Outside the Ring: Dr. Meeryo Choe

By Jill Diamond on March 13, 2016
Outside the Ring: Dr. Meeryo Choe
“My hope is that boxing will continue to be a sport that athletes can participate in safely.”

In the war against debilitating brain trauma, Meeryo Choe, and the Neurologists and Neurosurgeons at UCLA, may be some of our finest weapons…

Sports and Philanthropy: A series of articles dedicated to those who’ve given their all and still give more. Each article will feature a different community champion; no belts, no medals, no ratings… just good people passing it on.

Dr. Meeryo Choe is presently recovering from a fall sustained while riding her horse. She knows firsthand the pain athletes go through when they put their bodies through sustained tests of skill and rigor. It’s worth it to her. Maybe that explains why she, a Pediatric Neurologist, approaches her work with such determination and drive. Perhaps it’s more than just research. Maybe it’s personal.

One thing is certain: this petite, medical dynamo has a great investment in the research being done with the UCLA BrainSPORT group. It’s a Team effort, and she’s a chief second, working alongside many qualified physicians and researchers. She talks about concussions the way some other women discuss shoes or shopping. Her enthusiasm is infectious and her desire to educate and advance treatment and diagnosis for injured athletes undeniable. More prescient is her desire to contribute to ways those injuries can be prevented.

The movie Concussion shocked many people who were unaware of the dollars-and-cents value put on an athletes’ ability to play. Not Dr. Choe. She knows all about it. She’s witnessed, firsthand, the human toll these many irresponsible decisions result in. In the war against debilitating brain trauma, Meeryo Choe, and the Neurologists and Neurosurgeons at UCLA, may be some of our finest weapons.

Please tell us about your background?

I’m a Korean-American born and raised in Los Angeles. I attended Amherst College and graduated with a degree in Fine Arts in 1998, and then came to UCLA to do neuroscience research with Dr. Art Arnold on the sex differences in the brain in a zebra finch animal model. I then attended USC Keck School of Medicine, and graduated in 2002. I completed my pediatrics residency and pediatric neurology fellowship at UCLA in 2012. I had been doing basic science research in a brain tumor stem cell lab, but was uncertain of what I wanted to do after completing my training. I was coaching swimming at Harvard-Westlake, a local 7-12th grade school, who was starting a concussion program with Dr. Chris Giza at UCLA’s Brain Injury Research Center (BIRC). I already knew of Dr. Giza’s work, and with my affiliations at both the school and UCLA, I became involved. I attended the American Academy of Neurology Annual Meeting, and presented my research on post-traumatic headache, specifically with differences between how male and female athletes differ in recovery. At that meeting, I met many of the experts in sports neurology. And I was hooked! I then pursued a two-year fellowship with Dr. Christopher Giza in sports neurology/neurotrauma at UCLA. Since completion of that training, I have been faculty in UCLA Division of Pediatric Neurology, Mattel Children’s Hospital. I see patients in the outpatient clinic as well as hospital setting, from infancy to adult who have suffered brain injury of all severities. My primary role is to diagnose and manage brain injury, primarily working with athletes who have sustained concussions and their recovery process. My research interests center around post-traumatic headache and autonomic dysfunction, and specifically gender differences in injury and recovery.

What sport do you participate in and why?

I am currently an active equestrian competing as a show jumper with Mark Watring Stables, and have been riding since I was four years of age. I was a former swimmer competing through the collegiate level. After college, I began coaching the equestrian team, and was an assistant coach for the swim teams at Harvard-Westlake School from where I graduated in 1994. While my parents initially made the decisions for me to start in these sports, I have continued my participation even now because of my love of them, especially riding. The relationship that I have with my horse, whom I have owned for almost 20 years, is unlike any human relationship that I have. Oz, my horse, and I have a very trusting and loving relationship. Riding requires that type of bond as you face a course of four-foot jumps together, some of which look very strange and challenging.

How important is nutrition?

From a medical perspective, I have always known that nutrition is important. But as an athlete, I am acutely aware that my physical abilities are tied to my nutritional status. I know that I cannot ride well if I haven’t eaten well. I always encourage my athletes and patients to practice good eating habits in addition to good hydration status. I recommend three well-balanced meals and two snacks per day as well as 2-3L of fluids. Without the proper nutrients, our bodies and our brains cannot function at their best.

One of the things that we’re looking at UCLA is the type of nutrients to feed the body after a traumatic brain injury. Dr. Joyce Matsumoto is looking at utilizing the ketogenic diet in patients with more severe injury who are in the intensive care unit acutely after injury. The ketogenic diet is a high-fat, low-carbohydrate diet that has been primarily used to treat refractory epilepsy. The diet enables the body to burn fats into fatty acids and ketone bodies, which replace glucose as the energy source. The ketogenic diet has been shown to be neuroprotective after TBI in animal models.

As a woman in a field predominated with men, do you feel you face any specific obstacles?

I have been fortunate to be well-supported in my education and training, and have not encountered any obstacles specific to my gender and situation. I do admit that there are difficulties that women face that are not unique to medicine when they pursue careers. However, I have personally had amazing mentors and administrative support at every level, and have never faced any discrimination or bias.

Why did you choose Neurology?

My interest in neurology began when my favorite aunt was diagnosed with atypical Parkinson’s Disease while I was in college. She was a physician in Korea, and after immigrating to the US, became a health care administrator. I remember going to the clinic where she worked in Koreatown with her fondly. Her course was rapidly progressive, and she passed away shortly after diagnosis. She was a great supporter of me during my childhood and adolescence.

What turned you on to woman’s sports as a specialty?

As a female athlete and coach of girls’ athletic teams, I have always felt an affinity for women’s sports. I have also learned in my coaching how different male and female athletes are particularly in middle school and high school. For swimming, I have coached both the girls’ team and a coed team, and have seen firsthand that they require different coaching techniques at least at this stage of development.

Do you feel that women differ physiologically when it comes to injury and precaution?

I do feel that women are different when it comes to injury and prevention. I think that girls are typically engendered with a different type of attitude in sports. Boys and men are often encouraged to be macho and “tough it out,” whereas this attitude is not as promoted traditionally in women’s sports. In addition, sociologically, women are more encouraged to talk about their feelings, and we see that in studies where female athletes report more symptoms even at baseline as compared to the male athletes at various ages. In no way am I suggesting that women are less tough, but rather that they are more forthcoming and honest about what they are experiencing after an injury, which in some ways may be more beneficial in terms of recovery, because we can specifically address the concerns that they have.

Can you speak about the research/program being done at UCLA BIRC?

At UCLA we are so fortunate to have diverse research being done in the area of brain injury. On the science side, Dr. Mayumi Prins is working in an animal model looking at injury in the juvenile age group as well as repeat injury, and the long-term effects that this may have in the brain. There are also those working with our engineering colleagues to develop new helmet materials that may be useful not only in protection but in measuring impacts as well.

We have a lot of exciting projects in the clinical world. One of the biggest projects that we are a large part of is the NCAA-Department of Defense longitudinal study of athletes and military cadets through their collegiate years. There are currently 30 colleges/universities and the military institutions that have done pre-season baselines on every one of their varsity athletes and all the military cadets. This has resulted in about 18,000 athletes and cadets being enrolled. Out of this there have been almost 700 concussions documented. In addition to the CSC study of which we are a part, we are also privileged to be part of the Advanced Research Core. In this study, not only do the athletes get the baseline exam, but they also have blood drawn at baseline. And if injured, these athletes get multi-modal MRI, blood biomarkers drawn and neuropsychological testing at various time points throughout recovery. Due to the outstanding work of Max Zeiger, we have also instrumented our ARC athletes with helmet, mouthguard, or earpiece sensors to measure the impacts that they receive during practices and games.

We are trying to roll a similar study out in our youth athletes as well with a group of institutions throughout the country. This is still smaller scale at this point, there is the potential for this work to have more widespread implications. While there are many collegiate athletes, there are an even greater number of youth and high school athletes who are participating in year-round sports. This is the project about which I am most excited given the possibilities of promoting safe sports participation for the younger age groups.

Who is your Team?

The UCLA Steve Tisch BrainSPORT team is made up of the following individuals:
Chris Giza, MD
John DiFiori, MD
Talin Babikian, PhD, ABPP
Mayumi Prins, PhD
Sue Yudovin, RN, MN, CPNP
Adam Darby, MD
Doug Polster, PhD
Constance Johnson, MA
Max Zeiger
Briana Meyer
Sonal Singh
Philip Rosenbaum
Janet Kor
And numerous research assistants from local high schools, undergraduates and graduate students.

What advances have they made?

We have launched the projects that I have outlined earlier. Our program manager, Constance has done an immense amount of work this year digitizing our baseline collection tool which has made the pre-season baseline collection process much easier. In addition, it has greatly facilitated the data collection and output process which has allowed us to have greater contact with and contribution to the primary caregivers at the athletic trainer level.

Tell me about your experience at the WBC Woman’s Convention?

I attended my first WBC Women’s Convention in January 2016, and I was blown away. Admittedly, I came to the convention with only novice experience with boxing and combat sports. I was so impressed by the camaraderie between the fighters. After this experience, it was a great honor to be asked to join the medical committee for the women’s division. It will be my pleasure to participate and contribute to the promotion of health and safety in combat sports.

Did you come away from the WBC Woman’s Convention with any new ideas or information?

I have some great ideas on topics to discuss with the fighters regarding safe participation and healthy living. In addition, I was impressed with Dr. Paul Wallace’s plan for a pregnancy registry. I think that we could also add in other data points such as weight fluctuation, and to look at long-term women’s health issues for athletes such as osteoporosis.

Did you feel the audience was responsive to your talk?

I was very pleased by the responsiveness of the audience.I had several individuals come up to me afterwards asking for slides and/or more information. I felt very supported and appreciated by the audience and by the WBC. It was an extremely enjoyable experience.

What are your basic suggestions for boxers in order to maintain their health?

At the very basic point, I think it’s very important to maintain good nutrition and hydration throughout one’s athletic career. In addition, it is important to know how to continue participation in sport safely. From a concussion standpoint, getting educated on the signs and symptoms of concussion is the first step.

What are your goals?

My general goals are centered on creating environments of safe participation for all sports. My first concern is brain health. Concussion is an injury that can occur in any sport, and part of my role as a sports neurologist is to educate the community about the risks of sustaining a concussion and other injuries during play. Additionally, I would like to educate everyone on the health benefits of participating in sport, not only physical but psychological health. One of the problems facing our children is obesity. This has been a long-standing issue, and leads to a host of chronic health problems such as diabetes, heart disease, and cancer. We have encouraged our pediatric patients to pursue physical activity and healthy living. This continues to be a big part of my message.

In addition to treating and educating the community, my goal is also to lead research efforts particularly with regards to women and children in particular, as these populations are currently under-looked.

How do you see the future of health in relation to Boxing?

As we continue our research efforts, I expect that we will be able to provide more education to our fighters and other participants. In addition, I believe that the WBC will continue to be at the forefront in implementing guidelines looking out for boxer health both during their career, but more importantly throughout their lifetime.

As a doctor, how do you reconcile your feelings about health and contact sports?

Contact sports are without a doubt, an area of risk for the brain, but participation in sports as I outlined above is such an important part of a healthy lifestyle both for the body and the brain. To continue in a lifetime of physical activity, we have to love the sport in which we are participating, or our efforts wane. I believe that as long as we educate our athletes regarding the short-term and long-term risks of injury, and they understand these risks and follow recommended guidelines, they will be participating in the safest way.

Give us your hope for the future of our sport.

My hope is that boxing will continue to be a sport that athletes can participate in safely.

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