Hello, everyone. I'm Dr. Clay Noli from the University of Missouri. Today it's my distinct pleasure to have a fireside chat with Dr. Pietro Tonino. Dr. Tonino is a professor of orthopedic surgery at Loyola Medicine in Chicago and is the chief of sports medicine and the head team physician for the Loyola Ramblers as well. So it's my pleasure to talk with Dr. Tonino today. Dr. Tonino, thanks for joining me. My pleasure. One of my favorite people, so I'm ready to go. Thank you. Well, let's just, let's kind of start at the very beginning and then we can kind of jump into a lot of things as they, as we go along, but kind of get us maybe started with what got you interested in medicine and then what led you down that pathway and maybe what led you to Loyola? Well, medicine, I think my first generation Italian, my parents thought that education was important. And I think medicine, at least in the seventies and sixties, I was born in 56 and that period of medicine was still one of the highest type of occupations to achieve. I know there's a lot of competition now with different kinds of business ventures and artificial intelligence and all that stuff. But and it's one of the opportunities to help people. My mom, a little Italian lady, used to always say that doctors are better than priests because they can help people. And so I always kind of thought that, and my dad was a bricklayer, like working with tools and this gave me a chance to use my hands. So I've been doing stuff, manual kind of stuff for a long time. And that's why I chose kind of arthroscopic surgery out of all the surgical fields and surgery in general. I like the surgical being able to fix things and see things work right away. That's awesome. How'd you end up at Loyola? I was in practice, in private practice for about three or four years. I missed, so I was working with other attendings, but I missed working with and discussing things with residents. I think that I would have met people like you, Lance LeClair, other kind of people and stuff who are now, I've seen kind of flourish as young physicians in the field and stuff. And the back and forth with the residents, asking them what their favorite restaurant is in Chicago, what kind of music they like to listen to, and, you know, so Ricky Rose and all that stuff. So I like, I like keeping, it keeps me young, I think, and it's been a real good opportunity to see a lot of people develop, become, see them from their first year to their fifth year, then they become attendings. And then I'm referring, I refer people to people like you and other people that I know all over the country, because I've got friends from different fields and they live in different cities and it's always great. I think one of the difficult things in medicine now is getting someone to see a doctor. So being able to say he was my student or I knew him as a resident, or he's a colleague of mine, and it's one of those things that helps get people in to see a doctor. Yeah, that's awesome. I mean, I know I can, I can certainly speak for the many, the multitude of medical students and residents that you train when I say, we appreciate you for that. And we appreciate you deciding to make that choice and go back. And now as many years as you've done it, you've got connections literally probably all over the world. So I'm sure your patients benefit from that too, when they're across the country and across the world. Is there anything you would say to your younger self getting started in medicine or getting started in orthopedics and sports medicine? I really enjoy what you're doing. It seems like it goes by so fast and stuff. So I've been a Loyola for over 30 years and it seems like it moves in a quick, I tell them, I tell the ones that are married, just don't blink with your kids. Cause it seems like in two minutes, they're in high school and then they're out of the house. And it's just enjoy what you're doing and enjoy this, even though it can be completely chaotic. If you have family and kids and it's crazy and you're not sleeping and you're working your butt off, you need to do that a little bit. And it's a very difficult life balance between work and family. And I always say the family comes first. So trying to balance that is kind of difficult for physicians, whether you're a mom or a dad, a surgeon and stuff. But overall, enjoy what you're doing. As much as you think it's kind of crazy, it's a good crazy. Yeah, I think that's an awesome piece of advice. I think, do you have any piece of advice for anything specific maybe you and your wife or your family do or anything you guys have done in the past to kind of keep that balance or to keep that family life going forward? We're also, like you said, our work lives are also crazy. And then, you know, as we try to get involved in societies like the arthroscopy association or other different things or team coverage or things, life gets really, work gets really crazy and life gets crazy. But that family life is important. Do you have any kind of specific pieces of advice for how you've been able to accomplish that? Well, I think sports medicine, arthroscopic surgery, sports medicine is cool. And one of the things that I did, I started taking my kids to practice or training rooms or I work with the Dodgers. I used to take a man to see Tommy Lasorda. And when I, when they were kids, when I was covering Cubs games, so Loyola games, they all know the athletic trainer. By the way, athletic trainers are chief of sports medicine. I think they're the most integral part of a successful sports medicine practice, but that's another discussion anyway. But kind of involve your family in some of this stuff. I mean, your wife, your husband, whoever your spouse is, is looking for some help sometimes just to get the kids out of their hair a little bit so they can get something done. And if you can take them to a game with them, with you, I mean, I think it's a great thing to do and stuff. So I think you kind of integrate that, your family life a little bit. And then, I mean, you've got, I've got things coming about this committee, that committee and stuff. And I try to do committees that would not disrupt my family life too much. And even this, what I'm doing right now, I've got family stuff going on today and stuff. And I didn't want to change what I was doing. I'll get up early. I thank you for getting up early to do this. And I like, I try to fit it in within my, my life, my life, my family life. Yeah, that's awesome. I think that's a great piece of advice. It's a little bit of a double-edged sword taking the kids to the events though, because they kind of get a little bit spoiled. I think sometimes, you know, I took, I took my son to his first Chiefs game and he didn't understand why we couldn't go in the locker room and in the training room before or after the game, like he gets to at Mizzou games. So he just, you know, it didn't make sense to him. So it's a little bit of a double-edged sword, but I think that's great advice for sure. Trying to involve them as much as possible, which, which is great. So, yeah, I think it's, if you can do that, like I said, in especially if you're coming to an athletic event, like a football game, you got to be careful if you're on the sidelines and stuff, you got to keep your eyes on what's going on and don't put them in danger girls. You have someone to answer to when you get home. Yeah, that's for sure. No question. What, if you had to think of maybe like one thing or one or two things of kind of maybe your most impactful or, or just maybe one of the things that you're most proud of in terms of innovation or accomplishment in general, what would be something that, you know, something that you're really proud of over the course of your career? There's many things I know, but if you had to pick maybe just one or two or something that you really like. Well, I, you know, I was involved with a learning center, the orthopedic learning center, right off the bat, my mentor at Northwestern. I worked with John Heffron and Howard Sweeney. John Heffron was a orthopedic surgeon with the Bulls and I got to cover a lot of games. He gave me a lot of ability to do that kind of stuff at a very young age in the operating room. I was not bad with the scope and stuff. So he let me do a lot of stuff. And I had had some experience with doing that with Dr. Howard Sweeney. So the number one person, I think, as far as a mentor for me, as far as arthroscopic surgery would probably be Dr. Sweeney and just teaching. He used to have these things, very simple kind of stuff, where you'd have a shoe box with a little plastic truck, a toy truck inside of it. He'd make a little hole, and then you'd put the scope in a hole and you'd be able to, you'd have to show him, you knew the front and the back, how to show the front, the back of the truck, the top, the bottom. And then he had this thing, you'd play like Marble Mania, where you have to control things like that. And I'm going, that's pretty cool. I mean, even at that age, he was, you know, had been in practice for a long time. And I got to say, most of the arthroscopic surgery stuff I'm doing right now, I learned after I wasn't attending. I mean, I did a little bit. We operated on, when I did my fellowship at Kerlin Jobe Clinic, we operated on some pretty high profile athletes out there. But at that point, this is 86, 87, we were scoping, and then we'd make an incision and open the shoulder. And I worked with Dr. Jobe, so we did this capsule labral reconstruction thing. So I came back to Chicago in 87, talking about capsule labral reconstruction. I don't think anybody knew what I was talking about. But it was those years. And then, you know, industry is very helpful to my development in arthroscopic skills, because, you know, you want to learn a new way of doing it, a suture anchor. I remember going to the first AOS meeting where the suture anchor was introduced by MyTech. And at the beginning of the meeting, I was walking around because it was way at the edge where the little no-name companies are there. And I'd go, I'd see a little booth there with some people and go, this is kind of cool. And then about the by the third day, there were a million people at that booth, you know, those concept. I mean, I think a suture anchor like that, MyTech, their suture anchor that they developed, and I don't mean to use a company, but that's who had it. It was pretty cool how it transformed what you could do with arthroscopic surgery. You didn't have to drill holes and look in a little hole, kind of like doing gallbladder surgery sometimes, but this way you could see it on a monitor and stuff. It was pretty cool. Yeah, that's awesome. Well, that's got a, that's a good segue. You know, you mentioned OLC and, and so how did, and you mentioned kind of how you got a little bit involved in that. How did you get, how did you get involved in the Arthroscopy Association of North America? How did you get involved with Anna and then like, kind of how did that process go forward? Well, Dr. Sweeney being my mentor would ask me to come and help with the course and stuff. And when you're young attending, I may have done it when I was a resident, I don't remember right now and stuff too, but I tell my residents go there. I know you can volunteer on the weekends and stuff. You can get a lot of great experience unless sometimes people leave like one day early and you're like, Hey, here's a shoulder like, you know, and, and so I did a lot of learning center courses. I really, really liked the way the Dr. Sweeney taught things. And I took the way he, we're kind of a simple thing, not tying stations. Sometimes you don't need to know that too much anymore, but I still, I still like that tool, but you know, it's not tying, even if you don't need to go and tie knots, it's a manual skill. And so you're learning how to do some stuff manually and anything you can do to improve your dexterity. And, you know, not all residents are, have capability or at least have an innate capacity to tie a knot or do it like that. It's something you have to kind of learn, practice, practice, practice. So, and when I was at the learning center, there were four or five industries that had donated instruments, and then you get to meet some of the people from industry and they were, you know, I would, I use that to kind of use, to launch my international arthroscopy experience, so to speak. And, you know, we did a 10 years of an arthroscopic surgery course at the OLC on an off day, I think it was on a Monday and a Tuesday, because that's when it was open. And I had 40 orthopedic surgeons from Italy. It was all in Italian. And, but we'd invite, you know, Buddy, Brian Cole, we had Gilles Valche came from France one year, you know, like Freddy Fu. You've never done anything. God bless Freddy Fu up in heaven up there. What a great teacher and stuff. Trying to do a demo with Freddy Fu, it was very challenging because he was so excited about what he was doing and stuff. Were you his translator? Yeah, it was difficult to translate. Yeah. But it was a wonderful experience. The staff at the Anna were wonderful and stuff. And Pat Sickler, look, Pam Martins, and Dr. Sweeney, I'm never gonna forget those people. Some of them are up in heaven having coffee right now and stuff. But those are and I don't know who had to say never forget the people on the way up because you're gonna meet them on the way down or, you know, and I think it's important to be nice to everybody, whether they're a lab assistant, the video guy, I still see the video guy, Dr. Sweeney's memorial, the guy, the guys who did the video stuff for the meetings and stuff, but it was that was a great opportunity of, you know, 10 years to do a course in the Learning Center. Yeah, that's all. Let's talk about that a little bit more because you've been so involved with the Learning Center. And then I think obviously, as you mentioned, and alluded to your involvement from an international perspective, and all the things you've been able to do bringing, you know, Anna bringing an international perspective or international outreach to Anna and to the Learning Center, you've had played such a huge role in that. So tell us, yeah, tell us a little bit more about that. You mentioned kind of that 10-year program with you had bringing Italian surgeons over, and I know you had that big initiative with Vietnam and things. So tell us about some of those types of experiences and how you've been able to accomplish that. So my two, you know, my two primary societies are Anna and then sports medicine. A lot of stuff is interchangeable as far as that kind of stuff and shoulder and elbow to some degree as well. And I always enjoyed learning about techniques outside the United States. And there was a lot of resistance initially to including international stuff that Anna and sports medicine, or not resistance, but I don't think appreciation as much of what how you could kind of learn something from outside the United States. And I mentioned Gilles Balch, you know, he was, I went to see him work and on a vacation, I took a day off, I was with my family in Europe, we went to see him go, wow, we got to get, I never heard of this guy, I just kind of heard about him a little bit, but he should be at our meetings, talking, he's a great teacher, smokes a cigarette between cases and stuff. I don't know how he operated so fast and stuff, too, but very, very good, very kind. And, and was a great teacher. So we got him involved in some of those courses. And he came to some of our Italian courses at Anna. And as I mentioned, with knowing people from industry at the Rusby Learning Center, I was, they asked me, AOS asked me to do this program in Vietnam. We did it for 10 years. Teaching arthroscopic surgery. It was Stu Weinstein did spine, Mike Cavanella did arthroplasty, and I did arthroscopy. So I'm sitting there at the airport lounge with these two guys, kind of gods of orthopedic surgeries. I got, it was kind of, it was an unbelievable experience and stuff. And I'm still thankful to Lynn Dowling from the Academy, wherever you are now, somewhere in retirement for asking me to do that kind of stuff years ago, and my cat, Dr. Cavanella as well. And they're just wonderful people. And when you get to a place like Vietnam, like reality sits in. So you got the Learning Center, you got industry all over the place, you got things you can, you know, drop this on the ground and kind of bend that kind of thing. And then it's kind of, there's not as many resources when you go to countries like Vietnam. And for me, it was an important, it's probably one of the most fulfilling things that I've done. You need to have, you know, so I brought Dr. Sweeney with me the first year. He's my mentor. And so I thought, you know, you're kind of in charge of whether they like to diet and all that stuff. I didn't know what it was going to be like. I took all these pills and shots because I thought it was, I think they were thinking I was going to Vietnam in a jungle someplace. And I get to Saigon and there's 13 million people driving little mopeds around. It was not the jungle. And so it was already sophisticated, although they didn't have the resources, right? Very sophisticated country, great people. Thankful to Dr. Sweeney, thankful to Pat Byer and Limba Tech, because you can't do those kinds of things without the support of industry. And I mentioned learning different arthroscopic skills, you need, you know, going, those techs, the people that come to the OR with you or teach you how to do this new thing, you want to, you take advantage of that. And they have little labs or whatever, the learning center courses, go to those kinds of things to learn how to do things. Because I learned all that stuff after I was done with my fellowship. And residency. And so Limba Tech was very helpful for that. They provided saw bones. And Denzel, thank you, saw bones, for donating all those saw bones. And, but it was, I remember going with all these cases of stuff to Vietnam, to set up a dry lab. And everybody wanted to do surgery right away. I said, no, you got to practice this stuff. So dry lab, a saw bone, something like that, where they could practice knots, tying stations. And I have to say, arthroscopic surgery is, seems like a technical kind of thing. But for my course, it's a teach the teacher thing. But we want to teach people how to examine people, how to make surgical decisions. I can teach anybody. I could probably take my 20 or 30 year old and teach them how to do an arthroscopic knot, or put in a suture anchor. But deciding who needs surgery, how to examine the patient. I didn't get there, you go, you got an ACL, we have all these patients with ACL. I said, okay, examine the patients, a PCL, or rotator cuff care. And they go, can you externally rotate your arm with your arm and induction? They can't externally rotate. I said, no, frozen shoulder. And so it was a wonderful experience to help people as much by how to operate, makes great, great surgical decisions as much, that was as important as how to put an interference screw in for an ACL. I think more important, right? Because if you see what you can get in trouble in surgery and medicine in general, if you make the wrong decision about what to do for people, how to do it. And besides being lawyers and all that stuff, you don't want to be screwing up people's lives and stuff like that by doing something wrong. So not doing the best thing you could have done for them. As a surgeon, you have unbelievable powers. I used to laugh and say, you could talk to some people and say, I'm going to take your left leg off and stick it in the middle of your head, whatever, because I think you need to get that done. And they go, okay. You have unbelievable powers with people. You have a big influence on them and stuff. So you have to use that wisely and make sure that you're making the right decisions for people. So although it's a surgical skills course, the first day was all non-surgical and just kind of teaching people some basic kind of stuff. So it was fun to be able to do that. Yeah. I mean, those are such great points. I think, especially in today's day and age, is we have better modern imaging or better imaging and then a better instrumentation, all the things that you've mentioned, which are great, but certainly the art of the history and physical exam sometimes maybe gets lost. And I think you may have been the one that teach me all the way back then that like, you should be able to make 90% of your diagnoses from history and physical exam alone. You don't even need an MRI or an arthroscope that all those things are just conformatory. So sometimes I think that gets lost maybe, but that's really salient points for sure. Out of all the places you've visited, either in association with Anna or the Learning Center or on teaching trips or otherwise, what's the favorite place you visited? Is it Vietnam? Is it going back to Italy? Is it somewhere else? What's your favorite spot, you think? It's a different thing. You like different kinds of cuisines when you go out to dinner and stuff. And there's different, I mean, it's fascinating. I mean, I'm very, very thankful again for being, I was on an international thing for AOS. I mean, a lot of people have been very, I can't list them all here and stuff. It would take me a long time, but I'm supremely thankful to anybody who sees this for all, anybody who's done anything for me. But I love Vietnam for what I did there. It was, when you're in Chicago, I was, my dad's a bricklayer. I grew up on the west side of the city. And so I never was out of the country very much, or even out of Chicago until I did my fellowship. And then years later, I'm in Vietnam eating pho and walking around Saigon. It was an unbelievable opportunity, but more so in the lab for being able to teach people what we were teaching them and stuff. And then any country, and at some point you can take your spouse with you, which is great too. Although it's kind of a little bit honey or whether it's man or woman, these courses sometimes when you go with your spouse, they're sitting in a hotel room while you're giving lectures and stuff. So I think it's important to take your spouse places sometimes where you're not having to give a lecture for two days and giving lectures for two days and they're sitting in the hotel rooms. Because it was always difficult whenever on any of these trips, I've always thought when I was organizing them to have something for the spouses to do while you're in Tokyo or you're in Paris, you're in a room giving a lecture, but there's a big city outside. And I kind of wish I was with them to be honest with you, although it's great to meet a lot of people. You meet a lot of great personalities. You see a lot of fascinating stuff and it just makes you sit back and go, hmm. So even like from a political sense, sometimes we don't understand international politics because we just probably know what the box score was of the Bulls game last night and stuff like that. But we don't know a lot of what's going on in Paris right now or other kind of cities. So it was a great exposure, eye-opening to see different cultures, wonderful people, very kind people, and just make a lot of friends. Obviously, Italy, I think you can't go wrong there. But it was kind of cool to be able to talk Italian during some of the courses and stuff there. South America, it helps to learn languages for your kids, teach them how to speak Spanish, other languages, Italian too. Because you can give a lecture, somebody give a lecture, even when you see a patient and you can speak in their language in your office, it's unbelievable that you can see they kind of, I don't have a little meter or blood pressure monitor on them and stuff. It seems they get a lot more relaxed when you're talking and speaking their language and stuff. So it's one of those things that's important to do. Yeah, that was one of the things that I was always amazed when I would be in clinic with you. One room would be an English-speaking patient, the next room would be an Italian-speaking patient, the next room would be a Spanish-speaking patient, and you just go bang, bang, bang. There's no translators needed. Dr. Tonino is talking to the patient. I was always so impressed because it would just be right down the line. But you're right, the patients appreciate that so much. I've tried to pick up on some of that too. I don't know if I'll ever get Italian down. It'll work on Spanish, but we definitely teach our kids that. And so hopefully, yeah, I think that's a terrific life lesson learned for sure. Yeah, and it's really not something you think you're ever going to need and stuff, especially when you're a kid and stuff, because everything, a computer, I mean, when the computers came out and they were all in English, then that changed things and stuff. Because before, you used to have different languages on computers and stuff, but when it all switched, just everybody needed to learn English, and so the whole world needs to learn English. But it's kind of cool to be able to read a menu when you go to Italy or France or wherever you are and stuff, and to say merci beaucoup or grazie or whatever to the waiter. It's kind of cool. Yeah, I think that probably ingratiates you to them, and they appreciate you doing it in their native language or that you're trying to make the effort or you being able to do it and do it very capably, which is great. But you kind of mentioned some of these fun kind of trips and involvements. What would you say is your favorite aspect of being a member of ANA in particular or being involved in the Arthroscopy Association? Well, so I think it's one of the societies that's very open to doing things, and I think ANA was one of the big societies that understood the importance or appreciated the fact that international exposure is important. There's an opening day of ANA. There's all the international presidents there. You have a lady or a guy from Guatemala who's president of their association. It's probably this big, and they're standing on the stage in front of thousands of people and stuff. Then it's super cool to have a breakfast after that meeting, a breakout breakfast with the people there, and they are just so thankful to be there. Then a lot of times we'll have, I think when I did it, we had like the host nation would have a bunch of their lectures. In that sense, I always wanted to have some younger people. I've heard people that I mentioned like Gilles Vos, La Paz, all those guys talk a million times, and they're super wonderful people. They're like, cool, but people like you, younger faculty to get that exposure to talk about stuff. It's a great experience, and I think we need to do a little bit more of that kind of stuff and create those kinds of opportunities for younger faculty. Even when I'm on committees and stuff, some of them I turn around and tell them, I'm getting off, whatever you get it, pick somebody younger for this kind of thing. I've been around long enough. Like I said, with the residents, the music, the restaurants, it's a different idea, maybe you're missing on how to teach. A lot of it, we're trying to teach, and Anna has been very, very good with that. They've given me probably the most opportunity with asking me to go on trips and stuff like that, and getting to be able to meet people. Some of the other Rainmakers, Buddy, going on a course with Buddy, or Abrams, or Rick Ryu, any of those guys, Jeff, they're just, Gaglione, whatever. I probably missed some names there and stuff, but they're just, you go, wow. Wow, it's like turning with Elvis, a bunch of Elvis's and stuff. It gave me an opportunity to see the leaders in action and stuff, and I'm nowhere near their capacity and stuff, but it was fun. They're very kind people, very open people, fun. I could text them right now and say, hey, I need this or that. John Richmond, that's the people in Boston, wherever. They're very, very open, and the communication and stuff too. It gave me a lot of opportunities. Yeah, I agree so much. I've always been so impressed at how inclusive I think ANA is, and the ANA leadership in particular, all those people that you mentioned, and all the people that are coming through now. I think that's one of the greatest things about it is the inclusivity and wanting to get people involved. What would you, kind of to that point, what piece of advice would you give to maybe a new member or an incoming member of ANA, or maybe somebody, a resident, or a fellow, or a young, early career person, maybe wanting to get more involved, or coming into the arthroscopy world, so to speak? I'd join. Even our residents, I try to get them to join at an early age. If you get in there, go to the OLC course. You're going to meet Clay, who's doing some course up there with Lance, and all these two young superstars that are working. You get to meet them, and then all of a sudden, they ask you to come back to be a lab associate. You don't start being the head of a course. You got to get there. I did a lot of being there as a lab assistant, and at lab stations, getting my gym shoes wet, and stuff like that, but get out there and meet people, and stuff like that. Join ANA, and then get involved in some committees. Within, like I said, the constraints of your family, and what your family life is like. Some of these don't require a lot of substance with what we're doing right now. I don't have to fly to Missouri, although it looks pretty nice there. The sun's out. I don't have to fly to Missouri to see and stuff. There's a lot of educational stuff you can get involved with virtually. There's so much stuff, because we need you, to be honest with you. I just went out to dinner, and we're talking about artificial intelligence, and bio this, and bio that. I think things are going to change a lot in the next 10, 20 years, and things like that. They're not going to change with people like me, because I don't know some of that stuff. I don't even understand some of that stuff, but it's pretty cool to see some of the changes that are happening. Get involved. Join. You're going to meet a lot of great people. It doesn't cost that much to join, and go to meetings, go to the learning center, and get to know some of the people. Because even within a residency, sometimes you think you're meeting all the people you need to meet, and that's nowhere near. You may meet somebody at the learning center that's the head of a fellowship that you want to go to, and they're going to do that sitting at home. I don't care what kind of letters you get from me or anybody else. If you met them at the learning center, you had Diet Coke with them at a breakout session or whatever, it's unbelievable. They get to meet. It doesn't happen by sitting around. Those are such great points. Especially the learning center, and like you mentioned, the meetings and stuff. I know sometimes people say it's maybe hard to take time away from practice or take time away from training, as you only have a limited amount of time that you have, but I think there's such high value in just those short few days or those things for the annual meeting or the OLC learning center events. Even now, when I go and be part of those courses or part of the meetings, I've learned so much. Like you said, make a lot of connections with people. There's high value in the short duration of time at those things, I think. Yeah. Maybe you can get on this podcast that Anna does and stuff now too. There's a lot of stuff. There's electronic submission of articles. There's the technique stuff. There's a lot of cool stuff. They're great people, to be honest with you. You get to meet a lot of very famous people, but when you meet your uncle or normal kind of people and stuff, a lot of them have changed the face of arthroscopic surgery in the last 20 years. It's pretty cool. What would you say to the incoming leadership and future leadership of Anna? You've been part of the board of directors and got to see a lot of different leaders and presidents and presidential line come through. What would you say are maybe some of the best values or what would your piece of advice be to them as the future of the organization? I've mentioned younger people, but women in leadership positions and stuff are important. When you talk to female residents, it's a little bit different world for them than it is for you. Sometimes I'm completely oblivious of what's going on sometimes, but I've got two daughters and in the workplace, some of the things they have to deal with, it's an interesting thing to sit down and talk with them sometimes. Change it up a little bit because when you're sitting on a fastball and somebody throws you a change up, you're going to probably whiff, but if you're ready for the change up, then you may hit it to the opposite field. Like I said, change the face a little bit. As wonderful as all the people I mentioned are, it's great to see some new faces in there. Give exposure to younger people, to women, racial diversity, just get other things. When you go a step outside the United States, there's a lot of stuff that's different from way to way we do things here. One of the things, there is more diversity, I think, in a lot of countries that sometimes we don't have as much here, although we're getting better at it now. I think our younger generation understands that. Like I said, change it up a little bit and embrace change. Yeah, I think that's awesome. I think Dr. Gettleman, that was in the last presidential line or last presidential address in his year, that was definitely an initiative that he certainly wanted to kind of push forward and I think did a really good job of and certainly will continue to hopefully push forward and, you know, and go continue to kind of be more inclusive even more so than what Anna already is, which is awesome. If you had to change one thing, is there anything that you would change about your experience either with Anna specifically or even this is a very broad question, maybe your career in sports medicine overall, which certainly that's a very big question, but any changes that you think you would make? I always get asked, people ask that question and I think you've lived your life, the water's under the bridge, things have happened and I really wouldn't change anything because it's, you know, you don't get that position, this doesn't happen, this falls through, whatever, everything turns out okay. I see all these moms worried about this kid going to this high school, they gotta go to this high school, blah, blah, blah, or go get into this college, they go like 400 visits for college, they go, it literally does not matter, okay? It's gonna turn out okay and it's kind of cool, by the way, when you're in the office and even though you got a meniscus tear, but 80% of the time you're spending talking about what's going on at home and stuff like that because you already know what's going on, kind of palpated the joint line, did a little McMurray's test and then they go, wait a minute, I've been waiting, these people will wait for an hour or 45 minutes to see me, so then you start talking about that kind of stuff, but everything you learn from your mistakes, a lot of people have said that kind of stuff and we've all made mistakes, it hasn't been perfect and you make some mistakes and you learn from them and you deal with them, you have to kind of be upfront, no using the foot lie when you're playing golf, whatever, and kind of like be honest, I think even when you're talking to a young residents, be honest when you talk to patients and stuff like that and at that position, if you get the polls, you'd probably get the polls for one thing or another, be honest, be consistent and I tell my kids too, your word is everything, so if you have a reputation of not being a truthful kind of person and stuff, that's gonna hurt you and stuff and at some point in life, we've always been a little sketchy on the truthfulness or kind of, you know what I mean? And 900, like it always comes to bite you and stuff, it kind of, my mom, a little Italian saying that says, the devil teaches you how to do it, but not how to hide it, so. That's pretty good, yeah. And yeah, and so it's, you know, just be honest and stuff, it just, Yeah. You know, it may not be the most, it may not get you as much stuff as you need at that point, but if it's a situation where your truthfulness is more important, be truthful and be honest with you, with whoever you're dealing with. Yeah, keep your principles for sure. Yeah. I think that's obviously a terrific point. And you mentioned, you know, you mentioned Dr. Sweeney before, and I'm sure he probably influenced you in that way and kind of having those principles and building on the principles that you already had from your family and your parents, obviously. What advice would you have in terms of mentorship, in terms of maybe becoming a mentor or helping mentor others or kind of being part of that process for people? You touched on it a little bit, Sam, already, with the way that you teach, but just kind of in general. Yeah, I mean, make yourself available. I mean, I remember I had mentors. In pre-med, I had this guy with an Afro in my organic chemistry lab in Northwestern who I never met before, I never knew before. Now, my parents were godfather to their kids and stuff. I take him out. He's a 70-year-old. He was at Northwestern's med school and Obi Giney is one of my best friends and stuff. And Bernie Feldman was a ER doctor at the head of the ER in Northwestern. My dad built his garage. One day when he's building it, he says, come down, I want you to meet this guy. And he's the one who got me interested in a little bit in medicine and stuff too, because he was a doctor and my parents already taught doctors. So a couple of nationalities where doctors and lawyers are important and stuff. So Italians are just like that. So I met him and he was, be a mentor. I needed those people. They wrote my letters for med school. I've written letters to people for fellowships. Then you see them flourish and doing great things. I'm sending people to different people, Drew Burleson in Cincinnati, whatever, just, it's cool to be able to do that and stuff. And so it's wonderful to see people flourish that you've helped and been a mentor to and made yourself available to. It's kind of cool. I have a thing, I take them out to this Mother's Day restaurant, which is near Loyola and stuff. We go sit there for breakfast and time and just talk to them about life. And it's cool to be able to do that. They're all trying to figure it out. And obviously it's a lot of women now too. So it's a little different thing. So it's like sitting with your daughter sometimes and talking about what's going on. And like I said, the music and the restaurants and all the stuff that's going on in the friend group. And some of them are coming from outside Chicago. So like they're kind of learning to adjust to the area and stuff, but be available for them. I think myself, a lot of people have my cell phone number and stuff, so I usually kind of text. And even when I retire and stuff, I probably still get texts from people asking them, but it's kind of cool to be able to help people out and stuff like that. I'm sure you will. I'm sure you'll still be getting texts for a long time. It's awesome to hear you say that. I think it's a lot easier. It's hard to do sometimes, especially with our crazy schedules. I think I appreciate you and some of my other mentors now, even more than I even ever did, even going through training and through the process and stuff because as you get busier, like we've talked about, availability becomes harder and harder. And I think one kind of just quick story that I like still cherish in terms of the, to your point and to your like being available, but it's a gosh, it's almost, it would be almost 20 years ago now, but you were my preceptor and you said yes to being my preceptor, but I'll never forget, like in between a busy OR day, so running through cases, a ton of cases, you still sat down and I think reviewed just like a simple history and physical exam that I had taken on some random patient and sat down and reviewed it with me and then gave me pointers on how I could improve my history taking and that sort of stuff. And I still remember that to this day. You know, it's like I said, it's a gosh, going on 20 years or so ago now or whatever it is. And so, but it made that kind of impact on me, even all the way back then, you know, that somebody like you, who's accomplished as much as you have would take time out of your busy OR day to sit down and go over a simple H&P with me to try and help me learn and help me get better. And so, that's a credit to you, obviously, personally, but I think that's just a great example of what you're saying of being available and trying to meet people where they are and be available for what their needs are. Yeah, I recognized the potential early on and stuff, so. Well, I don't know about that, but yeah, but certainly that's appreciative. What do you think? Go ahead, yeah. It's little things like that. I mean, and I don't remember all, you know, it's little things like that, but they make a big difference for people sometimes and you don't realize, you may not realize it at the moment and stuff, so maybe that'll be you and somebody will say that about you 20 years from now if you decide to mentor somebody like yourself. Yeah, well, I certainly hope so. That would be fun for sure to hear, but what do you think the best piece of, kind of along those lines, what do you think the best piece of career advice, you know, maybe either Dr. Sweeney or anyone else or, you know, any of the great people that you've mentioned, what's the best piece of career advice somebody has given you? Oh, Lord. I think, I don't know that anybody's given me any one piece of advice or that's really made that much of a difference for me. I don't know, people didn't, sometimes your actions speak more than your words and stuff. So I've watched how people do things, what, how they do things, you know, how it turns out when they're not around the house as much and how you want to model yourself as opposed to someone telling you things, you kind of pick up some things based on watching their behavior. And I think that that's been more of a learning thing than somebody saying any specific thing, to be honest with you. And I'm still learning right now. I'm like 65, 66 going on 67 and looking around and go still learning things and seeing things happen. And so you kind of, every day is a learning opportunity, to be honest with you. So it wasn't one thing, it's more like observe and then see what works and what doesn't work. And it's pretty, those kinds of things are pretty self, become pretty self-evident and be nice to everybody. Just, you know, the OR tech, whatever people clean up the OR room and stuff, don't, you know, be nice to those people and stuff, not just the chief of the service and all that stuff. Yeah, yeah, that's awesome. Yeah, well, yeah, I'm certain you've had a lot of people around you too that I think share your vision and especially at Loyola there and stuff. And how's Sister Jean doing? Sister Jean is 103, she was just on the ABC News. Unbelievable. So I was at, in Indianapolis with Loyola a couple of years ago and during COVID and stuff. I don't know, I see the lights coming in here on this thing here, so I apologize, man. And so I'm sitting in a hotel room, it's Sister Jean, me, and her nurse that's with her and stuff. It just, it wasn't, during COVID, that year in COVID, everything was closed down. So there was nobody at the Indianapolis Stadium, whatever that's called, what, Lucas Oil Stadium, it was like, you know, a couple thousand people in the entire place and stuff. But it was a wonderful opportunity to spend some time with her. We see her, I see her all the time, obviously, with going to basketball games and see her and she's such, so before I went to the thing, there were a bunch of golf friends of mine that were talking, and one of them really liked Sister Jean from Boston and stuff, but he loves Sister Jean. So talking about, oh, you're gonna see Sister Jean. So at the thing I had her, I said, Sister Jean, I said, I have a friend of mine who's a golfer, would you mind recording a little video for me that says, hope you get a lot of birdies when you're golfing? And she would cry, we did a little selfie thing. Oh, it's Sister Jean, I recorded a little 15 second video saying, Lee, I hope you get a lot of birdies on the golf course this week and stuff. She just, she's so spontaneous, so good with just the spontaneity like that. Very, very sharp, again, you know, just a wonderful person and stuff. And a great lady, there's not gonna be too many like her. So yeah. Does she still go to quite a few of the games? Oh yeah, yeah, she just sits at the end of the court there. So you can watch the games and stuff. You'll see her sitting in a wheelchair and Tom Hitcho, the longtime athletic trainer of Loyola is, helps out with her quite a bit and stuff. And Tom was my athletic trainer when I started at Loyola. And I mentioned this early on and stuff, athletic trainers, Charlie Strasser with Dan Johnston, with Bill Bueller, with the Dodgers, Mark Fowler with the Bulls. I mean, just wonderful, wonderful people and stuff. And the residents, the trainers we have right now, Corey Oshikawa that left Loyola and Jen Jantzik at Lewis Universe. I mean, they're all, you know, I had a list of athletic trainers that I've met has been pretty big and stuff. None of them have been less important than the other one. I mean, you're, when you're doing sports medicine, I talk about ectoscopic surgery, it doesn't include, you're not gonna do sports all the time and stuff, but I, that's what I do and stuff. So you're athletic trainers, like your right hand person and stuff. And yeah, just very cool and wonderful people. Yeah, it's another one of the awesome things that, you know, we get there, you know, the capabilities that we get in this business is you get to meet a lot of really interesting people and a lot of really hardworking people across different fields or different specialties. And like you said, certainly with sports medicine, there's crossover with athletic trainers and therapists and stuff like that, but they come from different backgrounds or sometimes take different approaches to patients or athletes than we do. And it's, you know, it's again, kind of a constant learning experience and you get to experience some really, really cool people and really great people across those fields for sure. Yeah, absolutely. Do you still have the little red bag? Does that still come with you to the games? Many people may not know that story of like a little red bag. Do you still take that or was that mostly back at the, when you guys went to the, you know, went all the way deep in the tournament a few years back? Yeah, Terry Light, my chairman and stuff, got this thing off the internet, eBay or something like that, this little red bag, like way before Loyola became successful at a national level. And so I had it hanging in my office and when I went to the tournament that year, I had no idea. I mean, we had never been to a tournament like that. And I just said, I'm gonna bring this bag. It's kind of a good luck thing. And we went, we win the first round, I go, wow. We win the second round, I go, wow. And I had this bag with me all the time. It's kind of my good luck thing. I don't know why I decided to bring it with me, to be honest with you and stuff. And it had a picture in there of the 1963 team that won the national championship. And that year was the game of color where the Loyola team had gone to the South to play an all black African-American team in the South. There's a lot of cool things about that team. And a lot of those guys were at the basketball games and stuff too. So it was unbelievable. Yeah, and then I think it got a little more notoriety than me to some, almost as much, not quite as much as Sister Jean, but they asked me about it and did an interview about it at the, they saw me carrying it around and stuff. And yeah, I thought it was a good luck charm for that year. We went to the final four, so it almost worked out. So Michigan was pretty good the second half, so. Yeah, no, I was at that game way up high in the stands, but yeah, we kind of, Julia and I, cause he was in San Antonio. So we were fortunate to be there at the time. And we went, we were like, we, Loyola's in the final four, we have to go. Like, I don't care how much it costs or where we're going to be or where we're going to sit or whatever, but yeah, but no, that was a pretty good run. And so whatever luck the little red bag brought you guys, that's whatever, we'll take it. That's great. Yeah, it was fun. It was a surreal kind of year and stuff and something I won't forget. Yeah, for sure. Well, we're kind of running, we're running into the time. I don't want that, I'm sure, like you said, you got work to do or a committee meeting to go to. Is there any kind of like last piece of advice that you would give either to anyone, anyone in Anna or anyone involved in the Arthroscopy Association or just arthroscopy in general? You've had a really long and distinguished career and we've touched on so many of those things and we could keep touching on them probably for hours with all the stories that you have, but any kind of like lasting kind of advice that you would give to anybody coming into the field or into the Arthroscopy Association specifically? Yeah, I just think the biggest thing is get involved in committees. We want changes. We want young people to be involved and if you don't get on these committees and let your voice be heard, you won't hear that. And probably my last piece of advice, it's got nothing to do with arthroscopic surgery, but choose a good partner in life because there's gonna be a lot of difficulty with your day-to-day activities at work. You're gonna struggle at work someday. You're gonna need to have someone to go home to talk about. I was fortunate to meet my wife, Gwen. I've got four kids, Jenna, Brian, Andrew, and Laura. I mean, if the home life is good, it's gonna trump any ACL reconstruction or label repair you're gonna do. Awesome advice. Well, it's been fun. I wanna thank Dr. Tonino for giving us a significant portion of his time today and being such a integral member of the Arthroscopy Association of North America, of Anna, and then obviously being a great mentor to me personally as well. So thank you, Dr. Tonino, for all those things. And we hope you enjoy your work and your time with your family on the East Coast for right now. Thanks, Clay. It's been fun. Looking forward to a lot of good things from you in the future. And thanks to Anna for including me in this project.

Dr. Tonino

University of Missouri

professor

orthopedic surgery

Loyola Medicine

mentorship

Arthroscopy Association of North America

professional development

work-life balance