A Great Conversation With John (Jack) B. Selhorst

Kathleen Digre (KD): Today we have the great pleasure of speaking with Dr. Jack Selhorst, the former Chair of Neurology at St. Louis University (SLU) and, also, a past president of North American Neuro-Ophthalmology Society (NANOS). We are so excited to have you join us in this great conversation. Please tell us about your background, and how you decided on a career in medicine.

Great Conversations Section Editors: Meagan D. Seay, DO Rachel Calix, MD A Great Conversation With John (Jack) B. Selhorst Meagan D. Seay, DO, Rachel A. Calix, MD, Kathleen B. Digre, MD K athleen Digre (KD): Today we have the great pleasure of speaking with Dr. Jack Selhorst, the former Chair of Neurology at St. Louis University (SLU) and, also, a past president of North American Neuro-Ophthalmology Society (NANOS). We are so excited to have you join us in this great conversation. Please tell us about your background, and how you decided on a career in medicine. Jack Selhorst (JS): I entered the world as my family’s third son in a small, agricultural town in northwest Ohio with the imperial name of Napoleon. Boyhood was idyllic, but formal education was limited. For high school, I was sent to a prep school, Gilmour Academy, near Cleveland, Ohio. The experience in meeting others from around Ohio and the Midwest was broadening. Instruction was challenging, and the academic prowess of my classmates was impressive. In my junior year, the Russians launched the first space satellite, Sputnik, and a public outcry swelled for the promotion of science. At the same time, a close friend decided to choose medicine as a career as his father had. His father was a model physician who engaged well with people, including me. So, liking science and people, I aimed at medicine for a career. After having attended school in the Midwest, I was compelled to look beyond for college. The West was my desire, but too far away for my mother. I delayed applying until our headmaster recommended a small Jesuit college in the South with a strong pre-med program. Alas, in the fall of 1959, I found myself at Spring Hill College in Mobile, Alabama. KD: How did you select neurology as a career and ultimately come to neuro-ophthalmology as a subspecialty? JS: From Spring Hill College, my best ticket back into the Midwest for medical school was to SLU. After graduation in 1967, I remained there for 2 years in internal medicine. During that time when many of my colleagues were choosing a subspecialty, I rotated through a 2-month stint in neurology. The instructor was Robert M. Woolsey. His easy manner and wide range of knowledge had already inspired a cadre of students to enter his subspecialty. So, I elected another month with him and afterward decided on neurology for a career. Dr. Woolsey advised me to seek a Departments of Ophthalmology and Neurology (MDS, KBD), University of Utah Moran Eye Center, Salt Lake City, Utah; and Departments of Ophthalmology and Neurology (RAC), Ochsner Medical Center, New Orleans, Louisiana. The authors report no conflicts of interest. Address correspondence to Meagan D. Seay, DO, 65 Mario Capecchi Dr., Salt Lake City, UT 84132; E-mail: [e-mail] e558 residency at Case Western Reserve University back in Cleveland, Ohio. The faculty there were very accomplished neurologists and distinguished teachers. The program chairman was Joseph A. Foley who was as charming and affable as he was brilliant. Consequently, as a very congenial and principled administrator, he was a leader in academic neurology. The residency choice was not only sound for its instruction but also fortunate for me in 3 important ways. First, when I arrived, any hint of a neuro-ophthalmologic disorder provoked a response that a thorough discourse would likely come when a coresident, Jim Corbett, returned from an elective in San Francisco with William F. Hoyt. Jim’s frequent accounts about his experience in San Francisco and his discussions of all things regarding neuroophthalmology caused me to purchase the 3-volume, third edition of Walsh and Hoyt. In 1969, $500 was a hefty lift for a book. But as a comprehensive, well-illustrated, and thoroughly referenced text, it was much more than worth it. Second, just before I entered my third year, I was told that my 3-month elective would begin in July, and I needed to designate what it would be. I was so busy trying to be a creditable neurology resident and enjoying it all, I hadn’t thought about the forthcoming elective. Immediately, Jim Corbett’s elective was the one that stood out as the most rewarding. Fortunately, several resident positions were funded by a National Institutes of Health (NIH) grant to promote training in neurology. The department chair was able to set the regulations. Hence, resident stipends were available for 3-month electives at other institutions. Jim warned me that Dr. Hoyt’s program was uniquely demanding. Rounds began at 7:30 AM and ended after all admissions to the University of California San Francisco (UCSF) Hospital had been screened for a neuro-ophthalmologic disorder. Those cases relevant to neuro-ophthalmology were reviewed with Dr. Hoyt by telephone, and he then assigned several pertinent references from his index of hundreds of 399 · 599 cards. These were to be read before presentation the next morning. After rushing to the library and making copies of the articles for whomever was rounding (students, residents, and fellows), we often finished between 7:30 and 9:00 PM Fortunately, Bill and I matched up well in being curious and reflective about all things in medicine. His demand for excellence was a challenge to which I responded. At the outset of the elective, I asked Dr. Hoyt about his book on the ocular fundus, and he gave me his copy. With a thorough reading, my funduscopic skills went Seay et al: J Neuro-Ophthalmol 2022; 42: e558-e561 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations from near zero to a high level of competence. After 3 months, I was hooked on neuro-ophthalmology. Third, toward the end of my residency, Dr. Foley ran into the head of neurology at the National Naval Medical Center (NNMC) in Bethesda, Maryland, and recommended me. That facility was a Navy referral center for the whole East Coast, and I spent my entire 2-year tour there (Fig. 1). Besides the experience in general neurology, I was able to form and staff a clinic for neuro-ophthalmology cases. Moreover, I established a relationship with David Zee and David Cogan who were both located across the street at the NIH. We were delighted to invite them over from time-totime to round and discuss interesting patients. While in the Navy, I inquired about a fellowship with Dr. Hoyt who insisted that fellows bring their own funding. No such opportunity developed. Then, Dr. Hoyt called me and suggested I apply for a Heed Fellowship. It turns out that the UCSF Chair of Ophthalmology was on the panel selecting Heed applicants. I suspect this relationship boosted my selection, but I turned it down when a NIH fellowship was awarded to study retinal nerve fiber layer disorders. That project floundered, but the fellowship was hugely eventful. When I arrived in 1974, a neurosurgeon from Israel was there, Moshe Feinsod. Together, we published the first use of evoked potentials during surgery when an implanted light-emitting diode on a contact lens stimulated the optic nerve during pituitary tumor surgery (1). We also published a report of midbrain corectopia, FIG. 1. Lieutenant commander John B. Selhorst, NNMC. Seay et al: J Neuro-Ophthalmol 2022; 42: e558-e561 proposing the shape of the oval pupil resulted from segmental denervation of the iris caused by an invasive brainstem tumor (2). Many others who passed through during that time became accomplished neuro-ophthalmologists. Tom Shults was a cofellow and wonderful colleague for 6 months. For 2 months, we had Creig Hoyt and Ivor Levy, the latter from London. Neil Miller came from the Wilmer Eye Institute for 4 months. We were fortunate that Larry Stark, a neurologist and bioengineer at the University of California Berkeley, joined us in an effort to establish an eye movement laboratory. With the help of his postgraduate assistant, Al Ochs, we studied saccadic overshoot dysmetria in patients with cerebellar tumors. During that time, a patient presented with continuously widening and then diminishing horizontal eye movements that developed after a hemorrhage in the vermis of his cerebellum. Amazingly, Dr. Hoyt pulled a very similar case from his files from some years before, including a limited eye movement recording and a hemorrhage in the cerebellar vermis. Eye movement recordings of our patient were identical to computer models Larry Stark had made earlier in which a visual stimulus was programmed to produce progressively larger saccades. Consequently, we predicted that our patient’s macrosaccadic oscillations would stop in the dark, and they did! We reported these studies showing a high gain in saccades with disinhibition of the cerebellum in 2 articles (3,4). Shortly after this work, Ralph Sawyer came for several weeks from the NNMC to finish a manuscript on a patient we saw in the neuro-ophthalmology clinic there. The elderly patient developed a rapid loss of vision because of degeneration of her photoreceptor cells related to metastatic lung cancer (the term paraneoplastic was not used in those days.) This report came together when Ralph found a similar but misidentified case in the British literature, and Dr. Hoyt pulled another case from his files that he had mulled over 7 years earlier. Ocular pathology was consistent in all 3 cases (5). For all these reasons, the fellowship was immensely exciting and provided an unparalleled experience. Moreover, I was very confident about pursuing an academic career. KD: Well, after a year like that, how did your academic career unfold? JS: At Dr. Hoyt’s suggestion, I began attending the Frank Walsh Society (FWS) meetings in 1972. There I met a likeable neurologist, John Harbison, from the Medical College of Virginia (MCV) in Richmond. He had established a division of neuro-ophthalmology within the neurology department with a high clinic demand and was looking for an associate. I joined the faculty there in 1975, and my neuro-ophthalmologic skills soon proved very useful. Within several months, I identified 3 patients with idiopathic intracranial hypertension resulting from a toxic exposure to the insecticide, chlordecone or kepone. In another case, funduscopic examination showed patchy infarctions of the retina in a woman with confusion and a microangiopathy of the brain, later known as Susac e559 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations syndrome. With the considerable help of Robert Saul, a consummate fellow, and an interest in Uhthoff symptom, we found that visual loss and visual-evoked potentials while exercising was associated with a conduction block with only a meager elevation in temperature. Nine years went fast, and I was asked to be the interim chair of the department. At the same time, I was invited to consider chairing the Department of Neurology at my alma mater, SLU, which I eventually accepted. As 10 years ended, I encountered a man with rhythmic, converging eye movements that were synchronous with jaw closure, which we termed oculomasticatory myorhythmia (OMM) (6). More than a dozen similar cases have been identified since then, all due to Whipple disease, very well making OMM one of the rare pathognomonic signs in clinical medicine. Beginning in 1985, I chaired the Department of Neurology at SLU for 22 years and remained there for another 7 years (Fig. 2). Clinical demand for neurology and administrative work provided less time for neuroophthalmic observations and publications. However, I maintained a weekly neuro-ophthalmology clinic, and, thankfully, after several years, Sophia Chung came to staff and grow the service there. We became close colleagues, and I was delighted that she was so capable (Fig. 3). My contact with the ophthalmology department led to my being asked not once, but twice, to serve as interim chair, totaling nearly 4 years in all. Afterward, 6 years were devoted to the NANOS Board, 2 as president. I truly enjoyed this wider FIG. 2. Chairman years, SLU. e560 FIG. 3. Sophia Chung and Jack, NANOS. opportunity to engage with colleagues throughout the United States and abroad. Members are typically highly dedicated and delightful individuals. My wife and I have often said that the nicest professional people we know are FWS-NANOS members. Additionally, a friendship that developed with Tom Carlow was particularly gratifying. Finally, the need and demands for instruction allowed me to exercise a true passion for teaching students and residents throughout my career. As I look back, this is what I enjoyed the most and miss the most. KD: What was your role in the merger of the FWS and the NANOS? JS: This is a bit of a story. For many years, I regularly attended and presented at the FWS. I also urged and assisted residents and fellows to present there, too. Attendance at those meetings steadily grew. In the mid1980s, I was invited to participate in NANOS. Both meetings were in the winter and often just weeks apart. Many others attended both meetings, too. Because of the expenditure of time and money, grumbling developed, and in the late 1980s, murmurs for a merger grew. However, no movement or discussion from the leaderships evolved. Finally, in 1994, back-to-back meetings were scheduled in Salt Lake City. Then, Stanley Thompson, who was a highly respected neuro-ophthalmologist at the University of Iowa and I composed a letter to all concerned neuro-ophthalmologists to meet in the brief period between the 2 meetings. After a general Seay et al: J Neuro-Ophthalmol 2022; 42: e558-e561 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations discussion, 78% of the group voted for a merger which some considered a mandate. After 2 more years passed, the leaders of the 2 organizations agreed to shorten their meetings by one-half day each, and the current format of FWS on Sunday and NANOS over the next 3 and onehalf days took form. KD: What part of your career would you never guess you would end up doing? JS: For sure, I never anticipated being the interim chair of the Department of Neurology (MCV) and later twice the interim chair of the Department of Ophthalmology (SLU), nearly 5 years in total, plus 22 years as a full-time Chairman of Neurology (SLU). KD: What do you consider your biggest success? JS: Well, there are different types of successes. First, personal, and foremost, my decision to marry my wife, Mary. She is a great partner and is immensely supportive in all that I engage in. She has also been a faithful, inhouse editor for many of my writings. With her, I have 2 beautiful and wonderful daughters and, in turn, 2 fascinating granddaughters from each and 2 admirable sons-in-law. In my academic career, I am very proud of the wide range of my original observations in neuroophthalmology. Always looking for something novel and interesting was no doubt a carryover from my fellowship days when we scoured hospital admissions at UCSF to present on neuro-ophthalmology rounds the next day. I am equally proud of the success of many talented residents and fellows in whose training I was involved. Through them, I reach many more patients than I could have myself. Many remain personal friends to this day which is very special to me. KD: What advice would you give to those who are early in their career? JS: First, keep in mind that perseverance is the key to success. Second, engage with all those who have an enthusiasm for the mechanism of disease and its treatment. Third, contribute as best you can. Your life will then be more fulfilling. KD: Finally, what do you read, and what do you do in retirement? JS: I have recently read Porgy by DuBose Heyward. His familiarity and depiction of the Gullah community in Charleston, South Carolina, is remarkable. He lived just down the street from them and used their form of speech in the book and later in the musical Porgy and Bess. More often, I read adventure books, such as Endurance by Alfred Lansing and River of Doubt by Candice Millard. In retirement, I wanted to maintain an interest in medicine, but, more so, focus on other interests. Consequently, I read several weekly journals (Journal of the American Medical Association and Neurology), review an occasional paper, and maintain contact with former residents and colleagues. Much more of my time Seay et al: J Neuro-Ophthalmol 2022; 42: e558-e561 FIG. 4. Hosting friends at home, South Carolina. is spent exercising, golfing, playing bridge, and developing friendships in the Charleston, South Carolina, area (Fig. 4). ACKNOWLEDGMENTS Drs. M. D. Seay and K. B. Digre are supported in part by an Unrestricted Grant from Research to Prevent Blindness, New York, NY, to the Department of Ophthalmology and Visual Sciences, University of Utah. REFERENCES 1. Feinsod M, Selhorst JB, Hoyt WF, Wilson CB. Monitoring optic nerve function during craniotomy. J Neurosurg. 1976;44:29–31. 2. Selhorst JB, Hoyt WF, Feinsod M, Hosobuchi Y. Midbrain Corectopia. Arch Neurol. 1976;33:193–195. 3. Selhorst JB, Stark L, Ochs AL, Hoyt WF. Disorders in cerebellar ocular motor control. I. Saccadic overshoot dysmetria. An oculographic, control system and clinico-anatomical analysis. Brain. 1976;10:497–508. 4. Selhorst JB, Stark L, Ochs AL, Hoyt WF. Disorders in cerebellar ocular motor control. II. Macrosaccadic oscillation. An oculographic, control system and clinico-anatomical analysis. Brain. 1976;10:509–522. 5. Sawyer RA, Selhorst JB, Zimmerman LE, Hoyt WF. Blindness caused by photoreceptor. Degeneration as a remote effect of cancer. Am J Ophthalmol. 1976;81:606–613. 6. Schwartz MA, Selhorst JB, Ochs AL, Beck RW, Campbell WW, Harris JK, Waters B, Velasco M. Oculo-masticatory myorhythmia: a unique movement disorder occurring in Whipple’s disease. Ann Neurol. 1986;20:677–683. e561 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.