Episode 3: Adena Leder D.O. Neurologist - RockSteady Boxing for Parkinsons is going to kick your A@@!

Welcome to our third episode. We hope that you and your family are staying safe and healthy during these challenging times. Our podcast will continue to give you high-quality interviews with relevant information from the safety of our homes. 

For our interview, we have Dr. Adena Leder, a board-certified neurologist with fellowship training in movement disorders. Dr. Leder graduated from NYIT College of Osteopathic Medicine in 1999 and completed her neurology residency at Long Island Jewish Medical Center and Montefiore Medical Center. She moved on to finish her movement disorder fellowship at Beth Israel Medical Center in 2004 and practiced clinical neurology for 10 years before joining NYITCOM.

Transcript

Hi, my name is Tian Yu She.

I'm a fourth-year medical student at the New York Institute of Technology and you're listening

to Do or Do Not.

For our interview, we have Dr. Adina Leder, a board-certified neurologist with fellowship

training in movement disorders.

Dr. Leder graduated from NYIT College of Osteopathic Medicine in 1999 and completed her neurology

residency at Long Island Jewish Medical Center and Monte Fiora Medical Center.

She moved on to finish her movement disorder fellowship at Beth Israel Medical Center in

2004 and practiced clinical neurology for 10 years before joining NYITCOM.

At NYIT, she is not only a professor but hosts the Rocksteady Boxing Program, an alternative

solution to slow the progression of Parkinson's disease.

We hope you enjoyed this episode.

Adina, thank you so much for being with us tonight.

I'm happy to be here.

Thank you for inviting me.

Yeah, we're so excited.

You are the first NYITCOM professor that we're having on the podcast.

I think it's awesome.

I'm really excited.

Thank you.

Okay, Adina.

So, usually when we start the podcast, we ask doctors to tell us what their day looked

like.

Now, you are a professor at NYITCOM and you have a clinical practice, so I'm sure your

days vary a little bit, but can you tell us a little bit about, say, what your average

day looks like starting when you get up in the morning?

So, it depends on whether my day starts with my patience or if I start with a boxing day.

If I have patience, then I sometimes have to wake up between 5 or 5.30, so I'll have

time to do my workout before I get ready to go to work.

Adina, I'm sorry to interrupt you.

What kind of workout do you do at 5 o'clock in the morning?

I do a Peloton workout, so spin.

I have to take my dog for a walk.

I do a strength workout with arms.

I started lower body recently, and I always do 10 minutes of core every single day.

All right.

I just need a cup of coffee and stare at the wall for about an hour, so that's pretty impressive

at 5 a.m. to me.

All right.

So, you do your workout, and then let's say it's a patient day that you're doing.

Tell me what that day might look like.

Pre-COVID, I would start at 9 o'clock, and I actually get a half an hour for follow-ups

and an hour for new patients with an hour for lunch, and this would keep going until

about 5 o'clock, and at 5 o'clock, for the most part, I'm done seeing my patients.

This is very much in contrast to when I used to work in private practice, and my days,

my clinical days, started at 7 o'clock in the morning, and I had patients every 15 minutes

without a moment for lunch, and I would go until 7 o'clock at night.

Okay.

So, definitely a little more laid back than when you were in clinical practice, and we're

going to talk obviously about what type of doctor you are in your neurology practice,

but can you tell us a little bit, are you seeing students or are you seeing neurology

patients or are you seeing movement disorders, and again, we're going to talk about your

education and your residency, but can you tell us what kind of patients, and maybe an

example of a patient that you saw today?

So generally, I am seeing Parkinson patients or patients with movement disorders or people

that have concerns that they have Parkinson's or maybe newly diagnosed Parkinson's.

Occasionally, I do still see general neurology patients, but I've become more focused on

Parkinson patients in the last five and a half years since I started working at the

Parkinson Center.

So can you also tell me, Dina, I know you're doing teaching at NYIT Com, so where do you

fit that into your day?

And I know you teach some osteopathic manipulation, like where do those types of things fit in?

I've always had at least one or two medical students with me going into every single room

with me and seeing patients with me.

They would also come and help me in rock steady, so they were able to see patients in different

settings.

Currently, my patients are now joining me on my telemedicine Zoom calls, so they're

seeing patients like that.

And on the days that I'm not doing clinical medicine, such as this morning, I didn't see

patients, so I had a Zoom, I Zoomed with a student who's actually in Rochester right

now, and I did about two hours of teaching just general neurology.

And I do that at least three times a week with students that rotate with me.

That's awesome.

That sounds like a good mix of education and clinical.

And I know you mentioned rock steady, and the students were really excited that we were

going to have you on tonight, and they really wanted me to ask you about rock steady.

So this is a program, as I understand, that you brought to NYIT Com.

Can you tell our listeners a little bit about, first of all, what the program is, second

of all, how you got involved with the program, and third of all, what it means that you brought

the program to NYIT Com?

Well, I first learned about what rock steady was when I was in private practice.

I had a gentleman who came to me who was one of the more disabled patients in my practice.

He was practically blind.

He walked with a rolling walker, and it's been very challenging to get people with Parkinson's

disease to exercise, and they generally moan and complain, and they don't want to do anything.

And this gentleman that I met mentioned to me that he was going to Brooklyn at least

once a week because there was a fabulous boxing class there that he enjoyed taking.

And I was so stunned to see that the man in this condition was doing this exercise and

enjoyed it.

And I realized at that point that this would be something that I needed to look into because

clearly it had a high compliance, which is what's the most difficult aspect of treating

people with Parkinson's disease.

So when I started working at NYIT Com, 60 Minutes featured Lesley Stahl's husband, and

he was going to this exact program in Brooklyn, which was rock steady because Lesley Stahl's

husband has Parkinson's.

I'm so sorry, I'm like so out of touch.

Who's Lesley Stahl?

Oh, I'm sorry.

Lesley Stahl was one of the newscasters on 60 Minutes, and she did a whole program on

her husband who was going to rock steady.

In any case, after 60 Minutes aired, we got 50 phone calls asking if we had the program

at our center, and we realized that it was something that everyone in the community wanted,

and so we learned about it, and it turns out that it's a program that was started in 2006

in Indianapolis, and all the other programs are affiliates.

And in order to get a program at your site, you have to fly to Indianapolis, go to a boot

camp, get trained so that you could go back and start the program at your site.

And so that is what we embarked on here at NYIT Com.

So now, just as a generality, and this may sound like a stupid question or a silly question,

but I mean, this sounds like something that AT still would want to do for Parkinson's

patients if he was walking around NYIT Com now.

Do you think that really fits with the osteopathic philosophy?

Was that sort of the push to start the program at NYIT Com?

Well, it was my push because when I at least went there, before I went there, I didn't

realize the social component, I knew that it had all the protective effects, so I knew

it from a physiologic standpoint, but it truly embraces the whole mind, body, spirit aspect

of AT still's teaching.

And that's, I think, one of the reasons why I like it so much and why I think it's the

perfect program to have at NYIT Com.

That's just a great story, and it sounds like it's very successful and everything's going

really well.

I'm going to shift gears a little bit and talk to you a little bit about when you decided,

one of the questions that we always have for doctors is, when did you or do you remember

when you first decided that you wanted to become a doctor and became interested in medicine?

Right.

So I didn't go to college wanting to be a doctor.

I never thought I wanted to be a doctor.

I went to Union College, which is a small liberal arts school, and I was a psychology

major and as part of my psychology major, I had to take a class called psychobiology.

And in the middle of my sophomore year of psychobiology, I learned about dopamine as

one of the neurotransmitters.

And literally that day, I came home and said, I'm going to be a doctor.

I didn't know how closely dopamine was going to be involved in my life.

That came years later, but I started my journey already a little bit late.

I didn't really get to start my pre-med classes until the spring summer after my sophomore

year in college.

Okay.

So you decided you wanted to go to medical school.

It was not out of the gates, and you started working towards that.

Do you remember when you first heard about osteopathic school or what specifically sort

of led you to apply and how your application process was?

All of that is a little foggy given the fact that it was so many years ago.

I just know that there was no internet, obviously.

Everything had to be typed.

There was a graduate actually that was a year ahead of me from Union, and he had gone to

NICOM, which is what we called it back then.

And since I took the year off and I was already very much into exercise and the whole holistic

aspect of things, I loved the idea of osteopathy back then.

And that was how I applied.

I just remembered that my earliest memory was that I got in early from that class.

And so as a result, I was given a free microscope.

Yeah.

I think we had one other person on the podcast who also felt blessed by that microscope,

and that was sort of a very key part to his starting medical school.

He was really excited about it.

Right.

And it was very heavy to carry around.

He was a big guy.

He didn't mention that, but I'm sure it was heavy for him also.

Dina, two questions.

I guess one question is, did you apply to any allopathic schools or foreign schools?

I did not apply to foreign schools and I did not look into allopathic schools.

I applied to NICOM and I remember applying to Biddeford in Maine, PCOM.

I think those were, it was a big process, I believe, at the time.

Yeah.

Like you said, pre-internet, there was a lot of paper.

Exactly.

Right.

So also, so you took a year in between.

So before you started at NICOM, you did, I guess a lot of people call it a gap year.

What did you do during that year?

Well, I wanted to travel, so I actually got a job working for a teen tour company initially

in the summer right after I finished college.

So I traveled across the country, drove a U-Haul truck, and I camped for six weeks,

and I was paid to do it.

And then I got a bunch of different interesting temp jobs, so I was able to save up more money

so I could go and backpack through Europe the following summer before I started at NICOM.

I feel like, you know, a lot of people take gap years and sometimes they really feel that

it adds to them as a person and gives them some extra experience.

Do you actually look back fondly on that year that you took between college and medical

school?

I definitely, the traveling parts were amazing.

It definitely helped my growth and it helped me know what I didn't want to be doing.

So I guess in that respect, it was helpful.

Can you tell our listeners, if you remember, and I know this is going back a bit, but what

are your memories of medical school?

You know, what did you think about medical school at NICOM?

And did you meet?

No, we met great.

There were great people there.

I think overall, I had a very good experience overall.

My first two years there where we were on campus were fine and, you know, I had a good

anatomy group.

I had a good group of people that I bonded with and overall I had a pretty positive experience.

And did you do any special extracurricular activities or did you really focus on your

studies while you were there?

The only thing aside from my studies was that I went to the gym every day after lectures.

Okay, so a little similar to what you're doing now, except you shifted now to the morning,

right?

Right, exactly.

Exactly.

I don't have time after, I don't have time after work to exercise, so I just, I was always

at the lectures.

I never had anyone take notes for me.

I was one of those sitters that was there every day taking notes.

And at the end of every day, the first thing I did before I studied was that I went to

the gym.

And that was about it.

So you were studying and working out and that was your day?

That was it.

Okay.

And did you do any research while you were in medical school?

Nope.

Nope, I did not do any research.

I don't believe it was, I didn't know it was an option.

Now when, ultimately, when you sat for exams, did you take the USMLE or did you only take

the Comlex?

I don't even think it was called Comlex and if we were back there, it was the MBOME and

I never took the USMLE.

Okay, so you just, you took the MBOME.

When did you decide on your specialty and how did you decide that you wanted to pursue

a career in neurology?

That's a good question.

We went through every rotation third year and I tried to really keep an open mind and

each rotation I realized they just were not for me.

And once I had an opportunity to do neurology, it kind of brought me back to where I was

in college and I had that interest back then.

Within the first week of my neurology rotation, I was actually rotating at my monadies.

I was sold.

I don't know if you can answer this question, but you know, I remember on a specific interview

that we had with a neurosurgeon and a few other people mentioned this.

They said in medical school, there are people that decide that they want to do surgery and

then there are people that decide they want to do medicine.

So that's a little broad and it kind of leaves out neurology.

So do you think neurology has its own separate category and should be added as a third option

or would you put it into one of those categories?

Well, it's definitely non-surgical.

I think it has its own category because neurologists are definitely a species of their own.

And what do you think makes a neurologist or someone interested in neurology special

or different from say someone that's interested in medicine?

Like what are the interests and the thought process that make it a little different?

I just think neurologists are as a whole.

I mean, I'm used to them, but we're all a little bit more quirky than just people who

go into medicine.

There's something that's like different and quirky about us.

I don't know.

I think maybe I'd argue that a couple of the internists I know are a little quirky, but

I think I understand what you're saying.

So tell me a little bit about your application process to residency and how you chose your

residency program and specifically if you think your application process was a little

more difficult as a DO.

So I don't remember much except the total number of residencies that I applied to, I

believe were five, which is compared to today, people tell me that they applied to a hundred.

I literally, and I don't remember exactly how we did it, but I interviewed at all the

places and I ranked LIJ as my top choice and I matched there.

And there were no osteopathic options for doing a neurology residency, which was unfortunate.

The closest was Michigan and my family situation at the time didn't allow me to go to Michigan.

So I was very happy to have matched at Long Island Jewish.

Did they have DOs in the program before you and were there other DOs in the program at

the time that you were there?

It was a mix.

But yes, there had been DOs and our chairman already was very familiar with NICOM and really

liked our residents a lot.

So it was not an issue at all as a DO and interviewing, obviously my predecessors had

done a good job prior to my getting there.

Now Long Island Jewish, you know, I know well is sort of, I would say it's sort of a larger

institution and a little more of a public sort of inner city patient population.

You know, what do you think of the pros and cons of picking that type of institution as

opposed to say a more private place and maybe someplace a little more, a little smaller?

Well first of all, my program was related to Einstein and so I spent six months at Montefiore.

So compared to Montefiore, it was actually very much like a private hospital and it didn't

seem inner city at all compared to Montefiore, which is also happens to be a private hospital.

But I definitely think that you see more pathology, you see a more diverse mix of people.

You definitely have a higher patient load.

And I saw even more of that when I was up in the Bronx.

So if you had to give advice to someone comparing say Long Island Jewish as a more private hospital

to the Bronx, you know, the population in the Bronx, do you think that one of them is

better?

If someone didn't have that opportunity to have both of those experiences, would you

recommend one over the other or would you actually say that trying to find a place that

has both would be the best place to train?

It really depends on each person's personal situation and you have to weigh all of the

options.

And if you have an opportunity to see more, more patients, more pathology, of course,

that would be terrific.

Unfortunately, sometimes in those situations, you might also have to sacrifice teaching

because I was at Einstein, I feel that I had great teaching when I was in the Bronx as

well.

But you have to look into all of those aspects of the program because you want to have a

good balance of the pathology that you're exposed to and the teaching that you're receiving.

Okay, Dina, that's that's great advice.

So you decided to do a subspecialty, a fellowship after neurology.

What made you decide to do that?

Well, I didn't have any doctors in my family and I had no one to advise me.

And one of the residents that I worked with came from a family of doctors.

And she basically said to me, you need to do a fellowship.

And so I basically decided to pick a fellowship where I felt the most uncomfortable.

And that was in movement disorders.

I really didn't feel comfortable taking care of Parkinson's patients.

I could never make heads or tails of all the different medications they were on.

And so I thought it would be a good idea to do a fellowship in movement disorders.

Now obviously, looking back, that was an extra year and it took extra time.

And of course, it gave you a little extra expertise, which as we talked about earlier

in this discussion, really is what your practice is about now.

Looking back, would you have still done that specialty?

Would you recommend to a neurology resident today that exactly the advice that you were

given that they should do a subspecialty, that they should do a fellowship after the

residency?

I think it gives you a lot more flexibility, especially as a woman.

If you have an extra training, you can't go wrong with extra training, although it isn't.

It's sacrificing a year of your life, of course, where you're not making as much money as you

could if you're in practice already.

But you have to do what you love.

You have to really know what you're getting into and what you like.

So you decide you like movement disorders.

You feel the most, that's the thing that you feel most uncomfortable with.

And hopefully when you're finished with that, you feel the most comfortable with that.

And now you're looking for a job, right?

So can you tell our listeners a little bit about what that experience was like when you

started looking for a job, how you chose the job that you chose, and sort of how your career

was?

Again, obviously now you're in academics, but how it was in private practice.

And then ultimately, what made you decide to leave private practice for academics?

Well, once I was doing the specialty, because I was already from the area and trained at

LIJ, many of the local attendings knew of me and they knew what I was doing.

And so it really wasn't very hard for me to find a job.

Instead, people were coming to me asking if I wanted to join their practice.

So that was a very easy aspect of all of this.

The nice part was that I had just had a baby and the practice that I worked for had an

opportunity for me to work there two days a week.

And so I grabbed it because as a new mother, you had to have a private practice job where

you're seeing patients two days a week.

That's without call though, but in the office was a very nice opportunity.

So obviously, I can't even imagine, I can barely wake up in the morning, I don't go

to the gym, I go to work and do my thing.

If I had to raise kids at the same time, thankfully, my wife kind of takes care of all that, but

you had to take care of your family and raise the kids.

So working two days a week made a huge difference.

And how many years did you do that for?

I never only worked two days a week because I was on call at least every four to six weeks

where I had to round at least three hospitals starting for the first year, Friday, Saturday,

Sunday.

And after the first or second year, myself and one of the other colleagues decided that

we were tired of going to a non-teaching hospital where we could get called at three in the

morning to go in and do lumbar punctures.

So we whittled it down to two hospitals.

And then for the remaining eight years, every four to six weeks, I was rounding at, you

know, Friday, Saturday, Sunday, where I could go back multiple times to both hospitals then

plus the two days, but eventually I added another day or more.

And then I was ultimately doing that for 10 years.

Wow.

To me, that really sounds like that's not part-time.

That's like two full-time jobs.

So you are doing this neurology with call at the hospital plus clinic hours, plus taking

care of the family.

Right.

So I would have to go and see patients in the hospital early in the morning before the

babies woke up or late at night after I put them to sleep.

That's when I would have to round on my patients.

That's amazing.

And just, you know, your husband, I know, is a doctor also.

So was he helping out with this?

He would help, but sometimes he had to be seeing patients also.

So that didn't make things easy.

So you have to work around one another's schedules and sometimes it was real challenging.

Yeah.

Again, that sounds like 16 jobs, you know, the equivalent of 16 jobs.

So you did this for 10 years and did you just say at some point, this is not what I want

to do?

Or, you know, how did you decide that you wanted to go into academics?

Well someone from Nikon called me actually about a year before I decided to change because

they were doing research and they wanted me to be a PI on their project.

And I decided I would go over there to meet them to find out who it was that was reaching

out to me.

And while I was there, I said, well, this is a Parkinson's center.

This would be really a neat thing if I was able to be here.

And I started kind of talking to people and thinking about it and realizing that, you

know, this would probably be a nice switch for me.

And I was getting a bit burnt out with the combination of the hours and the hospital

call and the nights and getting called two o'clock in the morning on many, many nights.

And I think I was just realizing it was time for a change.

So you ended up going to New York Tech and I guess, you know, going back to the beginning

of our discussion, the rest is sort of history.

And I know that any student I've ever spoken to just absolutely loves to work with you

and thinks you're a huge asset, their medical education, which is amazing.

Thank you.

If you had to go back and choose a different specialty, is there anything else that you

think you may have liked?

Like maybe something you did in medical school?

You said, listen, if I didn't do neurology, I think I would have done this and been happy.

No, I wouldn't have been able to do anything else.

Okay.

So neurology or bust?

No question.

It was neurology.

Yes.

Yes.

Quirky and good.

No question.

Yes.

Absolutely.

Next question.

Again, a little bit personal, but we always ask people that we have on the podcast about

medical school loans.

Did you take any loans and did finance in any way affect your choice of your medical specialty?

So I'm not sure if anybody remembers, but when I was there, they were subsidized loans.

And so I did take loans, but they didn't have any interest.

It wasn't as difficult to pay them off.

You don't sound stressed about the loans.

So the loans, yeah, they didn't stress you out.

You're like, look, this is the cost of medical school.

And as far as residency goes, were you looking at like salaries of specialties or you just

like, look, all the neurology.

So LIJ actually had one of the higher salaries for residents compared to other similar residencies.

So it was everything worked out at that point financially.

That was okay.

So your husband is an internist.

Has he always been supportive of your career?

And was it difficult, do you think, in those 10 years where you were having this crazy

call at the hospital and maybe he was on call also, do you think it's really stressful and

difficult to have a two-doctor family?

Or do you think it's just like great that you have two physician salaries and it actually

makes everything easier?

So I'd say a little bit of both.

It was always 100% supportive.

There was never an issue with that.

It's always when you throw children into the mix that that's where the stress comes on.

It's great to have somebody that understands everything that you're going through, that's

supportive.

But once you have to manage childcare and things like that, it's a stress that's coming

from outside.

Otherwise, I think it's doable if you have the right partner.

I don't think that it makes things more stressful.

So what are your thoughts?

I know we touched a little bit.

We touched a little bit on the fact that you teach some OMM.

So what were your thoughts on OMM when you were at NICOM as a student?

And what were your thoughts?

Do you use any OMM in your practice of neurology?

And how do you feel about OMM as a teacher?

So I think as a student, I was skeptical because of the way we were taught at the time.

When I was a resident, I was in an allopathic residency.

And so unfortunately, it wasn't something that was taught during residency.

When I was in private practice, another DO joined our group and we decided that maybe

we would start trying to offer osteopathic manipulation.

And at the time, the person that we worked for did not want it done in their practice.

And so now I teach first years.

I think it's the one thing that is missing because here we've been out how long, 20 years

or so.

And there have been so many drug recalls that really feel that the one thing that you can't

hurt somebody with is using OMM.

I'm a huge proponent of it.

And I think my biggest regret was that I didn't have as much early on and I wish that I had

pursued it more and so now that's my biggest wish is to tell people to practice it more

because people want it.

And now there's a wait for people to get in with the doctors that have been practicing

it all these years.

I only wish that I had more hands on practice in OMM over the years.

So that's great advice.

So you really feel that specifically for the DO students that are listening, you think

they should take better advantage of the osteopathic manipulative classes, although it may not

always seem as pertinent as they're going through school.

Absolutely.

Absolutely.

I think it is such an important part of it.

It's what distinguishes, it's in part what distinguishes us and it gives us an extra

toolbox.

I've seen patients with concussion become healed by cranial manipulation and for a neurologist

to be able to do cranial is amazing, but you really need a lot of hands on time to master

cranial and based on what I've explained to you of my life over the years, unfortunately

I didn't have that extra time to really master cranial, but I wish I had.

We're building a website and trying to get the DO or do not website with a lot of different

links and one of the things that we came across on the internet is a campaign that came out

from the AOA called Doctors That Do and you are sort of the poster child for Doctors That

Do.

Like your face is sort of the face of the campaign.

Can you tell us a little bit about that campaign and how you got involved with it and what

you think the importance of that campaign is?

So in 2017, the AOA sent out an email to a whole bunch of DOs and said that they were

running this ad campaign and do you know anyone that really lives the osteopathic life and

is doing something different?

And I was nominated for this campaign and out of over 200 people that were nominated,

they picked four people and I was one of them and basically because of the Rocksteady program,

they decided to use me in their campaign and I was flown out to the AOA headquarters in

Chicago for a photo shoot day and so those are the pictures that you see there.

The campaign is great.

I think the campaign really highlights osteopathy and people like you who are really at the

forefront of medicine in general and really represent the profession to its utmost.

So I think you should be really proud of yourself for being chosen for that.

Thank you.

All right, Adina.

So my last question, sort of a grand finale question.

Do you have one piece of advice?

Now this advice, just to be clear, this advice is not from you.

So do you have one piece of advice that you were given throughout your education from

your parents or from a college teacher, someone at medical school or someone at residency

or just someone else that was close to you that really is important to you and that you

think would be worthy of passing on to other students or that you do pass on to other students?

So the best piece of advice is to do what you love because if you end up doing what

you love, it doesn't feel like a job.

It feels like a hobby.

And at this point in my career, I feel like I am just enjoying a hobby every day rather

than enduring a job.

All right.

Adina, I have to say waking up at five o'clock in the morning and working out and then doing

a boxing class with movement disorder patients, teaching and seeing clinical patients sounds

like a lot to me, but the fact that you enjoy that as a hobby is amazing.

And I just want to say from all of the students that recommended that we interview you and

have you on the podcast that they think you're doing a great job.

I think you're doing a great job and that New York Tech is lucky to have you.

Thank you very much.

Thank you for having me.

This concludes our episode of Do or Do Not.

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This is Tianyu Shea.

Thank you guys so much for listening to Do or Do Not.