Everyone loves a good origin story

Here's Ours:

     Dr. Ash Sangoram is an MD PhD who trained under two National Academy of Science neuroscientists and is currently a practicing neonatologist.  An avid golfer, Dr. Sangoram has implemented his fundamental expertise in neuroscience into his own golf practice dropping his handicap by 15 points while recovering and rehabilitating from a spinal cord injury.  He has used his own experience and academic expertise to create a golf  improvement approach based on a cohesive set of neuroscientific practice principles.   As a volunteer assistant coach to the Stanford Golf team, Dr. Sangoram has brought these principles to the team to improve performance. He founded GoaLoGolf to help elite golfers transform themselves into applied neuroscientists and elevate their games along the way.  To find out more and see if you are a candidate for a revolutionary approach to game improvement, you are invited to apply for a consultation with Dr. Sangoram.

In his own words:

   I undertook a PhD in neuroscience mainly because I saw it as the absolute hardest nut to crack.  How does the brain allow us to do the myriad things that we are capable of?  I started with a narrow question of biological clocks.  What is the fundamental mechanism behind our brain's ability to tell time?  Using cutting edge genomic techniques, I helped piece together the discovery of the very first gene involved in the generation and maintenance of biological clocks.  It was exhilarating work.  I almost missed watching Super Bowl XXXI on Jan 26, 1997 because that was precisely the day I had cooked into the lab to get some sequence analysis done prior to watching the game with friends.  The morning started out as an ordinary grinding session of sequence editing, a basically thankless task of cleaning up DNA sequence data so that we could start to glean what mysteries lay in this haystack of data.  I did not expect to find the needle... With the afternoon sleuthing running right up to game time, I found it.   There within the 200,000 base pairs of DNA which we had narrowed our candidate region, gleamed a glorious candidate: 24 exons (we joke that there's one for each hour of the day), 100,000 base pairs from tip to tail, and it was a transcription factor with a domain that suggested it could interact with a biological clock protein only found in fruit flies! A whale of a smoking gun for the first biological clock gene we had been hunting for in mammals. The interaction domain (dubbed PAS) was an incredibly weak hit, one that the computer algorithms were saying was not even statistically significant when we first noticed it months before.  But on THAT Super Bowl Sunday there was a new addition to the Genome project database, a gene with a much closer match to our candidate's PAS domain.  I lived the scientist's dream that day with a true Eureka! moment. Needless to say months of work ensued pinning down this discovery and painstakingly proving that this gene was the real deal. Continuing to use my newly developed database sleuthing skills I uncovered the mammalian gene equivalent for the fruit fly clock gene, timeless. In order to show that the mouse and human genes I found had similar function to the fruit fly counterpart, we engaged in a fruitful collaboration with Michael Young’s lab at Rockefeller to connect their original discovery of timeless (and its function) with our candidates. Michael Young was co-awarded the Nobel Prize in 2017 for finding period and timeless in fruit flies. It was amazing to have been part of the first extension of that Nobel Prize winning work into mammals 20 years prior.

  During this time in 1997 a few other interesting things happened.  April 10-13, the Masters was held and an upstart 21 year old ascended to a 12 shot victory, a harbinger of his transcendent golfing greatness.  A fan of sports in general, I too was swept into the tidal wave of popularity that ensued for the game of golf.  My younger brother had already started playing golf during his high school years and he got me interested in trying it out.  Applying the club-head to the ball to get a cornucopia of results (mostly bad but occasionally life-changingly scintillating) became a fascination for me, but one that was curtailed by the rigors of completion of my PhD thesis and return to medical clerkships (and later pediatric residency and neonatology fellowship).  Any real golf play would have to wait until my 32 year training period came to a close years later...

   With early golf outings and during continued work in the lab in the fall of 1997, I noticed another curious thing.  I started to get buzzing sensations shooting down my arms and feet every time I lifted my chin above the horizon.  Almost like touching a live wire with every extremity at the same time, very strange.  I also noticed at this time that my resting heart rate had dropped into the 30's and on one occasion I measured it at 28.   As a Chicago native, I was well aware of the lore that Michael Jordan had a resting heart rate of 38.  I used to joke with friends that I had MJ beat when it came to conditioning.  While I was physically active at this time, I was nowhere near the condition of an athlete with this kind of low resting heart rate.  Rounding out my symptoms were neck pain in the mornings and a pronounced briskness in my patellar tendon reflex.  I had noticed that I was getting every so slightly weaker in the gym despite a fairly consistent workout routine and the thing that finally got me to go to the doctor was one fall day in 1997 I went swimming for a short session of breast stroke at the Northwestern Sports and Aquatics Complex and could barely lift myself out of the pool.  Weak with buzzing paresthesias, I dressed and headed out to the basketball court to see if I could shake off the symptoms playing a game of pickup basketball.  Up and down the court I found myself tripping over my own feet, weak and uncoordinated and was soundly outplayed by a guy I knew I had owned on the court in years past.  I put my tail between my legs and went home.  Not having the benefit of undertaken my clinical clerkships for medical school just yet, I sought the advice of my mother, an internist.  When I made the extent of the symptoms clear to her, the worried look on her face was impossible to camouflage and she immediately sent me to a close colleague who was a neurologist.  Dr. Ilahi was a mentor of sorts even before becoming his patient.  He was among the voices that convinced me that I should pursue an MD PhD rather a PhD alone.  It was a hedge for someone unwilling to close any door, he related. "And you don't yet know what you want to do... Nor should you at 27 years old"

    "You have the classic sign of L'Hermitte", said Dr. Ilahi referring to the buzzing sensations I had when flexing my neck.  He astutely diagnosed a cervical spinal cord problem that was not going to be identifiable without an MRI.  The scan was scheduled for 3 days later and these 3 days were spent agonizing over the possibilities... A slow growing cancer? Multiple Sclerosis?  Could this be why I had noticed the symptoms come on so gradually over months (if not even earliest weakness symptoms dating 2 years prior?)  I went into a hazy but hyper-calm state during this waiting period. Whatever it was, I had no real control over and there was no real point in machinating over it.  Unlike with gene discovery, hours of cognitive gymnastics and analysis was not going to change what was already brewing.

   The loud buzzing/knocking of the MRI chamber occasionally woke me with a startle during the 45 minute scan as I tried to snooze through it.  The tech knew I was a medical student and deliberately kept me from looking at the images before Dr. Ilahi and the neuroradiologist had a chance to review it.  Truth-be-told I would have had little clue what I was looking at,  I was great at finding genes in the middle of a vast mass of sequence data, but imaging of the neck and spine were not yet in my wheelhouse.  A day later, back in Dr. Ilahi's office, the news came.  It was NOT a Tumor! (/schwarzenegger).  It was however a herniated cervical disk at C5-C6 that was pressing on my spinal cord and my neck movements were causing it to indent the spinal cord, eliciting the symptoms described by the French neurologist Jean L'Hermitte.  This diagnosis was of course odd, as I had suffered no trauma and I couldn't recall a singular event where the symptoms had started.  Nevertheless it was the least of many evils and it was (partly) fixable.

  I had surgery to remove the disc and fuse the C5 and C6 vertebral bodies in October of 1997.  All the while waiting for the surgery my scientific/innovative juices were flowing... Why couldn't we replace the disk with an artificial one that would preserve movement in addition to alleviating the pressure on the spinal cord?  Alas, no such artificial disc was available (and FDA approved) in the United States.   Time was of the essence as the surgery came during a period of work in the lab where I had discovered another biological timing gene in mammals called Timeless, ironically.  But there were competitors hot on my tail and I didn't have the luxury of time to waste recovering from surgery...  One week after the surgical procedure I was back at the bench scrambling to piece together the data fitting Timeless into the biological clock puzzle.  I did also pay attention to my rehabilitation routine and I was back on the basketball court after a few weeks able to shoot around and for a brief interval of one week (about a week after the surgery) was almost completely symptom-free.  Some symptoms crept back in over time and I had to work extremely hard to maintain strength.

  I had had an intimate encounter with the practice of neurology and it certainly fascinated me.  However it was clear to me that while a neurologist knew the workings of the brain, their modus operandi was to take patient's declining neurological function and deduce where in the nervous system the problem must have originated.  Clever Sherlock Holmes work for sure, but overall pretty depressing (even for a case like mine where I experienced improvement with treatment)  But it was not the neurologist doing the surgery, only the diagnosis. Neurosurgery on the other hand was out given my condition, as long hours stooped over brains in the operating room would have ruined my neck for good (and likely well within the span it takes to finish a neurosurgical fellowship).  So with this experience behind me, I was at a professional juncture to wrap-up my PhD (having found two of the first 5 genes involved in biological clocks) and embark on the parallel path of finding a medical specialty to couple with my neuroscience interest.  Some collaborative work led me to spend 6 months towards the end of my PhD in New York in a developmental biology lab at NYU headed by Alexandra Joyner.  There I rubbed elbows with scientists who were interested in how the brain develops.  The images they were producing of neural circuitry were absolutely incredible! It started me thinking that I would really want to spend some time in post-doctoral work studying the mechanisms of how the brain's architecture was constructed. But it was time to finish my medical degree.

  I returned to the wards on a high of having achieved a nice body of work for my thesis but without a firm idea of what clinical discipline I would pursue in order to best intersect my research interests  with the practice of medicine.  My first rotation back was pediatrics and it became clear not long into my clerkships that this was the best choice for me.  I loved working with the vibrancy of youth.  Even when sick with grave illness, children possessed a light in their being that shone bright enough to keep me connected to and fighting for their well-being. I matched at Massachusetts General Hospital for my pediatric residency and I went about the grueling 3 year pediatric residency with an open heart for my patients' conditions and an open mind looking for an area to focus my research efforts.  I managed a modicum of time to maintain good physical shape as well running three Boston marathons and two Chicago marathons during the course of residency.   Golf took a back seat for these years but I managed to get a few rounds in.  A memorable round at Stowe acres started off with me getting a Standing Ovation from the first tee... I had teed off in a downpour and was determined to get the round in with my limited ability to get out.  The rain let up by the 3rd hole and I had the course to myself.  These were the best type of rounds for me, nobody out there, with the ability to fiddle with my game the way a scientist would. I didn't know it yet but it was during this period that the seeds of GoaLoGolf had started to germinate below the surface.

    But pediatrics was a bit of left turn for a neuroscientist... Would it be pediatric neurology? or perhaps medical genetics?  Too depressing and those fields came without the hands-on immediate rewards of diagnosis AND cure that could perfectly complement a budding career in long, hard investigative research.  I settled on neonatology, the intensive care of the newborn, as it afforded me the ability to take care of kids with neurologic defects but also the bread and butter premature infants that a neonatologist treated did very well with short durations of intervention.  And saving a life, saved a life for a true lifetime.   I packed my bags at the end of three great years in Boston and was off to Palo Alto the train as a neonatologist at the Lucile Packard Children's Hospital.

     A major part of neonatology fellowship entails research and for this work I picked Matt Scott's laboratory to pursue neurodevelopmental work, understanding how the brain gets its structure.  Working specifically on the cerebellum, the coordination, error-correction processor in the brain, I peered into depths of the structure, at the layers containing the granule neurons and Purkinje cells set up like a lattice.  I was amazed at the solution evolution had come upon for what is the fastest processor that has ever existed.  This structure is responsible for us being able to catch a baseball, hit a golf ball, walk and chew gum... basically anything that requires body coordination gets its signals monitored and massaged by this processor at the base of the brain.  Using engineered viruses and genetically engineered mice that I constructed I started querying the structure for it's secrets.  Confocal microscope images of Purkinje neurons glowing green with jellyfish flourescent protein would dance in my thoughts and dreams as I looked for mechanisms which controlled their organization.   While contemplating fields of green neurons, my thoughts wandered to the equally green fairways and greens of the Stanford Golf Course nearby.  When I started fellowship I had bought a 10-play pass at the Pro Shop and on the last weekend of fellowship, I begged Herman McKee to take the last 4 punches of the card and use them towards my dad's green fee as I played only the 6th full round of my four-year fellowship.   A thought struck me as I played, elite golfers out there had no knowledge of the circuitry that I worked on for last 4 years, nor the other specialized systems of the brain.  While they obviously had trained these systems to perform incredible feats of tool implementation, I was convinced they could benefit from a novel approach to getting the most out of their practice.  

   I approached Conrad Ray, head coach of the Stanford Golf Team with this crazy idea.  Why not apply the power of neuroscience to golf training? I'd present an overview talk to the team about the importance of the cerebellum and get them involved in a study to test a hypothesis that taxing their cerebellums with difficult balance poses could improve their dispersion patterns with full shots.  This study yielded a number of insights into performance improvement methods and started my journey into applying my neuroscience expertise to the realm of golf in earnest.

   GoaLoGolf was born out of the vacuum of this type of applied neuroscientific work in the world of golf.  In short, I want to turn each golfer I interact with into an applied neuroscientist of his/her own right via neuroscience education and coaching.  I remain convinced that the techniques I employ are important scaffolds on the practice complex but must be fully discarded and the trained brain trusted to play golf without interference of these thoughts when out on the course.  As such my philosophy is not for the student of the game to build any kind of reliance on me or my knowledge-base but rather allow it to set their games free.  While I focus on the elite athlete, I also give a TED-esque entertaining Neuroscience of Golf for all golfing audiences.  I've delivered this talk at various venues including at The National Golf Links of America, Northwestern, Stanford Men’s Club, and the Kaiser Permanente annual golf outing.  I trust that you will be delighted with the results of trying my methods out as you seek to improve your game! 

A. M. Sangoram MD PhD