:21.750 --> 00:04:22.029 States. 00:04:22.071 --> 00:04:24.372 So I would argue that it's not necessarily 00:04:24.432 --> 00:04:24.752 niche. 00:04:24.793 --> 00:04:27.795 But from a programmatic perspective, 00:04:27.814 --> 00:04:29.495 when we talk about DPT programs, 00:04:29.576 --> 00:04:31.838 it is rarely, if at all, ever covered. 00:04:34.620 --> 00:04:37.242 So that was really cool that I mean, 00:04:37.341 --> 00:04:38.423 I really, you know, 00:04:38.562 --> 00:04:40.504 I give this talk every year to Ithaca 00:04:41.425 --> 00:04:43.125 because it's my way of giving back. 00:04:44.166 --> 00:04:45.367 And I'll get into that more in a 00:04:45.427 --> 00:04:45.728 second. 00:04:47.129 --> 00:04:48.790 And I always say, listen, you know, 00:04:49.050 --> 00:04:51.011 I'm an open book and I want you 00:04:51.050 --> 00:04:51.550 to learn. 00:04:52.732 --> 00:04:52.911 You know, 00:04:52.932 --> 00:04:54.892 the best thing I can do at this 00:04:54.913 --> 00:04:57.053 point in my career is to help bring 00:04:57.134 --> 00:04:58.774 somebody else into this realm. 00:04:59.274 --> 00:05:00.014 So, you know, 00:05:00.055 --> 00:05:01.334 this is my cell phone and this is 00:05:01.355 --> 00:05:02.074 my email. 00:05:02.134 --> 00:05:04.315 And, you know, I love having students. 00:05:04.375 --> 00:05:05.857 They are the future of our profession, 00:05:05.896 --> 00:05:06.216 Jimmy. 00:05:06.637 --> 00:05:07.057 You know, 00:05:07.237 --> 00:05:09.398 so I'm closer to retirement than I am 00:05:09.418 --> 00:05:10.257 being a new graduate. 00:05:13.559 --> 00:05:13.978 So, yeah, 00:05:13.999 --> 00:05:15.619 so when Amanda reached out to me, 00:05:15.639 --> 00:05:17.060 she was like, yeah, like, 00:05:17.500 --> 00:05:19.379 I'm willing to make a drive, you know, 00:05:19.420 --> 00:05:19.620 yeah, 00:05:19.819 --> 00:05:21.240 I'm going to have to drive up to 00:05:21.261 --> 00:05:24.261 Georgia to Connecticut to hang out with 00:05:24.281 --> 00:05:24.360 you. 00:05:25.100 --> 00:05:25.821 And, like, awesome. 00:05:25.841 --> 00:05:26.221 Also, you know, 00:05:26.242 --> 00:05:29.161 to the power of our alumni association, 00:05:29.201 --> 00:05:31.002 and I think everywhere we go, Jimmy, 00:05:31.021 --> 00:05:32.463 I know that you've been really, you know, 00:05:32.502 --> 00:05:34.983 connected with your alumni association as 00:05:35.023 --> 00:05:38.124 well, you know, with your PT program. 00:05:38.144 --> 00:05:39.024 So I think that... 00:05:39.303 --> 00:05:41.185 Right there, you know, 00:05:41.204 --> 00:05:43.266 just the power of those of us that 00:05:43.286 --> 00:05:44.007 have graduated, 00:05:44.047 --> 00:05:46.208 wherever we've graduated from, you know, 00:05:46.228 --> 00:05:48.149 to be able to give back, you know, 00:05:48.230 --> 00:05:50.411 to our universities is great. 00:05:50.730 --> 00:05:52.713 So it was really, you know, 00:05:52.793 --> 00:05:53.233 it was really... 00:05:55.153 --> 00:05:57.915 it felt really good yeah to have Amanda 00:05:57.935 --> 00:05:59.697 reach out to me and I've had other 00:05:59.737 --> 00:06:01.598 students do that now too where they say 00:06:01.978 --> 00:06:03.420 listen I want to see what it actually 00:06:03.459 --> 00:06:05.422 looks like like it's one thing you know 00:06:05.442 --> 00:06:08.463 to have the PowerPoint but what exactly do 00:06:08.504 --> 00:06:10.886 you actually do with these patients like 00:06:10.906 --> 00:06:12.786 and how is it different and when they 00:06:12.846 --> 00:06:15.168 come and they've observed me in clinic 00:06:16.149 --> 00:06:19.853 they realize that you know it's just PT 00:06:19.872 --> 00:06:21.733 right 00:06:22.358 --> 00:06:24.199 It's just the extra twenty percent layer 00:06:24.298 --> 00:06:27.220 of knowing what the drugs are and knowing 00:06:27.240 --> 00:06:28.759 what these side effects are from the drugs 00:06:29.220 --> 00:06:30.961 and being able to read that chart and 00:06:30.980 --> 00:06:34.161 decipher it and be able to predict what 00:06:34.182 --> 00:06:35.783 those adverse effects are going to be. 00:06:36.182 --> 00:06:38.043 So that way we can put on our 00:06:38.083 --> 00:06:39.524 PT hats and say, oh, 00:06:40.103 --> 00:06:43.225 that chemotherapy in particular can cause 00:06:43.425 --> 00:06:44.365 peripheral neuropathy. 00:06:44.605 --> 00:06:46.305 If that person can't feel their feet 00:06:46.605 --> 00:06:47.766 because of neuropathy, 00:06:48.047 --> 00:06:49.247 they're a falls risk. 00:06:50.307 --> 00:06:50.788 So what do you do? 00:06:51.327 --> 00:06:51.947 Falls prevention. 00:06:53.776 --> 00:06:55.437 Any PT could do fall prevention. 00:06:56.178 --> 00:06:58.519 It's just a matter of understanding why we 00:06:58.540 --> 00:06:59.961 have to do fall prevention for that 00:07:00.120 --> 00:07:00.541 patient. 00:07:01.062 --> 00:07:04.745 And why would persons with cancer and who 00:07:04.764 --> 00:07:05.584 have survived cancer, 00:07:05.625 --> 00:07:07.086 why is that particularly, 00:07:08.146 --> 00:07:09.327 why is that something important to you? 00:07:10.651 --> 00:07:12.913 So I was diagnosed with cancer when I 00:07:12.932 --> 00:07:14.033 was in PT school. 00:07:14.072 --> 00:07:15.973 I was in my last year of PT 00:07:15.992 --> 00:07:17.233 school at Ithaca. 00:07:17.894 --> 00:07:21.033 And you could say that I didn't really 00:07:21.113 --> 00:07:22.014 fit the profile. 00:07:22.555 --> 00:07:25.254 I ran cross country and track for my 00:07:25.295 --> 00:07:26.675 four years there at Ithaca. 00:07:27.235 --> 00:07:30.076 And I never drank, and I never smoked, 00:07:30.115 --> 00:07:31.076 and I never did drugs. 00:07:31.156 --> 00:07:33.156 I was always the designated driver for all 00:07:33.177 --> 00:07:36.298 my friends and all my teammates. 00:07:37.637 --> 00:07:39.538 And there was also no family history of 00:07:39.579 --> 00:07:40.040 cancer. 00:07:40.639 --> 00:07:42.261 And so I never would have expected in 00:07:42.300 --> 00:07:44.221 a hundred years that I'd be diagnosed. 00:07:44.262 --> 00:07:46.963 But as a twenty two year old going 00:07:46.983 --> 00:07:48.464 into his last year of PT school, 00:07:48.625 --> 00:07:49.384 that's what happened. 00:07:49.985 --> 00:07:52.047 And, you know, again, 00:07:52.067 --> 00:07:56.089 the why I feel so strongly about our 00:07:56.149 --> 00:07:58.130 program at Ithaca is because my professors 00:07:58.690 --> 00:08:00.932 stood by me and my classmates stood by 00:08:00.973 --> 00:08:02.653 me and my professors said, 00:08:03.990 --> 00:08:05.091 We're going to get you through this. 00:08:05.271 --> 00:08:07.391 You are going to graduate with your 00:08:07.451 --> 00:08:08.012 cohort. 00:08:08.192 --> 00:08:09.773 You've been with your cohort all these 00:08:09.812 --> 00:08:10.192 years. 00:08:11.252 --> 00:08:12.113 You're not going to go back. 00:08:12.134 --> 00:08:13.213 You're not going to stay back a year. 00:08:13.254 --> 00:08:16.394 You will graduate with your classmates. 00:08:17.074 --> 00:08:21.016 And so that's why I always feel that 00:08:21.057 --> 00:08:22.576 this is a small thing that I can 00:08:22.596 --> 00:08:25.298 do to give back to my program. 00:08:25.757 --> 00:08:27.538 And that talk even kind of morphed over 00:08:27.559 --> 00:08:27.918 the years. 00:08:29.004 --> 00:08:29.185 you know, 00:08:29.204 --> 00:08:31.365 initially I'd go back and I would just 00:08:31.446 --> 00:08:32.145 tell my story. 00:08:32.427 --> 00:08:34.226 And really it was almost like a PSA 00:08:34.307 --> 00:08:37.369 of, Hey, I was and I got cancer. 00:08:37.389 --> 00:08:38.828 So start doing yourself exams now. 00:08:39.809 --> 00:08:39.950 Um, 00:08:40.908 --> 00:08:41.908 And then as I got more and more 00:08:41.948 --> 00:08:43.149 into oncology rehab, 00:08:43.190 --> 00:08:45.850 then it morphed more into the actual 00:08:45.931 --> 00:08:47.131 oncology lecture. 00:08:48.393 --> 00:08:49.653 You know, what is oncology rehab? 00:08:49.693 --> 00:08:50.335 What do I do? 00:08:50.355 --> 00:08:52.515 And why do these patients need care? 00:08:52.975 --> 00:08:54.937 In addition to telling my story. 00:08:54.998 --> 00:08:56.879 So, yeah, so Amanda, 00:08:57.458 --> 00:08:59.080 you and your classmates kind of heard that 00:08:59.100 --> 00:09:00.321 version of it, you know, 00:09:00.480 --> 00:09:02.243 both the didactic piece of it, 00:09:02.263 --> 00:09:04.043 but also the personal piece of it. 00:09:05.524 --> 00:09:08.044 So our audience obviously is not public 00:09:08.065 --> 00:09:08.445 facing. 00:09:09.004 --> 00:09:10.085 It's pretty much internal to the 00:09:10.144 --> 00:09:10.826 profession. 00:09:12.025 --> 00:09:14.687 How do you answer this when fellow PTs 00:09:14.767 --> 00:09:16.267 find out, this is for both of you, 00:09:16.667 --> 00:09:16.807 hey, 00:09:16.846 --> 00:09:18.727 this is the type of patients that you 00:09:18.768 --> 00:09:19.268 work with. 00:09:20.187 --> 00:09:21.729 How do you answer the question, 00:09:21.769 --> 00:09:23.668 why do people with cancer need PT? 00:09:23.928 --> 00:09:25.730 Why are so few getting it? 00:09:25.789 --> 00:09:26.490 I mean, even Amanda, 00:09:26.509 --> 00:09:27.909 you said in the middle of PT school, 00:09:28.169 --> 00:09:30.671 this wasn't something you went into and 00:09:30.770 --> 00:09:31.870 expected to be there, 00:09:31.910 --> 00:09:33.611 but once the rationale was there, 00:09:34.292 --> 00:09:36.472 I don't think you could shout this enough 00:09:36.753 --> 00:09:38.134 just because people like you understand 00:09:38.153 --> 00:09:38.774 this deeply. 00:09:39.475 --> 00:09:39.774 Why? 00:09:40.335 --> 00:09:41.375 What is the answer to that? 00:09:41.436 --> 00:09:43.115 Why do people with cancer need PT and 00:09:43.155 --> 00:09:44.976 why are so few people getting? 00:09:47.778 --> 00:09:49.659 I think that I mean, 00:09:49.720 --> 00:09:50.720 I get this question a lot, 00:09:51.200 --> 00:09:53.361 usually not so much like from physical 00:09:53.402 --> 00:09:54.942 therapists, but like, obviously, yes, 00:09:55.062 --> 00:09:57.563 mostly from people like that are not in 00:09:57.604 --> 00:09:58.183 health care, be like, 00:09:58.344 --> 00:09:59.024 what do you do with cancer? 00:09:59.063 --> 00:09:59.664 And I'm like, 00:10:00.144 --> 00:10:02.265 everything they need so much. 00:10:02.658 --> 00:10:06.022 But from my peers, it's more like, well, 00:10:06.341 --> 00:10:08.984 OK, you know about the human body, 00:10:09.043 --> 00:10:09.485 obviously, 00:10:09.504 --> 00:10:10.765 and the movement systems and everything. 00:10:11.245 --> 00:10:13.488 Let's talk about what cancer treatment 00:10:13.548 --> 00:10:16.169 does to the human body. 00:10:16.509 --> 00:10:18.491 And I explained these things are so 00:10:18.552 --> 00:10:19.052 important. 00:10:19.113 --> 00:10:20.754 These things save the patient's life. 00:10:21.894 --> 00:10:22.956 And previous, 00:10:23.035 --> 00:10:24.756 and Scott can attest to this because he 00:10:24.777 --> 00:10:25.857 was a part of it as it was 00:10:26.238 --> 00:10:26.639 growing. 00:10:27.198 --> 00:10:28.799 But previously it was like, oh, no, 00:10:28.840 --> 00:10:30.581 like leave these patients alone, 00:10:30.922 --> 00:10:32.802 let them rest, let them recover. 00:10:33.504 --> 00:10:34.303 OK, well, 00:10:34.384 --> 00:10:36.525 now we have so many cancer survivors 00:10:37.046 --> 00:10:38.506 because of all these amazing treatments 00:10:38.626 --> 00:10:41.089 and they need to get back to doing 00:10:41.129 --> 00:10:42.269 things that they were doing before, 00:10:42.309 --> 00:10:43.510 whether that's child care, 00:10:43.850 --> 00:10:45.091 whether that's their job, 00:10:45.471 --> 00:10:47.514 whether that's caring for aging parents. 00:10:48.041 --> 00:10:50.501 So what are things that we can do 00:10:50.903 --> 00:10:53.043 that help them decrease the effect of 00:10:53.083 --> 00:10:53.724 neuropathy, 00:10:54.063 --> 00:10:57.326 decrease cancer-related fatigue, decrease, 00:10:57.667 --> 00:10:59.086 you know, help people sleep better? 00:10:59.366 --> 00:11:01.448 If you're not sleeping well because of, 00:11:01.548 --> 00:11:01.788 you know, 00:11:02.208 --> 00:11:04.289 like radiation fibrosis to your shoulder 00:11:04.450 --> 00:11:06.772 or shoulder pain and scapular dyskinesis, 00:11:08.793 --> 00:11:10.114 how can we help this person sleep better 00:11:10.153 --> 00:11:11.815 so they can function better during their 00:11:11.855 --> 00:11:12.575 daily life? 00:11:13.014 --> 00:11:13.755 With neuropathy, 00:11:13.816 --> 00:11:15.056 how can we help to decrease their 00:11:15.076 --> 00:11:16.616 neuropathy so that they can sleep better, 00:11:16.917 --> 00:11:17.778 so they can walk better? 00:11:18.153 --> 00:11:19.495 to decrease the risk of falls. 00:11:20.134 --> 00:11:24.197 I'm also studying for the specialty exam 00:11:24.236 --> 00:11:25.398 right now and just going through the 00:11:25.418 --> 00:11:25.798 textbook, 00:11:25.837 --> 00:11:27.899 it says something and don't quote me, 00:11:28.019 --> 00:11:29.159 numbers are not my strong suit, 00:11:29.580 --> 00:11:32.542 but something like forty percent of men 00:11:32.581 --> 00:11:34.822 that take androgen deprivation therapy for 00:11:34.842 --> 00:11:37.244 prostate cancer will have a fall and a 00:11:37.283 --> 00:11:39.384 fracture within the first few years of 00:11:39.404 --> 00:11:39.945 taking that. 00:11:40.605 --> 00:11:41.946 So we know what these patients are going 00:11:41.966 --> 00:11:43.486 to go through because we know the side 00:11:43.506 --> 00:11:44.248 effects of the treatment. 00:11:44.727 --> 00:11:46.389 So how can we help them during and 00:11:46.469 --> 00:11:46.729 after? 00:11:47.205 --> 00:11:48.426 or even getting prepared for it. 00:11:48.466 --> 00:11:50.126 Sure. 00:11:50.147 --> 00:11:50.346 Yeah. 00:11:50.767 --> 00:11:52.327 And to kind of answer the second half 00:11:52.347 --> 00:11:53.707 of that question, Jimmy, I think the, 00:11:54.528 --> 00:11:54.708 you know, 00:11:54.749 --> 00:11:56.149 I think there's still a lot of 00:11:56.289 --> 00:12:00.172 misconceptions, you know, probably about, 00:12:00.631 --> 00:12:03.933 you know, or with our oncology colleagues, 00:12:03.953 --> 00:12:05.495 first of all, you know, again, 00:12:05.534 --> 00:12:07.296 if somebody has been practicing for thirty 00:12:07.316 --> 00:12:08.336 years, thirty years ago, 00:12:08.416 --> 00:12:09.636 that's what the evidence said. 00:12:10.988 --> 00:12:12.067 Let these patients rest. 00:12:12.727 --> 00:12:13.769 Don't let them do anything. 00:12:13.788 --> 00:12:15.448 They need to conserve their energy while 00:12:15.469 --> 00:12:16.589 they're going through treatment. 00:12:17.009 --> 00:12:19.129 So that's what they got in medical school, 00:12:19.809 --> 00:12:21.110 oh, thirty years ago. 00:12:21.169 --> 00:12:22.750 And so that's probably what their mindset 00:12:22.791 --> 00:12:24.770 still is today. 00:12:24.870 --> 00:12:26.350 I'm noticing that I'm getting more and 00:12:26.370 --> 00:12:26.551 more. 00:12:27.072 --> 00:12:28.611 Most of my referrals are coming from 00:12:28.672 --> 00:12:30.371 younger oncologists because they're 00:12:30.392 --> 00:12:32.533 getting it more in in med school. 00:12:33.952 --> 00:12:37.394 And and again, we have the evidence now 00:12:38.274 --> 00:12:39.355 In twenty twenty six, 00:12:39.455 --> 00:12:41.636 we have all this evidence that shows the 00:12:41.677 --> 00:12:43.238 benefit of exercise. 00:12:44.339 --> 00:12:46.880 And so now I think the oncologists are 00:12:46.921 --> 00:12:47.902 starting to come up with that. 00:12:48.201 --> 00:12:50.063 But we're going to have a whole other 00:12:50.104 --> 00:12:51.384 conversation about, you know, 00:12:51.445 --> 00:12:53.025 we need to make this easier. 00:12:53.046 --> 00:12:53.147 Right. 00:12:53.586 --> 00:12:54.587 Like, Jimmy, 00:12:54.628 --> 00:12:55.568 we've talked about this before. 00:12:55.589 --> 00:12:56.909 You talk about this all the time, Jimmy, 00:12:56.950 --> 00:12:58.230 the easy button, you know, 00:12:58.530 --> 00:13:00.052 the target like, you know, 00:13:00.152 --> 00:13:01.312 or Staples easy button. 00:13:02.333 --> 00:13:04.135 We need to make it easier for these 00:13:04.196 --> 00:13:04.916 oncologists. 00:13:05.777 --> 00:13:07.697 and these oncology nurses to get these 00:13:07.758 --> 00:13:08.519 patients to us. 00:13:09.078 --> 00:13:10.639 They are dealing with so much. 00:13:11.659 --> 00:13:13.961 Exercise and rehab is not the first thing 00:13:13.981 --> 00:13:15.442 that's on their minds. 00:13:15.923 --> 00:13:17.004 And so we need to be able to 00:13:17.244 --> 00:13:17.504 build, 00:13:17.964 --> 00:13:20.164 if you're in a big academic institution, 00:13:20.546 --> 00:13:23.787 like use Epic to our advantage, 00:13:23.826 --> 00:13:26.009 like build it into the order set to 00:13:26.028 --> 00:13:28.330 make it easier for them to make that 00:13:28.429 --> 00:13:28.690 referral. 00:13:28.710 --> 00:13:29.730 They just have to hit the button. 00:13:30.291 --> 00:13:32.913 rather than fill out all the referral 00:13:32.953 --> 00:13:34.115 stuff. 00:13:34.316 --> 00:13:36.018 That's where a lot of it gets lost, 00:13:36.038 --> 00:13:40.722 honestly. 00:13:41.063 --> 00:13:42.264 You've said before that oncology, 00:13:42.304 --> 00:13:42.905 physical therapy, 00:13:42.966 --> 00:13:44.707 landscape is constantly changing. 00:13:45.948 --> 00:13:46.730 What's new 00:13:47.727 --> 00:13:50.370 What's new that PTs need to know? 00:13:50.629 --> 00:13:52.331 Maybe something that even if they thought 00:13:52.370 --> 00:13:54.772 they were on the cutting edge a year 00:13:54.851 --> 00:13:55.672 or two ago, 00:13:56.153 --> 00:13:58.894 what's something that's a big disruptor 00:13:58.913 --> 00:14:00.315 that maybe PTs still, 00:14:00.455 --> 00:14:02.035 even if they're ahead of the curve 00:14:02.076 --> 00:14:03.496 normally, that they don't know? 00:14:04.231 --> 00:14:06.413 Yeah, well, two things there, Jimmy. 00:14:06.472 --> 00:14:06.953 First of all, 00:14:07.014 --> 00:14:09.414 last year in twenty twenty five in the 00:14:09.434 --> 00:14:10.775 New England Journal of Medicine, 00:14:11.235 --> 00:14:12.797 kind of what I would consider the holy 00:14:12.817 --> 00:14:15.398 grail that we've been searching for for 00:14:15.498 --> 00:14:16.438 all of these years. 00:14:17.299 --> 00:14:20.081 The challenge trial was published and it 00:14:20.100 --> 00:14:24.264 was this huge multicenter study had almost 00:14:24.384 --> 00:14:26.865 nine hundred patients with stage two or 00:14:26.884 --> 00:14:28.765 stage three colorectal cancer. 00:14:29.506 --> 00:14:31.307 And the intervention group 00:14:32.268 --> 00:14:34.788 exercise and they had supervised exercise 00:14:35.269 --> 00:14:38.051 programs and one of the big things too 00:14:38.091 --> 00:14:39.951 about this this trial was that these 00:14:39.991 --> 00:14:42.113 patients could do cardio they had to do 00:14:42.173 --> 00:14:44.313 forty five minutes of cardio three or four 00:14:44.333 --> 00:14:46.034 times a week but they got to choose 00:14:46.534 --> 00:14:47.855 the kind of cardio that they wanted to 00:14:47.875 --> 00:14:49.235 do so it could have been walking it 00:14:49.256 --> 00:14:50.437 could have been hiking it could have been 00:14:50.456 --> 00:14:52.197 biking gonna be kayaking 00:14:53.736 --> 00:14:55.538 And so they had these checkpoints with 00:14:55.578 --> 00:14:57.421 their physiotherapists and exercise 00:14:57.461 --> 00:15:01.484 physiologists twice a month for one year. 00:15:01.904 --> 00:15:04.366 And then they can continue to still have 00:15:04.626 --> 00:15:06.448 touch points once a month for an 00:15:06.489 --> 00:15:08.110 additional two years beyond that. 00:15:08.130 --> 00:15:09.511 So three years total, 00:15:10.131 --> 00:15:11.634 they had somebody checking on them to 00:15:11.673 --> 00:15:14.375 making sure they were adhering to exercise 00:15:14.416 --> 00:15:14.956 and rehab. 00:15:16.038 --> 00:15:19.061 And the researchers found that 00:15:20.562 --> 00:15:23.427 Those that exercise decrease the risk of 00:15:23.466 --> 00:15:26.250 recurrence of the cancer of colorectal 00:15:26.289 --> 00:15:29.274 cancer by twenty eight percent and 00:15:30.075 --> 00:15:33.379 decrease the risk of death by thirty seven 00:15:33.418 --> 00:15:34.000 percent. 00:15:34.581 --> 00:15:35.902 I'm a huge fan of not dying. 00:15:35.942 --> 00:15:36.702 So that sounds good. 00:15:37.423 --> 00:15:39.065 Right, right there. 00:15:39.205 --> 00:15:40.206 Just by exercising, 00:15:40.225 --> 00:15:41.908 you decrease your risk of death by one 00:15:42.008 --> 00:15:42.528 third. 00:15:42.788 --> 00:15:44.250 And that's just the exercise piece of it, 00:15:44.269 --> 00:15:44.791 right? 00:15:44.831 --> 00:15:47.273 But those patients were monitored. 00:15:47.994 --> 00:15:50.657 They had accountability partners. 00:15:51.157 --> 00:15:53.580 They also got to choose that type of 00:15:53.620 --> 00:15:54.179 exercise. 00:15:55.191 --> 00:15:56.671 And then the kicker out of this study, 00:15:56.730 --> 00:15:58.091 out of all this great data, 00:15:58.392 --> 00:16:00.432 was that when they did an even bigger 00:16:00.471 --> 00:16:03.452 analysis and they put exercise up against 00:16:03.533 --> 00:16:04.133 chemo, 00:16:04.474 --> 00:16:06.153 a very particular chemotherapy drug, 00:16:06.394 --> 00:16:10.534 oxaloplatin, they found that exercise, 00:16:11.075 --> 00:16:12.515 the patients who exercise, 00:16:12.975 --> 00:16:15.256 it was more effective than the 00:16:15.297 --> 00:16:16.417 chemotherapy was. 00:16:17.136 --> 00:16:17.856 So that's it. 00:16:18.037 --> 00:16:21.018 We have the proof that exercise and rehab 00:16:21.618 --> 00:16:23.078 can be better than chemo. 00:16:24.195 --> 00:16:27.197 improving overall survival for our 00:16:27.236 --> 00:16:31.340 patients so that's one big thing that just 00:16:31.360 --> 00:16:33.701 came out less than twelve months ago the 00:16:33.780 --> 00:16:35.822 other thing and this is kind of you 00:16:35.842 --> 00:16:38.244 know alluding to the the talk that amanda 00:16:38.264 --> 00:16:39.284 steve and i are going to do at 00:16:39.565 --> 00:16:44.227 csm is the the increase in availability 00:16:44.288 --> 00:16:46.169 and the development of immunotherapy 00:16:47.412 --> 00:16:49.333 Immunotherapy is different than 00:16:49.394 --> 00:16:50.333 chemotherapy. 00:16:50.754 --> 00:16:53.417 Immunotherapy is more targeted therapy to 00:16:53.456 --> 00:16:56.840 try to turn the immune system on to 00:16:56.879 --> 00:16:59.961 try to identify the cancer cells and go 00:17:00.081 --> 00:17:00.523 after them. 00:17:01.263 --> 00:17:02.203 And again, 00:17:02.683 --> 00:17:05.487 new data that just came out in January 00:17:05.527 --> 00:17:06.267 of twenty six. 00:17:07.448 --> 00:17:08.909 The American Cancer Society always 00:17:08.949 --> 00:17:11.490 releases updated stats every year. 00:17:12.392 --> 00:17:13.512 for the first time, 00:17:14.574 --> 00:17:17.237 the overall cancer survival rate, 00:17:17.277 --> 00:17:18.657 if we put all the cancers together, 00:17:19.798 --> 00:17:21.980 has finally eclipsed seventy percent. 00:17:22.442 --> 00:17:24.202 So that's a big deal, right? 00:17:24.223 --> 00:17:25.565 That is a big deal because it was 00:17:25.605 --> 00:17:28.346 not that twenty, thirty years ago. 00:17:29.107 --> 00:17:31.471 And we specifically saw an increase in 00:17:31.510 --> 00:17:33.332 survival in some of the harder 00:17:34.413 --> 00:17:36.513 cancers that are out there, like melanoma, 00:17:37.454 --> 00:17:39.756 that survival rate almost doubled. 00:17:40.415 --> 00:17:42.076 The survival rate of patients with liver 00:17:42.116 --> 00:17:43.278 cancer almost tripled. 00:17:45.305 --> 00:17:47.746 And you could probably say that 00:17:47.885 --> 00:17:50.627 immunotherapy had a big role in that 00:17:50.667 --> 00:17:53.769 because immunotherapy was not readily 00:17:53.808 --> 00:17:55.210 available and readily used, 00:17:55.970 --> 00:17:58.730 in the treatment of a lot of these 00:17:58.931 --> 00:17:59.632 types of cancer. 00:18:00.172 --> 00:18:00.811 And now they are. 00:18:01.231 --> 00:18:03.192 And so we're seeing an improvement in 00:18:03.272 --> 00:18:06.234 overall survival by adding immunotherapy 00:18:06.654 --> 00:18:09.256 to some of the traditional treatments such 00:18:09.296 --> 00:18:10.957 as chemotherapy and radiation therapy. 00:18:12.627 --> 00:18:13.268 So we know better, 00:18:13.909 --> 00:18:15.449 it's just time to make sure we do 00:18:15.469 --> 00:18:16.329 better, right? 00:18:16.349 --> 00:18:17.830 We've been yelling for research left and 00:18:17.871 --> 00:18:19.131 right, now we have it, 00:18:19.632 --> 00:18:20.971 now it's time to execute. 00:18:20.991 --> 00:18:21.873 Well, 00:18:21.893 --> 00:18:24.273 this brings us to your talk at CSM, 00:18:24.314 --> 00:18:26.974 doing a lot of these sort of hype 00:18:26.994 --> 00:18:28.715 videos, which I think is good. 00:18:28.796 --> 00:18:30.416 If you're gonna huck yourself all the way 00:18:30.457 --> 00:18:31.136 out to LA, 00:18:31.617 --> 00:18:32.798 make sure you understand what's on the 00:18:32.817 --> 00:18:33.117 menu, 00:18:33.798 --> 00:18:35.019 because I wouldn't want you to miss it. 00:18:35.318 --> 00:18:36.660 So Thursday the twelfth, 00:18:37.339 --> 00:18:38.520 ten thirty to noon, 00:18:38.760 --> 00:18:39.781 nice in the middle of the day, 00:18:39.902 --> 00:18:41.962 not too early, not too late, smart. 00:18:42.803 --> 00:18:45.384 Um, I like the title. 00:18:45.663 --> 00:18:46.845 I don't know if I'm saying it right. 00:18:46.924 --> 00:18:47.825 Pronounce it for me. 00:18:50.346 --> 00:18:51.605 Sibs, nibs, and mabs. 00:18:51.986 --> 00:18:52.626 Oh my. 00:18:54.547 --> 00:18:56.428 And identifying opportunities in 00:18:56.448 --> 00:18:57.667 immunotherapy rehabilitation. 00:18:58.348 --> 00:19:00.308 I gotta be honest, sibs, nibs, and mabs. 00:19:00.729 --> 00:19:01.390 I don't know what they are. 00:19:01.470 --> 00:19:01.990 Help me out here. 00:19:05.378 --> 00:19:05.618 Yeah, 00:19:05.659 --> 00:19:08.720 so I think that that's the whole point. 00:19:09.059 --> 00:19:10.060 The sibs, mibs, and mabs, 00:19:10.101 --> 00:19:12.300 that is the tail end of a lot 00:19:12.340 --> 00:19:13.102 of these drugs. 00:19:13.801 --> 00:19:16.722 And again, as a student, 00:19:17.242 --> 00:19:18.323 as a new clinician, 00:19:18.703 --> 00:19:20.223 even a seasoned clinician, 00:19:20.263 --> 00:19:22.924 but you're getting into oncology rehab, 00:19:23.005 --> 00:19:25.885 or you're working in a sports rehab 00:19:26.026 --> 00:19:28.086 center, and you have this patient come in, 00:19:28.146 --> 00:19:29.626 and you look at their chart, 00:19:29.646 --> 00:19:30.586 and you see these things. 00:19:30.627 --> 00:19:31.508 You're like, what? 00:19:32.288 --> 00:19:34.892 and God's green earth are these drugs. 00:19:36.153 --> 00:19:38.896 And so that's why we wanted to demystify 00:19:38.936 --> 00:19:39.096 that. 00:19:39.116 --> 00:19:40.858 We wanted to talk about what is 00:19:40.919 --> 00:19:42.922 immunotherapy and the effects of 00:19:43.021 --> 00:19:44.202 immunotherapy on the body. 00:19:44.963 --> 00:19:46.946 And then what we can do as PTs 00:19:47.326 --> 00:19:49.430 to make sure that we're keeping our 00:19:49.470 --> 00:19:50.131 patients healthy 00:19:51.192 --> 00:19:53.813 and keeping them moving and potentially 00:19:53.833 --> 00:19:58.575 even helping to help enhance the effects 00:19:58.694 --> 00:20:01.737 of immunotherapy as they're trying to work 00:20:01.777 --> 00:20:03.478 towards getting rid of the cancer. 00:20:04.637 --> 00:20:05.097 Amanda, 00:20:05.919 --> 00:20:07.798 what do you hope people who walk out 00:20:07.839 --> 00:20:11.181 of your talk are able to do? 00:20:11.921 --> 00:20:12.701 What is the goal? 00:20:12.741 --> 00:20:13.981 What should they look like? 00:20:14.001 --> 00:20:15.883 What should they feel empowered to do? 00:20:15.923 --> 00:20:18.824 What's the change happen in ninety minutes 00:20:18.844 --> 00:20:20.845 with you guys in L.A.? ? 00:20:21.298 --> 00:20:21.698 Yes. 00:20:21.897 --> 00:20:22.538 So I, 00:20:23.218 --> 00:20:25.138 something that I really want to emphasize 00:20:25.259 --> 00:20:28.239 is that even though like the title of 00:20:28.259 --> 00:20:28.980 our presentation, 00:20:29.240 --> 00:20:30.420 not that it seems daunting, 00:20:30.480 --> 00:20:32.779 I think I love Scott's, uh, you know, 00:20:32.880 --> 00:20:34.601 idea of bringing in lions, tigers, 00:20:34.641 --> 00:20:35.080 and bears. 00:20:35.921 --> 00:20:36.201 Um, 00:20:36.421 --> 00:20:40.301 but it's not just for seasoned oncology 00:20:40.342 --> 00:20:41.122 PTs. 00:20:41.882 --> 00:20:42.162 Um, 00:20:42.201 --> 00:20:43.721 I think that's a lot of the audience 00:20:43.761 --> 00:20:45.202 that we're going to capture. 00:20:45.843 --> 00:20:46.803 Um, but. 00:20:47.394 --> 00:20:49.816 I want anybody to be able to come 00:20:49.836 --> 00:20:53.337 to our presentation and know what are the 00:20:53.397 --> 00:20:55.700 possible side effects that they should be 00:20:55.759 --> 00:20:56.579 looking for, 00:20:57.060 --> 00:20:58.701 for patients that are receiving 00:20:58.760 --> 00:20:59.761 immunotherapy, 00:21:00.061 --> 00:21:02.103 because it could be somebody that's coming 00:21:02.143 --> 00:21:04.285 to you in an ortho clinic for a 00:21:04.305 --> 00:21:04.805 knee pain. 00:21:05.365 --> 00:21:06.986 It might not be somebody that's going to 00:21:07.006 --> 00:21:08.807 a specialized cancer clinician. 00:21:09.907 --> 00:21:12.328 They could have either be on immunotherapy 00:21:12.348 --> 00:21:13.849 because people are on it for longer 00:21:13.890 --> 00:21:14.789 periods of time, 00:21:14.871 --> 00:21:15.631 or they have 00:21:16.020 --> 00:21:19.261 something big like a CAR T cell therapy. 00:21:20.042 --> 00:21:21.163 And we'll get into that in our 00:21:21.202 --> 00:21:21.803 presentation, 00:21:22.343 --> 00:21:25.924 but it might not be somebody that looks 00:21:26.025 --> 00:21:28.705 super ill that needs like specialized 00:21:28.746 --> 00:21:31.446 cancer care, or just in your community, 00:21:31.487 --> 00:21:34.607 you might not have a specialized oncology 00:21:34.647 --> 00:21:35.147 clinician. 00:21:35.508 --> 00:21:37.068 So it could be somebody going to any 00:21:38.029 --> 00:21:40.730 office for any problem that may have a 00:21:40.810 --> 00:21:42.832 history of immunotherapy or may be 00:21:42.872 --> 00:21:44.053 currently on it. 00:21:44.093 --> 00:21:46.614 So a big thing in our presentation is 00:21:46.773 --> 00:21:48.054 what are these side effects? 00:21:48.493 --> 00:21:50.494 How do they impact the human movement 00:21:50.515 --> 00:21:50.914 system? 00:21:50.954 --> 00:21:53.115 That's Steve's whole thing. 00:21:53.175 --> 00:21:54.636 It's how do they impact the human movement 00:21:54.656 --> 00:21:57.317 system and what like emergencies are you 00:21:57.337 --> 00:21:58.159 looking out for? 00:21:58.219 --> 00:22:00.219 Because some of these side effects can be 00:22:00.298 --> 00:22:00.819 life threatening, 00:22:00.859 --> 00:22:02.220 but some of them are very mild. 00:22:02.279 --> 00:22:04.621 So we're going to go over the mild 00:22:04.760 --> 00:22:06.342 ones, the life threatening ones, 00:22:06.686 --> 00:22:08.067 how to keep an eye out for them 00:22:08.167 --> 00:22:11.029 in your practice and how to discuss these 00:22:11.049 --> 00:22:11.691 with your patient. 00:22:11.711 --> 00:22:12.711 Yeah. 00:22:13.416 --> 00:22:15.077 I do want to say thanks to Empower 00:22:15.198 --> 00:22:15.637 EMR. 00:22:15.657 --> 00:22:17.377 If your clinic's stuck in an EMR that 00:22:17.417 --> 00:22:18.238 slows you down, 00:22:18.258 --> 00:22:19.558 you shouldn't have that EMR. 00:22:20.338 --> 00:22:22.098 Empower gives you speed, clean workflows, 00:22:22.138 --> 00:22:24.500 and features PTs actually ask for. 00:22:24.539 --> 00:22:26.000 Better notes, faster documentation, 00:22:26.039 --> 00:22:27.621 smooth operations. 00:22:27.881 --> 00:22:29.421 All wrapped in customer support that 00:22:29.441 --> 00:22:30.122 doesn't ghost you. 00:22:30.442 --> 00:22:32.142 EmpowerEMR.com. 00:22:32.342 --> 00:22:33.823 EmpowerEMR.com. 00:22:33.843 --> 00:22:34.942 Got to pay the bills here, guys. 00:22:34.962 --> 00:22:35.182 Otherwise, 00:22:35.202 --> 00:22:36.623 we don't keep the lights on the podcast. 00:22:39.064 --> 00:22:40.443 If someone says, 00:22:40.624 --> 00:22:42.484 I feel a little bit unprepared, 00:22:44.320 --> 00:22:45.122 Why should they come? 00:22:45.701 --> 00:22:46.843 Amanda just sort of touched on it. 00:22:47.423 --> 00:22:49.684 Is this going to be too over someone's 00:22:49.744 --> 00:22:53.028 head or is this pretty available and 00:22:53.067 --> 00:22:53.868 accessible? 00:22:54.068 --> 00:22:55.990 Like we want those advanced courses, 00:22:56.069 --> 00:22:56.289 right? 00:22:56.750 --> 00:22:58.211 Just who's this right for? 00:22:58.271 --> 00:23:00.614 Who should walk in and sit down? 00:23:03.688 --> 00:23:04.388 Yeah. 00:23:04.429 --> 00:23:04.788 And as Amanda, 00:23:04.888 --> 00:23:06.170 as you were just alluding to, 00:23:06.289 --> 00:23:09.791 I think any student and any clinician, 00:23:10.231 --> 00:23:12.772 whether they're an oncology specialist or 00:23:12.833 --> 00:23:13.114 not, 00:23:13.453 --> 00:23:15.755 they should walk in because we hope to 00:23:15.795 --> 00:23:18.115 be able to answer those questions so that 00:23:18.155 --> 00:23:20.637 anybody who walks in then walks out nine 00:23:20.678 --> 00:23:22.038 minutes later and says, oh, okay. 00:23:22.719 --> 00:23:24.582 You know, these immunotherapies, 00:23:24.622 --> 00:23:25.742 these sims, mibs and mabs, 00:23:25.782 --> 00:23:26.744 they're not that scary. 00:23:26.765 --> 00:23:27.025 Right. 00:23:28.186 --> 00:23:30.048 Because, you know, Amanda, 00:23:30.088 --> 00:23:33.673 you just said it like not every clinician 00:23:33.814 --> 00:23:34.955 is an oncology clinician. 00:23:35.016 --> 00:23:36.037 But again, 00:23:36.257 --> 00:23:37.880 with twenty million cancer survivors 00:23:37.920 --> 00:23:38.740 living in the country. 00:23:39.682 --> 00:23:41.782 This patient could walk into your 00:23:42.063 --> 00:23:45.943 traditional mom and pop outpatient sports 00:23:46.003 --> 00:23:48.304 clinic in East Tumbleweed, Kansas. 00:23:49.023 --> 00:23:51.365 But you have to be prepared for that. 00:23:51.724 --> 00:23:55.445 And so we want all clinicians and we 00:23:55.486 --> 00:23:56.165 want students, 00:23:56.365 --> 00:23:58.547 because I guarantee that's not like we 00:23:58.567 --> 00:23:59.446 talked about earlier. 00:23:59.906 --> 00:24:01.188 A lot of this is not being covered 00:24:01.228 --> 00:24:02.307 in DPT programs. 00:24:02.807 --> 00:24:04.288 I would love students to show up to 00:24:04.308 --> 00:24:06.090 this so that that way they feel empowered 00:24:06.111 --> 00:24:07.632 when they go out on their clinicals. 00:24:08.051 --> 00:24:09.953 They could be the ones that are teaching 00:24:09.973 --> 00:24:12.895 their CIs what this is. 00:24:15.157 --> 00:24:16.179 I like myth busting. 00:24:17.298 --> 00:24:18.681 I like correcting at least. 00:24:19.060 --> 00:24:20.142 So this is for both of you. 00:24:20.162 --> 00:24:21.583 You each get to pick maybe one. 00:24:22.222 --> 00:24:24.545 What's a myth about either oncology, 00:24:24.585 --> 00:24:26.507 physical therapy, or immunotherapy? 00:24:26.527 --> 00:24:27.688 What's one myth? 00:24:28.479 --> 00:24:30.740 that you find yourself sort of saying, 00:24:30.801 --> 00:24:32.103 well, yeah, okay, yes, 00:24:32.163 --> 00:24:34.625 but maybe they're not completely off, 00:24:34.786 --> 00:24:36.307 but maybe it's a couple degree course 00:24:36.346 --> 00:24:36.948 correction. 00:24:37.368 --> 00:24:38.630 I'll give you each an opportunity to 00:24:38.650 --> 00:24:41.153 correct one myth or update or drop a 00:24:41.192 --> 00:24:44.715 well actually about oncology PT that other 00:24:44.756 --> 00:24:47.660 clinicians need to stop missing the mark 00:24:47.700 --> 00:24:47.779 on. 00:24:52.304 --> 00:24:52.443 Well, 00:24:52.483 --> 00:24:53.486 I think one of the things that I 00:24:53.506 --> 00:24:54.586 would consider here, 00:24:54.646 --> 00:24:56.068 and maybe we're going to get into it 00:24:56.128 --> 00:24:57.309 in our talk specifically, 00:24:57.410 --> 00:25:00.034 is that immunotherapy is easier than chemo 00:25:00.954 --> 00:25:01.816 because it's not chemo. 00:25:02.478 --> 00:25:02.678 Right. 00:25:02.718 --> 00:25:04.818 Like we all know we have a pretty 00:25:04.838 --> 00:25:05.578 good understanding, 00:25:05.638 --> 00:25:07.279 even if you're not an oncology PT, 00:25:07.299 --> 00:25:09.461 like if you've had a loved one go 00:25:09.480 --> 00:25:10.320 through cancer treatment, 00:25:10.361 --> 00:25:11.662 like you're kind of used to seeing, 00:25:11.801 --> 00:25:12.082 you know, 00:25:12.102 --> 00:25:13.643 kind of the telltale signs of what chemo 00:25:13.722 --> 00:25:15.222 is, you know, 00:25:15.242 --> 00:25:16.943 the hair loss and the nausea and the 00:25:16.983 --> 00:25:19.984 vomiting and the fatigue and all that. 00:25:20.444 --> 00:25:22.965 And so you look at immunotherapy and you 00:25:23.006 --> 00:25:23.207 say, well, 00:25:23.227 --> 00:25:26.228 that immunotherapy is not chemotherapy. 00:25:26.548 --> 00:25:26.667 Right. 00:25:26.688 --> 00:25:28.689 It's not designed to kill all these all 00:25:28.729 --> 00:25:30.450 the cells at different points of their 00:25:30.569 --> 00:25:31.150 development. 00:25:31.769 --> 00:25:34.131 so there's no side effects so it's got 00:25:34.171 --> 00:25:36.231 to be good for you but amanda you 00:25:36.271 --> 00:25:38.353 were talking about this that there are 00:25:38.772 --> 00:25:40.594 mild side adverse effects and there are 00:25:40.614 --> 00:25:42.835 some pretty significant side effects from 00:25:42.914 --> 00:25:45.496 immunotherapy and as clinicians we might 00:25:45.536 --> 00:25:47.497 be the ones who see that for the 00:25:47.537 --> 00:25:49.958 first time in these patients and we have 00:25:49.998 --> 00:25:52.398 to know what that is recognize it then 00:25:52.439 --> 00:25:53.078 be empowered 00:25:54.059 --> 00:25:55.820 And to run that up the chain to 00:25:55.840 --> 00:25:57.061 the oncologist and say, hey, 00:25:57.442 --> 00:26:00.826 I saw Mary Jane in clinic today and 00:26:00.846 --> 00:26:02.527 this is how she presented and I know 00:26:02.948 --> 00:26:05.609 that she's on, you know, her luzumab. 00:26:06.490 --> 00:26:09.334 So I think you need to reach out 00:26:09.374 --> 00:26:10.714 to her and get her in clinic and 00:26:10.954 --> 00:26:12.115 do a full, you know, 00:26:12.155 --> 00:26:12.896 full workup of her. 00:26:13.257 --> 00:26:15.018 So I think that's one of the myths 00:26:15.038 --> 00:26:19.340 that specifically for our our talk at CSM 00:26:19.881 --> 00:26:22.522 to try to bust that myth that just 00:26:22.563 --> 00:26:24.324 because it's not chemo, 00:26:24.503 --> 00:26:26.025 that it's a breeze. 00:26:26.065 --> 00:26:28.967 All right, Amanda, you got to follow that. 00:26:29.007 --> 00:26:30.268 What's the thing that you that you know, 00:26:30.347 --> 00:26:32.430 what's the what's the rock in your in 00:26:32.450 --> 00:26:34.590 your flip flop that you'd like people to 00:26:34.891 --> 00:26:35.892 get right once and for all? 00:26:37.643 --> 00:26:37.742 Man, 00:26:38.722 --> 00:26:39.963 I have so many things in my brain. 00:26:40.163 --> 00:26:42.165 I think an important thing that Scott just 00:26:42.185 --> 00:26:43.606 brought up about pembrolizumab. 00:26:43.946 --> 00:26:46.528 So if you've ever heard of Keytruda in 00:26:46.567 --> 00:26:47.108 a commercial, 00:26:47.429 --> 00:26:48.970 I'm sure everybody's seen the Keytruda 00:26:48.990 --> 00:26:49.289 commercial. 00:26:49.589 --> 00:26:50.990 You know what immunotherapy is. 00:26:51.510 --> 00:26:52.251 That's pembrolizumab. 00:26:53.173 --> 00:26:54.773 So it's much more common than you think. 00:26:54.854 --> 00:26:56.674 There are a lot of these drugs out, 00:26:56.714 --> 00:26:58.115 even though they're relatively new, 00:26:58.576 --> 00:27:00.297 they're being used a lot, like Scott said, 00:27:00.356 --> 00:27:02.317 and they are responsible for some of the 00:27:02.377 --> 00:27:03.699 increase in cancer survivors. 00:27:04.058 --> 00:27:04.940 So there's that. 00:27:05.325 --> 00:27:09.226 Jimmy, you do know an immunotherapy, but, 00:27:10.465 --> 00:27:10.865 um, 00:27:12.185 --> 00:27:14.866 I think a rock in my shoe is 00:27:15.166 --> 00:27:20.167 that number one, cancer rehab is sad. 00:27:20.228 --> 00:27:20.508 Right. 00:27:20.827 --> 00:27:22.189 So a lot of like, man, like, 00:27:22.249 --> 00:27:23.209 how do you do that? 00:27:23.229 --> 00:27:23.888 Like, you know, I'm like, Oh, 00:27:25.148 --> 00:27:27.009 because so many people are surviving. 00:27:27.049 --> 00:27:27.230 I mean, 00:27:27.250 --> 00:27:29.230 of course I do have some patients that 00:27:29.269 --> 00:27:31.030 are stage four more end of life. 00:27:31.431 --> 00:27:32.871 It's equally as important for them. 00:27:34.055 --> 00:27:34.095 Um, 00:27:34.394 --> 00:27:35.994 but I have so many patients that are 00:27:36.035 --> 00:27:38.776 surviving and we're doing prehab and it's 00:27:38.816 --> 00:27:40.816 not just death and dying, 00:27:41.056 --> 00:27:43.277 but I think that the most important thing 00:27:43.297 --> 00:27:44.636 that I do want to bring up is 00:27:44.696 --> 00:27:44.977 that. 00:27:45.936 --> 00:27:49.077 PT belongs in hospice and palliative care. 00:27:49.278 --> 00:27:50.637 I think there's a misconception, 00:27:50.758 --> 00:27:52.659 especially on an inpatient side, 00:27:52.679 --> 00:27:53.898 because I've done that as well. 00:27:54.298 --> 00:27:55.638 When you go into the patient's chart, 00:27:55.679 --> 00:27:57.680 you see a palliative or a hospice note 00:27:57.740 --> 00:27:58.599 and you're like, Oh, defer. 00:28:00.116 --> 00:28:01.478 Get that patient off my list. 00:28:02.198 --> 00:28:03.739 And, um, 00:28:03.759 --> 00:28:06.119 there's another really awesome CSM 00:28:06.140 --> 00:28:07.240 presentation about. 00:28:08.161 --> 00:28:09.161 You know, palliative care. 00:28:09.461 --> 00:28:09.601 Um, 00:28:09.661 --> 00:28:11.481 I believe that's Chris Wilson's doing that 00:28:11.582 --> 00:28:11.701 one. 00:28:12.462 --> 00:28:12.742 Um, 00:28:13.282 --> 00:28:15.663 so PT belongs in palliative care and 00:28:15.683 --> 00:28:17.384 palliative care is not just when the 00:28:17.424 --> 00:28:18.986 patient's dying palliative care, 00:28:19.246 --> 00:28:20.767 especially for patients for cancer 00:28:20.807 --> 00:28:23.567 patients is often involved from the point 00:28:23.587 --> 00:28:25.429 of diagnosis to help with comfort, 00:28:25.588 --> 00:28:27.789 but it's not just comfort care and dying. 00:28:28.330 --> 00:28:29.352 it's helping them. 00:28:29.731 --> 00:28:32.394 And there are ways that physical therapy 00:28:32.474 --> 00:28:35.097 should be involved in palliative care. 00:28:35.417 --> 00:28:36.898 And just because like, 00:28:36.919 --> 00:28:38.961 let's say a patient was, you know, 00:28:39.040 --> 00:28:41.123 more end stage, you know, 00:28:41.182 --> 00:28:43.184 you weren't expecting them to improve. 00:28:43.204 --> 00:28:44.606 You're expecting a decline. 00:28:44.906 --> 00:28:46.888 That's an even more important reason why 00:28:46.969 --> 00:28:48.911 physical therapy should be involved in 00:28:49.771 --> 00:28:51.512 And there are ways to write a plan 00:28:51.532 --> 00:28:53.593 of care and write goals for maintenance 00:28:53.613 --> 00:28:55.913 therapy where you're not saying, oh, 00:28:55.953 --> 00:28:57.054 the patient's not approving, 00:28:57.094 --> 00:28:59.174 so I have to discontinue care. 00:28:59.255 --> 00:28:59.474 No, 00:29:00.615 --> 00:29:02.816 you should be involved to help prevent 00:29:02.875 --> 00:29:03.415 decline, 00:29:03.455 --> 00:29:05.896 to help prevent increased reliance on 00:29:05.957 --> 00:29:06.737 caregivers, 00:29:06.896 --> 00:29:08.676 to help them maintain their function and 00:29:08.696 --> 00:29:10.278 independence through their end of life, 00:29:10.298 --> 00:29:13.439 which is such a huge quality of life 00:29:13.638 --> 00:29:13.878 thing. 00:29:14.866 --> 00:29:15.488 Yeah, I mean, 00:29:15.508 --> 00:29:17.489 I'm so glad you brought that up because, 00:29:18.048 --> 00:29:19.230 you know, and right there, 00:29:19.250 --> 00:29:20.151 what you were talking about, 00:29:20.171 --> 00:29:22.532 like goal writing for that patient who's 00:29:22.613 --> 00:29:23.854 at end of life care, 00:29:24.034 --> 00:29:25.714 like one of the biggest things that we 00:29:25.755 --> 00:29:27.656 could do as rehab professionals in that 00:29:27.737 --> 00:29:30.419 setting is caretaker education. 00:29:31.159 --> 00:29:33.701 Because if the caretaker, you know, 00:29:33.760 --> 00:29:35.502 is trying to do transfers for that 00:29:35.542 --> 00:29:36.103 patient, you know, 00:29:36.123 --> 00:29:37.923 trying to do bed to commode transfers or 00:29:37.944 --> 00:29:38.944 whatever that might be, 00:29:39.566 --> 00:29:42.228 and the caregiver throws their back out, 00:29:43.451 --> 00:29:45.134 They can't care for their person. 00:29:46.494 --> 00:29:48.476 So there is always a role for physical 00:29:48.496 --> 00:29:49.856 therapy, especially in that setting. 00:29:49.876 --> 00:29:50.218 So Amanda, 00:29:50.258 --> 00:29:52.439 thank you so much for saying that. 00:29:52.459 --> 00:29:55.141 That's the rock in my shoe. 00:29:55.161 --> 00:29:57.262 You each get one shot, one opportunity. 00:29:57.282 --> 00:29:57.982 Don't throw it away. 00:29:58.723 --> 00:30:00.986 Someone who's listened to this episode to 00:30:01.006 --> 00:30:02.707 this point and they're going to get on 00:30:02.747 --> 00:30:03.907 a plane or they're on a plane right 00:30:03.948 --> 00:30:05.169 now as they're listening and putting 00:30:05.209 --> 00:30:07.651 their, their schedule together for CSM. 00:30:08.652 --> 00:30:09.432 What's your pitch? 00:30:09.612 --> 00:30:11.233 What's your one or two sentences and why 00:30:11.253 --> 00:30:12.815 they need to come to your talk? 00:30:16.479 --> 00:30:17.660 When they come to our talk, 00:30:17.700 --> 00:30:22.583 they are going to feel empowered that they 00:30:22.603 --> 00:30:25.545 can treat any patient with a history of 00:30:25.585 --> 00:30:26.086 cancer. 00:30:26.546 --> 00:30:28.787 We want to be able to demystify not 00:30:28.866 --> 00:30:32.910 just immunotherapy specifically and its 00:30:32.950 --> 00:30:34.611 treatment in cancer, 00:30:34.852 --> 00:30:36.833 but we want to be able to demystify 00:30:36.853 --> 00:30:40.816 the whole aspect of oncology care and that 00:30:41.195 --> 00:30:43.897 any PT can care for anybody with a 00:30:43.917 --> 00:30:44.498 history of cancer. 00:30:44.538 --> 00:30:45.679 And they need it. 00:30:47.664 --> 00:30:50.205 Amanda, what do you got? 00:30:50.226 --> 00:30:52.547 I think that, yes, Scott, 00:30:52.686 --> 00:30:54.268 that's it as well. 00:30:54.968 --> 00:30:57.969 And we are also going to go over 00:30:58.009 --> 00:31:00.710 some cases in our presentation. 00:31:00.750 --> 00:31:03.050 So I'm really excited about that. 00:31:03.330 --> 00:31:07.232 And it's going to show that there is 00:31:07.252 --> 00:31:09.314 a huge opportunity for prehab, 00:31:09.753 --> 00:31:11.294 not just in immunotherapy, 00:31:11.374 --> 00:31:12.694 but in cancer care. 00:31:13.603 --> 00:31:15.003 Because like I mentioned before, 00:31:15.463 --> 00:31:18.964 since we know roughly the route that these 00:31:18.984 --> 00:31:20.326 patients are going to take with their 00:31:20.346 --> 00:31:20.746 treatments, 00:31:20.826 --> 00:31:22.886 of course it changes as they monitor the 00:31:22.906 --> 00:31:23.946 disease progression, 00:31:24.247 --> 00:31:25.448 hopefully lack thereof. 00:31:27.087 --> 00:31:29.209 But since we know what they're going to 00:31:29.249 --> 00:31:31.269 be going through with the treatments and 00:31:31.289 --> 00:31:32.630 the medications that they're prescribed, 00:31:33.029 --> 00:31:36.192 how can we prepare these patients for what 00:31:36.211 --> 00:31:37.172 they're going to be going through? 00:31:38.182 --> 00:31:39.803 which then helps to improve their 00:31:39.864 --> 00:31:40.463 function. 00:31:40.784 --> 00:31:43.006 It also helps to decrease their anxiety 00:31:43.506 --> 00:31:44.826 about the treatments that they're going to 00:31:44.846 --> 00:31:45.627 be going through. 00:31:45.768 --> 00:31:47.388 And it also helps them move their body 00:31:47.429 --> 00:31:47.888 through it. 00:31:48.930 --> 00:31:51.692 So I think that highlighting prehab there 00:31:51.852 --> 00:31:54.074 and showing the opportunity for 00:31:54.153 --> 00:31:56.736 intervention at that point is going to be 00:31:56.776 --> 00:31:59.657 so empowering for physical therapists of 00:31:59.897 --> 00:32:02.319 any specialty, 00:32:02.380 --> 00:32:04.101 but also our oncology colleagues. 00:32:05.019 --> 00:32:06.441 Sibs, Mibs, and Mabs, oh my, 00:32:06.540 --> 00:32:08.321 demystifying challenges and identifying 00:32:08.342 --> 00:32:09.743 opportunities with immunotherapy and 00:32:09.763 --> 00:32:10.443 rehabilitation. 00:32:10.844 --> 00:32:13.086 That is Thursday at CSM, 00:32:13.185 --> 00:32:14.547 ten thirty till noon. 00:32:15.007 --> 00:32:17.808 And that is in the oncology section. 00:32:18.529 --> 00:32:20.510 Last chance for what we call the parting 00:32:21.092 --> 00:32:21.491 shot. 00:32:21.511 --> 00:32:24.775 This is the parting shot. 00:32:25.295 --> 00:32:27.316 One last mic drop moment. 00:32:27.375 --> 00:32:28.196 No pressure. 00:32:28.616 --> 00:32:30.759 Just your legacy on the line. 00:32:32.173 --> 00:32:32.972 pressure whatsoever. 00:32:33.432 --> 00:32:33.653 Scott, 00:32:33.673 --> 00:32:35.653 we'll let you go first since you've done 00:32:35.673 --> 00:32:36.114 this before. 00:32:36.134 --> 00:32:38.193 Amanda, give you some time to formulate. 00:32:38.453 --> 00:32:39.753 Parting shot is just whatever your mic 00:32:39.773 --> 00:32:41.214 drop moment is, your soapbox statements. 00:32:41.255 --> 00:32:43.015 What's the last thing you want to leave 00:32:43.375 --> 00:32:48.336 with the audience as we wrap up? 00:32:48.375 --> 00:32:49.655 I think we've already covered it, 00:32:49.715 --> 00:32:54.777 but I would say that use CSM. 00:32:55.817 --> 00:32:57.497 I would say my parting shot right now 00:32:58.057 --> 00:33:00.458 is use CSM to network. 00:33:01.580 --> 00:33:04.022 build your network, talk to people. 00:33:04.483 --> 00:33:07.926 It is absolutely a good thing to have 00:33:07.967 --> 00:33:09.308 a little bit of imposter syndrome, 00:33:09.588 --> 00:33:13.071 but check your imposter syndrome and go 00:33:13.153 --> 00:33:13.952 talk to somebody, 00:33:14.294 --> 00:33:16.236 go talk to a seasoned clinician, 00:33:16.276 --> 00:33:18.637 because I guarantee you, 00:33:19.318 --> 00:33:20.980 those of us that are seasoned clinicians, 00:33:21.079 --> 00:33:22.141 we want to talk to you. 00:33:23.462 --> 00:33:25.424 And again, like we let off, 00:33:26.326 --> 00:33:30.268 I'm already like way into my profession 00:33:30.328 --> 00:33:30.489 now. 00:33:30.848 --> 00:33:33.309 I know that the future of our profession 00:33:33.650 --> 00:33:35.509 are students and new grads. 00:33:36.070 --> 00:33:37.770 Please come talk to me because you are 00:33:37.790 --> 00:33:39.092 going to grow this profession. 00:33:39.771 --> 00:33:43.593 And so use CSM as an opportunity to 00:33:43.653 --> 00:33:45.314 talk to somebody. 00:33:45.354 --> 00:33:46.294 Please come talk to me. 00:33:46.354 --> 00:33:47.555 That's Scott's parting shot. 00:33:47.595 --> 00:33:48.335 Please come talk to me. 00:33:49.231 --> 00:33:49.971 Amanda, what do you got? 00:33:49.991 --> 00:33:51.553 You can reiterate a point you did before 00:33:51.573 --> 00:33:52.252 or drop something new. 00:33:52.272 --> 00:33:52.692 Doesn't matter. 00:33:52.712 --> 00:33:53.453 What's your parting shot? 00:33:53.673 --> 00:33:54.153 Yes. 00:33:54.394 --> 00:33:56.674 So I'm going to piggyback off of what 00:33:56.694 --> 00:33:57.414 Scott just said. 00:33:58.976 --> 00:34:03.237 And so I am on the APT Oncology 00:34:03.777 --> 00:34:06.558 Students New Professional SIG. 00:34:07.219 --> 00:34:10.360 And we host a networking session where... 00:34:11.047 --> 00:34:13.447 Anybody interested in oncology rehab, 00:34:13.608 --> 00:34:15.349 students, new professionals. 00:34:15.650 --> 00:34:18.371 We also have some really awesome seasoned 00:34:18.811 --> 00:34:21.172 oncology practitioners like Scott that 00:34:21.193 --> 00:34:21.893 always pops in. 00:34:22.173 --> 00:34:23.954 Chris Wilson typically pops in as well. 00:34:24.815 --> 00:34:26.516 So we are planning to have a really 00:34:26.576 --> 00:34:27.817 awesome networking session. 00:34:27.976 --> 00:34:29.538 It is Friday the thirteenth. 00:34:30.077 --> 00:34:30.539 Spooky. 00:34:31.938 --> 00:34:33.860 Nine thirty to ten thirty a.m. 00:34:33.900 --> 00:34:36.641 You will find that in the oncology section 00:34:36.702 --> 00:34:39.643 in the programming on the app. 00:34:40.460 --> 00:34:43.242 And we love to have people that are 00:34:43.262 --> 00:34:45.282 just kind of intrigued by oncology. 00:34:45.603 --> 00:34:46.543 They don't know much about it, 00:34:46.563 --> 00:34:47.684 but they want to learn more. 00:34:47.724 --> 00:34:49.646 They want to talk to other students, 00:34:49.706 --> 00:34:50.527 new professionals, 00:34:50.887 --> 00:34:53.789 even seasoned professionals about it and 00:34:53.829 --> 00:34:54.108 just, 00:34:54.818 --> 00:34:58.081 make the community grow. 00:34:58.101 --> 00:34:58.701 So that's what we like to do. 00:34:58.740 --> 00:34:59.762 So I hope we need a better name 00:34:59.802 --> 00:35:00.643 though for next year. 00:35:00.682 --> 00:35:01.483 This is already locked, 00:35:01.503 --> 00:35:02.844 but students and new professionals 00:35:03.005 --> 00:35:03.925 networking session. 00:35:03.985 --> 00:35:04.987 I feel like with AI, 00:35:05.027 --> 00:35:05.467 we can come up. 00:35:05.507 --> 00:35:06.648 We will, we got to, we, 00:35:06.668 --> 00:35:07.889 this needs to be judged. 00:35:08.269 --> 00:35:09.550 We got to judge this and we'll do 00:35:09.590 --> 00:35:10.331 it for next year. 00:35:11.431 --> 00:35:12.532 Hey, thanks for doing what you do. 00:35:13.293 --> 00:35:15.954 Coming to a conference is a great 00:35:15.994 --> 00:35:16.994 networking experience, 00:35:17.094 --> 00:35:18.835 but the amount of work that you guys 00:35:18.876 --> 00:35:21.237 put together and put into these things is 00:35:21.317 --> 00:35:22.297 usually no small feat. 00:35:22.416 --> 00:35:23.998 A ninety minute presentation doesn't just 00:35:24.038 --> 00:35:24.338 happen. 00:35:24.378 --> 00:35:25.759 So thanks for doing this. 00:35:26.239 --> 00:35:26.918 Steve's not here, 00:35:26.938 --> 00:35:29.400 but Steve is a great friend of the 00:35:29.420 --> 00:35:29.639 show. 00:35:30.039 --> 00:35:32.300 So we'll see you guys in in L.A. 00:35:32.320 --> 00:35:33.822 and Anaheim in just a couple of weeks. 00:35:34.081 --> 00:35:35.943 And thanks for doing this. 00:35:35.963 --> 00:35:36.802 Thanks for having us. 00:35:36.842 --> 00:35:38.083 This is great. 00:35:38.103 --> 00:35:38.483 Yes. 00:35:38.523 --> 00:35:39.483 Thanks, Jimmy. 00:35:41.567 --> 00:35:42.626 That's it for this one, 00:35:42.907 --> 00:35:44.588 but we're just getting warmed up. 00:35:45.047 --> 00:35:46.969 Smash follow, send it to a friend, 00:35:47.168 --> 00:35:48.829 or crank up the next episode. 00:35:49.349 --> 00:35:50.369 Want to go deeper? 00:35:50.730 --> 00:35:54.751 Hit us at pgpinecast.com or find us on 00:35:54.811 --> 00:35:57.351 YouTube and socials at pgpinecast. 00:35:57.771 --> 00:36:00.052 And legally, none of this was advice. 00:36:00.112 --> 00:36:01.833 It's for entertainment purposes only. 00:36:01.893 --> 00:36:03.494 Bulls**t! 00:36:03.534 --> 00:36:04.114 See, Keith? 00:36:04.333 --> 00:36:05.394 We read the script. 00:36:05.695 --> 00:36:06.335 Happy now?