Fitness and Ophthalmology

Darrell White, MD, joins Gary Wörtz, MD, to highlight the value of exercise to reduce physical and psychological stresses of ophthalmic surgery. Dr. White explains how CrossFit has helped him become a better surgeon—highlighting that the intense workout regimen has helped him not only to stay in peak physical shape but also on an emotional level.

G. Wortz, MD: Hey everyone, I just want to take a quick minute to thank everyone for listening. I've gotten such tremendous feedback from people from all over the country. I've gotten letters from listeners in South Africa, I've got letters from residents across the world.

When I go to conferences it's not uncommon that someone will stop me and say, "Hey, thank you for having so and so on their story really impacted me."

So, as we have transition this year from stories just about topics in ophthalmology, more to stories about ophthalmologists, what's interesting in their practice, and what's interesting in their life. I hope that transition has been something that has been met with a lot of favor from the audience.

That being said, I'd really like to know what topics, what ideas, and what people have inspired you this year. We would like to know that not only to thank those guests maybe in a special way. But, also know as we plan on going forward what topics you're most interested in.

Ultimately, this podcast is not about me or really even the guests, it's really about those who are listening. We've really found that the podcast is a new way to share information, and we think it's really being impactful.

One of the thing I'd like to do is, I'd really like to thank Alcon for their sponsorship. We just come off thanksgiving and as I was sitting around thinking about the things I'm thankful for; I'm really thankful to have this opportunity to do this podcast with a sponsor like Alcon.

As you've noticed we don't stay on label, we don't stay on talking about just one company. We go all over the place, and that's really the point of Off The Grid. We are not really bound by those typical industry rules.

I just want to thank Alcon for sponsoring something in a way where they're allowing us to have an open voice, and really just spreading good information about ophthalmology and not product specific. I think that's really unique.

So, if you are a listener of this show I would like for each of you to thank your local Rep, because even though they're not ultimately the decision maker in that sponsorship, they're connected with Alcon and those thank you's go a long way. They have a tough job too, and I think it's always important that we show our appreciation where we can.

Finally, if there's a topic that you would like to have covered, if there's a thought that you would like to share, please tweet me @cataractmd. You could use the hashtag; #ootg for Ophthalmology Off The Grid. So, @cataractmd, #ootg.

I'd like to start the conversation, and I'd like you to be a part of it. Maybe in 2018, we can be even a little more interactive with the podcast. So, here's to the next year and hopefully we'll have tons of more interesting content for you. Thanks.

Gary Wörtz, MD: Open, outspoken. It’s Ophthalmology off the Grid. An honest look at controversial topics in the field. I’m Gary Wörtz.

While the benefits far outweigh the costs, being an ophthalmologist is not without some price. In addition to the emotional stress of being responsible for patients’ most valued sense, ophthalmologists are also subject to the physical demands of performing microsurgery through a scope. As you listen to this, are you growing aware of a pain, say in your neck or lower back? Well, you are not alone.

The unfortunate thing is that the effects of this physical pain can be far-reaching—altering our moods, our mindsets, and our performance in the OR. Therefore, just as we carry a responsibility for our patients’ health, we should also carry one for our own.

Today’s episode is all about finding ways to transfer our physical stress, reduce the pains of operating, and ensure that, when in the OR, we are operating at peak performance. Joining me to dissect this important topic and tell us a little bit about how CrossFit has changed his life for the better is Dr. Darrell White.

Speaker 2: Ophthalmology off the Grid is an independent podcast supported with advertising by Alcon.

Gary: Today I have the pleasure of interviewing a great friend and colleague, Dr. Darrell White. Darrell and I have gotten to know each other over the past couple of years but recently had a chance to go and spend a little bit of time with him at the Cleveland Ophthalmology Society meeting. It was just a real treat to get to know Darrell a little bit better. We recognized that we had some cool things in common, and I'm not going to reveal that at this point, but we will get into that. Darrell, with that being said, thank you so much for carving out a little bit of time to come on and discuss things that you're passionate about both inside ophthalmology and outside ophthalmology.

Darrell White, MD: It's my pleasure Gary. It's a treat to be here.

Gary: We should just dive right in. One thing that I've been trying to do this year, personal goals, has been to work out a little bit more regularly, with the ultimate goal of joining CrossFit, which I did a couple of months ago. That's been a really cool renaissance for me. I've really derived tremendous benefit from that. Lo and behold, I'm actually sitting across from CrossFit royalty as it were, and that's something I did not know but as it turns out, Darrell White is probably, correct me if I'm wrong Darrell, maybe more famous as a CrossFitter than even as an ophthalmologist, and you're very prominent as an ophthalmologist. Talk to me a little bit about when you got into CrossFit, and let's just talk about your journey there.

Darrell: Sure. I'm basically a partially brain damaged, washed-up example football player. A big part of my personality, a big part of who I think I am, is wrapped up in my athletic past. It was December of 2005, I was bored and lonely in the gym. I was starting to get a little soft around the middle, and it just was really bumming me out. I stumbled across a Men's Journal article on this thing called CrossFit.

Gary: This is way back in the very beginning of CrossFit, correct?

Darrell: CrossFit really was launched as CrossFit as in 2003 or thereabouts. CrossFit was this concept banging around in the brains of this genius ex-gymnast math major from UCLA who decided that he didn't want to be a rocket scientist, and thankfully for all the rest of us he decided, well, I'm going to revolutionize physical fitness—guy named Greg Glassman. Greg goes by Coach in the CrossFit community. Coach had come up with this process and had one gym. Somebody from Men's Journal discovered CrossFit Santa Cruz. There was in the article, CrossFit, here are 5 days’ worth of CrossFit workouts. But, on the side, a little tiny sidebar, and this is where it really happens, CrossFit.com. When I went there and went to CrossFit.com in December 2005, there were 50 gyms and maybe 5,000 people all over the world who were doing CrossFit, most of them actually military, first responders, SWAT officers, special forces guys. I looked at it, and I said, "This looks pretty good,” and went to the gym January 1, 2006, and I did a workout called Angie. As you know Gary, our some of the benchmark workouts in CrossFit are named after women, like hurricanes, and they pretty much leave you like you're in the backend of a hurricane.

Gary: Yeah, exactly.

Darrell: Angie is 100 pullups, 100 pushups, 100 sit-ups, and 100 squats. You're supposed to do the 100 in a row; you don't break them up. It took me 45 minutes to do it, and then I could not stand for 45 minutes. That was the beginning of my CrossFit journey.

Gary: That would probably be the end of a lot of people's CrossFit journey. Maybe it is the end of a lot of people's journey into fitness.

Darrell: Don't forget, brain damage was part of my self-description.

Gary: That's right, that's right.

Darrell: Right.

Gary: My backstory, I don't know if I've really told too many people this, but I decided back in 2008 to really get in shape, and I'm this all or nothing kind of guy. I decided to hire a personal trainer, do the whole thing. After my first workout, I actually developed rhabdomyolysis. For all of us who are removed from our training in general medicine, as a reminder, rhabdomyolysis happens when you stress your muscles too hard and they actually leech all the proteins in the muscle into the bloodstream, which can actually cause kidney damage, and it has a 5% mortality rate. Usually it's caused from crush injuries after a car accident or something, but you can get it from doing too many squats in a deconditioned state. I found that out, and I was actually in the hospital for a week—couldn't even operate. So, I realized, all right, I need to be a little bit more careful. So, I've been, over the past few years, going back and forth about how I want to engage physical fitness and exercise.

To that aside, there are risks involved with any workout regimen. I've really found that as I've continued to be more active surgically, there is a certain level of both mental stress that is involved with the unique job of being an anterior segment or actually any surgeon, but especially surgeon doing microsurgery through a scope. There is a certain amount of mental stress there, but there is also a certain amount of physical toll that that takes on your body, especially when you're sitting there for hours upon hours. It may be a hunched over position. You're trying to accommodate the patient's morphology. You're trying to accommodate their situation, and you put yourself in uncomfortable situations. I really realized I was starting to get some lower back pain, I was starting to get some neck pain, and I had been told from colleagues and mentors that this was an issue the affects most ophthalmologists at some point in their career.

This year, I started actually doing more Olympic lifting and really not as much running—some running, but really more high-intensity training. It's almost miraculous how that just went away. I don't know if it was stress relief or just conditioning the body to be able to withstand more of these posture or bad posture positions. Darrell, what have you seen on your journey from 2005 throughout this whole time? And then we can get a little bit more into the actual nuts and bolts of what it's like working out. What benefits have you derived? And that can go in any direction from physical fitness as that being a very important part of your life.

Darrell: My backstory goes all the way back to high school. I played football in high school and college, and I broke my back returning a punt when I was a sophomore in high school. From that time on, I had continual real back issues. Even as young as 17 or 18, doing or feeling what we colloquially hear people say as throwing your back out. You're not supposed to have your back thrown out when you're 17. I had that periodically literally until I started doing CrossFit, from the time I started doing CrossFit until today. I need somewhere to bang on here.

Gary: Let's collectively bang on some wood.

Darrell: I have not had that kind of back problem. And it's somewhat counterintuitive: high-intensity workouts that also include relatively heavy lifting and things which would be sacrilegious in certain parts of the fitness community. Heavy squats and heavy dead lifts. I weigh about 155 at 57 years old. I have about a 315-pound dead lift and about a 270-pound back squat, which would be totally unimpressive if you were 27, but is relatively, let's just say that's it's meaningful, at 57. The net result for me is that my endurance in the operating room and my endurance in the office is now a nonissue. People watch ophthalmologists operate and they say, "Dude, all you do is you move your fingers a matter of millimeters.”

Gary: “And you're sitting the whole time. How hard could it be?”

Darrell: “How hard can it be?” The combination of increased stamina but also that strength, which I really didn't have as a younger surgeon, has allowed me, thus far, more wood to knock on, has allowed me thus far to be really relatively comfortable and, more to the point, pain-free when I walk out of the operating room. I attribute that to the work that's gone on in the last 12 years for me in CrossFit—just a straight physical result of high-intensity workouts. The CrossFit mantra is constantly varied, functional movements performed at relatively high intensity. That has meant, for me, a pain-free surgical experience thus far.

Gary: I've experienced the same thing just over the past about 12 months. A dramatic reduction in lower—actually not just reduction, complete elimination—of low back pain, because I started incorporating dead lifts into my workout. Again, that seems like it's the most counterintuitive thing. You would never want to stress your back if your back is already giving you problems, but the problem comes down to: those muscles atrophy if they're not being used, and, if they atrophy, obviously they're weaker and they're not supporting your spine. By having good core strength and good back strength, it's just incredible that that pain just goes away.

Darrell: It's important to mention you and I can just go through this conversation because we're able to make certain assumptions because we're both CrossFitters. It's really important for us to mention to the part of your audience, which is probably going to be 99.7% of your audience that is not doing CrossFit, that one of the key critical elements of doing these exercises is doing them properly.

Gary: That's right.

Darrell: We emphasize as CrossFitters, whether we work out in a CrossFit gym or a box, as you do in Lexington, or work out solo, which is the way that I've worked out most of the time, that the most important thing, the first thing is we have to have proper mechanics.

Gary: That's right.

Darrell: You don't just go out there and lift up some huge massive amount from the floor. You do it properly and build up to it. It's not only that we're becoming stronger, but we're also doing something mechanically that properly aligns the strength in that midline.

Gary: Darrell, I know this a little bit, but I want you to tell your story a little bit about not just the physical improvements that you've noticed, one layer deeper than that and potentially more important is the, I want to say it in two ways, the stress release of working out and also the ability to cope with stress because you are stressing your system in a meaningful way through working out.

Darrell: Those are great questions Gary, and those are especially great questions in the CrossFit context because CrossFit is hard. You simply can't get the benefit from doing CrossFit without being uncomfortable. There are lots of little catchphrases, being comfortable being uncomfortable, it's doesn't have to be fun to be fun. Those things that CrossFitters ...

Gary: If it feels good you're not doing it right.

Darrell: Those are the kind of things that CrossFitter throw back and forth at each other. We have stressful jobs. If you think about what we do, all surgery has been called in general, controlled arrogance, and you think about we do, we go inside people's eyes. We do things to people's eyes to make them see better, to make them more healthy, but it's a very, very stressful, zero-error-tolerance world, and we simply can't escape the fact that it puts us under pressure. When I was starting my CrossFit journey, in addition to that, I had just started the new practice and in addition to that I had a sick child. Anybody who's listening who has a child knows that it's the single most frightening thing possible to have a child who's sick. My daughter's been very generous with people talking about the problem, and I'll simply say that we almost lost her when she was 16.

Gary: Oh my gosh.

Darrell: I had fear, I had anger, I had anxiety, and I went to the gym and I brought all of it to the gym. In CrossFit, we talk about going to the dark place. You go to a place of real exertion, but I was able to go to that dark place and I was able to leave all of those bad emotions there. They were back the next day because my daughter was still sick.

Gary: They weren't compounding on each other.

Darrell: That's absolutely correct. And I was not laying those onto another human being who was important in my life. I wasn't laying them on the rest of the family. I wasn't laying them on staff or, heaven forbid, not on patients. The first stress release is I was able to go to the gym, and, because of the particular nature of crossfit, I was able to literally purge those really, really hard and dangerous emotions and leave them in the barbell.

The second thing that I noticed, which was not something which was widely known at the time, was my response to stress overall was blunted. Any stress. The stress in the operating room. Things start to go a little haywire in operating room, your natural response, the natural physiologic response is your pulse rate goes up, your breathing becomes more shallow, and it's a chemical reaction. It's the neurochemical response to stress.

Gary: Fight or flight.

Darrell: By stressing yourself in the gym, you actually teach your body to respond to stress in a more general way. It's not just the physical stress of the exercise, it's also the neurochemical, neuroendocrinologic, emotional response to the stress. And I noticed that in the operating room, I was never uptight. I'm never uptight. Things are sometimes difficult, but that's all they are. Things are difficult, but my response has been blunted. Subsequent to my first realizing that, there is a large body of evidence that's been collected at CrossFit Inc. about that response and a lot of doctors who have casually studied it; it's a real thing. I'm better at what I do and I'm a better leader in the areas of my life that could be stressful because there's been a transference of that stress response training physically to the stress response emotionally and neurologically in every aspect of my life.

Gary: I can vouch for that. I've had the exact same experience. Actually my wife, who is just incredibly in tune with my psychological state, if I haven't worked out for a couple of days I start getting uptight and I don't recognize it. I feel like this is just me. I'm uptight because the situation dictates I should be uptight. But Mary's like, "You know, it might be a good idea to go to the gym." That's her not so subtle of saying, "Going to the gym is going to make a little bit kinder, a little bit less responsive or reactive, and a little more zen. A little more chilled out." The highs and lows don't really, they're blunted. The highs aren't blunted.

Darrell: I would say just the ...

Gary: But the lows are buoyed. A become a lot more mellow.

Darrell: My kids were a little older than yours when I started doing this, and it wasn't just my wife who made that observation, it was also may children who made that observation. They also felt very free to share with dad, "Hey, you know, have you been to the gym recently?"

Gary: Right, exactly. To be honest, that's a good thing. It's good to have people who recognize the healthy habits that you're developing and when you are a better person for it. That's great. Darrell. I'm going to use you as a resource and share a little bit about my fears before starting CrossFit. I was really intimidated by going into the box the first time because I felt like I was going to be around a bunch of people who were in way better shape than me, and I was going to be almost like the intern again. Going back to square one and being around people who are much better and happy to express that. For a long time, I was pretty happy just working out in my gym, and I was getting some good benefits, but I knew that there was a next level, there was this make or break moment that I decided I'm going to do this.

My experience was so positive, it was absolutely 180 degrees away from that. It was a bunch of people who were extraordinarily kind and welcoming and were happy to show me how to do exercises in a little bit way if it wasn't ready for the what they call the full RX workout—the scaled workouts. And they were really happy to show me how to do that and to do those alongside me, and it really became almost, this is a short journey in my life, it's been a couple months, but it's just really been amazing to see how a group has been able to be so welcoming and it was a big barrier that was just not there. It was actually a fake barrier. It was just mental. Do you feel like people struggle with that?

Darrell: Yeah, I don't think there's any question about that, Gary. I think that there's a perception out there that CrossFit is hard and CrossFit is only there for the people who are super fi. Just like you, a lot of people say, "Well I'm going to exercise so I can get ready to do CrossFit." The reality is that, in the definition of CrossFit, it is not high intensity; it is relatively high intensity. The relativity is relative to what's high intensity for you.

Gary: That's right.

Darrell: In fact, almost everybody can go to a CrossFit gym, assuming that the trainers and the lead dog trainer is fully onboard with the CrossFit philosophy, and you can start tomorrow. You can start tomorrow if you can walk into the gym. The hardest day in anybody's CrossFit journey is walking through the door the first day.

Gary: That's right.

Darrell: Because you really have put your big boy and big girl pants on, get over that notion that “I can't do this, this is too much for me,” and walk in the door. You walk in the door, and almost everybody has the experience that you have when you walked in. Everybody says hi. The coach comes over and talks to you. You get an opportunity to share your fears and share your concerns, and the next thing you know you're in the middle of a WOD, which, for your audience, WOD stands for workout of the day. Since this is probably a PG production, we'll try to steer away from some of the other more ribald and frisky things that CrossFitters talk about our exercises.

The second hardest day in CrossFit is to go back the second day because, even though it's a relatively high-intensity experience, you still likely worked harder than you've worked in any other time in the gym, and you're sore.

Gary: Right, that's right.

Darrell: You go in, and you're getting out of bed and you're thinking, “What did I do? I just don't know if I can go back.” But then you remember, hey, everybody was happy to see me. The coach is really excited about working with me, and I was really pumped. You gather up your courage, and you go back. After that, it just makes a ton of sense and you don't want to leave.

Gary: That's right. What do you think are the biggest mistakes that people make when they first start working out?

Darrell: You have to check your ego at the door, man. Back when I was doing it, there were only 50 gyms. There were no gyms in Cleveland. I live in Cleveland, and some of us have gone back, and it looks like that I was actually the very first CrossFitter in Cleveland, Ohio.

Gary: Can you tell people your name? Can we link that? I want proof that I actually know the world-famous ...

Darrell: I don't know if we can say the world-famous, we need to be a little reasonable here, but back in 2004, five, six, people who had even the tiniest bit of a public job went out of their way not to put their real name on the internet. On CrossFit.com there were lots of people who had nicknames or call signs. My call sign in CrossFit is Bingo.

Gary: Bingo. There it is.

Darrell: I've been told that there may be a couple dozen people who know Darrell White, but there are lots and lots of people who know Bingo. It's because for many, many years I've written for the CrossFit community on Sunday. And just as an aside, I wrote Sunday Musings for CrossFit.com on an iPad today. I'm not really very good on the iPad, so I must have proofread it 11 times. In the CrossFit world, I'm known by whoever knows me as Bingo.

Gary: I'll verify this because I went to my local box where I work out, Crossfit 859, tremendous people. I was like, all right, I gotta call Darrell out on this. Is he really famous? 'Cause if these guys know who he is, then that's very much a verification. So, I talked to coach at the gym. I said, "Hey, just curious, have you ever heard of a guy named Bingo?" They’re like, "Oh yeah, Bingo's huge. Everyone knows Bingo." He's like, "Why?" I'm like, "Really?" It's like, “Yeah, absolutely. Everybody knows who Bingo is.” I'm like, "He's actually a friend of mine." And they're like, "What? Really? You know this guy?" It was a really funny conversation beause Darrell is the man. Darrell White is the man in CrossFit. I've independently verified it. You're hearing it here first, it was, it's awesome.

I had to say, I thought at that moment, we've got to talk about this at some point because this, Darrell, you can be a resource. You're obviously known as a resource for anterior segment surgery, dry eye, you add so much to our education side of ophthalmology, but this is such a unique skillset that you have, your experience that is unique. I feel like we don't do a good enough job as ophthalmologists trying to take care of our bodies or even talking about that. I've not heard at the academy meeting any talks about keeping your body in shape to be a surgeon. That is a concept that is vitally important. There's some stats here that I was able to pull up. In 1994, there was a survey that 54% of ophthalmologists report significant attacks of back pain in the past month. In 2005, 52% of ophthalmologists said they had neck, upper body, or lower back pain in the prior month, and 15% of ophthalmologists said that limited their ability to do work.

We know that oculoplastics guys, they're hunched over doing blephs and elevator recessions, etc., advances, I should say. Almost 75% of them have neck issues that limit their work while operating. As we face a work shortage in ophthalmology and we are asked to be in the operating room longer, we're asked to do more cases and we're asked to operate longer in our careers, maintaining our physical health is, it's almost a public health service for us to maintain ourselves because there's almost not enough of us, and we can't exit early. Don't you agree with that?

Darrell: I agree with all that. First of all, a little bit of disclaimer. In the CrossFit world, there are people who really, really famous. I like to describe myself as a C-list personality who has B-list aspirations.

Gary: Fair enough, fair enough, fair enough.

Darrell: My contributions have been quite modest, and what I've received in return for my modest contributions has been way, way, way off the charts in my favor. I agree with all of that, Gary. I actually shared a cab with someone from Ohio who has a disc problem in his neck. It's an incredible problem, and it's going to be a huge problem just for people we know. From a societal standpoint, yes, we have to take better care of ourselves. We are unique in that we have a certain physical stress, the position in which we have to put ourselves to work, the hours that we have to work, the things that we do. We're just one version of a larger societal thing. You certainly see this in the office. If we look around the floor, we're at a convention together, we've got lots of colleagues and we're seeing all different kinds of body types, but what we see in the physicians who are older than us is a certain lack of physical fitness.

I would love to have an opportunity to talk to the kids just coming out of their residencies. I would love to have an opportunity to talk to those people in their mid to late 30s who are just having their first injury and say, it doesn't have to be like this. It's possible in a very highly time-effective manner. It doesn't have to be Crossfit. I personally think that CrossFit is the way you should do it, but it doesn't have to be CrossFit. You can prolong your career, but not only that, make the career more pleasant. If you get the other things that you and I have enjoyed, lower stress, the ability to handle stress better, just generally feeling better about our bodies, that's awesome.

Gary: That's a win right there.

Darrell: That's terrific. And if you get that, man, that's the cherry on top of the whipped cream on top of the ice cream sundae, which we're not supposed to be talking about. It's interesting that's there's no venue within which you and I can talk about that. There's no established opportunity that's there for us to seize. We have to create it.

Gary: Right. Maybe this is just the beginning of a larger conversation where that becomes part of the culture inside ophthalmology, that we discuss ways to take care of ourselves. Not just from a physical fitness standpoint, which we're both biased towards, but also ergonomics. Occupational therapy, how do you hold your instruments and your neck and your body during surgery? I feel like that is an unmet need that perhaps our societies can rally around because keeping us active, healthy, and being able to take care of patients is ultimately going to reap tremendous benefits for both ourselves and our patients long term.

Darrell: I totally agree with that, and, not for nothing, there's also that trickle-forward effect in the rest of our lives.

Gary: That's right.

Darrell: I am quite frankly, and if I didn't believe it, my wife who is universally known in the CrossFit world as Bingo's better 95%, my wife who's shared with me that I'm frankly a better human being for having had this type of outlet in my life. Not only am I'm healthier, but I'm just frankly a nicer guy.

Gary: With that being said, Darrell, you were a nice guy, I'm sure, before. And now you are the nicest guy ever. Darrell, thank you so much for coming on and sharing your story and encouraging others to take care of themselves. Let's further this conversation at least every year because I want to continue to move the needle on this.

Darrell: Gary, it's my pleasure. The only thing that would make me happier would be able to do Fran side by side with you.

Gary: You'd destroy me. You'd destroy me. Maybe next year we'll do that, okay? All right, thank you. This has been Ophthalmology off the Grid with Gary Wörtz and Dr. Darrell White. Thanks.

Surely not all of us are going to turn into Bingo overnight, and CrossFit may not be the perfect regimen for everyone. But I think Darrell and I agree that finding a way to burn off some steam through physical activity is a key exercise for all ophthalmologists. Your body, your mind, and, yes, those around you will thank you.

And with that, thanks for listening to another episode of Ophthalmology off the Grid with Dr. Gary Wörtz. As always, please be sure to rate, review, and subscribe, and if there is something on your mind, let’s talk about it on Off the Grid.

Speaker 2: Ophthalmology off the Grid is an independent podcast supported with advertising by Alcon.