Meanwhile, neurologist engages in dizzying hobbies

Whether it's flying at supersonic speeds in one of his refurbished Russian MiG jet fighters or climbing to the top of a towering mountain, the San Diego physician gets a rush from pushing his body to extremes in altitude and G-forces. But it's a different story when he's in his office at Senta Medical Clinic at Alvarado Hospital in the College Area.

Purcell is an otoneurologist, one of a handful of neurologists in the United States who specializes in finding the cause of people's vertigo and ending it.

At the center of his practice is an array of unusual machines – some that he built himself – that he uses to diagnose and treat all forms of dizziness, including extreme cases that can last for months or years and leave sufferers unable to drive, shop or even walk without assistance.

A large circular steel contraption that fills one of Purcell's examination rooms in Alvarado Hospital looks like one of those spinning gyroscope rides that can be found at shopping malls or amusement parks.

Profile | Ian Purcell

Career: Senta Medical Clinic, partner, 2004 to present.

Education: Bachelor of science degree from Southwestern University in Georgetown, Texas, 1985; doctorate in philosophy in neuroscience from University of Texas in Galveston, 1997; medical degree from University of Texas in Galveston, 2001; University of California San Diego, neurology resident, 2004.

Personal: 42; has a wife, Tracy, and two children.

Hobbies: Flying and restoring Russian fighter jets; mountain climbing; restoring antique Packard automobile
Another room houses a mechanical pulpit with a breakaway floor that sits under a mirrored disco ball. The device tests a patient's ability to maintain balance while being bombarded with sensory challenges, such as a shifting floor and floating spots on the walls and ceiling.

When patients visit the clinic for the first time, they're usually at the end of their ropes, Purcell said.

They've been to emergency rooms. They've consulted their family physicians and been referred to a host of other medical specialists. They've had their brains scanned for signs of hemorrhages or strokes. They've been checked for arterial blockages and viruses and screened for adverse reactions to medications.

Oftentimes, even the patient has trouble explaining what is wrong, Purcell said. “Describing vertigo is like describing air. Sometimes it's there. Sometimes it's not,” he said.

Purcell's partner in the clinic, Dr. Michael O'Leary, said that caring for a vertigo patient requires a broad-based, multi-specialty team approach.

“It's bigger than any one person,” said the head and neck surgeon, a retired Navy captain. “This diagnosis overwhelms a single doctor.”

When other diagnostic efforts come up short, the patient becomes a prime candidate for testing for benign paroxysmal positional vertigo, an inner ear condition that can be hard to pinpoint and equally difficult to treat.

BPPV occurs when tiny crystals made of calcium carbonate – a naturally occurring compound that helps make sea shells and egg shells hard – break free from tiny hairs in the inner ear and float into one of the fluid-filled canals that help the brain determine the body's position to maintain balance.

Normally, the crystals act as weights on the hairs, bending them in the direction of gravity's pull. As the hairs move, their positions are transmitted through nerves to the brain, which combines that information with eyesight and feeling to compose a complete picture of the body's position in space.

Vertigo can occur when broken crystals bend some of the hairs the wrong way.

Diagnosing BPPV can be difficult because most of the common symptoms – a sense of spinning, lightheadedness, blurred vision, nausea or vomiting – can be caused by other problems.

O'Leary recalled one patient who had been told for more than a year by other doctors that her recurring dizziness was psychological because they failed to find any physiological explanation. A visit to Senta, however, indicated the problem wasn't in her head, or more specifically was in her ear. She had BPPV.

“She broke down when we gave her the diagnosis,” O'Leary said.

To determine whether BPPV is the cause of vertigo, a patient is strapped into a canalith repositioning chair, the large steel machine built by Purcell that nearly fills one of the clinic's exam rooms.

His homemade device is a knockoff of a design developed by Dr. John Epley, a Portland, Ore., otoneurologist who pioneered the diagnosis and treatment of BPPV.

Only six of the Epley chairs are in use, Purcell said, and the machines have not yet received approval from the Food and Drug Administration. “All of them are considered experimental,” he said.

The steel beams for Purcell's contraption were supplied by NASA Ames Research Center in Mountain View, where he worked as a researcher in the early 1990s. Patients sit in a jet fighter pilot seat, taken from Purcell's considerable stash of aviation spare parts, that is bolted to the circular steel frame.

The doctor assembled the machine in his father's workshop on Adams Avenue in San Diego. He said he spent about $30,000 on parts and materials.

The patient is strapped in, then tilted, turned and rolled in every direction by the device as infrared goggles record the tiniest eye movements. That's critical because BPPV triggers telltale eye motions that identify a sufferer.

Once a BPPV diagnosis is made, Purcell moves the patient in the chair to maneuver the dislodged crystals out of the sensitive inner ear canals and into an area where they can be absorbed by the body.

Think of the treatment as a human-sized version of the child's toy that requires subtle tilts to roll a marble into a game-winning hole.

The treatment can have stunning and immediate results, Purcell said. He said some patients leave the spinning chair symptom-free.

Purcell's vertigo-inducing hobbies don't seem to faze his patients, who are exposed to evidence of his favorite pastimes at every turn.

Office end tables are stacked with books about flight and issues of Air Force Magazine and Climbing. The walls are decorated with vintage bomber jackets, autographed photos and lapel pins from members of the Flying Tigers, the legendary volunteer pilot corps that flew missions in Asia during World War II. And on a recent afternoon, the movie “Top Gun” played on a large flat-screen television hanging in the waiting room.

Purcell said he doesn't know what developed first, his love of experiencing dizziness or his passion for curing it.

Source:www.signonsandiego.com