October 2006

Introducing ...

A member of the International Scientific Advisory Panel: Isaac Ogwel Opole MD, PhD

When David Jackson, DC; Matthew McCoy, DC; and Robert Blanks, PhD founded Research & Clinical Science (RCS), they realized that the credibility and validity of the program would rely in great part on the quality of researchers chosen to analyze the data collected by chiropractors around the world.

They sought out a world‑class group of respected scientists with unimpeachable credentials and proven expertise in health care research. The result of their efforts was the RCS International Scientific Advisory Panel, a multi‑disciplinary group charged with overseeing the collection of, and analyzing, data compiled on hundreds of thousands of volunteers and chiropractic patients across the globe.

Each month during this special series, The Chiropractic Journal profiles one member of this prestigious panel.

Isaac Ogwel Opole MD, PhD

Isaac Opole MD, PhD ‑‑ Assistant Professor at the University of Kansas Hospital, Department of General and Geriatric Medicine ‑‑ is one of those rare professionals with two careers.

First, and foremost, he is a successful practicing physician specializing in general and internal medicine, geriatrics and health promotion. He is also an accomplished scientist having completed his PhD in the field of brain imaging and nerve stem cell proliferation.

Dr. Opole's medical and research career began in his native country of Kenya. He began his career after completing his Bachelors of Science (1988) and medical degree (1991) at the University of Nairobi.

He went on to complete his internship at the 2000‑bed Kenyatta National Hospital, the medical training center for the University of Nairobi. This hospital has the distinction of being the largest in a system of public health institutions that provide medical care to about 70% of the population.

With a population of 30 million, Kenya is among the more progressive and politically stable countries in East Africa. The outstanding quality medical training received in this environment is the result of the country's long‑standing investment in medical training of nationals and Europeans. The environmental and economic challenges of East Africa and the high prevalence of diseases such as malaria, tuberculosis, HIV, diarrheal diseases, and malnutrition made the training uniquely wide ranging and intensive.

Throughout his clinical training, Opole pursued research interests in neurobiology. One of his first studies, published in 1991 with Prof. Kimani of the Department of Human Anatomy, University of Nairobi, was to examine the structural organization and adrenergic innervation of the carotid arterial system of the giraffe.

Because of their long necks, these animals must undergo tight regulation of the cardiovascular output to supply the brain during the dramatic shifts in head position (often 15‑20 feet) while feeding from trees and then drinking from a pool of water.

Interestingly, they found comparatively large adaptations in this unusual animal indicated by the increased number of sympathetic nerve fibers particularly in the outer muscular layer of the carotid arteries in this species. They suggest that the rich sympathetic innervation of the giraffe carotid arteries maintains a basal tonic state in the neck arteries allowing the animal to modulate cranial circulation particularly when it bends its head to drink.

In order to further his research interests in neurobiology, Opole and his family moved to the United States in 1997 to conduct graduate studies in the Department of Anatomy and Neurobiology, University of California Irvine (UCI) College of Medicine.

His major instructor during this time was Prof. James Fallon who now serves with him as a member of the RCS International Scientific Advisory Panel. Opole's PhD research focused on two areas: techniques for standardization and analyses of PET data in functional imaging studies, and regulation of neural cells in the adult mammalian brain.

The foldings, surface characteristics, and to some degree size, of every human brain are different making it difficult to pool functional imaging data (e.g., fMRI and PET) across patients.

To solve this problem, Opole and his colleagues developed a standardized neuroanatomical template for use in imaging, and applied a sophisticated analytic technique called structural equation modeling allowing researchers to analyze the "before and after" effects of specific intervention such as nicotine exposure, and frontal lobe metabolism in normal and disease states, etc.

These computer‑generated ("morphed") templates have reduced the need for large number of patients in imaging studies, and have greatly improved the spatial resolution of functional brain imaging of patient and control populations.

While at UCI, Opole's work also focused on the discovery and characterization of a special population of stem cells in the brain of adult rat. This population of cells is capable of cell division, growth, migration and differentiation to regenerate nerve cells in the mammalian central nervous system.

These exciting results were reported in the Proceeding of the National Academy of Science (Fallon, et al., PNAS, 26:14686‑14691, 1997). The implications of these findings, since confirmed by other laboratories, to the field neurodegenerative diseases (e.g., Alzheimer's), stroke, are enormous.

Opole has also been a pioneer in the use of multimedia and web‑based technology for medical education. While at UCI, he developed a well‑earned reputation for delivering superb, wonderfully illustrated lectures for medical students, residents, and graduate students.

He developed a web‑based interactive teaching and assessment system for neuroanatomy and human gross anatomy that was used extensively by medical students in preparation for medical board and quarterly assessments. His students and colleagues at UCI will always remember him with pride as the "graduate student" with the sporty British accent, sparkling personality, sharp wit and tireless dedication to his teaching and research.

The field of translational research attempts to bring laboratory technology into the patient setting for evaluation and eventual widespread use in clinical practice. Basic science trained physicians such as Opole, are critical in this type of research. In fact, his discoveries both in brain imaging technique and those he developed on brain stem cells with Dr. Fallon at UCI, will have important long‑term implication in terms of understand brain diseases and brain recovery from injury.

However, Opole's first love is academic medicine, so upon completing his PhD in 2002, he went back to complete a three‑year residency in Internal Medicine at the University of Kansas. In 2005, he joined the University of Kansas Hospital as Assistant Professor in the Department of General and Geriatric Medicine, specializing in general and internal medicine, geriatrics and health promotion. Opole is a hospitalist by choice, dedicating himself almost exclusively to the care and well‑being of hospital in‑patients.

Hospitalized patients are a particular challenge. This population is typically older, and their medical conditions are more complex. Opole's training and personality serves as a perfect match for providing care to this critical care population.

He describes his personal philosophy as "providing compassionate, expedient and comprehensive care to hospitalized patients."

His hospital is a liver transplant and referral (tertiary care) center for all of Kansas and several surrounding states (e.g., Okalahoma, Nebraska). Liver disease from alcoholism, hepatitis C, and/or other causes (e.g., autoimmune disease, toxin‑induced, genetic) accounts for 10‑20% of its patients. A majority of his patients are complex and suffer from multiple diseases, e.g., hypertension, type II diabetes, myocardial infarct, etc. The challenges are great.

Drug side effects are an important concern in any age group but particularly in the elderly, who can typically be on as many as 10 different prescription medications.

Opole points out, for example, that "pseudomembranous colitis," an inflammatory disease of the colon, is a common side effect of antibiotics. It is thought that the resistant bacterial strain in the gut, Clostridium difficile, proliferates in the presence of antibiotics, releasing a toxin that produces the gastrointestinal symptoms.

Patient with this condition experience diarrhea after taking antibiotics for as little as 4‑5 days. He comments that C difficile is an unusual component of healthy bowel; one way to treat this form of colitis is to apply a holistic approach, and have the patient repopulate gut flora and fauna by eating natural yogurt or milk.

Opole philosophy is to always apply a global, i.e., holistic, approach to patient care. He maintains that the "patient comes in with a need for healing. Modern medicine sometimes forgets that technology is not a replacement for the body's innate ability to heal itself."

The important role of the physician is to provide a positive patient interaction to promote healing. He constantly reminds his residents: "Remember that patient want to feel well, and to be touched ... touch can be therapeutic. Remember to communicate and not just treat the patient."

Opole feels strongly about taking the time to have patients address health life‑style issues (smoking cessation, weight loss, etc.) in order to promote the healing process.

Correspondingly, he is impressed with the published studies showing significant improvement in health lifestyle behavior in patients undergoing regular chiropractic (e.g. Blanks et al., JVSR 3:24‑30, 1997; Schuster et al., J Alt Comp Med 10:349‑356 and 357‑368, 2004a,b).

In fact, it is in the management on health risk factors and health promotion that Opole feels that he can make the greatest contribution to the RCS research. He looks forward to working with the scientific teams and the RCS database to better understand the general health and wellness outcomes of patients undergoing chiropractic.

Finally, Opole was asked to comment on his vision for better health in the future. "Be more proactive, adopt a healthy lifestyle and become a well‑educated consumer of health care."