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NEUROLOGISTS MAKE SPORTS AND FITNESS PART OF WORK AND PLAY

Avitzur, Orly, MD, MBA

IN PRACTICE

Making time for regular fitness and exercise is not often easy for busy professionals. Last month Neurology Today spoke with neurologists who have followed their creative drives and succeeded in blending their talents with medical practice. In this month's column, neurologists describe the rewards of physical pursuits and, in some cases, how they combine them with their medical interests.

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MOUNTAIN-CLIMBING

Charles Clarke, MD, Consultant Neurologist at National Hospital for Neurology and Neurosurgery in Queen Square, has also been practicing at Whipps Cross, a busy District General Hospital in London, since 1983. His lifelong enthusiasm for mountaineering has led to expeditions to the Alps, Caucasus, Himalayas, Kun Lun, the Picos Europa, and the Pyrenees; his current focus is in remote ranges of central Tibet, the Nyenchen Tanglha.

“My interest in high altitude medicine began after I became a doctor. I wanted to continue exploratory climbing but became scared of major routes,” he said.

Between 1965 and 1975, he led small expeditions to remote areas of the Himalayas to unclimbed peaks of 5,000 to 6,500 meters. “These trips provided an apprenticeship for higher peaks.”

In 1975 he participated in the British expedition led by Chris Bonington to the unclimbed southwestern face of Everest. There, he carried out original work on the retinal circulation at high altitude, studying intraocular pressure and the use of contact lenses.

His perseverance led to roles as Chief Medical Officer on numerous expeditions, allowing him to pursue his interest in the clinical effects of chronic hypoxia and medical problems of high altitude, and ultimately to study a field that he has helped to develop. Along his journeys he has treated fellow climbers, local villagers, and even himself. In “Amchhi Inji-ne, the English doctor, Part 1” published in Wilderness and Environmental Medicine 1999, he wrote:

“I have had to deal with life-threatening high-altitude cerebral and pulmonary edema, lobar pneumonia, frostbite, kidney stones, amebic dysentery, and, on two terrible occasions, fatalities. These major issues have been in settings far from the support of a hospital, of medical colleagues, intensive care wards, and nurses – the expertise one comes to rely on at home. On every expedition there are also the common and medically less serious problems – diarrhea and vomiting, coughs, chest infections, and toothache – and the inevitable acute mountain sickness (AMS).”

AMS, a condition characterized by headache in an unacclimatized individual who ascends to an altitude above 2,500 m, is accompanied by one or more of the following: anorexia, nausea, vomiting, insomnia, dizziness, or fatigue.

In 1982, Dr. Clarke started a Mountain Medicine Centre at St. Bartholomew's Hospital, which provides an information service for mountaineers and travelers to high altitudes. Currently run by the British Mountaineering Council, for which he has been named Honorary Medical Officer, it generates approximately 900 inquiries per year. Dr. Clarke has written several books including Tibet's Secret Mountain with Chris Bonington (Weidenfeld and Nicolson, 1999). He also lectures extensively on altitude and exploration medicine. For more information about the British Mountaineering Council, visit www.thebmc.co.uk.

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DIVING BELOW

For Harry T. Whelan, MD, Bleser Professor of Neurology at the Medical College of Wisconsin, professional and personal interests have led to depths exploration. “My Navy and research training led to diving and ultimately hyperbaric medicine,” he said.

Dr. Whelan, who has written extensively on the subject, said, “We are soon planning a pilot study on the use of hyperbaric oxygen as a possible addition to the early management of hyperacute stroke.”

Capt. Harry T. Whelan currently serves as a Diving Medical Officer (DMO) in the US Naval Reserve and Director of the Hyperbaric Medicine Unit. “My Navy diving duty still takes me all over the world, including the Middle East and Latin America, on nuclear submarines as a reserve DMO.”

“In a little over a month,” he added, “I'm going on orders to perform research at the U.S. Navy Experimental Diving Unit.”

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“One of my more interesting Navy diving assignments, was my deployment with SEAL Team Four, to Vina del Mar, Chile, as a DMO and neurologist, to instruct the Buzos Tacticos (Combat Divers) of the Armada de Chile in the proper use of oxygen re-breathers, so that they would decrease their casualties from underwater seizures, resulting from CNS toxicity.”

Capt. Whelan also serves as the reserve medical research advisor to the US Navy Surgeon General at the Bureau of Medicine and Surgery. Over the past ten years he has been conducting research on the use of new light technologies in the treatment of cancer and wounds. His use of NASA space-based light-emitting diode (LED) technology to activate cancer-killing drugs has extended further into studying the direct effects of near infrared LED light on human growth stimulation. He contends that this may potentially benefit Special Operations Forces and space station astronauts by preventing muscle atrophy and healing tissue, particularly within the brain and visual system.

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A PRO TO THE TENNIS PROS

For those physician athletes who prefer more grounded pursuits, tennis is a popular pastime. When Brian W. Hainline, MD, played tennis at Notre Dame, he was number one in singles and doubles his senior year. “Tennis has been a part of my life since I was a child growing up in Detroit,” said Dr. Hainline, who maintains his practice in New Hyde Park, NY, and New York City. So in 1986, soon after he began practice, he was delighted to become a consultant for the US Tennis Open Championships.

He co-authored his first book, Drugs and the Athlete (FA Davis), in 1989 and subsequently created the rules of eligibility for drug testing within the US Tennis Association (USTA). In 1991, when a tennis player at the US Open almost died of heat stroke, the organization knew that it needed a stronger medical foundation.

Dr. Hainline was asked to become Chief Medical Officer the following year, a role that he has continued to serve ever since. “It is really quite fantastic,” raved Dr. Hainline. “I have an insider's view of the Open, beginning with the qualifier tournament the week prior to the main draw in which top players compete for 16 of the 128 main draw spots.” His office, which is located on-site near the men's and women's locker rooms, oversees medical emergencies of spectators and staff as well as tennis players. It includes a mini-hospital, three ambulances, nine paramedics, an emergency room physician, internist and orthopedist, two physical therapists, an acupuncturist, and several nurses.

“Because this is the last Grand Slam, some players are nursing chronic and subacute injuries. Our goal is to provide them with care, to attend to the comprehensive medical needs of all players, and to anticipate every potential disaster,” he said.

In 1999, when Pete Sampras was going for his thirteenth Grand Slam, a scenario that would have put him in the record books, he developed low back pain. When he approached Dr. Hainline and said, “Doc, I think I did something to my back,” Dr. Hainline knew that he was facing a tough decision.

An MRI detected an acute midline annular tear at L5-S1 and, after weighing the risks, he advised Sampras to withdraw from the tournament. (Sampras ultimately made a speedy recovery and went on to win Wimbledon in 2000 achieving a 13th Grand Slam and to attain his fourteenth Grand Slam and fifth US Open Men's Singles championship in 2002 against Andre Agassi.)

In addition to his work with the USTA, Dr. Hainline works with the Association of Tennis Professionals, the Women's Tennis Association, and the International Tennis Federation to promote healthy use of the sport through the application of sport science and medicine.

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He has created the USTA Drug Education and Testing Handbook and has rewritten the USTA Drug Testing Rules. Dr. Hainline who had just returned from the French Open at the time that he spoke to Neurology Today, said, “I feel grateful to be able to pursue this passion. It created the core of who I am and now this is my way of giving back.”

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A YOGA TEACHER

Julio L. Kuperman, MD, has been practicing yoga for almost as long as he has been practicing neurology. When a bad back laid him up in 1978, he found that yoga gave him relief. He began studying the disciplines of Ashtanga and Vinyasa yoga and in 1995 became one of its teachers. He had been teaching for seven years as often as five classes per week when he first spoke to Neurology Today two years ago.

Dr. Kuperman, who had cardiac bypass surgery in 2003, said, “I believe that yoga helped to stave off my heart disease for some time. It is certainly true that the steady practice of meditation has been shown to decrease blood pressure. I also believe that the physical benefits including joint flexibility and being in good shape helped me in the post-surgical period.”

Dr. Kuperman, whose neurology practice is in South Philadelphia, said: “When I was younger, I preached diet, meditation, and exercise to everyone. Over the years, I learned to moderate my lectures. But when a patient returns to my office and says, I tried it and it has changed my life, it makes my month!”

When Neurology Today caught up with him again recently, Dr. Kuperman was in excellent health. He continues to practice yoga on a daily basis.

Of all the gravity-bound activities, he said, yoga is the most complete. He added, as only a neurologist could, “It includes flexion, extension, side bends, rotation and inversions…all the actions that the cranio-sacral complex can accomplish!”

©2005 American Academy of Neurology