Don’t Wait for Menopause: What Every Woman Should Know About Bone and Muscle Health — Dr. Vonda Wright

Sameena Rahman (: 00:01

Hey, hey y 'all, it's me, Dr. Smita Mangana Girl. I'm very excited today. We have a special guest. You guys heard the intro. She is an amazing advocate for women around the world and a groundbreaking researcher. We're gonna get into everything that she's been doing. You guys heard my intro. This is Dr. Vanda Wright. Thank you, Dr. Wright. Thank you, Vanda, for joining us today. I'm great, I'm great.

Dr Vonda (: 00:24

How are you?

Sameena Rahman (: 00:27

You know, welcome to my podcast, Gyno Girl Presents Sex, Drugs and Hormones. I'm super excited to talk to you because you've been everywhere doing everything. I just want to say that we had a big shout out for you. I know that you were unable to attend the menopause conference because of like logistics. But when the doc got up and she was talking about sort of like osteoporosis and muscle stuff, your whole little menopause, when she put up your study, we were like, yay, Javonna!

Dr Vonda (: 00:49

you

Dr Vonda (: 00:55

that's so great!

Sameena Rahman (: 00:56

Cause they put up Dr. Vonderreid's study on the musculoskeletal syndrome menopause, which we're going to dive deep into today. And we were at the menopause conference in Chicago and someone was giving the talk, which actually should have been you, FYI. But anyway, and she did, she referenced her talk and she's like this, I had to include this cause it just came out in the press. so has, and she talked about at that time, and I don't know how much it's changed since then, but there were 175 ,000 downloads.

Dr Vonda (: 01:19

Mm.

Dr Vonda (: 01:25

Yes. Yes.

Sameena Rahman (: 01:26

So I'm sure it's more than that now because I'm sure everyone that didn't download it from the conference downloaded it. So let's talk. Let's talk first. I want to talk to you about like what brought you into this space of because you're an orthopedic surgeon. I said that my intro and but you're an extremely amazing women's health advocate, which we don't always find in orthopedics, honestly, you know, and you're one of the few women in the sphere too. So I want to find out like what brought you into orthopedics.

Dr Vonda (: 01:36

Yeah, I am.

Dr Vonda (: 01:48

Cool.

Sameena Rahman (: 01:55

And what brought you into the menopause space? Because what you've been doing is really groundbreaking and I think has answered a big puzzle piece for so many women that have been struggling for so long.

Dr Vonda (: 02:05

Well, you know what? I haven't said this before, but I'm gonna say it here and then hopefully we'll all say it is that the health of a woman, whether we're talking about reproductive health or menopause health or there are births or our puberty, it is a multiple disciplinary process. I got into this because, well, how I got into orthopedics, because you're right, orthopedic surgeons,

Sameena Rahman (: 02:25

Yeah,

Dr Vonda (: 02:35

We have a job to do. It is generally not thinking about the whole health of a woman. And it should be, it's generally not, but bless these guys' hearts. 94 % of my colleagues were born without the blessing of ovaries. So they're never, the closest they're gonna get is their wives or their mothers or whomever they're closest to who were born with ovaries. And that's as close as they're ever gonna get. So they're not gonna understand.

Sameena Rahman (: 02:49

Yeah.

Dr Vonda (: 03:00

the power of these two little organs and producing estrogen that can really controls almost every body system. So my job and our jobs is to educate them because they don't have a lived experience themselves, right? And so, and I'm trying, know, they're less receptive than the OBs are. They're like, what, what are you talking about? But they'll come, bless their hearts. They'll come and I love those guys.

Sameena Rahman (: 03:25

Yeah.

Dr Vonda (: 03:28

But I'm an orthopedic surgeon because, you know, in medical school, we sort out, I mean, all these are surgeons, right? We sort out by who thinks like a surgeon, which is assess the data, make a decision, act on the decision versus the medicine doctors, fix it, versus the medicine doctors. Thank God that they are around, but they tend to ruminate over the data all day long.

Sameena Rahman (: 03:45

and try to fix it.

Sameena Rahman (: 03:51

Yes.

Sameena Rahman (: 03:56

Yes.

Dr Vonda (: 03:56

Our rounds are very different when we're training at four o 'clock, they're putting in the notes and we've done it by 7 a to get to the O .R. So I sorted into the surgeon category very early, but, and blah, blah, blah, my orthopedic surgery career is from 11 years old to death, people of all ages and skill levels. I'm a sports surgeon. So my work is very aspirational. So there's kind of an analogy between,

Sameena Rahman (: 04:03

Yeah.

Dr Vonda (: 04:25

Menopause, when the National Zeitgeist, until the menopause started raising our hands and saying we can live a different way, was that Hallmark was gonna send you a black rest in peace card, you're gonna get your AARP card in the mail and be all mad about it, and then it was a decline to the end of the life. We don't believe that in the menopause, and I have never believed that in orthopedics because I'm a sports doctor and my job is to continue.

Sameena Rahman (: 04:37

Thank

Dr Vonda (: 04:55

to help you live an aspirational life. So there's this parallel, right? My first job in medicine was as a cancer nurse. And so at 23 years old, when I was, I had a master's degree in nursing, I was pushing chemo, I was running the Cancer Institute, I saw women in the struggle of their lives. I saw women doing hard things, prioritizing. And at 23, that leaves an indelible mark.

took it with me. And then in: 2012

Sameena Rahman (: 05:52

Mm

Dr Vonda (: 05:54

of the health of a woman and started throwing live events and writing for women. Because here's the deal, women make 80 % of all the healthcare decisions in this country for themselves and everyone we touch. So if we change the health of one woman, we're gonna change the health of her family, probably her neighbors, and then one neighborhood at a time, then one city at a time. We're gonna change the way people age in this country.

Sameena Rahman (: 05:56

Thank

Sameena Rahman (: 06:13

Awesome. Yep.

Dr Vonda (: 06:23

So that's kind of the long answer to how I got into this. And I truly believe that life after 40 is multidisciplinary. It's not just the fan and steel incision, right? It's not just what happens to our ovaries, fallopian tubes, uterus, everything else that goes on. It's from the top of our heads to the bottom of our toes. And frankly, every tissue, every musculoskeletal tissue has estrogen receptors.

Sameena Rahman (: 06:34

Good night.

Sameena Rahman (: 06:51

Yes, exactly.

Dr Vonda (: 06:52

Why wouldn't we want to understand that?

Sameena Rahman (: 06:56

Right? Right?

And I think what you're saying is truly true about the midlife woman and how she really tries to balance everything. So much goes put, so much gets placed on her shoulders. And I think that once she makes the decision, we've seen it just on social media how so many midlife women are speaking, not only doctors, not only nurse practitioners, but women who have a lived experience, who are coaching, who are doing other things. I mean, we're both on the Balance Docu series and those were the...

Dr Vonda (: 07:16

Mm -hmm.

Sameena Rahman (: 07:27

our favorite monks who were just like experiencing perimenopause and decided like, we got to talk about this. This has to be something. And so I think it's true that we're making a movement, we're making a difference. You did also say that like it's a little more accepted in the OB -GYN community. I'll just give you an example of something that happened on a Facebook group the other day that there was somebody who was complaining, someone in the OB -GYN group who said that they were concerned about everyone

thinking everything was related to perimenopause. And she actually mentioned, even my patient's chiropractor said that her shoulder was because of menopause. So I guess like anyone over 50 is about to go, and I was like, yes, your chiropractor is awesome. Yeah.

Dr Vonda (: 08:11

That's right. Good chiropractor. Well, you know, in Asian cultures, the frozen shoulder, which probably this chiropractor is referring to is called the 50 year old woman problem. Well, duh. What happens to 50 year old women? We lose our estrogen. So.

Sameena Rahman (: 08:25

You got it!

Yes, absolutely. It was so funny. was like, well, and you know, it was kind of like they were like almost like, you know, denigrating the chiropractor in some capacity. But I was like, wow, this is amazing. Like your chiropractor gets it, you know. But I think that's the hurdles that we're trying to overcome at this point. But I did reference your article and give it to them. So that was hopefully another day.

Dr Vonda (: 08:38

Of course, it is amazing.

Dr Vonda (: 08:50

Thank you.

Sameena Rahman (: 08:52

But I think that just the whole idea of like, what is this musculoskeletal syndrome menopause? And when did you make the connection? mean, you said the Asian culture denoting the 50 year old female shoulder. Is that kind of when you started thinking about it more or how did you like start making the link? And then you did the research on it, obviously.

Dr Vonda (: 09:11

Yeah. So every Monday and Thursday, I have my orthopedic clinic and probably like all clinicians, I read ahead on my list, just get my brain who might be here today. And I started noticing because actually I started be interested in this in 2000 during the during COVID when I had a lot more time we shut down our offices, right. And so I knew a lot of what was going on. But then

Sameena Rahman (: 09:22

No.

Dr Vonda (: 09:40

I started noticing in my clinic, because it was in the forefront of my brain, my gosh, every 45 -year -old woman who comes with shoulder pain, it's a frozen shoulder. And then I took that information and I gave a talk on menopause to a women's orthopedic group. And out of that, the chairman of Mount Sinai in New York, Dr. Lisa Galatz, invited me to come do grand rounds. I hadn't named it yet.

but on the musculoskeletal effects of menopause. What is menopause? And she brought the physiatrist and the rheumatologist and the orthopedics. And for that grand rounds, I had to do all the deep dive, all the things we'll talk about now. I gathered the research on, made this talk, and I thought, what am I gonna call this? Literally, what am I gonna call this? I can't call it all six things because it's too much, right? So I knew that the OBs,

Sameena Rahman (: 10:28

Yes.

Sameena Rahman (: 10:34

Right? Right.

Dr Vonda (: 10:38

had gotten together and came up with the gyneco -urinary syndrome of menopause. And so I pulled those original articles and I said, you know what, this is the way to frame it. Just like this group has had, we're putting six or seven things together with a common origin into a named nomenclature. And so that's how I came up with the name. But within the basket of the musculoskeletal syndrome of menopause, I put

Sameena Rahman (: 10:43

Yes,

Sameena Rahman (: 10:56

Mm -hmm.

Dr Vonda (: 11:07

all the inflammatory manifestations, total body pain, is arthralgia, frozen shoulder, that's due to inflammation, which we know is determined by estrogen, loss of lean muscle mass, loss of bone density, rapid progression of arthritis due to the role of estrogen on cartilage, and lastly, two more things, the redistribution of adipose tissue, which falls into the MSK basket, and then finally,

Muscle stem cells, which are called satellite cells, lose their potency, lose their ability to produce growth factors because of loss of estrogen. Yeah, well, that's it.

Sameena Rahman (: 11:48

Amazing. I mean, that is awesome. mean, I feel like that is so validating for so many women. I think when you name something, you know, I have, you know, as you know, I do a lot of sexual medicine and I recently had a patient.

Dr Vonda (: 11:55

Yes.

Sameena Rahman (: 12:02

there's this persistent genital arousal disorder, is like 1 % of sexual medicine patients, but it's very distressing. It's this feeling, this dysesthesia of arousal. And she said, I've been living with this for 40 years and I don't know if you can help me, but the fact that you, I looked on your website and there was a name for it. I started crying like, cause I was like, here I am suffering with this thing for like 30 years. And I didn't even know. I just thought it was something wrong with me. Right. And I feel like now that you've named it, so many patients tell me, my God, this

makes sense, that plantar fasciitis, that, you know, the muscle aches that I have, the feeling of just like not responding as well after workouts, right? Like the whole thing, that name is so powerful. So I mean, that in and of itself is such a service to women.

Dr Vonda (: 12:35

Mm -hmm.

Dr Vonda (: 12:42

Thank you.

Dr Vonda (: 12:49

Do you know what women also said, just like your woman, you just described, in clinic without prompting, they would be telling me and they would say, I feel like I'm falling apart and some days I feel like I'm going crazy because no one will believe me. And I didn't prompt that vocabulary, but it happened time and I said, my God, we have got to validate exactly what you said. We've got to validate and listen.

and not just roll our eyes and walk out and say, another woman with six problems. And that's why I make a joke or not even a joke. It's kind of a pointed comment to my orthopedic peers who haven't had this lived experience. I don't know if I would be quite as passionate. I can give deep empathy to something I haven't experienced, but it's different when you experience it. So these guys of mine,

Sameena Rahman (: 13:34

Mm -hmm.

Sameena Rahman (: 13:45

difference.

Dr Vonda (: 13:49

They can have deep empathy if they want to, but they can never truly know. So I think it matters, right? All the things we've just talked about matter.

Sameena Rahman (: 13:54

All

Sameena Rahman (: 13:59

Yeah, I mean I just say like last year as I've entered period menopause that was one of the first things I had was like my knees, you know, I'm a runner and like what is going on with my knees now and I was like, fine.

Dr Vonda (: 14:12

no, shoot. Now I'm going to have to lift weights to help my knees.

Sameena Rahman (: 14:13

But it is... Yes.

Yes, I'm lifting now. but like for sure, like I think that that was like, you know, one of the and if you question if you ask the right questions to patients, tell you right? Tell us how like, I mean, you've been doing a lot of talks around the country, you got on a lot of podcasts. What's been the overwhelming response by some of the naysayers? I would say like, you know, I just told you an example of one of the OBs that were like, everyone over 50. I was like, you know, menopause shoulder, like, what

Dr Vonda (: 14:42

You know what? Yeah, I don't try to argue with people. Nothing I'm saying is made up, right? There are papers to describe each one of these things that I'm talking about. Now, let me tell you, there aren't that many. We have a body of work to do. In fact, I just spoke in front of a residency group and I said, listen people,

If I were to start over again and I wanted to make a name for myself, I would make a name for myself examining the role of hormones in the musculoskeletal system, virtually unstudied. So I don't try to argue with people. I present the data. I discuss lived experience. say, listen, you can choose to treat your patients well or not. That depends what kind of doctor you want to do. If you want to be the doctor who has their hand on the door,

Sameena Rahman (: 15:29

Yes.

Dr Vonda (: 15:32

and only wanna cuts people, but so you be a technician, you go be the technician. If you wanna care for the health of people, then we need to listen. We need to think of them as a whole, a whole elephant, not just the knee and the trunk and the tail, right? You you probably heard that blind doctor goes into a room and puts his hand on an elephant and feels a trunk and doesn't realize it's an elephant. I mean, it's talked about it because we're not considering the whole.

Sameena Rahman (: 15:47

Yes.

Sameena Rahman (: 15:59

Yeah. More person. All right.

Dr Vonda (: 16:01

being, right? But for instance, you know, when I talk to total joint people, the people who replace knees, and it's a midlife person, I said, you have to consider the bone density of the person that you're operating on. Has this woman been without estrogen for 30 years? Her bones are going to be like butter. You have to consider the muscle mass. Have they passed 60 and lost all their muscle mass? How are you going to prehab them?

Sameena Rahman (: 16:19

Yeah. Yeah.

Dr Vonda (: 16:30

Are they on hormone replacement therapy? Maybe they're on pills. What does that mean for blood clotting post -surgery or are they on transdermal, which has no effect on the clotting system? So there are so many applications across multiple disciplines. No doctor, no doctor should be unaware of what's going on in 51 % of the entire world population for 40 years of their lives. It's unacceptable.

Sameena Rahman (: 16:58

Yes, unacceptable. Totally agree with you.

Let's talk a little bit about that prehab and the treatments that you recommend around some of these things. Because we talk about frozen shoulder, but there's a big mortality, obviously, associated with osteoporotic fractures, particularly the hips. So let's address some of that and what you do to kind of, for patients that are maybe behind the eight ball, they didn't take estrogen and now they're worried. What can they do? And then let's talk about how you counsel your patients.

Dr Vonda (: 17:06

Yeah.

Dr Vonda (: 17:29

Yeah, so if we start with osteoporosis, which is this nebulous thing, like if you did the mic on the street thing, what is osteoporosis? What does it manifest as? What does it feel like? Most people wouldn't know. So here's the deal. Well, just by definition, osteopenia is low bow density. If you have a DEXA scan, which is how we measure it, it's a bone density of minus one and...

Sameena Rahman (: 17:37

Yeah.

Dr Vonda (: 17:59

zero to minus one or minus one and below, sorry, minus one is the number. Osteoporosis is defined as minus 2 .5. But what does that even mean? Well, one in two, 50 % of all women will sustain an osteoporotic fracture in her lifetime. So one of us, you and me, probably not, because we're working on our bones, but if we were to the general population out of the know,

One of us would have an osteoporotic fracture. 70%, if it's a hip fracture, 70 % of all hip fractures, so everybody out there, think of their Aunt Minnie, think of their grandma, everybody knows somebody that's broken their hip. 70 % of those happen in women. 50 % of the time after that happens, they never return to pre -fall function. They're not living alone. They don't get to stay in their house. One in three women because of frailty end up in a nursing home.

and 30 % of people after a hip fracture die. So I don't know if you think that's a serious problem, but it is a serious problem. So how do we get in front of it? Well, I wanna talk about this in a lifespan way because probably some people listening to you are still in their 30s, right? We lay down bone optimally until we're about 30. So I'm seeing an entire generation of young women who are coming to me with low bone density.

either because they've given into the myth that women have to be the size of my pinky to be valuable and they never laid down enough bone because they never fed themselves, or maybe they were athletes all their lives. We're 53 years into Title IX, which equalized the playing field for men and women in sports, but they were so athletic and had such low body fat that they never had periods. I mean,

Sameena Rahman (: 19:39

Right.

Sameena Rahman (: 19:50

Yeah.

Sameena Rahman (: 19:55

They didn't

Dr Vonda (: 19:58

Women go six months, nine months without periods. And now OBs are very sensitive to that. They're putting young girls on birth control to try to build their bones, frankly, regulate their periods. But without periods, you don't have enough estrogen. You're not laying down bone. And so for women in the audience listening, if you are in your thirties, now is the time to get after it. You must pound the pavement. You must lift weights. You must eat enough food.

Sameena Rahman (: 20:16

Exactly.

Dr Vonda (: 20:28

protein in particular, to build better bone. If you're already in your 40s, right, this time where you're turning into perimenopause, well, you have some hormones left. It's not too late. Same thing. We must do impact exercise, which includes jumping and marching and running. We must lift, we must begin to lift weights. If we haven't already, we need to lift weights.

We need to get enough protein, one gram of protein per ideal pound. And we must be thinking about supplementing with vitamin D plus K2, 500 milligrams of magnesium a day, and then get your calcium from your food. We have to think about it because here's what happens when estrogen gets low enough and we are in the really end stage of our perimenopause through our menopause and for the first few years of post menopause.

we can lose 15 to 20 % of our bone density. It just leaves because estrogen is such a critical regulator of the bone breakdown versus the bone rebuild process. And it happens silently. You know, I used to say a lot, I don't say it anymore, bones are silent until they scream. That means you don't even recognize your bones. You think they're not doing anything except holding up your muscle. Bones are actually master communicators.

Sameena Rahman (: 21:26

down. Yeah.

Sameena Rahman (: 21:37

Right.

Dr Vonda (: 21:52

They produce hormones. They communicate from the top of your head to the bottom of your toes. and yeah, they hold up your muscles so that muscles just not a quivering mass of tissue. bones are talking all the time. What the problem is, is we're deaf. We're deaf to the language of bones until one in two women fracture and then bones scream, right? So.

Sameena Rahman (: 22:16

Yes.

Dr Vonda (: 22:19

40s, 50s, so what do you do if you find out your menopausal, you've lost bone density, you find out maybe you're osteopenic, what now? Well, listen, there's a study called the Lift More study that looked at how to lift with osteopenia and osteoporosis. What that study showed was that even with women with low bone density, when they are careful, when they have been taught what to do, can safely lift.

in order to build muscle, in order to support bone health. So it doesn't mean you cannot, it just means let's be careful not trip over our dog. Because here's the reality, even though we think it happens, and I don't have the percentage, that sometimes bones get so brittle, you're just standing in your kitchen, your bone breaks and then you fall, the reality is that most

of the devastating fractures that take us from able to disable our dude to some kind of fall. So we have to work on our muscle and our strength and our balance so that we don't have the devastating fall that takes us from simply osteoporotic to disabled.

Sameena Rahman (: 23:38

Absolutely. And I think that's really critical because, you know, and that's why fall prevention is really big for so many patients that are already, you know, in that state of osteoporosis, you know, are you living in a house with a much of stress? I've lost, you know, a couple of ants to hip fractures because of falls and most of them were down the state, you know, and so these are things you don't think about when you're young and healthy, but

Dr Vonda (: 23:54

Right. Right.

Sameena Rahman (: 24:02

It's that one slip up that can be very catastrophic actually. So we all have to be cognizant of our surroundings and where we're living to.

Dr Vonda (: 24:11

Well, I was gonna say, you know what thing, one thing about house environment people don't think of, they think of stairs, like you said, and they'll get to rugs, right? Like, I've got throw rugs all over. But you know who's the culprit? It's that little dog that you got in your, you know, let's say you got them when your kids moved out in the 50s and you've had them. So now the dog's older and you're older.

Sameena Rahman (: 24:26

Yeah.

Sameena Rahman (: 24:35

Yes.

Dr Vonda (: 24:36

and it's used to being under your feet. I can't tell you how many people tripping for their little dogs. I know.

Sameena Rahman (: 24:38

Yeah, so true. my god, so true. The little one. And you trip over those little guys all the time. It's so true actually. And it's devastating for both parties. Yeah.

Dr Vonda (: 24:46

I know.

Dr Vonda (: 24:50

It is. Poor little dog and then poor broken hip.

Sameena Rahman (: 24:55

Let's talk about some of the treatments. We know, you and I both know that the use of transdermal estrogen, if you want to absorb through the skin or if you want to take it orally because you're not getting good absorption, will help in that menopausal transition and it'll help. And it is one of the reasons that is identified for the use of hormone therapy. So that's what a lot of people don't remember or choose to forget is that risk of osteoporosis, family history, concern around it is enough of a reason to

Dr Vonda (: 25:01

Mm -hmm.

Dr Vonda (: 25:14

Yes it is.

Yeah. Yeah.

Sameena Rahman (: 25:26

on hormone therapy.

Dr Vonda (: 25:26

It is. Yes.

Sameena Rahman (: 25:28

And so we were both proponents of that. What about like the people that already have a frozen shoulder already have significant joint issues? Can we talk about some of the treatments? I know, I think I've told you my husband is an interventional pain specialist. So he's a physiatrist who does these injections. But can you tell us a little bit, because people always ask about some of these stem cells and other regenerative technology. Where's your thoughts on this?

Dr Vonda (: 25:44

-huh.

Dr Vonda (: 25:51

Mm

Dr Vonda (: 25:55

Yeah, absolutely. So I'll just go through the roadmap that I give all my patients. I sit down, I write it out for them. I just don't hand them a paper because they won't read it. But if I'm writing it by hand, they are listening, they're reading. Number one, every woman deserves no matter what age to make her hormone replacement decision. We're all sentient beings, we all have choice, and we deserve to go through our risk factors and benefits. Whether you're within the 10 year window of menopause,

Sameena Rahman (: 26:08

Yes. So true.

Dr Vonda (: 26:24

or whether you're older, you have the right to go through your risk and benefits. So that's number one. Number two, if we're talking about osteoporosis and bones, family history matters. Is your mother shrinking? Right? Did your aunt mini break her hip? What about your own history? Did you smoke? Did you think it was cool and you smoked?

Sameena Rahman (: 26:41

Mm -hmm. Mm -hmm.

Sameena Rahman (: 26:49

Yeah.

Dr Vonda (: 26:50

Did you vape? Did you give up the cigarettes and then you vape? Vaping is a huge culprit. Tons of nicotine, tons of poison. Did you have an illness where you needed to take a lot of prednisone, for instance, like asthma when you were growing up? Those are bone toxins.

Sameena Rahman (: 27:05

Right. Or these autoimmune processes, right? Like all the...

Dr Vonda (: 27:08

Right, autoimmune processes. So do you have your own family history? Or do you fall in one of the categories we talked about, you never had a period, you'd go six months without one, nine months without one, blah, blah. So all that family history, personal history, social history, add up to osteoporosis risk. So while the world is arguing about whether we should be using hormones for anything except the symptoms,

and brain fog and hot flashes, I have the only legitimate flag in the air saying the FDA, this is my femur, the FDA has approved estrogen as a way to prevent fracture, right? So if your amp mini is shrinking, if you have any of these risk factors and you want hormones, you are at risk for osteoporosis and it is legitimate to ask for it.

Sameena Rahman (: 27:41

Right.

Yeah.

Sameena Rahman (: 27:51

Yeah, absolutely.

Dr Vonda (: 28:05

and the beautiful side effect that we're going to affect your brain, your heart, every other organ system. So I've got the only clear runway as an orthopedic surgeon. you get to make a decision, number one. You need to identify your history, but then what do you do about it? Number one, if you have one hour in the day to do nothing else, you are going to march your way to the gym so you get some impact on your legs, and then you're going to lift weights.

Sameena Rahman (: 28:13

Yeah.

Dr Vonda (: 28:34

You're literally gonna lift heavy and build some muscle. That will build bone, that will build strength power in you, and that will help your balance and your posture so you don't fall over. muscle. you're long to completely grip strength as a measure of longevity. Number two, you are going to feed yourself. You are going to feed yourself an anti -inflammatory diet free of added sugar.

Sameena Rahman (: 28:46

Yeah. And longevity, right?

Dr Vonda (: 29:03

I didn't say carbs. I said free of added sugar, which is in every boxed product. You got to read the label, grams of added sugar. We're going to focus on getting our carbs in because active people need carbs in fiber, 30 grams of fiber a day. One gram of protein per ideal pound, 30 grams of fiber, cut out the sugar, supplement with vitamin D, K2, magnesium, omega -3 at a minimum.

and then you can decide about all the other things. Then we're gonna stop with the six day a week intense cardio because we have to think about what are we training for? Well, if you're actually training for a race, fine, do your racing. But if you're training for life, if you're training for longevity and power, we need two ends of the spectrum. We need low heart rate based training to build endurance and to build our...

Sameena Rahman (: 29:40

Yes.

Sameena Rahman (: 29:44

Yeah.

Dr Vonda (: 30:01

all our other zones and we need sprint intervals. When I say sprint intervals, people always think of Usain Bolt or Shakira Richardson. I'm not talking about that kind of sprinting. I'm talking about getting your heart rate up to as fast as it can go for a very short amount of time because that will stimulate muscle protein synthesis, stem cell regeneration, bone building. So I'm going to summarize. So you get to make your own decision.

Sameena Rahman (: 30:11

Thank

Dr Vonda (: 30:29

You need to evaluate your risk factors. You're going to build muscle. You're going to build bone. You're going to feed yourself. And then you're going to be careful not to trip over your baby dog.

Sameena Rahman (: 30:42

Yes, all of that. And then if you still, obviously when it comes to like frozen shoulder, usually it's a quarter zone injections, right?

Dr Vonda (: 30:52

So yeah, frozen shoulders. So for frozen shoulder treatment, frozen shoulder, you can't raise your arm, pain out of nowhere, no accident, or you can't do your bra. It's the bra strap test. Here are the steps. Make all those decisions. And you know what? There has been a study on estrogen and frozen shoulder by Dr. Jocelyn Whitstein out of Duke. Women on...

estrogen have less frozen shoulders. So let's make that decision and get on some to decrease your inflammation. Keep it moving. I'm going to send you to physical therapy. I'm going to ask you to hang from a pole if you can grab something higher than you and just hang and stretch it out. I may give you a steroid injection. I don't love steroid injections, but if you're in such terrible pain, you can't even think straight. I'll do that for you. The thing that's more effective in a

and this was just documented in a meta -analysis of 14 randomized control trials, using platelet -rich plasma as an anti -inflammatory for frozen shoulder is highly effective and more durable than steroid injections. So I do that often. Platelet -rich plasma, for those of you who have never heard of it, is platelets are one of the components in your blood that when you cut your leg shaving, rush to the scene and block the hole.

but they're not just bricks, they're sacks of growth factor. So they block the hole, they release the growth factor, and then they start to heal you. Well, that's what happens when we take blood from your arm. I take 120 cc's of whole blood. We spin it in a centrifuge, collect 10 billion platelets and put them into your shoulder to allow them to decrease the inflammation, soothe your synovium.

And that can be highly effective because what we're trying to do is not bring you to the operating room where I manipulate you under anesthesia or have to do surgery. We're trying to avoid that at all costs.

Sameena Rahman (: 32:57

Well, I think that's wonderful. Vonda, tell us what you also do because you offer these boot camps. I'm going put everything in the show notes about all the things you're doing, but I know you offer these amazing boot camps and we're actually doing some of the exercises that works. So tell us about these a little bit too.

Dr Vonda (: 33:03

Yeah, please do.

Dr Vonda (: 33:13

Yeah.

Thank you so much. So I've talked a lot about my orthopedic practice, but I have another side of how I treat people. I build menopause roadmaps for them. I've stopped prescribing hormones because you guys are much better and it's very nuanced. And I just don't think that that it's so nuanced, right? But what I do when people come to me is we, we do all the labs, we do body composition. hear your story and

Sameena Rahman (: 33:34

it.

There's a lot of back and forth. Yeah.

Dr Vonda (: 33:45

And I build you a roadmap. For instance, I'll say, okay, here's all the things we need to do. Here's who you're gonna go get your hormones from. Here's how we're gonna teach you to lift. And so that's one aspect. And I do that one -on -one. But if people wanna come and do it together in a group, I hold these three times a year retreats. They're three days long called midlife mastery. Because not only do you get your menopause information and I bring in

great speakers. We teach you how to lift. We teach you how to do zone two and measure your lactate threshold. By the end of the weekend, you have your entire roadmap for how to master midlife. And you know what's the most amazing part? Each and every one of my retreats forms a community and they talk to each other. And they're a group of 30 to 50 people. They don't even need me anymore because they're all advocates for themselves.

Sameena Rahman (: 34:33

Yes, I love it. I love

Sameena Rahman (: 34:40

Yeah.

Yes.

Dr Vonda (: 34:43

So the other thing I do besides these retreats, and it's coming up November 9th, is I hold one large event a year called the Women's Health Conversation Summit, where we just pack in eight hours of the best speakers. We talk about all the topics about what are the things that frankly kill women and what are we going to do about it? And so it's just fun to be in a big live event. And that's coming up November 8th and 9th in Lake Nona, Florida. Yeah.

Sameena Rahman (: 35:11

Wonderful. Yeah, I think those events are great. We host them in my office too. And it's just nice when people form their own little community and then they...

Dr Vonda (: 35:18

Mm -hmm. Yeah.

Sameena Rahman (: 35:19

can then talk to each other and then they talk to other people and they talk to their friends and that's the web that it forms. But I think just even like having that shared experience with somebody like women, we love, you know, communicating about our own shared experiences if given the right arena for it, right? Otherwise there's so much taboo around it. No one wants to talk about it, but I think that it's great. And that's amazing. I have to say that, you know, all the work that you've done, you know, like I said, I share my office with my husband who's an interventional pain sports medicine and he

Dr Vonda (: 35:24

Yeah.

Sameena Rahman (: 35:50

He has a new junior partner and I just had him read your article. He's like, this is blowing my mind right

and my husband talks to other physiatrists and other pain doctors and he works with all these orthopods. And for a while they were like, what dude? Cause he also treats a lot of my PGA patients and a lot of that comes from the spine. And so he's always talking about sex med and menopause with people and they're like, what? And I'm like, yeah, but he's doing the work too. So I appreciate the fact that he's in a team with me.

Dr Vonda (: 36:20

him!

Sameena Rahman (: 36:22

You know, we share the same office space and we have a physical therapist that works with us, pelvic floor. And so she does everything too. So it's a good little like, you know, multi -discipline. But you know, it's just interesting because he'll tell all his orthopedic friends or, you know, interventionalists. And sometimes they're like, dude, come on. And then other times they're like, whoa, this is like pretty cool. Actually, this makes sense to me, you know?

Dr Vonda (: 36:29

Really good!

Dr Vonda (: 36:43

Yeah, you're in Chicago? Yeah, so you know, I trained in, I mean, I did all my education in Chicago and I know the Rush Orthopods really well and I trained at University of Yeah, I should send this paper to them so they're not so surprised.

Sameena Rahman (: 36:51

Yeah.

Sameena Rahman (: 36:54

Yes, that's where my husband did his training for inter -psychiatry. Yeah, that's a great theme. Yes. yeah, they're great. The Russian orthopods are really you know, really renowned over here. So I think,

Dr Vonda (: 37:09

They are so good.

Sameena Rahman (: 37:11

Well, I appreciate all that you're doing. I love spreading your information. just, when I was just on, when the menopause conference was in town, I did a segment for the local Fox 32 news and I mentioned your study and you, so was like, one of the big things was the Muscov's I just felt like it was the biggest thing to come out of that for so many people because so many of the attendees were like, I didn't realize that this was a thing. And then of course the people that are online probably saw a lot of what you said, but.

Dr Vonda (: 37:28

That's so good.

Sameena Rahman (: 37:41

I didn't mention it to the people. I'm spreading the word as much as I can.

Dr Vonda (: 37:44

Thank you.

Dr Vonda (: 37:48

Thank so much.

Sameena Rahman (: 37:51

But thanks for being on my show today. You guys will read in the show notes how to get in touch with Dr. Vonda Wright. She's doing amazing things and she's on Instagram as well so you guys can see all the stuff that she's up to. But you know, I really appreciate, is there anything else you would tell your, like the listeners, like one of the things that you know we always hear is like how do I find someone that can help me? Like what do you guide, how do you guide your patients on that?

Dr Vonda (: 38:18

Well, I think one of the biggest roadblocks that patients repeatedly come up against is just the remnant of the fact that most doctors are not trained in medical school at all. And so I want to give doctors the benefit of the doubt in saying it's not that they don't want to help you, it's that they either don't know, they don't know, or they don't want to hurt you because they don't feel comfortable. It's outside of their scope of work.

Sameena Rahman (: 38:40

you

Dr Vonda (: 38:46

So what I encourage people do, and it is not in a mercenary way, is you have to keep looking until you find somebody that has menopause training or like me, has done a deep dive and I've self -educated. It is okay to sever your relationship with a doctor that's not working. It's a relationship. And it's not about pleasing your doctor. It's about finding the help you need. And so if you wanna stay with your...

PCP or your OB -GYN and they don't know this, well then, find one of the menopause who can, do one of the online services. You can keep the doctors you love, but you're looking for an additional service through one of the women's platforms that can support that. It's okay, I want you to know it's okay. You're not gonna, it's not, that's not because you hate your doctor that you're seeking help outside of it.

Sameena Rahman (: 39:20

to supplement.

Sameena Rahman (: 39:43

And I always say like, you know, like for me, I'm here to educate so you can advocate. But the reality is at the end of the day, no one's going to save you. You have to like really invest in your own health. And so that's, that's what we have to do as women. That's what everyone has to do really. But I think women actually try to help their partners a lot. So at least you have that. We always joke that, you know, if you have a work wife, I wish we had a work wife and I wish I a help.

Dr Vonda (: 39:53

You do. Yeah.

Dr Vonda (: 40:09

No, right? I could use one. Yeah.

Sameena Rahman (: 40:13

Yeah.

But thank you again, Dr. Vonda Wright. You're amazing. I love everything you're doing and I appreciate you being on my show and hopefully the listeners have found some validation in everything you said and know where to get some help when they need it. And if you want to join her, the information is going to be on the show notes, how you can join one of her midlife mastery retreats. But I'm Dr. Samina Rahman, Gyno Girl. Thank you for joining me on Gyno Girl Presents Sex, Drugs and Hormones. Remember, I'm here to educate so you can advocate for yourself. Please join me next

Dr Vonda (: 40:26

Well, thank you so much.

Dr Vonda (: 40:34

Thank you.

Sameena Rahman (: 40:43

week for another show.