INTERVIEW WITH

DR. CHRIS SHIELDS

     Recently Adair Progress Editor, Tiffany Hadley, Columbia Internist, Dr. Chuck Giles, and Family Physician, Dr. Phil Aaron, had an opportunity to interview Dr. Chris Shields. Shields is the head of the Department of Neurological Surgery at the University of Louisville and Head of the Neurological Institute of Kentucky. He is one of the most widely respected and well-known neurosurgeons in our Nation.

Tiffany Hadley: Dr. Shields, I have been told that physicians all over the United States are familiar with the research and surgery being performed at the university of Louisville. How is it that such a well-known and respected group of neurosurgeons come to Columbia?

Dr. Shields: Tiffany, we had had the opportunity to come here for the past eight years. Either I or one of my partners, Dr. John Harpring or Dr. George Raque, come on a regular basis we are here at least once a month. It has been a wonderful opportunity to collaborate with the physicians of this area. They have supported our group so warmly.

Dr: Giles: Dr. Shields, tell us how a small state like Kentucky can have such a great impact on neurosurgery across the Nation.

Dr. Shields: While it is true that Kentucky is far down on the list of states in population and wealth we rank eighth in the nation in the amount of money contributed toward spinal cord research. Our Neurosurgery Department has recruited researchers from Canada, Poland, South Africa, and China. Several years ago when I looked at the problem of injuries on the ball field and in motor vehicle accidents it was apparent that many of these spinal cord injuries could only be treated through research. I took time off, a sabbatical, and went to the world’s leading spinal cord research center, studying so that I would be able to put together a research team in Louisville. We wanted to improve the lives of patients who had sustained spinal cord injuries.

Dr. Aaron: From where does your money for research come?

Dr. Shields: There have been three major sources. Fist the State of Kentucky has supported us. Any time an individual is stopped and given a speeding ticked in Kentucky $12.50 of that fine goes to support spinal cord research. This has gone on for the past eleven years. We receive about three million ($3,000,000.00) dollars a year form this source. This money is shared with the University of Kentucky. Secondly, the State has allowed us to apply for bucks for brains money. Such funding has allowed us to recruit outstanding researchers and place them in positions to conduct their research and we have received grants from private and public sources.

Tiffany Hadley: What is the goal of your research?

Dr. Shields: In many of these severe spinal cord injuries there is no hope for a cure. Instead we attempt to make small advances in patients’ lives; to improve their ability to feel sensations; to improve feeling in patients’ hands; to help them use their bladder and bowels. Perhaps they will not be able to walk, but some of these smaller improvements which many of us take for granted are big advances in patients who have spinal cord injuries. This research has brought the Neurosurgical Departments at the University of Kentucky and the University of Louisville closer together as we attempt to spend the states money wisely.

Dr. Giles: What are the most recent advances in spinal cord research?

Dr. Shields: There have been major advances in spinal cord research. Dr. martin Schwab of Switzerland has learned the spinal cord is kept form regenerating or mending together because of inhibitor molecules. Peripheral nerves our to one’s arms and legs, for example, do not have such inhibitory molecules. This has helped to advance our knowledge in treating injuries. I believe Dr. Schwab will eventually receive the Nobel Prize in Medicine for his contribution. And there are many other advances in what we call genetic engineering and molecular biology, a whole area of Major research that wasn’t even known about when I went to school. We have made great advances in the following diseases: Parkinson’s, Huntington’s, Amyotrophic Lateral Sclerosis (Als-Lou Geherig’s Disease), Multiple Sclerosis, and Alzheimer’s Disease. In each of these diseases a combination of approaches are taken; e.g., A researcher might build a cellular bridge across a damaged area of the brain, enzymes are used to digest scar tissue and growth hormones can be used to boost a neuron’s capacity for growth. There is a great amount of research in the creation of neuron’s to replace the injured parts of the brain. Just how fast and how much is able to be done in this area is the future of resea4ch in neurosurgery.

Dr. Shields: It is estimated that 11,000 spinal cord injuries occur each year in the United States and the 247,000 Americans are living with spinal cord injuries. Most individuals with spinal cored injuries are young adults, primarily males. The major causes of spinal cord injuries are motor vehicle crashes and traffic accidents (50.4%), followed by falls (23.8%), violent acts (11.2%) primarily gunshot wounds, and recreational sports activities (9.0%). It is important to understand that the success of spinal cord surgery is often very limited. It is very important that before undergoing spinal surgery one should attempt to reduce the risk factors that may have caused the spinal cord injury. The type of work on does, for example, heavy lifting or repetitive movements of joints sometimes causes injury to the spinal cord. Treatments before surgery include medications, physical therapy, injections (e.g., epidural blocks) to relieve the pain. When there is pain that does not respond to these modalities, that is intractable pain, surgery is sometimes attempted to take pressure off a pinched nerve.

Tiffany: Do these surgeries involve risk?

Dr. Shields: Yes. Two major risk factors in neurosurgery are patients who are overweight and patients who smoke. Neither responds to surgery as well as patients who are nonsmokers or patients who are not overweight. This is especially true when fusion has to take place and there is a grafting of bone, a welding or bones together to prevent slippage. Thus we encourage patients to lose weight and to stop smoking three to four weeks before surgery and six to nine months after surgery.

Dr. Giles: what are some of the advance we expect to have in neurosurgery in the future?

Dr. Shields: we are already far along researching artificial discs, for example, when a ruptured disc is surgically removed we will eventually be able to slip in a disc made of metal or plastic. This may require inserting a plastic polymer like putty which will later harden. These artificial discs will allow patients to maintain motion with quicker healing.

Dr. Aaron: As we interview you here today, the Winter Olympics are taking place in Italy. At one time years ago you were an internationally accomplished figure skater.

Dr. Shields: Yes, and my partner was Peggy Fleming. Sports Illustrated recognized Peggy as one of the seven athletes who changed the game including Arnold Palmer, Billie Jean King, and Jackie Robinson, Peggy has had a monumental impact on sports in America. In 1961 the entire U.S. Figure Skating Team was killed in a plane crash on its way to the Prague World Championships. Peggy was eleven years then and her coach was one of those killed. Using her career as a tribute to her fallen friends she put together a remarkable skating career. I last saw Peggy four years ago when she came to New Albany, Indiana, to speak about her own bout with Breast Cancer. When you’ve grown up with someone, skated and trained for hours upon hours on ice with them, to see Peggy again was like we had never been separated through those years. It was a close and special occasion. She is a wonderful lady with a glamorous image. Her focus today is on encouraging Americans to maintain their physical fitness.