Author: Patricia

President’s Message
Save the Date!
FSPMR 2022 Elections
Targeted Muscle Reinnervation: An Innovation Solution for Nerve Pain Craig Lichtblau MD
Amputation and Neuroma Craig Lichtblau MD
EMG Corner: Report with Case Study Paulette Smart-Mackey MD
Residency Updates U Miami Memorial Healthcare Larkin Community Hospital West Florida Hospital/UCF Univ. of South Florida Univ. of Florida
Professional Opportunities: Offered and Sought

PRESIDENT’S MESSAGE
By Mark Rubenstein, M.D.
COVID-19. Burn-out. Inflation. Global warming. Workforce inadequacies and inequities. All these issues are dominating the media and influencing our lives. Good news is hard to find. It seems that everything we do currently relates to an issue with “supply chain” in some fashion. I embarked on the process of drafting this President’s Message with the same goal I set for myself: try to find something useful, tangible, informative, or relevant for our membership. Admittedly, this one was challenging.
Politically the legislative session is now in full force in Tallahassee. Bills that the FMA is following include the possibility of defining state regulations of abortion, and a somewhat unusual bill that would potentially limit a medical board from censoring a physician who may post something deemed inappropriate on social media. As an update to what I have previously written about, there is a bill with regard to telehealth. This bill pertains to physiatrists as it would revise prohibition on prescribing controlled substances through the use of telehealth. As mentioned in previous correspondence, we expect that this bill will allow certain Schedule 3, 4, and 5 drugs to be prescribed thru telemedicine/telehealth means.
The bill which makes it a misdemeanor to provide any aid as a physician to any minor without written parental consent is likely to be revised. HB 817 and corresponding Senate Bill 1114 remove the requirement that emergency medical care or treatment by a physician be performed only in a hospital or other certain settings. This will help fix the glitch so that as a good Samaritan or even as a team physician you would render care and not risk criminal charges simply from providing such care.
There are house and senate bills that would expand psychologist’s scope of care to prescribe medications, and set forth rules for certification, continuing education, DEA registration, etc. The FMA is, of course, opposed to such expansion of privileges in that regard.
There are house and senate bills proposed related to “Step Therapy.” Specifically these bills will revise the circumstances under which step-therapy protocols may NOT be required, and provide requirements for procedure requests and appeals of denials of protocol exemption requests, etc. The FMA supports these bills.
Among other bills that the FMA team is following include COVID liability protection. These bills would extend the duration of liability protections from COVID-19-related claims against health care providers. FMA is supportive of such protection. COVID has become ubiquitous in terms of its effect on our society, and clearly has affected the way we practice medicine. Part of the problem with COVID in our country is the political influence of same. In the 1980’s, evidence-based medicine became the standard of care. For reasons that are largely political, the utility of evidence-based medicine relating to COVID care has been challenged. Whether you support vaccinations, mask-wearing, quarantining, safety measures, and even hand washing, we are definitely seeing patients who have suffered from COVID infections in our offices. The FSPMR recognizes this and is seeking to help educate our members to expand the utility of physiatrists in management of said patients.
The Annual Meeting of FSPMR in July (held in conjunction with FSIPP) will likely be one of the strongest yet. Our education committee for the meeting (led by our esteemed Vice-President, Dr. Andrew Sherman) has formulated an exciting agenda for the FSPMR Breakout. The keynote speech is going to focus on the physiatrist and Long-Haul COVID patients. Believe it or not, COVID is likely here to stay. Planning for the intermediate and long term care of patients becomes relevant and important. Stay tuned for more details on the meeting.
Each day I receive countless articles, letters, announcements, data dumps, and opinions about a myriad of medical issues from a multitude of organizations and entities. Many of you subscribe to PhyzForum (the All Physiatrist Member Forum Digest for members of AAPM&R). Thus far I have limited my comments and replies to the digest in a private matter (i.e. if I feel the need or desire to respond I do so privately). I believe in the adage that while “someone needs to say it, but not everyone needs to speak.”
The PhyzForum is often a complaint blog. It is a place for people to vent. At times there are positive ideas and suggestions that are beneficial or educational. In the week leading up to the draft of this message, I note the repeated complaints in the Forum about the injustices of physician payment compared to insurance companies, pharmaceutical companies, and other arms of health care. Buried in one of the posts was a reference to a Medscape survey that was published about BURN-OUT. The past-president of the AAPM&R pointed out that surveys were published in 2011, 2014, and 2017 identifying Physical Medicine & Rehabilitation amongst the top 5 specialties experiencing burn-out. More recently in 2019 there was an article published specifically relating to PM&R Burn-out and a lack of professional satisfaction.
AAPM&R has embarked on a longitudinal survey in collaboration with Stanford University to study burn-out trends in our specialty. I hope some of you took the time to complete the first leg of this survey (I know I did within the last 3-6 months). Changing the course of burn-out is a much bigger problem. More research and surveys will not improve the outlook. I fear that one of the issues will be that identifying the problem in our specialty will have significant negative connotations. Specifically I’m concerned that qualified medical students considering their future may give less credence to a career in PM&R if the satisfaction level of the current physicians is declining. When I went to medical school, and despite being at a competitive and well-respected institution in NY, we did NOT have one trained physiatrist on the faculty. The only exposure to PM&R was thru a geriatrician who had decided to oversee a rehabilitation facility when the need was identified. I was exposed to the field when a Dean of the medical school insisted I do an away elective at a top PM&R program. It was then that my eyes to the field were opened. I distinctly remember reading about physiatrists, their satisfaction levels, their careers, their lifestyles, and their responsibilities. Physiatrists were well respected and amongst the elite in non-surgical sub-specialties with an excellent quality of life (not necessarily financially although that was true – I’m referring to emergencies, call, responsibilities, etc.).
Today, physiatrists face incredible challenges in terms of what managed care has done to regulate the field of medicine. Prior authorizations, denials, peer reviews, formulary issues, scope of practice expansion, and insurance regulations force us to spend excessive time on non-patient care activities, and often intervene in our ability to properly provide care for patients. Studies about burn-out often cite these very issues.
We have seen a dramatic shift in the way physicians practice. When I entered practice, more than half of the physician work-force were self-employed (or worked in physician groups as associates until they became partners). Currently, more than half of the physician work-force is now “employed.” This means that physicians have given up control in many ways. There are certainly advantages to being an employed physician. These include less administrative paperwork, less responsibility for staffing issues, and support in dealing with the challenges of over-regulation of our industry.
I worry for the future of medicine. I worry about the quality of medical care in the future. I worry about the over-regulation of medicine. I worry about the future that our medical students and residents will have in this society. I worry that medical students will not choose the field of PM&R since job satisfaction is declining, and PM&R burn-out rates are higher than most specialties. I certainly do NOT have the answers. Ignoring burn-out is not productive. Some of my colleagues in other specialties have started to reduce their work schedules citing the need for better balance in their lives. For many of us that is not an option.
Organized medicine helps us practice medicine. It represents us and does things that many of us just don’t have the time to do. Our own FSPMR needs to stay engaged. We promise to be educational and informative. We look forward to a productive year and hope that all of you have started 2022 in a positive fashion. We hope you have figured out a balance in life, have practice satisfaction, and stay safe and healthy. Until the next President’s Message, I wish you all well.

President’s Message—continued

President’s Message—continued

President’s Message—continued

FSPMR 2022 Elections
Interested in serving on the Board of Directors for the Florida Society of Physical Medicine and Rehabilitation? Officers are elected by a majority vote of the members at the Annual Meeting. Elections for the 2022 – 2024 FSPMR Board will take place at our Annual Meeting on July 30, 2022. The Nominations Committee will present a list of nominees to the FSPMR membership in our June newsletter. Nominations can also be made from the floor at the time of the Annual Meeting.
Open seats will be for President, Vice President, Secretary, Treasurer, and 4 Member-at-Large seats. Those currently holding seats can choose to run for re-election, or choose to run for a different position, or not at all.
If you would like to nominate someone, please email that information to Executive Director, Lorry Davis, who will forward it to the Nominations Committee (lorry4@earthlink.net, or text or call 904 994 6944).
SELF-NOMINATIONS are encouraged! If you would like to self-nominate, please email that information to Executive Director, Lorry Davis, who will forward it to the Nominations Committee (lorry4@earthlink.net, or text or call 904 994 6944).
Thank you!

AMPUTATION AND NEUROMA
by Craig H. Lichtblau, M.D.
Amputation is a result of trauma, medical illness or surgery. As a surgical procedure it is used to control pain or a disease process in an affected limb, such as malignancy or gangrene, in certain instances. In general, amputation is a disorder where fetal limbs have been cut off by constrictive bands. In the United States of America, the majority of new amputations are secondary to complications of vascular compromise, especially from diabetes. Approximately 185,000 amputations occur in the United States each year.
Causes of amputations include diabetic vasculopathy, sepsis with peripheral necrosis, peripheral artery disease which leads to gangrene and a severe deep vein thrombosis (phlegmasia cerulea dolens) which can cause compartment syndrome and gangrene, neoplasm, cancerous bone or soft tissue tumors which include osteosarcoma, chondrosarcoma, fibrosarcoma, epithelioid sarcoma, Ewing’s sarcoma, synovial sarcoma, sacrococcygeal teratoma, liposarcoma, and melanoma. Trauma includes severe limb injuries in which the limb cannot be saved, or efforts to save the limb fail, traumatic amputations can occur at the scene of an accident, and amputation in utero (amniotic band). Also, congenital abnormalities can lead to amputation, which include deformity of the digits and/or limbs (proximal femoral focal deficiency, familiar hemimelia), infection, osteomyelitis and/or diabetic foot infections, gangrene, trench foot, necrosis, meningococcal meningitis, streptococcus vibrio vulnificus, necrotizing fasciitis, gas gangrene, legionella, influenza A virus, animal bites, sepsis, and bubonic plague.
Amputation is uncommon in humans. It is 1 per 20,804 population per year. Loss of limb usually happens immediately during the accident but sometimes a few days later after medical complications. Statistically the most common causes of traumatic amputation are traffic collisions, including cars, motorcycles, bicycles and trains, labor accidents, equipment, instruments, cylinders, chainsaws, press machines, meat machines, wood machines, agricultural accidents with machines and mower equipment, electric shock hazards, firearms, bladed weapons, explosives, violent rupture of ship rope or industry wire rope, ring traction which includes amputation degloving injuries, building doors and car doors, animal attacks, and gas cylinder explosions. There are other rare accidents.
Epidemiology:
In the United States in 1999, there were 14,420 nonfatal traumatic amputations. According to the American Statistical Association, of these; 4, 435 occurred as a result of traffic and transportation accidents; 9,985 were due to labor accidents; of all traumatic amputations, the distribution percentage is 30.75% for traffic accidents and 69.24% for labor accidents.
The study found that in 2010 22.8% of patients undergoing amputations of a lower extremity in the United States were admitted to the hospital within 30 days.
Prognosis:
A large proportion of amputees, 50%-80%, experience phantom limb pain. They feel body parts that are no longer present. The limbs can itch, ache, burn, feel tense, dry or wet, locked-in or trapped, or they can feel as if they are moving. Phantom sensations and phantom pain may also occur after the removal of body parts other than limbs. An example is after amputation of a breast, extraction of a tooth, and/or removal of an eye. In many cases, the phantom limb aids in adaption to a prosthesis as it permits the person to experience proprioception of the prosthetic limb to support, improve resistance or use ability, comfort or healing, some type of stump socks may be worn or a part of wearing a prosthesis. Another side effect of amputations includes heterotopic ossification, especially when a bone injury is combined with a head injury. The brain signals the bone to grow instead of scar tissue to form nodules, and other growth can interfere with prosthetics and sometimes require further operations. This type of injury has been especially common among soldiers wounded by improvised explosive devices in the Iraq war.
In summary, complications after amputation include edema, open wounds, infection, pain, muscle weakness and contractures, joint instability, autonomic dysfunction and neuromas. Reviewed data of 2008, 179 patients in the USA who had major lower extremity amputations following traumatic injuries to the lower limbs, discovered a high rate of complications among this patient group and at least 41.8% of these patients had to undergo at least one surgical revision of the amputation. These patients stayed 5.5 days longer in the hospital when compared to patients who did not undergo a revision. For this population, compartment syndrome following initial trauma was a significant predictor of complications post surgery.
Neuromas:
Neuromas are benign tumors of the nervous system most commonly arising from non-neural nervous tissues, although they are not considered neoplasms. Certain neuromas have a particular location and symptoms, while others can develop anywhere in the body. The term neuroma is often used for posttraumatic swelling of nerves as well. They develop as an injured nerve starts to heal in an uncontrolled manner resulting in a lump of unorganized axon fibers and non-neural tissue growth. Neuromas often arise post trauma including elective surgery. They can also be part of a syndrome such as neurofibromatosis, or they can be a true neoplasm such as acoustic neuroma or Morton’s neuroma. Diagnosis is mainly clinical, and treatment is most often surgical excision with a strong emphasis on prevention meaning surgical exploration and repair of the nerve injuries. Neuromas are a common complication after amputations. Targeted muscle reinnervation is an excellent surgical intervention to treat neuromas.

Amputation and Neuroma—continued

Amputation and Neuroma—continued

EMG CORNER
EMG Report with Case Study
by
Paulette Smart-Mackey, MD
Welcome to the EMG CORNER, a new section of the FSPMR Newsletter created for the new electromyographers, and to give tips to the already seasoned ones. It is a space to submit challenging cases for a deeper analysis. The passion to upgrade the EMG report reflects the feedback received from several orthopedists and neurosurgeons over many years.
The last newsletter listed nine simple components of the EMG report:
1. EMG clinic, physician, and patient demographics
2. Brief patient history with the reason for referral
3. Brief physical exam
4. Nerve conduction studies with data and waveforms
5. Summary of nerve conduction studies
6. Needle Electromyogram data
7. Summary of needle electromyogram findings
8. Interpretation (with discussion and conclusion) of EMG/NCS findings
9. Recommendations (if consultation pursued)
10. End with your signature line
The following case applies these principles to an EMG case with some brain teasers attached.
EMG Clinic Physician& Patient Demographics
Name: John Smith
Date: January 19, 2022
Referring Physician: Dr. Jaclyn Smythz
Account: 000009
Age: 32
Height: 60 inches
Reason for referral: Right-hand numbness
Brief Patient History
• 50-year-old male with numbness in the right fifth digit for two months
• There is no history of pain or weakness
• There are no prior studies
• Medical history is unremarkable for any illnesses, surgeries, or hospitalizations.
Focused Neuromuscular Exam
Physical exam is remarkable for decreased sensation over the right fifth digit without weakness to finger abduction. The remainder of the neuromuscular exam was within normal limits.
NCS DATA: Motor
• R Radial Motor (EIP)
• Latency 2.8 msec, Amp 36mV, NCV of 54 m/sec (FA); 58m/sec (A)
• R Ulnar Motor (ADM)
• Latency 3.7 msec, Amp 36mV, NCV of 60 m/sec (BE) & 46 m/sec (AE)
• R Median Motor (APB):
• Latency 3.4 msec, Amp 30mV, NCV of 62 m/sec
NCS DATA: Sensory
• R Radial Sensory (Dig 1, 10 cm)
• Peak latency 3.4 msec, amplitude 32 uV
• R Ulnar Sensory (Dig 5, 14 cm)
• Peak latency 4.4 msec (<3.9msec), amplitude 26 uV
• R Median Sensory (Dig 3, 14 cm)
• Peak latency 3.2 msec; amplitude 42 uV
Summary of Nerve Conduction Studies
The right ulnar motor and sensory NCS are abnormal.
There is a mild delay in the right ulnar sensory nerve conduction time to the fifth digit
There is decreased right ulnar motor nerve conduction velocity across the elbow
The right median motor and sensory NCS findings are normal
The right radial motor and sensory NCS findings are normal
Needle Electromyogram Data
Patient consented to the needle EMG study on several muscles within the right upper limb, utilizing a 37 mm 25-gauge monopolar needle electrode without complications. The following muscles were sampled: Deltoid (C56, axillary), Biceps (C56 musculocutaneous), Triceps (C678, radial), Flexor Carpi Radialis (C56, median), Flexor Carpi Ulnaris (C78, ulnar), Ext Dig Com (C78, radial), APB (C8T1 median), ADM (C8T1, ulnar), FDI (C8T1, ulnar), lower cervical paraspinals. Membrane irritability, fibrillation potentials, and fasciculations are absent. Insertional activity, waveform amplitude, duration, polyphasicity, and recruitment pattern are normal.
Summary of Needle EMG Findings:
The right upper limb needle EMG study is normal
Membrane irritability, fibrillation potentials, fasciculations are absent.
Insertional activity, waveform amplitude, duration, polyphasicity, and recruitment pattern are normal.
Acute and chronic denervation are absent.
Brain teaser one: What is the most likely diagnosis?
Ulnar neuropathy at the right wrist
Median neuropathy at the right wrist
Sensory polyneuropathy
Ulnar neuropathy at the right elbow
Other
Brain teaser two: Analyze the data compiled
Are the EMG findings satisfactory?
Does the EMG data match the diagnosis?
Are the patient’s questions answered?
Are the referring physician’s questions answered?
Are severity, acuity, location, outcome, and prognosis of lesion addressed?
Any other findings to disclose that might be helpful to the referring physician?
Are there any pertinent negative findings?
Interpretation of EMG study findings:
There is EMG evidence of an early onset ulnar neuropathy developing across the right elbow. The prognosis for recovery is good with treatment.
There is no evidence of right median or radial neuropathy.
There is no evidence of generalized peripheral neuropathy.
There is no evidence of right cervical radiculopathy.
Recommendations:
Fifteen minutes was spent face to face with the patient to answer all questions and concerns regarding the electrophysiologic findings.
We discussed ergonometric measures regarding right elbow biomechanics and the need to cease right elbow weight-bearing activities.
We discussed the importance of proper nutrition to enhance nerve growth and repair.
The patient will maintain a scheduled follow-up visit with his referring physician for ongoing medical management.
Thanks for the privilege of this EMG referral.
Jaclyn Smythz, M.D.
Board Certified Electromyographer
PH: 300-200-1000 Web: Jaclynsmythz.com

Review of Spasticity Management – continued

Review of Spasticity Management – continued

Review of Spasticity Management – continued

Residency
Updates

University of Miami Miller School of Medicine/Jackson Memorial Hospital PM&R Residency Update
Edwin Amirianfar MD, Resident Liaison Chane Price MD, PM&R Residency Program Director

Hello again from Miami!
This academic year is flying by and we have some amazing news from our program.
We would like to congratulate our PGY-4s who all have matched at fellowship programs around the country.
Pain Management
Armando Alvarez, MD - Dartmouth
Michael Appeadu, MD – Emory
ISMM Fellowship – NASS recognized
Richard Rosales, MD - Vanderbilt
Pediatrics
Cristina Brea, MD – University of Minnesota/Gillette Children’s
Nanichi Ramos Roldan, MD - University of Minnesota/Gillette Children’s
TBI
Natalia Miranda-Cantellops, MD – Emory/Shepherd Center
SCI
Omar Walli, MD – Mt. Sinai
Sports Medicine
Quan Le, MD – Johns Hopkins
We are also welcoming our new TBI Fellow who will be starting in August 2022:
Mollie Andreae, MD who comes from Penn State’s PM&R program
We have announced our Chief Residents for the 2022-2023 Academic Year, where they will take over duties starting in May:
Reed Yaras, DO
Edwin Amirianfar, DO
Congratulations to our Quiz Bowl team on winning the national AAPM&R 2021 Quiz Bowl this year!
Interview season has come to a close and we are looking forward to see who matches with our program in March!
Until next time,

Edwin Amirianfar MD

Memorial Healthcare System PM&R Residency Program Dr. Yvette Little PM&R Resident Liaison to FSPMR Jeremy Jacobs DO, Residency Program Director

Greetings Everyone and Happy New Year! Hope everyone is having a great start to 2022. Below are announcements from our program that we would like share with you.
We officially completed another successful virtual interview season. Due to the pandemic these last two years, we have had to transition interviews from in person to all virtual. At first, this transition came with some obstacles we have had to overcome but as each interview season passes, we have better improved our interview process. With that being said, we are very excited for the upcoming Match Day and to see who will be joining our Memorial PM&R Family.
Next, we would like to congrats Dr. Robert Mousselli and Dr. Andres Gutierrez who have been elected to become our new Chief Residents. In addition, we would like to congrats Dr. Uday Mathur for being elected as the Director of Sports Medicine and Adaptive Sports. They will start their new responsibilities and roles on Match day, March 18th.
We would also like to say a special thanks to our current chiefs Dr. Steven Tijmes, Dr. Michael Boeving and Dr. Abhinav Mohan who have done an amazing job as chief residents and as our senior residents. They started this residency program as the inaugural class of residents and have really paved the way for the rest of us. They will be missed very much when they graduate!
Lastly, MHS PM&R Residents really strive to spend time together outside of work. Resident wellness is an important component to our program that is highly encouraged by our faculty. Most recently, the residents started a kickball team which we play against other local teams every week. It has been a blast and we even made it to play offs last season! Below are some pictures of our most recent get togethers.

Yvette Little DO

West Florida Hospital /UCF PM&R Residency Program Zeeshan Haque, MD PGY-2

Hello all,
I hope you are all doing well! I would like to start off by introducing our newest faculty member, Dr. Marisa Terry, MD. Dr. Terry is a graduate from the Michigan State University College of Human Medicine. She received her PM&R training at Mayo Clinic. Furthermore, she completed a fellowship in pain management at the University of California-San Diego. We are more than excited to have the opportunity to learn from such a brilliant physician with a strong background!
We have also begun our resident team sideline medical coverage opportunity with the Pensacola Ice Flyers professional ice hockey team. The team doctors, Dr. Rocha & Dr. Dewey, have been very welcoming to us. Having the opportunity to see the role of the team physician firsthand in evaluating and treating an acute injury in the midst of a high-intensity, fast-paced game as well as learning more about return to activity protocols have been a great learning opportunity for us!
Dr. O’Leary (PGY-2), Dr. Haque (PGY-2), Dr. Gill (PGY-2), & Dr. Tran (PGY-2) all plan to work together on a case report on an “Iliacus Hematoma Resulting in Femoral Neuropathy.”
Furthermore, with the change of seasons nearing, we plan to incorporate more outdoor wellness events and take full advantage of the many beach activities that Florida has to offer!
Best Regards,
Zeeshan Haque, MD PGY-2
West Florida Hospital/UCF PM&R Residency Program

Zeeshan Haque MD

University of South Florida PM&R Residency Update Kareem Qaisi DO, Resident Liaison Marissa McCarthy, MD, Residency Program Director

Hello from sunny Tampa Bay! We have exciting updates we would like to present from the University of South Florida.
First, we would like to congratulate our chief residents! Dr. Jonas Santos and Dr. Matthew Vassaur have both matched into the University of South Florida’s Pain Fellowship program! We are so excited to have them continue their training at USF and look forward to working with them as fellows next year!
We would also like to celebrate Dr. Daniel Leary who recently accepted a position with Rehabilitation and Electrodiagnostics upon graduation. Dr. Leary has even more to celebrate this year as he has blessed our USF PM&R family with a newborn!
We were able to restart in-person didactics this year which has provided a richer and more stimulating learning environment. For example, we recently provided hands-on ultrasound training experiences for the USF medical student’s PM&R interest group. We have a strong desire here within the USF PM&R community to foster great educational experiences for the upcoming, next generation of physiatrists.
With over 500 applicants to our program, difficult decisions had to be made to narrow down the stellar applicant pool for the 3 residency spots available. We are thankful for all those who have applied and have done our absolute best to remain transparent with information throughout the application process. Interview season has now officially ended, and we are excited for the next wave of physiatrists to enter our field. Goodluck to all throughout this residency match season!
Kareem Qaisi, DO
Resident Physician | PGY-2
University of South Florida
Physical Medicine & Rehabilitation

Kareem Qaisi DO

University of South Florida PM&R Residency Update Kareem Qaisi DO, Resident Liaison Marissa McCarthy, MD, Residency Program Director - continued -

University of Florida Michael Brownstein MD, Resident Liaison Andrew H Dubin MD, UF PM&R Residency Director

University of Florida PM&R Residency Program
Hello from Gainesville! My name is Michael Brownstein and I’m excited to introduce myself as the FSPMR liaison for the new University of Florida PM&R Residency Program. We consist of 4 pgy2 residents and many renowned and enthusiastic physicians, researchers, and supportive staff. We have matched next year’s pgy2 class who we are excited to meet in July and have just finished this year’s interview season where we met many impressive future physiatrists. While our residency program may be new, our departmental staff has been making a name for themselves across multiple fields for decades. We are led by our Department Chair, Dr. Kevin Vincent, well known in sports medicine, and our Program Director, Dr. Andrew Dubin, who has recently been awarded the AANEM Ernest Johnson Outstanding Educator for 2021. The department is growing internally and also expanding across multiple campuses, and we are on the cusp of adding several new and accomplished faculty members. Please stay tuned for the next edition where we introduce some more of our many faculty members we’ve had the pleasure to work with and learn from so far.
My co-residents and I are spending the majority of this year at our stand-alone acute inpatient rehab hospital that has been ranked among the top in Florida for years. We manage a wide variety of patients and pathologies including TBI, SCI, CVA, amputation, trauma, burn, cardiac, post-Covid-19, neurological disorders, and liver-lung-kidney transplantation. Additionally, we have already had the fortune to attend conferences, submit several papers for publishing, and cover our local sports teams on the side lines.
Please allow me to further introduce myself and my new friends and colleagues.
I was born and raised in New York, where I completed my clinical rotations after spending the first two years of medical school on the tropical island of Grenada in St. George’s University. It was on that island I realized snow was a thing of my past. After completing my pgy1 year in Internal Medicine in NYC last year, I moved to Florida several decades younger than my grandparents did. I have many clinical interests including sports, pain, and general physiatry to appreciate the wide variety of medical complexities. In addition to fine-tuning my knowledge, passions, and career, I’ve been enjoying rock climbing, pickle ball, hiking, local breweries, and soaking up this 80 degree February sun.
Dr. Caroline Fryar grew up in North Carolina and received a biomedical engineering degree from Tulane University. After working in regulatory affairs for an orthopedic device company for two years, she went to medical school at USF and was a member of the SELECT program, completing her clinical rotations in Allentown, PA, and prelim year in general surgery at the University of Kentucky. She is planning on going into sports medicine, with an interest in injury biomechanics and treating gymnasts. She is excited to be back in Florida, and in the same city for more than two years for the first time since college.
Dr. Aimee Madsen is originally from California and attended medical school in Michigan. She is interested in sports medicine, and particularly hopes to work with female athletes. Her background is in figure skating, dance, viola and piano. She is excited to be back in Florida, as she lived in Miami for a period of time as a child.
Dr. Shammi Patel is coming from New Jersey, where he completed 2 years of general surgery and an additional year of independent wound care before joining the University of Florida PM&R residency program. He enjoys traveling, hiking, auto repair, and exploring local breweries. His medical interests include critical care, TBI medicine, and interventional pain medicine.
We are excited to join FSPMR and look forward to getting to know you and working with you in the future. Please let us know next time you are in the Gator Nation!

Michael Brownstein MD

University of Florida Michael Brownstein MD, Resident Liaison Andrew H Dubin MD, UF PM&R Residency Director - continued—

Dr. Caroline Fryar grew up in North Carolina and received a biomedical engineering degree from Tulane University. After working in regulatory affairs for an orthopedic device company for two years, she went to medical school at USF and was a member of the SELECT program, completing her clinical rotations in Allentown, PA, and prelim year in general surgery at the University of Kentucky. She is planning on going into sports medicine, with an interest in injury biomechanics and treating gymnasts. She is excited to be back in Florida, and in the same city for more than two years for the first time since college.
Dr. Aimee Madsen is originally from California and attended medical school in Michigan. She is interested in sports medicine, and particularly hopes to work with female athletes. Her background is in figure skating, dance, viola and piano. She is excited to be back in Florida, as she lived in Miami for a period of time as a child.
Dr. Shammi Patel is coming from New Jersey, where he completed 2 years of general surgery and an additional year of independent wound care before joining the University of Florida PM&R residency program. He enjoys traveling, hiking, auto repair, and exploring local breweries. His medical interests include critical care, TBI medicine, and interventional pain medicine.
We are excited to join FSPMR and look forward to getting to know you and working with you in the future. Please let us know next time you are in the Gator Nation!

Larkin Community Hospital PM&R Residency Update Arun Zachariah DO, Liaison Jose J. Diaz, DO, Residency Program Director

Greetings from Larkin! We are half-way through the year and hope everyone is doing well! Congrats to everyone who matched TBI and SCI recently! Two of our PGY-4s have matched into TBI. Trevor Persaud matched with Mayo Clinic and Kevin Estes matched into Carolinas rehab!
Special congratulations to Colleen Neubert,
who recently was married!
Good Luck to all of those who applied to pain and NASS fellowships!

Arun Zachariah DO

Professional Opportunities Offered and Sought

Opportunities:
Southeastern FL. Pelvic Rehab Medicine Be at the forefront of this specialized medicine. Training will be provided. This rapidly-growing field offers much professional growth. Comfortable lifestyle with 8-hour days and no call.
St. Augustine, FL. Medical Director Rehab. Brand-new 40 bed acute inpatient rehab hospital slated to open 2/28/2022. Enjoy the advantages of an independent contractor affiliation. Income guarantee PLUS a Medical Director Stipend PLUS your professional receipts. Other opportunities include an outpatient practice purchase in Palm Beach; a pelvic rehab medicine in Palm Beach; inpatient in Melbourne, Fort Pierce, Broward and Vero Beach; subacute in Ocala and Sarasota; and remote nurse practitioner supervision statewide.
Just added Tallahassee!
Contact Linda Farr, Farr Healthcare, Inc., farrhealth@comcast.net, 888-362-7200, www.farrhealthcare.com

Professional Opportunities Offered and Sought—continued

Zachary S. Gulergun
St. George’s University School of Medicine
MD/MBA Candidate (MS4)
(917) 743-6286 | zgulergu@sgu.edu
Dear FSPMR Members and Physiatrists:
I am currently a fourth-year medical student at St. George’s University School of Medicine, graduating in June 2022, and have been completing my clinical rotations in Miami, FL. I am in pursuit of a one-year research and/or clinical opportunity, from July 2022 to 2023, to establish the skills necessary to carry out my own research projects as a future physician, enhance my competitiveness for a PM&R residency position, and to continue to develop my medical knowledge and clinical skills.
It wasn’t until my early, mid-twenties that I decided to pursue a career in medicine with the goal of becoming a Physiatrist. Since then, I have focused all my attention and efforts on this goal. Prior to my postbaccalaureate premedical program at Columbia University, I volunteered under the Director of Orthopaedics and Sports Rehabilitation at Mount Sinai-Beth Israel while attending courses in Biology, Anatomy and Physiology, and Exercise Physiology at my local community college. During my postbaccalaureate program, I volunteered for the medical team at several marathons in NYC, earned a clinical intern position to learn more about private clinical practice, and held three different research positions in Sports Neurology, Orthopaedics, and Public Health. In my research experiences, my responsibilities included, but were not limited to all aspects of clinical coordination, assisting with sponsored and multi-site research projects, assisting with IRB protocol preparation, and use of EPIC, Cerner, and RedCap. During medical school, I have continued to volunteer at various sporting events and will soon be completing electives in Neurology, Orthopaedics, Sports Medicine, and Physical Medicine and Rehabilitation. My prior clinical research experience and medical school training have provided me with the communication and clinical skills as well as the knowledge of medical terminology that may be required for any research position. Most importantly, I have always worked and thrived in a multi-disciplinary team setting.
To be a successful physician, I have consistently believed that involvement in ongoing research is an essential aspect of our duties because we utilize evidence-based medicine to guide our clinical recommendations. I have taken a longer path than most to reach my career goal because I am determined to have an integral role in the advancement of medicine through research. I have always been incredibly dedicated and motivated in my endeavors and will continue to put my best effort forward for any clinical and research teams that may consider me.
Please feel free to contact me directly to obtain my CV and any other pertinent information you may need.
Sincerely,
Zach

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FSPMR Office: 904 994 6944 Executive Director Lorry Davis MEd, lorry4@earthlink.net

NEWSLETTER MARCH 2022

June 2019

Enhancing Health And Function Through Education And Research In The Field Of Physical Medicine And Rehabilitation

In this Issue

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NEWSLETTER MARCH 2022

June 2019

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