Dr. Vonda Wright is a clinical instructor at the University of Pittsburgh and is also doing an additional year of training in sports medicine at the Hospital for Special Surgery in New York. She earned a Master’s degree from Rush Presbyterian St. Luke’s Medical Center in Chicago and her medical degree from the University of Chicago- Pritzker School of Medicine. She did her Orthopaedic Surgery Residency at the University of Pittsburgh Medical Center. Dr Wright has received numerous honors and grants for her orthopaedic research and studies on senior athletes. She is the author of more than 25 published works. On October 18th she is a guest speaker at the media event sponsored by the American Academy of Orthopaedic Surgeons at Madison Square Garden.
Knee1: When did you know you wanted to be a doctor?
Dr. Wright: You know how you ask children “what do you want to be when you grow up?” A pretty standard answer is “I want to be a doctor” and I carried that with me all through my education. For me it all fit together, using the scientific part of your brain as well as the creative to be able to take care of people. It’s a very holistic approach that fits my personality.
Knee1: How did you end up in Orthopaedics?
Dr. Wright: I decided in medical school that I needed to be a surgeon because I can see with my mind how I want something to be put together and then I am capable of doing it with my hands. So, that three-dimensional spatial ability is really handy in surgery. I decided to be an Orthopaedic surgeon because it encompasses the entire life span from tiny little babies all the way to the very geriatric patients. There are so many different kinds of procedures from highly complex 12-14 hour surgeries down to small out-patient surgeries. There is just much you can do in this field. Frankly, you can never be bored.
Knee1: Have you seen a lot of changes in your field in the last five to 10 years?
Dr. Wright: In the last five years I’ve been noticing that the technology is enabling us to really do amazing things through smaller and smaller incisions. When I started Orthopaedics we were doing hip replacements that were nine to 10 inches long and now we commonly replace an entire hip through a five or six centimeter incision. That’s all that we need because our instruments are better and our skills are better. Not to mention arthroscopy where you need several one centimeter incisions to do a remarkable amount of work with a camera in one portal and working instruments in other portals. This is especially true in sports, which is my specialty.
Knee1: How knowledgeable are your patients? Do you need to spend a lot of time educating them?
Dr. Wright: It really depends on the person. You’ll have patients who want to hear your opinion and desire to be told what to do. But there are many people who are on the Internet before they come into the office. Sometimes they will print off articles and ask, “What do you think about this doctor?” While we still have both ends of the spectrum, I think compared to 10 or 15 years ago people are definitely self-educating.
Knee1: Do you find the Internet to be a good resource tool?
Dr. Wright: I think it’s hard. People have to be very careful on the authority of the Web site. As you know anyone can start a Web site – you can just put up an address. I think people have to be wise consumers and not just believe anything they read. When they bring in something they have printed off the Internet I will read it and if it’s from a reputable source or if it’s information consistent with the medical literature, we discuss it. If it’s someone selling a product that I don’t have any information on or is blatantly wrong, then I’m happy to tell the patient that.
Knee1: How do you develop a treatment plan with your patients?
Dr. Wright: Visits are structured the same way they are for family doctors. The patient will come into the office and if I don’t know them I will introduce myself and then sit down. I feel sitting down is a good way to indicate to the patient that they have my time. Then I ask, “How I can help you today?” As the patient starts telling me their story I direct the information by asking questions since people won’t know which information I need to know to help them. As they are talking I will be thinking, “Well they may be having problem A, B or C. What could be the cause?” Based on that I direct the questions further until I have a short list in mind of the problems – in medicine we call it the differential diagnosis. Then I do a physical, maybe ask more questions, usually take an x-ray as a base line or an MRI if the problem warrants it. Then based on all that data, we make a decision on what I think is going on with the patient and what the first step in treatment should be.
Knee1: So how do you balance doing research with your practice and the need to stay current with all the new technology?
Dr. Wright: I think it’s a little difficult. But for academic surgeons that is the balance. We do patient care and we have designated research days. All doctors are reading all the time. You never stop keeping abreast because within a year you can get behind. So you just do it. It’s like any job where you multi-task.
Right now, while I am studying in New York my connection with the University of Pittsburgh is to analyze research gathered from the 11,000 amazing senior athletes at the National Senior Olympics held in Pittsburgh this year.
Knee1: When did you first start studying older athletes?
Dr. Wright: I first became aware of it in 2001 when a large group of researchers from the University of Pittsburgh went to study athletes at the Senior Olympics in Baton Rouge, Louisiana. I realized there are 77 million baby boomers turning 59 this year. So in five to 10 years a huge segment of our population will qualify as seniors. These people are not the same kind of seniors as their parents. They are highly active and motivated to stay young. They have the financial resources to seek out the very best in not only healthcare but also avenues for being active. It occurred to me that we didn’t really know much about how the musculoskeletal system ages or how best to keep athletes functioning as they age. Orthopaedics and science in general has done a fantastic job at treatment of disease and treating congenital illnesses in the young but we haven’t done a really great job defining what a healthy aging musculoskeletal system is. So I saw this huge opening and a ready population and it sparked my interest.
Knee1: What were the senior athletes like?
Dr. Wright: Well in general they were healthier than the general population. On their self-assessment they felt healthier both physically and mentally. They were well-educated people. Many of them were retired but not due to illness. It was purely because it was time or they were seeking out a different kind of life. It was a very interesting group of people.
Knee1: You have also been doing research around osteoporosis in men? This is not something we hear much about.
Dr. Wright: Actually it is a subject that is not as widely recognized. Women get our DEXA scan early, we get diagnosed early and we begin treatment early. But with men osteoporosis has not been as widely studied. It happens 10 years later, when men enter their 70s. Whereas with women it’s after menopause, a decade earlier. In men often the first sign is a frailty fracture of the hip or loss of height because of the spine collapsing. So we don’t catch men as early as women. When we did the 2001 screening of 800 senior athletes we found that even the oldest senior women maintained bone density fairly well through exercise and HRT (which was still being used then). But our 80-year-old men had a high rate of osteoporosis and osteopenia, (a lesser degree of bone mineral density loss). So that was very interesting to us.
Knee1: Why is it so much later for men?
Dr. Wright: Well as men age their level of testosterone declines as well as their level of available estrogen – because men do need estrogen – and that’s important for bone health even in men. So as they decline in age along with hormones their bone density declines. You don’t think of that in men prevalently because men don’t go through menopause.
Knee1: How do you respond to this inactive younger generation? We have Ronald McDonald doing commercial exercise breaks.
Dr. Wright: Isn’t that incredible! We begin being sedentary as children because if the adults are sedentary then children see that and will do what their parents do. Seventy percent of the people in this country do not meet the minimum threshold for exercise, which is 30 minutes per day of moderate to intense physical activity. If 70 percent of the people in the United States do not achieve that it’s not a mystery to me that our children are not achieving it either. It has to do with computer use, television watching and the physical education in the schools.
The reality is that this country is aging. There is good news and bad news. The good news is that because of our advances in technology, our public health advances and our ability to treat disease, we are living much longer lives than we were at the beginning of the century. Our average life span is up into the 70s, which it never was before. The bad news is that we are no longer a farming society and with that we have sedentary jobs, education and leisure. That adds up to people living long lives in a very sedentary and unhealthy way.
Knee1: So these senior athletes are good role models.
Dr. Wright: If you are looking for a healthy model of active aging to find out what we are capable of as we age without the limitation set upon us by a sedentary lifestyle, the senior Olympians are the place to look. They maintain their incredibly physically active lifestyle throughout the ages so their aging process can be attributed to the actual process and not contaminated by the effects of disuse. We can’t get away from the changes our bodies go through with aging but we can change what our bodies go through from disuse. So I study the senior Olympians because they are the best examples. For the general public I try just to educate them about how our bodies change as we age.
Knee1: What are some of those changes?
Dr. Wright: Well our rate of cell division and how fast we are able to recover after exercise slows down. As we age we lose lean muscle mass. By age 80 we have lost 50 percent of our lean muscle mass. So the effect is that we become weaker. We can’t get up from a chair as easily. We are unable to balance ourselves when we trip, which leads to falls. Another effect of aging is a loss of bone density, and that leads to frailty and disability because of fractures. Our ability to balance declines as well so that by the age of 65 one in three people will have a significant fall.
Knee1: How should exercise be adapted for older people?
Dr. Wright: Those are four main areas effected by aging and as we are prescribing exercise for seniors we need to address those areas. It’s not just about cardiovascular fitness, which is what we look at when we think of for young people. Young people can go out and be intense every single day and have relatively fewer injuries. Senior people not only need cardiovascular fitness a minimum of 30 minutes of moderately intense exercise per day; they also need to do flexibility training as well as proprioceptive training. Proprioceptive helps us maintain the ability to keep our balance. So if you are beginning to fall to the right, our neuromuscular sense contracts the muscles on the left side to pull us back up and compensate. But we lose that as we age so it’s important for seniors to work on that. And finally it’s important for seniors to lift weights and do resistance training. We know that even 90 year old men living in a nursing home can significantly improve their muscle strength by doing a short course of strength training.
Knee1: But most nursing homes don’t have exercise rooms or equipment.
Dr. Wright: Exactly. But you don’t need a lot of equipment. You can do resistance training with a can of peas. You can lead people on a walk, do exercise in a chair where you do flexibility and some mild aerobic exercise sitting in a chair.
Knee1: It sounds like your research is going to help us determine what is lost through natural aging and what seniors are losing simply from not using it.
Dr. Wright: The exercise physiologists have done a good job in the last 15 years of defining, on a very technical level, what we need to do. But somehow the body of information out there has not been well integrated into our society. It sounds horrible to say but fitness in this country is a myth. If you go out into any newsstand every magazine is going to tell you how to shape up your abs, lose 10 pounds and get fit. But then you look around and clearly the message in the newsstand is not being translated into action. My goal is to educate the seniors to get off the couch and take control of their health. I read a quote that said, “If you don’t take the time to invest in your health and fitness when you are young, you will have nothing but time in the end to deal with your illnesses.” A third of the seniors in the United States have age-related disability. It is seven times more expensive to take care of a disabled senior, someone who can’t live in their own home and can’t do their own activities. According to the Medicare Beneficiary, it costs 26 million dollars a year to care for people who started off living independently in their own home but become frail or disabled and need help. I think that if we do not address this before 77 million baby boomers become seniors in 15 years it will be tidal wave with social and financial consequences.
Knee1: Why 15 years?
Dr. Wright: That’s when baby boomers turn 75. In the research I did with the 2001 senior Olympians I looked at the way even the healthiest of the healthy declined physically by looking at their sports performance. I looked at the top eight finishers in every race both swimming and running from a 100 meters to 10 kilometers. I found that performance declined gradually from age 50 to 75 at a rate of less than 2 percent per year, which is pretty steady. But at age 75 the rate of decline skyrocketed and their performance plummeted at a rate of 8 percent a year. So you have to ask yourself what happens around age 75 that even the best of our best senior athletes have physical decline? If you have sedentary people reaching age 75 who have never been fit, it’s a scary proposition if we don’t address it aggressively. Information clearly is not motivation so we have to find a way to capture people’s imaginations and get them exercising. One of my roles as an orthopaedic surgeon and senior athlete researcher is to present our seniors with practical, research-based methods for maximizing their potential for successful aging!
To learn more about Dr. Wright’s research, visit her Web site.