Oceanic Time Warner Cable's Community WebsiteHe arrives at the beach punctual and at ease, with a friendly smile and his portable hospital slung over a shoulder and clasped in each hand. Along with the customary medical supplies and the always present stethoscope, a few padded massage and examination tables are neatly lined up in the assigned floor space where he does his work. It’s all set up in an intentionally peaceful corner of the otherwise bustling surf contest site complex. But when the Vans Triple Crown of Surfing machine fires up, the surf goes big, and the competition gets fierce, Dr. Leland Dao and his mobile triage unit get right busy.
I met Dr. Dao by necessity while we were working at the last Reef contest. I’d sliced my foot badly in two places the day before while surfing and thought I could tough it out with a couple of bandaids and some sports tape. Uh, it didn’t work. So in acute discomfort, I sought him out in hopes of bigger bandaids, fresh tape, relief, and a clean getaway. With wounds a’ swollen, and grief on my face, he was having none of it and ordered me up on the table for a proper exam.
I joked with him that man-pride and stubbornness were well entrenched traits of mine, and that I was a card holding member of the dreaded “non compliant patient” demographic. He grinned politely as he surveyed my wounds with a sterile needle and said I wasn’t alone amongst surfers, who tend to be largely dismissive of their overall health, injuries, and the proper treatment of them. Sure enough, he’d mined enough sand, limu, and dirt out of the leaky red slits to grow a decent crop of _____________ (insert preferred choice of produce), and after a well deserved talking-to, I invited Dr. Dao to share some of his experiences and advice on surf related injury prevention and treatment with Around Hawaii readers.
If you’ve put in a fair bit of time surfing, you’ve been injured. If you haven’t been, you’re gonna be, there’s just no avoiding it. Between the many hard, sharp points and edges on a surfboard, jagged reefs, prickly and defensive ocean flora and fauna, and all the water borne pathogens that love to invade your wounds and orifices (ewwww!), your body will take a sound thrashing to be sure. Powerful waves tie them all together into one dodgy high risk/high reward package. Over the years, I’ve acquired a wide spectrum of injuries and afflictions in varying degrees of severity, most of which I’d never encountered while participating in other sports;
Without question, the most memorable amongst them was taking the rail of my surfboard hard and square between the legs after a failed floater attempt on a hugely forgettable 2’ wave. What ensued were 20 delightful minutes of involuntary dry heaving and audible whimpering in the channel, and an extremely ginger, assisted walk back to my car. I spent a week at home convalescing in very tender, muted anguish. Luckily, I’d already had my children before this happened. Man, just thinking about it makes me cringe all over again! It should be noted that Dao is a highly keen surfer himself, not the casual weekend warrior that many in the full time medical profession are forced to be. Because of this, he knows first hand what surfers have to endure both physically and physiologically. I’m sure the good doctor has collected his own share of physical dings and has an intimate understanding of surf injury potential, prevention, and treatment. Hopefully, he didn’t have to experience the “hard and square” thing like me, but he did share a real humdinger recently. “On a nice 4’-5’ foot solo day a few weeks ago, I paddled out and tried for what I thought was to be my first nice wave of the day. I stood up and my front foot slipped out, I did the splits and heard a loud ‘pop’ from the back of my leg. Immediate burning and excruciating pain, I knew it was the classic hamstring tear. I belly rode back to shore, hobbled up the beach, and had to lie down for over an hour. After a few icepacks and anti-inflammatory meds, I managed to limp to work. Painful!! The next day while still very sore, I was determined to not let the injury get all of me, so I hobbled back to the beach, over the rocks and reef, and paddled out. It was bigger, 4’-6’ Hawaiian scale, easily double overhead on the sets, and no one out! I managed to get three waves, barely, and paddled back in. The bruise that formed on the back of the leg was huge! I ended up surfing just about every day for that whole week, very carefully, just because I enjoy surfing that much!”
Of Vietnamese and Chinese descent, Dao could easily be mistaken for a Hawaiian local boy, but he was born and raised on the US mainland, spending the bulk of his formative years in Southern California, where he learned and honed his surfing skills, and even competed in NSSA collegiate level surf comps while studying at UC San Diego. The decision to pursue medicine as a career occurred to him while at Reseda high school (uh oh …Val alert!) and soon after he went on an extended educational junket through UCSD to study Biochemistry & Cell Biology, the College of Osteopathic Medicine of the Pacific to acquire his D.O. Degree, Med College of Wisconsin/St. Mary’s Hospital to do an internship, and then finally the University of Hawaii’s John A. Burns School of Medicine Family Practice Residency. Dao is board certified by the American Board of Family Practice and is a Clinical Instructor/Preceptor Attending Physician for Med students and Resident Physicians from medical training programs across the United States. Lecturer and contributing medical journalist also part of his extensive medical resume.
Now a resident of Mililani Mauka in Central Oahu, Dr. Dao lives with wife Wendy and young children Adam and Sarah, and he runs a private solo practice on the North Shore called Kaena Kai Clinic across from Ali’i Beach in Haleiwa. He’s also a staff physician at Wahiawa General Hospital and has some privileges with other area medical facilities.
I asked Dao how he wound up involved in the annual Vans Triple Crown of Surfing events. “I started working the ASP in 1997 after meeting Bernie Baker and Randy Rarick, and I’ve been working with the Triple Crown of Surfing ever since. We also have a Chiropractor and Massage Therapist help out each season now, and we get inquiries from Health Care providers from all over the world interested in helping. I usually have a student or medical resident assist at the events, and they’re very excited to meet and treat the top surf pros,” he said. You’d think this is a pretty good gig for them, and you’d be mostly correct. However, in the highly competitive environment of professional surfing in the huge powerful waves of the North Shore, there can be moments of real urgency when a competitor sustains physical damage.
I watched Dao closely as he operated at a recent Pipeline contest and the thumping surf had competing surfers dropping like flies and lining up outside his med tent like cattle, with bloody gashes, abrasions, twisted joints, and the like. In addition to the water patrol and city lifeguards providing speedy rescue in the surf, Dao ‘s presence and skill set offers these elite athletes immediate (and sometimes critical) onsite treatment. The end result of this kind of perceived security blanket is that the surfers are freed up psychologically to charge dangerous waves and surf fans get one whale of a show. In the early 80’s, Pipeline Masters competitors Chris Lundy and Steve Massefeller suffered horrific life changing injuries during their heats; Lundy’s leg was grotesquely dislocated and Massefeller was sucked over the falls, pile driving his head into the reef, and incurring extremely critical skull and brain injuries. Because there was no comprehensive onsite medical assistance back then, the two men had to endure long, bumpy, agonizing ambulance rides to a hospital in downtown Honolulu. Dao commented on the hyper alertness at Pipeline, “The injury rate does increase with larger waves and harder bottom contour. Thus at Pipeline, when the waves are pumping for the contest, we’re always on our toes. I have to credit the Hawaiian Water Patrol and Hawaii lifeguards though, they’re the ‘Guardian Angels’ of the beach when a situation occurs. The jet ski assist can rescue an injured victim out of the surf and bring them to shore in 60 seconds …pretty amazing. After they’re on land, we will triage and either take them to our medical area, or assist them to the ambulance.”
Being on the receiving end of ailing surfers, Dao sees a wide range of maladies. “Surfing uses many muscles which other sports don’t, and waves can be compared to moving mountains on those big days on the North Shore. Most common are soft tissue injuries, either strains or contusions (bruises), cuts and abrasions from the board, and hitting the reef. Neck, back, shoulder pains come from paddling and overuse. The joints, knees, ankles hips can also become injured when not prepared or overly fatigued. Head wounds to the scalp can bleed quite a bit, I’ve gotten used to carrying a medical stapler in my car and at the house. I think the big message here is make sure you know what you are getting yourself into when dealing with Mother Nature, respect her power.” Aside from the power of the surf, the ocean’s resident critters are big concern as well. “I once had a young woman come into my clinic, who’d been learning to surf at Pua’ena Point, and she stepped into a bed of Wana (urchin), literally a hundred purple spines on the bottom of her foot! We pulled some out, but most were embedded and deep. We cleansed and wrapped her foot. Can’t say that we recommend urinating on these. Better to just try to pull them out. If you can’t, they usually disintegrate eventually. Watch for infection though. For jellyfish stings, meat tenderizer and warm to slightly hot water (thus the urine remedy) have been used. The theory behind this was that the jellyfish organism’s toxins were broken down by enzymes in the meat tenderizer, or the heat from liquid would denature the toxin proteins, making the injury less severe. A new product on the market called “Jellyfish Squish”, has a different approach. It is a solution of Lidocaine anesthetic, which is sprayed onto the area. This seems to wash the toxins off intact, thereby causing less reaction on the skin while providing pain relief at the same time,” he said.
Because of the mounting urbanization of Hawaii, another challenge for surfers has been water born infection. Effluent from sewage spills, runoff from our streets and industrial and agricultural areas, expose surfers to dangerous pathogens and chemicals when they surf brown water conditions after heavy rains, a practice that seems to be increasing. “Surfing after rains can be tricky. Obviously runoff from the land will alter the water color, but I’d say some days are more dangerous than others, depending on the surrounding environment. If you hear of sewage spills, heed the warnings.” Dr. Dao pointed out an aggressive strain of Staph that’s an increasing concern, “MRSA (Methicillin Resistant Staph Aureus) is now a common finding in the community. Hawaii has the highest rate of this bad bug, and I see it nearly every day in my office. Many times I will see a bloom of this condition in a number of patients, who may have a routine cut from surfing or from kicking something on the beach, and the infection of the wound may spread and worsen rapidly. If you aren’t sure, better to have a health provider take a look. Shower off w/ soap and fresh water after being in the ocean, and take care of those wounds!”
Dao points out that although the potential for surfing injury is always there, it can be avoided if you’re careful. “We had a medical research paper published on the incidence of surfing injuries during competition in the American Journal of Sports Medicine several years ago (2007), it actually had gained a lot of national attention in both the New York and LA Times, with the headline ’Surfing Safer than Soccer’. They used much of the records that I keep on competitive surf injuries. No one had really known how dangerous surfing competition was until this data was analyzed and it turns out that surfing is a relatively safe sport!”
I’ve always been a believer of (clean) ocean water as a healing agent, with distinct medicinal properties for both mind and body. Dao confirmed it, saying, “The Ocean definitely has therapeutic properties; “Thallasotherapy” is one form of bathing in seawater to achieve some of these benefits. We as surfers use the many facets of the breaking waves and moving ocean to refresh, stimulate, and challenge our bodies. For myself, it is a daily goal and part of life to be in the ocean. It is a time of peace and solace when I need it. Sometimes our line of work can be very difficult and trying. After coming out of the water, I always feel good, and can continue to work no matter how bad the situation is. Recently surfing has gained recognition as an aid to helping Cystic Fibrosis patients, as breathing air near the ocean and seawater appears to help those with this condition breath better. I had a chance to play some golf this year with some of the representatives from the Mauli Ola Foundation, one individual told me how surfing has changed his lives for the better.” I know for a fact that the ocean has helped my young daughter cope with chronic Asthma, clearing her airways, exercising her lungs, and increasing their capacity.
At a minimum, surfing requires a decent level of operational physicality and endurance, and as I’ve gotten older and busier and my family involved in more activities, I’ve found myself unable to surf nearly as much as I’d like to. I haven’t cross trained away from the beach the way I should, and my surfing psyche and muscles can “atrophy” because of it. Admittedly, half the problem is getting and staying motivated, and I know that many other working/aging surfers are going through the same thing. I asked Dr. Dao how those of this ilk climb out of their ruts? “Gotta make the change! Diet, exercise and lifestyle changes are the first recommendations for nearly all of the major diseases we see in our office every day- High blood pressure, diabetes, obesity, etc. So “Surfing Deprivation Illness (SDI)” is no different, it starts with a decision to change, from small change to big change, but the key is the positive changes need to be long lasting, and potentially lifetime changes. Obviously not everyone can surf everyday (although I do try), making the commitment that surfing and health are important, more so than say eating lunch, (I try to avoid a full sitdown meal midday), and would rather get in the water for this time. This two for one deal (surf and cut calories) should be a no brainer to do if you love to surf!” I’m not completely sure you’d be able to find “SDI” in your standard medical journals, but it’s definitely an affliction no self respecting surfer wants to suffer from for sure!
So what does a busy doctor do in his rare spare time? “Surf, surf, surf! ASP and the Vans Triple Crown of Surfing keeps me pretty busy during the North Shore Surf Season. Family, of course is #1, raising Adam and Sarah to be good kids and appreciate their lives in Hawaii (and trying to keep the wife happy too)! I spend quite a bit of time working on our place (vacation home) on the North Shore, it is a lot of work to maintain, but I love being there. We’re maybe 33% complete with the build; it’s my “third job” as I call it, although when I look at the view it doesn’t seem like work!Currently, I’m working on a new medical invention, a pain relieving brace device I designed for treating Tennis Elbow. I’m very excited about it, and so far it seems to be very promising. I have several parties in China who are very interested in manufacturing the device as a new and better treatment for tennis elbow. May potentially help many stand up paddlers too, look out for the Super Tennis Elbow Brace soon!”
Considering his professional success, thriving family, service to the public, entrepreneurial pursuits, and surfing frequently, you wouldn’t be alone in thinking that Leland Dao lives an idyllic lifestyle, and you wouldn’t be too far off base. “I must say I have been very lucky in the experiences I’ve had in my life. The ocean and surfing have always been such a big part of my life, from my early days growing up in Southern California, to the decision to move to Hawaii and the North Shore. It has been an amazing ride, which is still going strong! I’m glad my parents pushed me to work hard and do well in school, and somehow I’ve been able to combine my work as a physician with my lifestyle choice as a lifelong surfer. It has been a great career choice, and I love my job as a health care provider, always working to help others. In Hawaii, we get to work with so many surfers and athletes which is an added plus! As a teaching physician I work with a number of young physicians and medical students, and one thing I always remind them is that they will have to make what they want in their lives and career. So with lots of hard work, and a bit of luck you might just have your life dreams come true.”
* For more information on Dr. Dao’s credentials and practice, visit him at the Kaena Kai Clinic (located at 66-214 Haleiwa Road) or online at http://www.drdaohi.com/.
Coming up this month on Oceanic SURF Channel
• Replay of the 2010 Billabong Pipeline Masters. See 10X World Champion Kelly Slater get a perfect ten at Backdoor, and darkhorse Frenchman Jeremy Flores become the first European surfer to win the Pipe Masters.
• More scintillating pro surfing action on Oceanic SURF Channel, April 19th - 30th with a live broadcast of the 2011 Rip Curl Pro from Bells Beach in Victoria, Australia. Bells is one of the most prestigious events on the ASP World Tour as the world’s top professional surfers battle for the highly coveted Bells winner’s trophy and a share of the $425,000.00 cash purse.
