Welcome to the Dr. Gabrielle Lyon show where cutting edge science meets innovation and practical application for everyone. In today’s episode, I sit down with the epic Dr. Vonda Wright. She is an extraordinary physician, physician, scientists, and truly changing the game in women’s health. Now, as always, I hope you enjoy this episode and in this conversation with Dr. Vonda Wright. 

Thank you so much for coming on the show. I am very, very excited. In fact, I would say I am more excited to talk to you than I think now, now friends that are listening that have been on the show. Don’t take this the wrong way, but I’m so excited to have a conversation with you. I feel like we’re old friends and we’re just sitting in front of each other for the first time. I absolutely agree with you. You are a mom, you are a mom, you are a mom, you are a mom. You are a surgeon, you are an innovator. You’re so many things. 

What I want to know to start is how, why, how are you here? 

How did I work hard enough to get to this place and still standing or? Yeah. Is that what you’re asking me? Let me, let me ask it in a little different way. It takes a lot of sacrifice. It takes a lot of grit and resilience to even become a doctor. Let’s just say to become a physician, but then to become a surgeon and to be a mother, but even before that you had a bit of a non-traditional beginning. Yeah. 

And I’ll just, I’ll just end with this one last thing is that it’s in those moments of transition that you really see what someone is made of. Cause you could have just kept doing what you were doing. I could have been really happy there. So, you know what? I think I love it. You give me the opportunity to talk about this road of mine because I was just invited by a group of women doctors to talk in their event and guess what? They want me to title my talk something about the long view or the long road. And I said, are you just doing this because I’m getting older and you think that 30 years is enough story to tell. Yeah. But you know what? I was fortunate to be raised by two of the hardest working people that I know there, and so I didn’t know any other way ever that education and hard work would get us off, get me off the homestead where we lived on land that our family had gotten from the government in the 1800s on a farm, right? And, and I understood that my father was the first in his family to get a master’s degree. My mother, who immigrated here at 21 with nothing and made a life from her in a new country. Education was the key. So I left the farm. I went to college in Chicago. Where? What farm? Wheaton. I went to college in Wheaton College in Chicago, right outside of Chicago. My father had gone to graduate school there. So I was a little bit of a legacy and I went sight unseen.

I’d never seen it. I just thought, OK, well, let’s just find a place to get a great education. Where did your where did your mom immigrate from? My mother is Chinese from Hong Kong and she was raised in British Guyana, which is on the tip of South America. She and her nine brothers and sisters. And I love her work ethic because as the oldest of nine in a British school system, you’re done at about 16 and she could have just stayed and managed the stores that my grandparents had. But she was going to get out of that country, which is now totalitarian. There is no future there. So this woman took a secretarial course, saved a thousand dollars and took off for California where she went to college. Right. And the funny story is that my dad met her and tried to date her. And she’s like, I did not come here for an MRS. I came here for a BS. Now let’s not talk. But he must have won her over. So these two really hardworking people, it’s all I’ve ever known. And they all they ever said to me was, Vonda, you can be anything you want to be. And I never questioned that I could be anything I wanted to be. And I’m really smart and my brain can memorize a lot of things. And at the time in the 60s, smart people became doctors. I mean, now that’s not so tracked, right? But at the time you’re like, OK, so you’re smart. Go be a doctor. 

And so that was the trajectory I went on. And then in college at Wheaton, this is lesson number one. 

One failure does not predict your future. So in college, I show up right from a small farm town in Kansas. And it was a big adjustment to learn to study at the level that I needed to succeed at a college that was pretty high level. So I failed my first organic chemistry exam in my sophomore year. Nobody told me that that was not the end of my medical career. They’re like, oh, I guess you should find something out bad counseling. I didn’t seek hard enough. By the end of the semester, I had had a B, but one failure does not predict your future. So I had pivoted where I would I was going to do by then. And so after I got a degree in biology, which if you’re counseling, your children is not an entirely useful degree. Biologists out there don’t hate me. But you got to go to grad school to use biology, right. So I had a degree in biology. So I went to grad school and in three years I got another bachelor’s and a master’s degree in oncology nursing. And then it was in the early 90s. I was staffing a cancer floor where we were treating a lot of women with breast cancer. At that time, it wasn’t as curable as it is now. We were doing the tamoxifen, the GCF and the and the Zofran trials. It was it was at Rush, a very academic place in Chicago, in Chicago. I know exactly where that is. And then I after six years of that, I became the second in command at the Rush Cancer Institute under the chairman and learned so much at a very young age about life and work and what I wanted to do. And ultimately, I decided to go back to medical school, which was the always the direction when I was 28, because I could have gone into business. I was interviewing on that pathway. I could have gotten a PhD. It would have been very easy to get a graduate degree. But I decided ultimately I wanted to care for people and do great research. And as a physician, you can do both. Right. And so that’s what I did only to choose the longest frigging pathway like orthopedic. I know. 11 years later at 39, I emerge and start this orthopedic career. So that’s how I’ve gotten to orthopedics as a career. But how orthopedics because you were working with cancer and you were seeing women with breast cancer and they were reducing their estrogen, right? Tomoxifen. 

Was there but you’ve been a lifelong athlete. I was. OK, how how why we are orthopedics from cancer. And is that one reason why you circled back really as an advocate for women’s health because your early career or is kind of a different trajectory? It’s all tied together. It seems circuitous. It is not. It is pretty linear. 

So in medical school, do you remember how personalities just divided? There were the medicine people who like to circle the doorway with all the data and think about it a lot. So funny. The different architects. Yes. And then there’s the surgeons who want to assimilate the information, make a decision, go to the OR. And thankfully, I come from a farm in Kansas and I have mad hand skills. Right. So coupled with my decision making process, which is more surgical, my I have actually good, very good hands. They can my brain can see something in my hands can do it. So I knew I had to do surgery. And then in choosing surgery, I tried a bunch of different things. I can’t stand secretions. So I can’t do. 

Yeah. Colorectal surgery was out. None of that. But, you know, the beauty of orthopedics is I get to treat people from birth to death. And here’s the driving mantra of my entire career. When I make you walk again, when I save your mobility, I am going to save you from the ravages of chronic disease. So it is more than just putting muscle and bone. It is more than the technical aspects of reconstruction, which I’m all about. You know, I love new technology, but the fact that I am actually saving lives in the same way that I did when I was a cancer nurse by being an orthopedic surgeon really drives me. It’s why I get up every morning and make the donuts, if you will. It would never be enough for me just to be an orthopedic technician, meaning just put the metal in and walk on because I am a whole person surgeon. Every person coming in, if a man comes in bursting his tendons everywhere, we’re going to talk about his testosterone. If a woman comes in and has is in midlife, we’re going to talk about the hormonal changes because it affects everything. 

And that’s one of the things that makes me different. Well, I would argue that there’s many things that make you different. You’re extremely well thought out. You I think that there’s just

layers to think about as your career as a physician, but also as truly an advocate. You know, I had asked you before we started recording, what is the thing that you are most excited about? And your answer was that women are rising and people are listening to the message that has been my same message, not that it’s not new and fresh, but the message that you are worth the daily investment in your health and that by investing every day in your mobility, you can change the trajectory of your health. I have never, ever believed that aging is an inevitable decline from the vitality of youth. Down a slippery slope to frailty. And yet, Gabrielle, I still have to take call even this many years in and I see the future of men and women today who are dying of frailty, laying in bed and excruciating pain incontinent for women in particular with hearts so bad that I can’t even clear them for surgery with either a touch of dementia because they’re sick or full on Alzheimer’s. But do you know what they’re saying to me? And usually their daughters who are at the bedside, it’s usually the daughters. They’re saying, I was once like you. 

How did I get here? 

Don’t ever get here because they want to be remembered as the vibrant people they were in midlife, not as the frail person who is no longer in control. So if I can do anything to get in front of that for myself and the people that I serve, that is work worth doing. 

We shall take a minute and just take that in. It’s powerful. 

So it drives me. And it’s not easy, right? People probably thought you were crazy. They still do. I love my orthopedic brethren. 

Bros. Bros. I love you. I am here to save you from becoming frail old men. But you know what, Gabrielle, I have always had to publish my work outside of orthopedics because there was not an ear to musculoskeletal aging or whole person. And that’s OK. I mean, orthopedics is what it is and I love them. 

But to get to serve the most people in the way that I want to serve people, we just find other avenues. And where where does this service come from?

Just yeah, this this servant leadership. 

You know what, I was raised in a home that that revered God and service was at the heart of my father. My father is a servant leader. My mother gave up her own career. My brother, my mother is more brilliant than I am. And she just it wasn’t the time she’s 84. It was not the time in this country for her. But they’ve always done it. And I think I just learned it. Yeah, it became a really strong driving value. Yeah, I don’t know another way. 

That makes it very powerful because that makes an individual unwavering in the pursuit of excellence and the pursuit of real change. Yeah, which isn’t something that you could find inspiration for on TikTok. It is this kind of internal driver. 

When you talk about musculoskeletal aging, it’s now almost it almost is having its moment. Not quite yet. Right. You and I are sisters in this and it’s not quite there yet. But from the time you are seeing a patient, there there seems to be in different grades of aging. 

The young individual that you’re seeing that pops her Achilles tendon versus the, I don’t know, guy who is on a motorcycle, super healthy 30 year old, race is like. Yeah. To the postmenopausal woman, their musculature, their bone health all is very different. Completely. 

Can you talk about some of the work? And by the way, again, there was this amazing paper, Musculosy syndrome of menopause. You were the first. You coined that the first. 

Talk to me a little bit about what happens as we age from these different perspectives, both in muscle and bone and then in menopause. Because we’re really behind the eight ball when it comes to probably arguably all hormonal changes, but in particular for women. Right. Well, I want since you’ve given me the luxury of this, I want to start back with the first work that we did at the University of Pittsburgh in the musculoskeletal aging in itself. So there was this big NIH funded cohort study called Health ABC. Yes. Yes. It follows. I mean, you’re you’re a geriatrician, right? So, you know this. Yeah. So the so it one of the the researcher in Newman was at Pitt. So

they followed a cohort of 70 year olds for a decade or so and just saw what happened. And one of the things they saw happening is the the quads and the leg muscles in these people, for lack of a better term, term became grossly infiltrated with fat. They became well marbled. Their strength decreased. They became more frail. 

Having a father who has always been an endurance athlete, seeing I became involved with the Senior Olympics, which you have to be 50 year old, 50 years old to compete in these things. You have to win your state games to go to the national games. They are some of the most fit people I’ve ever seen. I can’t believe 50 would be considered senior. Oh, and let me tell you, the 80 year olds are mad that the youngins are in the same race, same group as them. Right. True. 50 is not that old. It isn’t very old. I mean, I’ll tell you, I’m way past 50. But, you know, the NIH describes a master’s athlete as 35. I mean, come on, people. But, you know, if you look at life expectancy, it’s younger than you. Midlife is younger than you think. I know. 35 to 40. I mean, people don’t realize. So anyway, so Anne Newman was doing that foundational work at Pitt where I was. And I said, I don’t believe it. I do not believe that that is our destiny. And so most aging studies are done on populations. What do we know about our population? 70% of our population does not do one extra step of mobility a day. So what we know about aging is what we know about sedentary aging. We do not know what we’re capable of long into the foreseeable future. So my group and I, we called ourselves PRIMA, the Performance and Research Initiative for Master’s Athletes, began studying all these master’s athletes. We had, we did a series of studies and basically in summary, what we found is you can preserve your lean muscle mass. You can preserve your bone density. If you do impact exercise, it’s even better. 

We can preserve the, we can make satellite cells replicate again. Which is fascinating because, and we can circle back to the satellite cell conversation because most people would say that the health of satellite cells is in youth and then there’s senescence that happens, but yes. You can reverse it. Fascinating. And then the last study we did, well, there’s two remaining in that series, took us, the brain study took us five years and this was long ago. No one was talking about the relationship between muscle and brain as we are now, thankfully, but we showed that we can preserve three of the executive functions of the brain with chronic exercise. And then finally, right before I left Pitt, we started looking for the Y and we started studying a protein called Clotho, the longevity protein. And this is all in coordination with the lab of Dr. Johnny Huard, who’s one of the leaders in muscle aging and Dr. Fabrizio Ambrosio, who is a physical therapist, PhD, who is just brilliant. And so I say that because as a clinician, no clinician ever goes as far as they do. Unless they’re paired with a great PhD. I agree with that wholeheartedly. Yeah. I wholeheartedly agree. So we did that series, dispelling the myth that aging has to be a decline.

And then most recently I applied what I, the passion I have for that I learned taking care of women as a cancer nurse. I began doing work with Women’s Health in 2012 before the crest of the wave, because I think women are in the most powerful position to change the health of this country because we make 80% of all the health care decisions in this country for ourselves and everyone we touch. Because I don’t know about your husband, but my husband will go to the doctor if I make the appointment or he can’t play golf or various other activities he likes. So no, my husband is at the doctor every week. He’s like, Oh, this is great. Free VA care. Oh, I think I should get a sleep study cardio echo. Where’s the list? How about some acupuncture? My VA gives all the guys acupuncture. But majority of the time, most people are very, just that’s right. We’re to follow up and don’t take care of themselves at all, which is why I always harp on getting blood work, doing the, just the basic stuff. Your body’s talking to you. Whether you’re listening or not is the issue. 

So you were saying that aging, you know, based on this earlier work, that there doesn’t have to be this decline of aging. 

Do we know that to be true in a meaningful way? So let’s, if we were to think about the majority of individuals are fully sedentary, 70, 50% of Americans don’t work out over 70% don’t even meet the recommendations of, uh, resistance training plus cardiovascular. 

So that means most people are completely sedentary. What we think of a quote healthy normal is a disease population in activity. It’s a disease population period. What is normal actually, if you frame it is being diseased and sedentary. Correct. The anomalies are people that we care for or try to care for it. Right. But I want to, your, your whole mission is to pivot that. My whole mission is to pivot that. Mm-hmm. And, and my question to you is at what point does an individual have to interject in midlife, let’s say we have a, or even, um, kids, like at what moment do we know and what activities from a practical standpoint do people have to take to have a meaningful impact? And we could say from a metabolic standpoint, or even from, you know, a durability standpoint, you talk a lot about mobility, durability, collagen. How much is enough? How much, what is the min max? 

Yeah. For the maximum. Yeah. Well, if you, if we were talking about our children before, and I’ve just started to read this, I was introduced to this by the head of our metabolic lab at, I happened to practice in this wonderland of technology. Um, our children are replicating their mitochondria and building the mitochondrial load and, um, from the time that they’re running around. And so if we’re raising a generation of children who are not active enough to stimulate

that, that has lifelong consequences, right? But what if, what if we’re not talking about children when I, maybe what you’re asking me is two questions. When do we have to really get serious and how much do we have to do? I mean, maybe those are the questions I’ll ask. I describe a critical decade to get your shit together. If you have never thought about it before and tell me if you disagree, I think  between 35 and 45 is a critical decade because you’re an adult, you’re settled in your career, you’re hopefully you’re out of your parents’ house. You’re, you know, all the social things. Unless you’re my child, you can stay. Yeah. Actually come home, taglianate each other. Um, but you know what I mean? Yeah. We have a little bit more agency. Yes. At that point, Oh my God, we’re peeking out on our muscle. We’re peeking out on our bone and we still have our hormones, men and women. 

It’s the time when we still have an active contribution for women. Many women start the decline in estrogen at 40. We have, we have 1% of our eggs left. It’s a miracle. I had a child at 40, right? I squeezed out a healthy egg. But before all those midlife changes start happening, it’s a critical decade to start back on caring about what our heart does, our VO two max at that point. I like to talk about the frailty line of VO two max, right? You’ve probably talked about this too. Where if, if we don’t do something about it every decade, we decrease our VO two max, which is our absolute fitness level. Your crowd knows this by 10%. So if at 40, your VO two max is only 30 and you decrease by the time you’re 70, you’re going to cross the frailty line, which is 18 for men and 16 for women. So we need to do everything we can to maximize that from a cardiovascular standpoint, I prescribe for people. I was of the generation where I was doing hit every single day. I know I heard that in an interview. Every single day I was running marathons and all the things that, and I have biomechan, I have kinetic chain issues. So when I’m training like that, I have a predictably because of my repetitive kinetic chain issues, I have Achilles tendon on the left. I have right hip flexor and my fascia on my left thigh is predictable. Sounds like a good time. Yeah. And basically what she’s saying for you guys listening is this kinetic chain, her movement patterns. Right. Um, when she is doing movements that are more explosive, less controlled, less slow. More frequent. More frequent. Five or six times a week, right? So many people are still doing moderate intensity, but here’s what I prescribe now. Uh, I want everybody to do base training at a lower heart rate because that affects all levels of heart rate. How much are you recommending? Helmet time, a week, three or four 45 minute sessions. 

Skip, unless it’s icing on the cake, unless you want to just join a class and do fun and then sprint twice a week because we have to have to maintain that. Yeah. We have to get in that intensity and only sprint after you are thoroughly warmed up with your base training. And friends, it doesn’t have to be on a treadmill. You could sprint on an air dine bike, an assault bike,

a rower, an alpine. Any it’s about heart rate. It’s not about being Usain Bolt. It’s about heart rate. Right. And in that way, I have not been hurt in years versus when I was training. Like I was before, I was pretty hurt. I would have to stop. And that’s what I see because people, I know I called you. Right. I mean, this is the truth. 

Vonda. Um, can you help me? I just had an issue, but, um, so that’s the aerobic side of it. 

And like you, I want everybody to lift heavy all the time. Talk to me about that because there is, it’s interesting. And I think it means how do we prioritize, define heavy? Why are we lifting heavy? 

Um, so we’re lifting heavy because in order to stimulate muscle protein synthesis, we have to have an intensity threshold and then we have to feed that threshold. So it gets an, it’s important to think about nutrition, but what, and it depends what our goals are, right? I’m not lifting for hypertrophy. Some people are. So they need to lift in a different way. I being less than a thousand days from 60 and lifting for longevity and power, I must build power so that I do not fall down and break my hip. And will you define power for us? Power is strength through movement. It’s over, it’s through time and there’s a time velocity. So how, um, explosive, how much you can move. Yeah. Can add, and there’s an added, it’s not strictly power, but it is. Can’t do I have enough explosiveness to move my feet fast enough so that I don’t trip over my own red bag, which is my work bag is, or I put it too close to my desk, I trip every day, but I have the speed I posted box jumping lately and people are like, Oh my God, why are you doing that? Well, because I want the power and agility to not fall down. So my goals and the people that are the midlife people I serve, I want them to be powerful. You can live for hypertrophy. So what’s, so what do I, what do I suggest? 

I suggest, and I’m just trying to make it easy for people. I don’t know what you have found, but I found I, in my first books, I just tried to give suggestions of here’s a regimen, choose what you want to do. Here’s the principles. I have found people do better when you give them something specific. Totally. Yep. Totally. So I specifically say for the four power lifts, push, pull upper body, push, pull lower body. 

I just chose a number out of the range, four lifts, four sets. What does it mean to be heavy enough? It means you have two, one to two lifts in the tank reps and reserve. You could probably squeeze out one or two more with good form and then you’re done. It’s not to exhaustion. It’s just before that. 

So, but that’s only the four power lifts, the supporting lifts. And how often are they doing this? Are they doing cardiovascular activity? Does this matter if it’s men or women? Midlife? 

Uh, this is specifically for women. Men, men can go up to whatever you want and you can go up to more, you know, I listened to Andy Galpin, like everybody else, you know, men can go up to about eight reps, but still the same principle. We are not lifting manby pamby weights. 

I’m going, you please do not give me hate mail, but one of my patients was something he read in an ancient magazine. He, he was hurt. He came to me hurt because he was doing the whole, I don’t even know what it’s called, Centurion thing. It was 10 reps, 10 sets every single day. And it was just, he got hurt. And I’m not saying that he got hurt because of that, but it’s a lot of stress 

on the tendons. And, um, I want to come back to tendons because I think that that’s, I’m very interested in that, um, as a recent, as you know, because I’m, I just keep injuring myself, but the four women, it’s interesting. The three to four days of cardiovascular activity zone to keeping their, um, keeping the cadence where you can talk. And it’s 45 minutes. How many days, two days a week of high intensity interval. Do you care about how they do it in terms of, is it a 15 second all out? I do. Great effort. Or 30 seconds, four times. 

What about recovery? Do you, do they have to be fully recovered? That’s how I do it. 30 seconds on. So here’s how it goes for me. I’ll just give you my example. My base training, I keep my heart at one 30 ish around that range, um, is five incline and four speed, 4.2 sometimes, but that’s that awkward stage or am I running or my jog? So I do that. And then when I’m ready to get my heart rate up, I punch it to 11. Now I’m not that tall. So I am just trying not to fly off the back of this treadmill, um, for 30 seconds. 

And then I completely recover. It takes me about two minutes completely to about one 40. I don’t make myself go down to one 29 or whatever. Okay. But, and we, and I just repeat that four times and that’s enough stimulation for me. This year I’m trying to layer on VO two specific training. It’s a, it’s a lot to get in. It’s a lot. I have a life on the outside, but that would be four minutes.

As hard as you can go with only four minutes of recovery. And there’s good data to support this extremely good data. I’m not making it up. It’s not my data, you know? Yeah. Um, and what are some of the changes or why do you want to do high intensity interval training for the listener? They’re thinking, okay, well, why would I do that? You guys are, yeah. That sounds like a terrible idea. That doesn’t sound like fun. I don’t want to do 30 seconds of I’m going to vomit in my shoe. Why do we, why should they do that? So our goal is to convince them to want to vomit in their shoe. Why? 

Well, the most so extreme guys really don’t do that. Uh, especially if the most esoteric answer is, and then I’ll list the few of the science and you fill in, cause I know, you know, these data probably so much better than me, but the esoteric answer is how do you want to live? Totally. Do you want to be that frail person that I meet in the hospital bed wishing that you were still the vibrant mid lifer? Well, there’s this problem in the country. It’s called temporal disconnect. This is what I, I have spent my entire career trying to motivate people, even when people pay me a lot of money to go one on one with them, people don’t always follow through and, and so the idea of temporal disconnect is it’s a banking idea we cannot see into the future to care about that person. So we do what feels good today, which is skipping our things or going easy on a day and, and I’m not saying that I have to be intense every day, but you have to put in the effort consistently. If you want to not be that frail little person temporal disconnect connects us from our goals, because we, I don’t know who the 70 year old Vonda is. I don’t care about her. Jacked. I don’t care. I’m going to be Jack, but yes, but, but this from the, from the, what does it do metabolically? Well, it contributes to mitochondrial health. It stimulates muscle protein synthesis. You need an intensity to keep that system going. Yeah. It increases your insulin sensitivity. I mean, it drives insulin into your muscle. All the things happen when you’re intense enough that your body thinks that you’re still alive. Our body doesn’t know whether you’re sitting in a cave in the middle of winter about to die, unless you tell it by the intensity of life. Right. Right. And that is, um, you know, you’re asking people to up the ante. You’re asking them to, to train in a meaningful way. And I’m asking people to not waste their time and not be a trash compactor with their diet. 

You hear that honey? It was basically a shout out to my husband and Matt over there. Matt, the producer over there, um, by the way, we will be getting in my camera.

Yes. And the high intensity interval training in terms of what goes first, what goes first for, have you seen in your research with women in aging? It probably is variable. People will often say power decreases quickly, power strength, then hypertrophy. But again, I don’t even know if that matters muscle fibers decrease. It’s the power muscles, the power fibers that go first. We know that. Yeah. Um, when you design, when you are thinking, do you design programs for people or you do amazing. 

When you have now covered those three things, where do you think about mobility and how are they maintaining joints? Um, how are they, uh, maintaining and preventing tendinopathies? Because, uh, I really think that this listenership would value greatly from hearing about some of those things, because that’s what seems to take people out of the game. It is right. They can. They can spew out the intense stuff, but until they break. So when I help people remember what to do, I call it facing your future. There are four components that I asked people to think about. F is flexibility and mobility, meaning that the natural tendency of tendons is to get tighter and tighter with age because the covalent bonds between the fibers get stronger. And that’s why older people are hunched over and shuffling. It’s because they’ve lost joint range of motion. They lose joint range of motion because the collagen and their ligaments and tendons becomes tighter. And so we need to prepare those not only to keep them at length muscles work at a set length to be optimal, but also so that they’re not so friable, if you will. So every workout needs to start with a dynamic warmup where we, depending on whatever activity we’re doing, we’re warming up every muscle group and every joint that they’re going to use. And I have the same little, I walk for 15 minutes every time, every time before I lift, I then do this eight or 10. It’s not stations, but exercise dynamic warmup where it’s hip rotations. It’s inchworms. It’s deep squats, like planting rice in a field, deep squats. You know, you’ve seen those pictures of people who work like that. Um, it’s warming up my hamstrings. It’s glute activation. Put a band around my, um, ankles and activate my glutes. If I’m going to go squat or something to get everything going. If I’m doing my upper body, I’m so it’s specific to what I’m doing that day. Before I then go do my main course, my aerobic. So flexibility, flexibility. Uh, A is aerobic. If that’s what I’m doing that day, or C is carry a load. FAC I specifically don’t say lift weights because I think you can carry a load in a lot of ways. It doesn’t have to be under a bar. It can be with kettlebells. I, um, I used to prescribe in my first series of prescription only functional and body weight, and now I only, yeah. Why did you, why did you do that? Uh, I evolved. We, it’s funny, right? As we go through this all, we, we evolved because then someone say, what were you prescribing before? When you say just body weight and by the way, that’s what everybody wants. Everybody says, I don’t want to have to go to the gym. I don’t want to have to do, they want to do it at home. You want to do it at home. Well, and you know what? I use those programs, um, to get people started because if 70% of people in this country don’t do anything, I have to start them somewhere. So we start with body weight. We start with getting to know how our body moves. And then we add kettlebells or bands and through, uh, just a series of what I would call mobility and functional and body weight things. Because if someone who was stepping off the couch for the first time in 30 years goes and tries to get under a bar, something’s going to hurt. We don’t necessarily want you to do that, but we want to get ahead of this. We do. So if we worked people through that

stage for a few, six weeks, three months, and then we’ll move you to lifting heavy. And this is the time when I encourage people to invest in an expert, because if you’ve never done it before, there is a technique matters where your body is matters. So that’s the time. So carry a load in E F A C E is equilibrium and balance because you can have the weakest bones, you can have the weakest muscles and you may be okay until you lose your balance and you fall down. 

When did you start introducing balance training? In 2008. Okay. Wow. Before I first spoke, I was thinking this is going to be, uh, a later addition to the first Vonda right program, but it’s not. It’s always been, and probably it would make sense because fast forward. Um, did you ever see the movie? It’s a wonderful life. Yeah. I mean, that’s kind of what this, this storytelling that we’re talking about is basically you’re thinking about balance. Cause you see people that are falling and breaking a hip and they’re never walking again, they’re never getting out of the hospital. I know. I see the future today. Do you know? That’s how I got into social media. No, I was, I did. I did geriatrics because I was studying nutritional sciences and the deal was in order to get funding, uh, and I wanted to work in this metabolic lab and I had to do a fellowship, a clinical fellowship, a clinical fellowship and the clinical fellowship that I had to do at that time. What was available to me was geriatrics. Yeah. 

And part of geriatrics is palliative care. Yes. 

Um, I was not prepared for what I saw. I was not prepared for what I saw in geriatrics at the nursing home, constantly consulting orthopedic surgeons like yourself. 

And, um, I wasn’t ready for it. I’m going to tell you a story and you’re going to, you’re going to say I’ve seen that I was, I was talking to one of the ICU nurses in the hospital a couple of weeks ago and she was telling me about one of her patients. She was her patient. Let’s call her aunt Minnie. I love that aunt Minnie. Um, she’s 89. She was the lady, she was, she was old, right? But she was the lady who still had her driver’s license and she was driving around the seven year olds and the six year olds who weren’t as able as her. They had this little community of, of collaboration. She was the able one. Didn’t mean she wasn’t frail. 

She stumbled and she fell and she broke her hip and she broke three ribs, which puts you in the ICU. And she was too frail to get cleared for any surgery. And so her 70 year old son made her palliative care just to take the pain away. So you go one fall away from dead.

Right. Yeah. 

And it is, um, you know, the, the larger conversation is, I mean, this is so preventable and when we begin to see skeletal muscle added to the, the muscle as an organ system, then we can absolutely change the fate of everything. We can change the trajectory of her future. Totally. And so I love that you and I have gotten to this place in the conversation because sometimes when, when I don’t know if this is true for you, but I think people see me box jumping and they’re like, Oh, it’s just about being strong. And she’s box jumping at her age or they see you lifting and they think it’s, you’re just building muscle mass because you love muscle mass. 

Well, I love muscle mass, but the fact of the matter is I don’t want that to be me. And I’m not being histrionic. No, I, the reality of frailty. Yes. And I don’t know the statistic, but a lot of our old people end up dying in nursing homes. Absolutely. And with the increasing levels of sedentary behavior and obesity, it’s only going to increase sarcopenic obesity. And you know who I really worry about? I worry about our kids. Because the training that they do when they’re young influences, the satellite cells influences, cartilage influences, the tendons influences their metabolism. Absolutely. For later on in life, we don’t even know what it’s going to be like if we continue down that road. You know, my kids train with me. I see that. They’re not that good and that’s okay. They’re little kids. They’re not supposed to be. As long as they’re doing something. But I think if we lead by example, then things will begin to fall into place. What do you do for balance training? Yeah. So it is the Romberg. 

It is as simple and because I don’t do any balance training by the way. So this is new for me. It’s Carlos’s fault. We’re going to have to. Carlos, Monica, this is your fault, buddy. Carlos, we need to stand Dr. Lyons on one leg and do mini squats. Okay. And see if your knee falls into valgus in your hip drops. Definitely will do that. Yeah. 

We are not meant to walk like supermodels. We are meant to walk straight. We are, we are unipad people, meaning every time we run, we’re on one leg. If every time we run, our knee falls into valgus, like an L, people who are listening and the hip drops, it’s causes hip instability. It’s bad for your back. It’s you’re going to be more injured. So what I do for teach people for balance, listen, when you’re brushing your teeth, stand on your right leg and the perturbation of moving your arm on one leg is going to retrain your balance the next day. Stand on your left leg

or do tree pose. However you get one foot on the ground. Okay. Then the other thing I do for the women who come to my retreats is I have our speed coach, her name is coach B, who works with Olympic athletes. 

Teach my people agility with the, we jump through hexagons over the, it’s just like you would see in an elite athlete training over the little hurdles. We’re just teaching our bodies to move faster in a controlled way so that when we need to jump over our bag and not trip, our body’s used to that. That makes a lot of sense for everybody listening. Um, what Vonda is saying is get a cardiovascular base, lift heavy things, you know, three to four, three days a week. How often are they? At least two, at least two, three preferably. Okay. Um, everyone here can do that. Push, pull. Um, and then you had lower body, right? Push, pull squat, deadlift, squat, deadlift, balance training, which now I’m going to have to do and flexibility slash mobility. Would you consider that’s kind of the durability, but let’s answer the elephant in the room question. I get this question every single day, but I do yoga and Pilates. Is that enough? Is that enough? And I say that is amazing. I sing on the cake. You do that. If you make it makes you happy, that is never going to be enough to build the muscle we need to not die frail. Well, since we’re going to the elephant in the room, I’m going to throw out another elephant. 

And the other elephant is, is walking enough to maintain, um, strength, power, all the other things, muscle mass walking is a good base, but I think you have to sprint. 

So you’re what you’re saying. So you guys, Vonda, right. Dr. Vonda, right is going on record of saying that walking is not enough exercise. 

Listen. 

So you want to know where this elephant came from? I’ll take anything because people sit around, sit around brisk walking, sprinting twice a week. That’s what I’ll take. Fine. Where did that come from? So I, two things. Number one, I actually got a lot of heat because I said yoga and Pilates was not enough. I’m sure you did. Um, I thought that my head was on a chopping block. Really there could have been darts at my back door. Um, which you and I both know as medical professionals who specialize in muscle yoga and Pilates is wonderful. It’s not enough. It’s not going to be enough. It’s not enough to maintain. I care about hypertrophy because I care

about the metabolic benefits of having mass and it’s very difficult to maintain mass. For me, my patients hypertrophy matters. 

Um, so how many reps do you prescribe? How many? Yeah. How do you do it? Well, I think that there’s a lot of data to suggest that you don’t have to lift heavy for hypertrophy as long as you’re going close to failure with reps. With reps. However, that can take a long time, right? We don’t have, I mean, I can’t just do 25, 30. I mean, I’d be yawning. The someone becoming and going, my son would pee on the wall. It would just be a whole thing. Yeah. 

I like to see people do, you know, there’s this repetition continuum. Yeah. I mean, anywhere from eight to 15, it’s okay. Probably if they want to do higher rep range and we see that data from Schoenfeld and, um, Stu Phillips that, you know, you can do 15, whatever 20 reps doesn’t matter, but doesn’t maintain power in the way that you are talking about. Right. And this, yeah. And what I’m trying to avoid women doing in particular is picking up the man be pamby little pink away thinking it’s enough. I don’t, okay. So do a lot of reps, but could you pick up a meaningful way? And I think that there’s something absolutely to be said for that. So, um, that is where the elephant in the room, the yoga and Pilates, which, you know, again is wonderful. And then the other thing is I had a lot of backlash because I said walking wasn’t exercise in the span of a two hour conversation, all about maintaining type two muscle fibers and, you know, mass and these type, these type of fibers that are necessary for strength. The data supports that walking will not maintain these fiber types. That’s not right. So it was taken out of context, right? One, it’s like doing an article in review in one sentence is pulled. Right. But it was interesting. And I think that it exploits the predatory nature of the internet. 

Um, because, you know, this is really interesting and I don’t, I don’t want to sidetrack too much, but, um, in order to become an expert, you have to go to, um, you know, for your field, especially in medicine or health and wellness, you have to get an undergraduate education and then you have to get, I don’t know, a graduate, a graduate education. And then graduate education is not enough, right? Then you have to do, I don’t know, medical school and then fellowship and then work in, um, the scope and then, you know, slave away for 10 years or so. And then maybe then you become an expert. 

Now, when we have influencers, they get to bypass all the things that would make someone humble.

I’m just laughing because I’m thinking 17 effing years. I did 17 years too. Took me 17 years. It took me 17 years. So then what we do is now. If you have a big enough following and you’re a quote influencer, that’s enough. So you don’t actually have to have the humility nor the understanding that you, that there’s a level of respect. None of your colleagues would, I mean, orthopedic surgeons are a little bit different, so I’m going to rephrase that. But the reality is, um, the place at which one gets information matters. And also, um, there are things above and beyond the information that is put out there, it’s the way that it’s said, it’s the way that it’s evaluated. And so that’s where those two elephants in the room came from. 

Not important soap boxes over. Um, but anyway, so when it comes to, I just want to say, listen, if you are not, if you and I were out to hurt people or to make more money, we’re brilliant. It would be easy, but we’re not. 

So when we’re criticized online, I just swipe right. Yeah. It’s a good one. I just, I, I mean, there are so many people, people can listen to. 

I know that I’m, I know where my heart is. 

Yeah. So I just swipe them off. They can listen to whomever they want to. They don’t have to listen to me. And I think it’s a good point. I think it’s a good point. Um, yeah, it is. It’s doesn’t mean it’s not hurtful. I’m like frick or frack, I swipe right. Left. Whatever. So I swipe to the side. Yeah. Well, this actual, this clip went viral. And it was amazing to see. 

Um, I think the bigger point is that it divides us. So if the overarching goal is how do we get people metabolically fit, stronger, more capable, more resilient than the way to do it, isn’t to, uh, create this cancel, I mean, it’s so nonsensical. People, it can be, and then, and so, and then people don’t get better. Or they hold themselves to a lower standard. Mm-hmm. Um, because I would say, and you know, I’m not going to speak for you, Vonda, but I think what we’re asking people to do is to work hard physically.

And not because you want to get into your little black dress. No. Because you care about your future. Yeah. That’s why we were designed to be under environmental pressure. Yeah. And yes, exactly. 

Now you and I were talking about, you know, we’ve covered your components that you add in, tell me about this tendon, tendinopathy, these injuries. There was, I was looking at some of the research because I do want to also get to the musculoskeletal syndrome of menopause, which is extraordinary. Um, when women are in their forties or fifties, it seems as if there is this 

precipitous decline in tendon health. Is that true? Or they get more injuries, they get more tendinopathies. Well, here’s the background is that sometimes we think of estrogen, testosterone, progesterone as only sex hormones. The fact of the matter is they’re just hormones because almost every tissue has receptors for these hormones. So why wouldn’t the musculoskeletal system have receptors? Is my little receptor basket. I always do this. I like your receptor basket. If you were in neurology, they would think it’s something else. Oh, you’re married to a neurologist. I get that. Um, has receptors, right? So when estrogen is taken away, whether it’s an alpha or beta, estrogen is taken away, none of the good downstream things are going to happen in terms of supporting the collagen matrix or, um, in the, in the, in terms of cartilage and tendon, none of the things that we use to maintain will go on if the ligand estrogen is not sitting in the receptor. So I don’t know why it surprises us, right? Ooh, why is that surprise us? So what I see a lot clinically is I see a lot of tennis elbow in women. I see a lot of, uh, rotator cuff pain without Frank tearing because some, you know, often I will do an MRI if they’re presenting in a certain way, lots of Achilles tendonitis out of nowhere. They’re like, I’m not really playing pickle ball that much. Why is my, why is my tennis elbow hurting? Um, it’s because the normal metabolism of those tissues, the support for the collagen is being withdrawn in a precipitous way. I have two questions on this. Do you think that the various receptors, and there might not be an answer for this, but let’s say there are certain individuals that have like CAG repeats that are more sensitive or less sensitive to androgens because of their receptor density, let’s just say that seems to be variable for everybody. Mm-hmm. Do you think, um, you know, and this is just kind of us thinking individuals that have lower, uh, let’s say less estrogen receptors in their tendons, maybe age better because whatever circulating estrogen, it seems that, it just seems that there is a vast difference even between athletic individuals as to how their tendons maintain themselves. Yeah. Have you thought about that? I’m going to tell you, this is, this is not only do I not know, I don’t know that anybody knows because there is so little research being done on musculoskeletal aging as it pertains to hormones. 

I can think of, I mean, the paper I just published has 80 references, but they’re on all things. So to really answer that question, you need to sample a lot of people. And they don’t do, I mean, there’s no studies. Yeah, there’s no studies. I mean, your, your crowd may have heard these data that of $450 billion of NIH funding for medicine, uh, 150 million are for women and 14 million or are those numbers wrong, 450 billion, 450 million, 145 million for women post fertility.

So when I say to you, I don’t know, I truly don’t know that anybody could give you receptor density. But isn’t that interesting to think, you know, if we were to think about, um, who ages better or what, why is there such a variation in aging well? Or is it receptors or is it metabolism? 

Totally. Yeah. You know, I, you know, I just think about it because, you know, when you are beginning to see these injuries, why do you think that they’re happening? Is it the lack of, well, you know, here’s a, something that has been, has been studied in orthopedics, not at the receptor level, but in every orthopedic clinic, when men start showing up with multiple tendon injuries, midlife, either they’re on anabolic steroids or if they’re not their own natural testosterone is low. Oh, interesting. So we measure testosterone levels. 

And I want to talk about the musculosce, um, skeletal syndrome of menopause. I have the paper pulled up if you want to. I do want to talk about what can women do kind of prior, if they are suffering from gluteal tendinopathies, are there wheeze or tennis elbow? What do you have them do? And what do you have them do for prevention and what role of so many questions does hormone therapy? Yeah. Yeah. So when a woman in midlife comes into my office with one of these, I don’t address the musculoskeletal injury right away. We actually start about talking about the fact that you’re 45 years old. 

Your estrogen is starting to, starting to drop precipitously if it hasn’t already. And then they usually volunteer their, their, you know, do they have a uterus? Do they have their ovaries status to me? Then we start talking about all the other things, because I find that when I open the door to say, we are going to treat you like a whole person, not just a tendon problem, that it is better for them. And so we have that conversation and then it gets around to, well, why are your glute tendons so inflamed or frankly, rupturing off the greater trochanter? The gluteus medius rips off the greater trochanter. It’s very painful or tennis elbow out of nowhere. 

When I put women or I send them off to be put on estrogen or menopause hormone therapy, that goes away many times. The, the severity of the pain, because not only is estrogen important for tendon health, but it’s a huge anti-inflammatory.

And so it quiets down the fire within. 

But then when people have glute tendinitis or tennis elbow, I don’t send them to do stretching. I send them to do strengthening because both the tendon and the muscle must be able to bear the activities of daily living. 

So we strengthen them. I stand women on one leg and in glute tendinitis and see if they can even balance on one leg because every step you take, you spend time on one leg. And if you can’t balance your pelvis for a microsecond, you’re prone to injury. Interesting. The, the tendon issues, why are they more common in women? 

I don’t know that they’re more common in women. Let me rephrase that. The gluteal tendinopathy. Oh, because women have weak butts. 

Okay. I do. It’s true. 

How can you have a weak butt? How is that possible? I don’t know. It just happened, but the, I don’t think it’s true. I think you’re making that up. 

No, no, I totally do. But the, so the gluteal tendinopathy has nothing to do. And by the way, what we’re talking about is your sit bone. If you were to sit on your sit bone, a true story, I did call Vonda pretty freaked out. Although I was very calm because that’s my freak out. I thought it was your hamstring. Yeah, my hamstring. Your hamstrings. Okay. So it wasn’t my glue, but the ischial tuberosity. Yeah. But then you should explain gluteal tendinopathy. Where is it? Yeah, I could stand up and show people, but it is. So these, these bones on the side of your body where everybody thinks their hips are, they’re like my hip hurts and they’re putting their hand on the side of the body. That’s actually not your hip at all. Your hip is in your groin as a purist. The joint is in your groin. That is the side of your femur. So if the femur is shaped like this, this is the bone you’re feeling. Your glutes, all three layers wrap around the back of you and attach to the side. And so the big muscle that we’re all sitting on, the maximus, that does okay for itself. It’s the medius, the middle level that is so critical for balance and propelling and slowing you down. That is usually most damaged. And it can be tendonitis. People mistake it for a bursitis, which is

a different thing. So guys, I just want to be very clear. I was giving you the absolute wrong guidance and actually explaining hamstring tendinopathy. 

So please disagree. We’re going to talk about that next. 

But what she is talking about, gluteal tendinopathy is on the lateral side of the hip. It’s you kind of feel if you were to rub it, there’s a bursa there, but individual. The glutes are just behind you. If you have them. But if someone were to have that, it is same in men and women. Pretty much has nothing to do with the sex difference so much. Women tend to have glute tendonitis more. And I attribute it not only to the estrogen deficit, but literally weak butts. I mean, so that’s number one. But hamstring. Yeah, let’s talk about that. So the sit bone that we’re all sitting on the issue of tuberosity, three of the hamstring tendons come up and attach to it like this in a kind of a Y shaped. I find people get hamstring tendinopathy at the origin, which is where it is due to the kinetic chain. Totally right. And basically kinetic chain is the is the you know, from the tip of our big toe through every joint of our leg to the low spine. We really are the hip bone connected to the leg bone to, you know, to function correctly in our gate. When we strike our heel, we have to bend our ankle enough that our tibia can internally rotate, right? That then our femur can internally rotate, which will then cause firing of the glutes. You must have enough motion for that. You must. Yeah, yeah, yeah, I see. 

What would someone do aside from, let’s say they they have a little bit of a muscle? Aside from, let’s say they don’t have access to hormone replacement. Yeah. You know, if you do, wonderful. But if they don’t choose not to, right? Or they choose not to have women do how many what percent? Seven percent are prescribed hormones. So that’s a lot who do not. Seven percent of women are on hormone replacement therapy or would choose it or would choose it. And guys, that is it’s just because we’re not yet over the WHI. Yeah, we’re not yet. Hopefully my goal, we’re getting on another topic, but my goal is that for the next generation, my daughters and my daughters-in-law are 30, 31. That it’s going to be a non-issue. They’re going to know how to choose. They’re going to know where to get it. But right now we’re still getting over. So when I say that to you, we’re just getting over it. 

Still not there. No, we’re trying. We’re still not there. Seven percent are on hormone replacement, which is crazy low. But I think our patient population, that’s something that they come to us for. Very interested in understanding the kinetic chain, right? Would be prevention. What she’s saying is don’t be stubborn and continue to train on it. Not that I don’t know anything

about this. Who are you talking to? Nobody. I’m just talking to the air. Maybe my mom is listening to this podcast. 

You don’t continue to train on it, right? Really go and fix those kinetic chain movements. I think you have to have an assessment by someone who understands mobility. It’s a different science than how do you lift well. 

Correcting motion is a different kind of eye. So sometimes physical therapists can do it. I call them hip whisperers, just movement specialists who see the body move in 3D. How important is it to have imaging of these things? 

For example, x-ray, MRI. Mm-hmm. So it depends how people present to me. I don’t get an MRI on every hip bursitis or every glute tendonitis right off the bat. It depends on how painful it is, how long the duration, if they have tried therapy. But if they have tried the simple things and they’re still not recovering or still in a lot of pain, I want to see the quality of the tendon. Because if it’s about to rip off of bone, well, we have to have a conversation. If it is doing something called mucoid degeneration, which is tendon, 

looks like a white rope. It is structurally beautiful. But when it starts to degrade from the inside out because of micro tears, tendons don’t heal because they have a very poor blood supply, right? And so you accumulate– They don’t heal. They don’t heal. Gosh, it’s so interesting because tendon turnover, people think it’s really slow, but it’s similar to muscle. It’s like 1.5% per day. It’s very hard to get a bad tendon to heal. Wow. I mean, I’ve never seen it heal. I’ve never seen it heal, but it’s interesting because the turnover isn’t necessarily– You would think it would. Right. It’s slow. It just seems like a– 

I don’t know. And in the lab in 2000, when I was in the lab of Johnny Huard, we were trying to inject 

VEGF– it’s been a long time since you said that– VEGF, yeah. VEGF, to tendons to see– Well, it creates more capillaries, but it makes it structurally less sound. So we don’t want to do that. That is the process that happens in tendinopathy, not tendonitis, but tendinopathy. And the

tendinopathy is the chronic condition versus the invariant condition. The chronic condition where there is mucoid degeneration, meaning this gorgeous structural white rope of a tendon, becomes kind of like a jelly donut in the middle, as I tell my patients. And so that’s when– that’s never going to recover. It’s never going– isn’t that crazy? What about stem cells, exosomes? Yes, exactly. Any of those kind of opportunities. So we have a couple options. Before I go and ellipse out the tendon and reattach it, asking your own body to create the healing response. At this point, we have orthobiologics, which I use a ton of platelet-rich plasma about– depending on what we’re doing, 10 billion platelets, injected into the microenvironment, asking the body to try to create a healing response. I tend to use– although I tend to go in order, sometimes people go straight to stem cells. I tend to go platelet-rich plasma first. And it’s from their own blood. It’s their own– I draw 120 cc of whole blood from the anacubital vein. My phlebotomist does. And then we spin off 10 billion– We don’t want to bond it to try those veins. Well, if someone has garden hose vase, I can hit that. But if they have– I can’t. You do not want me coming to draw your blood. 

But then also, we have the availability of mesenchymal stem cells, or adipose stem cells, which is a little bit of liposuction. But because I’m a little conscious of the cost for people– Yeah. And so I start with PRP and then move to– because short of that, it’s a surgical incision, ellipsing out the rotten part. And that works. But– 

For you guys listening, I think this is a really important conversation. We’re covering– we covered what Vonda thinks needs to happen if you are in midlife to continue training. And I’m also very sensitive to the fact that many people get injured. And it’s not necessarily muscular injury. There’s a lot of tendon injury that, whether it fully takes someone out of the game, whether they rupture or whatever it is, if the endpoint is tendinopathy, and you now have to then begin to limit more your box jumps or any kind of activity, we have to really think about what are the solutions to that, and how do we prevent ourselves from even getting to that place. Right. And those are some of the things that you’re talking about. Now, what could happen is that the PRP, the mesenchymal stem cells– That’s right. I would try– because we have them now, I would try all the biologics first. 

Exosomes, we may get hate mail for this. They’re not FDA approved. And I don’t think they’re ready for prime time. Same with stem cells. I come from a stem cell lab. Do I believe the body is capable of healing itself? Absolutely.

Do I think that we have a handle on what kind of stem cells? What are the cell surface markers? How many do we need? Because stem cells gone bad is cancer. 

Sounds very risky. We don’t know the answer. Do I think we’ll get there? Absolutely. Just give us a minute. We try all the orthobiologics, and then if we can’t get there, Gabrielle, it does work for hamstrings, for glutes, to take down the damage tendon, you lips out the bad part, and put it 

down to a fresh bed of healing bone so that your bone can heal to the tendon. Bone heals to tendon. So how does that work? If someone were listening to this and they’re like, you know what? 

And is this the same for– so we’re talking about hamstring. Is this the same for any tendon? It’s the same for glute. It’s the same for a tennis elbow. OK, wow. 

When you say ellipse it down, is you just strip it down? No, so ellipsing is– let’s take– Is this when you’re stitching? No, I make a small incision over the area of damage, spread through the tissue layers. The body is in very discrete layers to the area of damage. You can usually see it. Tendon’s gorgeous. This looks like brown mucus. With a– if you want to know specifically– a 15 blade, we just take out the badness 

and then sew the goodness together. Wow. Yeah. Or in the case of a hamstring, if this is the ischium, the hamstrings are attached like this and they’re just very unhealthy, very painful. Tendinosis is very painful. 

I physically take it down, again, ellipse the damaged part, and using little anchors in the ischium that are made out of suture, put it back down so that it’s sealed down to bone. Bone then, the stem cells from the bone grow into the tendon. Oh, that’s interesting. Yeah, tendon doesn’t heal to bone. Bone heals to tendon. Bone heals to tendon. And then, is that always successful, or does an individual have to change the kinetic chain and the dynamics of the movement? Yeah, in the rehab process. So we give them– we give biology a month head start, and then we start moving. But if we do not change the kinetic chain, the movement patterns, you will re-injure yourself. So that’s a really critical part of recovery, is not just returning or being– I get this in runners a lot, actually, hamstring injuries in runners, because their backs are tilted, their hamstrings are too tight. And so if you don’t correct that, you’ll just go accumulate enough miles

to hurt yourself again. And that sounds like a terrible idea, right? Yeah, don’t go through it twice. Don’t do it again. I mean, don’t do that. 

But what you’re saying is that the goal is to not get to that point. Yes. And then, can you send something really interesting about bone? But when it comes to bone and muscle, that relationship, can you just– Let’s talk about that. I love that. So you know, medicine tends to be siloed and mechanistic, right? So people assume that even though muscles live next to bone, connected to bone through their tendons, they’re in their own separate neighborhoods. They’re not talking– the fact of the matter is, if we think of muscle, as you talk about all the time, as the metabolic center of the universe, people think that bone is just the strong silent type hanging off in the corner, not talking to anybody. The fact is, bone is a master communicator. 

And that makes sense. Why wouldn’t our bodies use the ability of bone as an endocrine organ, from the top of our heads to the tip of our pinky toe? So bone– here’s an example. Bone creates a hormone called osteocalcin. Alsteal calcium goes to the brain and helps stimulate the production of neurotransmitters. It goes to the muscle and the papancreas and works to increase glucose metabolism. If you’re a man and have testicles, it works on the lytic cells to help you produce testosterone. Bone is not just– And that’s interesting. I know. Yeah, osteocalcin. It is not just providing structure to an otherwise quivering pile of muscle. It is a master communicator. And they work together in the same neighborhood such that when you have osteopenia and sarcopenia, it’s not one plus one equals two, it’s one plus one equals three. Yeah. It’s even worse. Is that why, in your paper– and I’m referring to this paper, you talk about women have an average reduction of 10% in bone mineral density. 

Is that why you wrote the musculoskeletal syndrome of menopause? Because, yeah, and it’s musculoskeletal syndrome of menopause. I named it that. 

The purpose of the paper was to put a nomenclature to the six or seven things that– there might be 20 things, but these are the things that I’ve identified so far and my group has identified. Because women need something to be able to communicate about. Because if someone came into my office, which they often do with eight complaints, that is a lot to get our heads around. But if they come in and say, I am midlife, I have the musculoskeletal syndrome of menopause,

and I called it musculoskeletal and not just osteoporosis or not just sarcopenia, because it’s the whole system working together. Yeah. Was that the answer? Yeah. I mean, I really– I think that this will put this in the show notes and the newsletter. I’m assuming it’s– is it open access? It is. OK. We made it open access. Amazing. Yeah. And which, guys, that means that she paid for it to be available. I paid for it. You paid for it, yeah. But you know what? Listen to this. This is how competitive I am. No. Are you really? You’re competitive? 

Totally kidding there. This paper in three weeks has been downloaded 143,000 times. I looked it up. 

What is the average download in the best journals, JAMA, New England Journal, British Medical Journal? 

10,000. Is the average. And 50% of all academic papers are never read by anybody but their author. So I tell you that because I’m competitive. But also, it shows the tremendous need for a communication tool. That’s why we published it. I love it. Can you summarize this paper for me in what you think that– I mean, I can pick what I think the greatest highlights are. But from your 

perspective, again, as the senior author on it, what is it? So the musculoskeletal syndrome of menopause are the five or six 

diagnoses, symptoms that women can present with when estrogen plummets. 80% of all women will experience the musculos– one of the symptoms of the musculoskeletal syndrome of menopause. 25 will be disabled by it. It was one of my biggest perimenopausal problems. I’m an athlete. I couldn’t get out of bed because of my arthralgia, which is total body pain. 

And when you go to a doctor and get a workup, MRI of your shoulder, MRI of your hip, 41% of the time, there is no structural damage. And then people are told to go home. There’s nothing wrong with you, blah, blah, blah. So I wanted people to recognize that estrogen is a huge anti-inflammatory. 

And inflammation can give you total body pain. It can give you the dreaded frozen shoulder because the shoulder capsule is very sensitive to inflammation. And that is one of the other

things that people will often see with menopause is this frozen shoulder. Completely. But it is an inflammatory problem because men with diabetes, who are highly inflamed out of control A1Cs will also show up with it. In the group besides the inflammatory problems are sarcopenia. Our osteoporosis is the rapid progression of osteoarthritis. Before 50 years old, men have more osteoarthritis than women. As estrogen walks out the door and never looks back, women rapidly progress. And what happens during midlife, women gain 30 pounds or more. So the pressure on the joints increases five to 10 times whatever weight they’ve gained. So it’s just problem on top of problem, right? So there is rapid increase of arthritis. There is a loss of satellite stem cells, which puts us behind the eight ball. And so we wanted people just to have a way to talk about all that. And we fashioned the name after the gynoco urinary syndrome of menopause. Oh, interesting. This is a great, a really great paper. Again, we will include it. 

What has been the biggest feedback from your colleagues on this? Because again, now just to paint the picture, you are in the orthopedic realm. You are now coming out with new nomenclature, essentially. 

What has the, I don’t know, the feedback been from your colleagues? Well, the biggest group that has picked it up are the Obigaines from across the world. Isn’t that interesting? So the chairman of Mount Sinai in New York is a woman. And she had the vision last year to have me come to Grand Rounds, to all of her departments, all the musculoskeletal departments. 

So that’s one. I am speaking at a orthopedic conference in September and they don’t know it, but this is what I’m talking about. And then in the group that I practice with the Houston Clinic, we’re going to train our doctors. 

There is one doctor on the internet who is harassing me about it and get in line, I say to him. 

But the rest of them are still yet to learn. Interesting. For the arthralgia component, is there a dose specific outcome that we’re looking for? For example, are you going to get or is every woman variable? Are we going to give a woman a 0.05 milligram transdermal patch, change it twice a week in her? Every woman is variable and hormones are dosed by symptom relief. But if you ask me about bone, studies have been done that shows the minimal effective dose for caring for bone is 0.025. There have been some studies that 0.0125, which is tiny dose, is the minimal effective dose. But that being said, every woman is different. I take 0.0375. Some

women need 0.075 right out the door. And that has to do with their metabolism and just their unique biology. Do you think that there’s one delivery pathway that’s more effective for muscle and bone or muscle or bone? I don’t think we know that. What we suggest is transdermal because then you don’t have first pass kinetics through the liver that you have with oral. And also, transdermal estradiol is bioidentical to what your body makes versus orals are synthesized or gathered from horse urine. And there are multiple types of estrogen versus estradiol because we can make it in a lab like we make insulin. 

So most of the time, transdermal patches is what we suggest. Most of us do not suggest pellets, although that’s a big business. For the main reason is that you cannot control dose, whether it’s estrogen pellets, testosterone pellets. It’s in, you’re stuck. 

That’s right. 

I have seen some less than desirable outcomes of that. But if we do creams, we can titrate the dose. We also use transdermal. We find that patches are really great. Have you also looked into the testosterone side and testosterone treatment, especially for bone? I mean, obviously, estrogen is very impactful on bone. And what have you found? And do you have general recommendations? 

Well, the FDA’s only approved reason to give a woman testosterone is low libido. I don’t think that’s the only reason to give a woman testosterone, but that’s their party line. 

Testosterone in women starts to decrease in their 40s also. So in the same way that estrogen declines, the production of testosterone does. And so you have lack of energy, you have less ability to build muscle. 

I don’t have a dose response way to tell you it’s going to take this much cream on your arm. There’s no studies. We don’t know. Which is so fascinating. For example, we couldn’t say, okay, well, our goal for testosterone is that even though the range is, what is it? It depends on the lab, but the total testosterone might be up to 45. Yeah. In a woman you want it to be 50. So ridiculous.

But whatever. We can’t say, okay, I’m going to give you testosterone. We’re going to increase it to, I’m just arbitrarily picking a number, a hundred, which you don’t care about, but your free testosterone is three times the normal limit. You’re feeling great. 

But it’s interesting because then there’s no outcome for muscle. Do you know what I mean? Or bone. The studies haven’t been done yet. It would be so helpful if we could get a better perspective to use these pharmacological agents alongside of exercise, which we know we need. It would just be so fascinating. We just don’t have studies. 

And I don’t know. Do you think we’re going to get there? I mean, I even think on the male counterparty. It’s a matter of funding, right? We haven’t gotten there so much. So yeah, we just need some really invested philanthropist to fund these studies because I don’t see them coming rapidly from the NIH. 

What are you thinking about next? Just out of curiosity. So typically how this goes is you’ve probably already, how long did it take this paper to write and get out? I’ve been thinking about it for a lot of years. And finally. 

Finally, it just came out. With your schedule, how did you get that done? Because I have a brilliant medical student. Amazing. I do. Because the University of Central Florida is next door. And so they don’t have an orthodepartment. So I’m a good resource for them. And yeah. How often, just out of curiosity with the hormone replacement therapy, do you think it would change outcomes for people? Are you pre-treating them prior to surgery? Is that even the standard of care? Could that be beneficial? You know, orthopedics is just getting to pre-treating with nutritional intervention and protein and carb loading before surgery. Six weeks of high protein before surgery. We are not to the place of hormones. Although there are a few papers looking at women on estrogen, and how they do with total joint. That’s interesting. There’s a couple papers, right? But it’s not the field’s practice. Yeah. 

Do you think most people are concerned with osteoporosis?

Bones are silent until they break. I know. I was hoping you were going to say that. People don’t know they have bones until they break. Unless they’re cheekbones. Everybody knows they have beautiful cheekbones, right? So funny. Yeah. Yeah. 

What are some– well, number one, do you think that the screening is set up in a way that’s going to be meaningful to protect women? So insurance will pay for DEXA scans. If the doctors remember to order them at 65. I know. It is too late, people. So I scream from every podium I’m on that– I just drew an arbitrary line in the sand. Based on what I see, every 40-year-old woman needs a DEXA scan. Because I have 24-year-old women who have low bone density already. So just to bring the people listening up to where my brain is, is if we’re “maximizing” our bone density by the time we’re 30– because that’s what the DEXA scan does, right? It compares us to the bone density of a healthy 30-year-old. But this is what I’m seeing. And this is– some studies have been done on youth athletes doing DEXA scans. But here’s what I see. 

Either girls have been athletes their whole lives. We are 52 or 53 years into Title IX. And girls have been athletes. But this was my case. I would not have a period for six or nine months because I was so relative energy deficient, right? I was working out so much. I had such low body fat until I had my daughter, which sounds like a high body fat in the presence of you. But I was only 19, which is low for– which is pretty low for a woman. 

You don’t lay down on a bone without periods, right? And so we have an entire generation like that. You also then have a generation of sedentary people who never exercised. So they may have had periods, but they’re not pounding bones. They’re not building muscle. So I’m seeing 24-year-olds with low bone density because I get them on almost everybody. I’ve had 28-year-olds with hip fractures. I’ve had very young women. So anybody I’m suspicious of or has a mother who’s shrinking, if they’re shrinking, if they have been on steroids because of another disease– And when she means steroids because we have a lot of practitioners and male listeners– Oh, prednisone. We are not talking about– Matt over there, my producer, we’re not talking about prednisone. We’re talking about– Prezma, things like that, glucobardicoids. 

If you are a smoker, if you have autoimmune disease, any one of those 12 or so risks, I’m using it as an excuse to get a DEXA scan, so that at least we know what our stance is. Because if you get to be 65 and your first DEXA scan shows a T score of minus 3, which means your three standard deviations below what we consider normal, Frank osteoporosis, it is very, very hard.

Are the drugs good with osteoporosis? Is that something that you prescribe? You send them to endorhizomorrhizal. I send them to endocrinologists. There are many categories of bone maintaining or bone building drugs, but what I find is, at least in social media, women are like, “I don’t want to be on pills. I’d do anything not to.” When you’ve got a T score of minus 4, I encourage them to rethink their decision. Totally. 

I was talking to Katie, who you met, Katie Burns, the makeup artist that makes me look presentable. Hey, Katie. We were talking about people with hypothyroidism. And one of the things that we hear a lot is, “Well, I don’t want to be on a medication for my life.” And in my mind, I would think, “Okay, well, I think that that’s part of the internet.” Because if, for example, someone has low thyroid and it’s not going to be recovered, why would we not? 

People would say, “On the internet, well, because it’s not natural.” And in my mind, it’s like… It is actually natural. Your body makes it. I thought you were just saying. Well, yes. So when we think about that, it’s interesting. 

There’s a very divergent path. Either people are very medication adverse, or maybe there’s 14, 15 pills, whatever. Supplements or something. Whatever it is. But I think sometimes, too, that what is a medication in your mind? I mean, your body makes this. It’s not really great. We’ve just figured out by recombinant DNA technology, how to make it for you. Right? Yeah. I mean, the ultimate goal is to be taking as least amount of supplements, medications, as possible. Right? You get your lifestyle to balance out. Totally. Exercise. It’s restorative sleep. Just because you’re taking 15 supplements doesn’t mean that that’s the best strategy either. What’s the difference? I don’t know how people come to you in your clinic, but I have a part of my practice called precision longevity. And what people come to me with is sometimes they want to go straight from fine. How do you feel of fine to biohacking and all the weird esoteric stuff? Yeah. But we have to optimize health before we get to performance, before we get to do whatever thing you want to do. And I think people skip that a lot of times. 

And not wanting to be unnatural and restore their hormones. People don’t know because they’re not in medicine is our bodies are in such fine tune homeostasis. I mean, it’s a miracle. And if you’re not making one of the key constituents, well, we can help you with that. Yeah. And it’s not unnatural. It’s restoring nature. And there is the reality that menopause is coming. Oh, it’s inevitable. And I think there has to be a little bit. People have to understand that it’s coming. Anybody born with ovaries is going to go through it one way or the other surgically. How are we going to do it? Right. It is an interesting conversation because people will be like, “Stay as natural as possible, Roxy. I’m not talking about you.” 

For as long as possible. And we’re joking. It’s like, “That sucker’s coming. How do you want to do it?” And how do you want to end up? Because you know what? I hear that. 

Okay, you can stay as natural as possible. You can choose not to hormone replace. That is, I believe women are sentient beings with the agency to make that decision. 

You can then not ask to not be frail, laying in a hospital bed with a fracture, incontinent with a bad heart and dementia. 

You have to do something to get in front of that, whether it’s your lifestyle or it’s your lifestyle plus hormone replacement. But if you just let time pass… That’s tough. That’s like the would you rather, the books that’s kind of… Yes. Choose your own adventure. Yes. Would you rather do these things? Would you rather train hard or would you rather you pick it, be in a hospital bed? What do you think the risks are of hormone replacement therapy? 

At this point, the book I love best that summarizes the world’s literature on this, and I know you know these people, is Estrangent Matters. Avron Blooming and Carol Taveras. It’s the book that changed my life, really. 

It got me in front of the data. What do I think the risk factors are? Even for women that have a history of breast cancer, it is not always no. But what I think… 

Women in active cancer care, that’s a contraindication. But when you’re done, it’s not always a no, and each woman deserves that risk assessment, whether we’re talking about breast cancer risk, cardiovascular risk. There are some, if you’re taking oral estrogen, risks of clot, especially you’ve had a clot history, or you have a predisposition genetically.

But to blank, my point here is the blanket statement of bad good is not actually the answer. It is you deserve to have a personal risk assessment instead of just following the crowd. That’s what we deserve. 

And eventually, the idea of following the crowd, I think it’s going to look a lot different. And it will. 10 years? Yes. Hopefully my daughters. Not five. Yeah. Hopefully my daughters will. The follow the crowd will be healthy, vital, active, joyful, long into the foreseeable future. One thing that I really love and respect about you that I find extraordinary is that you are also a mom. 

And I’m just curious, because people probably ask you, “Oh, how do you do it? How do you maintain all this resilience?” And I mean, how do you do it? 

How do I do it from a time perspective or an energy perspective? All of it. So right now, your kids are older. Yeah. But there was a period of time you had your daughter at 40. I did. You were building a career. You were not well-established. You came out of training at 39, had your daughter. 

You are now entering your career as a orthopedic surgeon with a newborn. Yes. Actually, what’s funny, I could show you these pictures. 

I was given in the first year of my practice the head physician for the University of Pittsburgh football team. I was one of the only women at the time taking care of football at that level. And I was nine months pregnant. I got the team when I was five. So there’s these pictures of me nine months pregnant, standing on the football field. So my daughter has been around sports her whole life. So how do I do it? Well, number one, I think for me and for all women, you have to recognize your capacity. Everybody is different and has a different amount of energy and a different amount of capacity. And you cannot compare yourself to somebody else. I have a tremendous capacity. And I’ve just accepted that. And I’m no longer apologetic. When did that change? When did you stop apologizing for that?

Well, there’s two parts to that story. I have stopped apologizing for it when I started extending grace to people who are not as high capacity as me, because I did not realize that people had different energy levels or different abilities. I thought everybody could do what I did. And I would expect that. And I drove my teams like that until I came to the authentic self reflection that everybody’s different. And I have to meet them where they are. That’s when I stopped apologizing for my capacity because I was capable of giving grace to other people who couldn’t keep up. And I think that probably happened around 2018 when I left the University of Pittsburgh and went to Atlanta to build an orthopedic surgery department. It was not only culturally different, but the pace of work was different. And that’s when I realized these are not bad workers. 

They are just different types of workers than me. So I’m a high capacity person. But that’s only part of it. 

When I first heard of Hillary Clinton’s book, It Takes a Village to Raise a Child, I was young and stupid and I scoffed at that. It takes a village to raise a child, whether it’s a village of your family, a village of your girlfriends, a village of your family and your girlfriends, a village of the nanny that you hired to come at 5am in the morning. So the way I did it, and it’s a privileged position to be able to say this, I was a surgeon, so I could hire a nanny who would come to my house at 5am. She would stay until 1.30. And then my parents who were retired came and helped me. I am not too proud to tell you that I could not have been a Division I football doctor, a surgeon at a premium in an orthopedic surgery department, building a practice in my 40s all by myself. 

And then when I married my husband, he took 50% of everything from me. 

And that’s not always the case. So it has taken a village for me. I’m high capacity. It’s taken a village. But I also spend the money on the things that are going to buy me time. 

I’m a firm believer. And I see this demonstrated in my sons. 

When a group of guys get out of college and get their first department, they pull their money and they get somebody to help keep house for them. Women wear it as a badge of honor that

only she can do that. She’s going to keep it. WTF. What are we doing? Right. So- You outsource it. I outsource. Anything that you can isn’t going to be valuable of your time. All of those things matter. Do you find you still put yourself in crucibles, like challenges of resilience? And selfishly, I’m asking for my own knowledge for myself and also to be able to share, but you’ve obviously done really hard things. Yeah. Things are easier for you. It’s just the fact than probably many people. Some people. It’s just- True. It is. Now, how do you then put yourself in a position of crucible or change? Yeah. I love that you asked that. 

Two years ago, I started… So I was a runner, a lifter, right? All those things, the sports things. 

Two years ago, I started doing Spartan Stadium races, obstacle course races, right? We put it all together, swing from bars, and I was afraid of getting hurt. I wasn’t actually afraid of getting through the 3.2 miles- I’m afraid for you. I’m afraid of getting hurt too. So the first one I did, I was just so pleased that I got through it. The second one I did- You’re not worried about your arm popping out a socket or any other stuff? No, I’m strong. Like, I’m not strong as you, but I’m strong. I’m strong. But so I got through the second one, I increased my time, blah, blah, blah. 

This last one I did in Tampa because it was 600 degrees, I can usually swing through the the rings. I had the upper body straight to swing through the rings. It was hot, it was sweaty. I jumped off the steps because women can… It’s high, it’s like eight feet. So to reach the rings, I have to climb up on steps. I jumped off, I grabbed the first ring because I needed a momentum to swing across. My hands slipped off. I’m flying through the air like a starfish and I land on this flank. And it’s on camera because I was being filmed for a documentary at the time. And so I’m laying on the ground like a starfish and something popped in me. I think it was my quadratus lumborum because I could barely move. But I’m like, “I’m in the third optical of this race, I’m going to go.” And it just got stiffer and stiffer the whole race, but I am not going to quit. I’ve gotten through this before, plus there were cameras on me. It was embarrassing. Do not let the quit in. That’s what my friend Lisa always says, “Yes.” I don’t care what age you are, you can still do hard things. I’m not dead yet. 

That is pretty intense and amazing. Well, I don’t know what I’m going to do next. I’ve done a few of those. No, I was just thinking, “Well, you’ve already done that. Talk to that.” I know, I don’t know what I’m going to do. What’s going to be the next? I don’t know. I don’t know, actually, but… It’s just an interesting thing to think about because comfort kills. Comfort kills no matter what. Kills us physically, kills us mentally. I like the feeling of feeling like a badass. I mean,

maybe that’s my ego speaking, but yeah. Totally. Yeah. What is next? What do you think is next? For you, for the industry, for the movement? 

My goal is to pivot the conversation that I’ve been having about women’s health to a different place. And I think that’s what we’re doing. We’re helping to pivot that conversation because I’m offended. 

Listen, my research is in aging and longevity. It has been since 2000, but I’m offended that the National Zeitgeist talking about longevity from living long for men is longevity. In fact, there was a darling GQ spread with Clooney and Brad Pitt, 

Clooney’s 60th birthday, two guys in the French Riviera, just looking like distinguished gentlemen aging in a glorious way. 

Longevity and men getting older is viewed like that. Women getting older is viewed as anti-aging, and I’m offended by that. Wow. I never thought about that. I love that. Yeah. What’s the description? I love that. Yeah. Everything is anti-aging for women. I’m not anti-aging. I want to live long and prosper. So all of my language is pivoting female living longer to longevity and healthy, vital, active, joyful, and frankly, being unbreakable. If I do not want to be in the hospital bed, which I’ve said nine times now on this podcast, then I have to train for longevity, power, and to be unbreakable in body, but also in my mindset. And part of that is to stop looking over my shoulder, everyone. Stop looking over your shoulder to worship your youth, because you think 20 and 30 was the best time of your life, but you just think that because you’ve not been 40, 50 and beyond. 

Powerfully said. Powerfully said. What are you doing now and where can people find you? Yes. So the primary place where I am every day is Instagram, DR Vonda Right. We’ll link everything here. Yep. I show up there every day. I do have a new book coming out in the end of 25 called Un breakables. We will have that. And when is that coming out? Probably December of 25. Okay. Great. We’ll have you back on to talk about that. I can’t wait. That is so fun. And then you know what? I have all kinds of live events for people, and so they just need to stay tuned on Instagram to see what I’m up to. Amazing. And if they want to see you in practice, you have a website. As a practice, yes. So you send them to your website and… You can come see me as an individual, both for ortho pedics and for precision longevity. Well, thank you so much for spending the time with me. You are really truly extraordinary. Oh, it’s my pleasure. It’s a privilege. Thanks.