Midlife Body Aches & Frozen Shoulder

Vonda Wright (00:00:00) - I want to empower you to get in the driver's seat of your own health and just be a student of your health, because otherwise you're the victim of whatever anybody tells you. If you don't self educate, you're a victim.

*Sarah Milken * (00:00:16) - Hey peeps, welcome to the Flexible Neurotic Podcast. I'm your host, doctor Sarah Millican. Yeah, you heard that right. I'm a real PhD doctor. Long, long ago, like last fucking year, I was sitting in the midlife funk wondering, was this it for me? That day, I realized I needed to get off my ass and start my midlife remix. I dusted off my PhD, wipe the menopause sweat off my forehead, grabbed my golden shit shovel, and started digging deep to all my midlife bitches. It's not just luck, coffee, and hormones that get you through your midlife remix. It's action steps. Let's do this. Hi peeps! This is the next episode of the Flexible Neurotic Podcast. I'm Doctor Sarah Millican, the flexible neurotic. Today I have a repeat guest she was just on in the last month or so.

*Sarah Milken * (00:01:13) - I got so many messages about our topic today that we arrange this second interview in between my dental cleaning and her surgeries. So this midlife hottie, double board certified orthopedic surgeon sought after speaker on empowering women for longevity health practices and is a five times best selling author. She's always on the Today Show and so many other news outlets because her information is critical for our midlife selves. Hi, doctor. Vonda, right.

Vonda Wright (00:01:47) - Hi, doctor. Sarah.

*Sarah Milken * (00:01:48) - Oh my gosh. So I don't know if the beginning got caught on the recording. Doctor. Vonda, right, is she's training for a Spartan race. And I told her that that was the opposite of my fun and that's her fun. And I'm like, interesting. I want to run in a £30 weight sweating profusely. Climbing shit. Sure.

Vonda Wright (00:02:10) - Yeah. You know what? When you put that way, I see your point.

*Sarah Milken * (00:02:14) - Ha ha ha ha ha. Well, how do you. How do you frame it?

Vonda Wright (00:02:19) - You know what? Here's how I frame it.

Vonda Wright (00:02:22) - women have always done hard things, for God's sake. You pushed two kids out. I pushed a kid out. We solve all the problem. We have always done hard things. So there got to be a time in life when, you know, I used to run marathons, and I. At 40, I was in the best shape of my life. And I'm like, Holy cow, I'm not dead yet. On top of that, my neighbor is the CEO of the Spartan Races, and he's all the time jabbing me like, what? Are you dead? Are you dead? I'm like, I'm not dead yet.

*Sarah Milken * (00:02:54) - Oh my gosh.

Vonda Wright (00:02:55) - Just to clarify, I only do the Spartans that are held in legendary stadiums. So I did it in Fenway. I'm doing it in Raymond James. Next year. I'll do it.

*Sarah Milken * (00:03:04) - So you're not. You're not in a jungle.

Vonda Wright (00:03:07) - I'm not in the jungle. We get to go behind the scenes at these famous stadiums, and it's only 3.2 miles.

Vonda Wright (00:03:13) - So I don't want you guys to think that it's a marathon with 40 obstacles. It's still a lot of work. However, I'm going to tell you for sure that when I am done, I feel incomparable. And you know what? Women actually show up to do it with me. Ten showed up in Boston, ten are showing up in Tampa because we do hard things, ladies. We just do hard things.

*Sarah Milken * (00:03:39) - I might just start with the cold plunge. Like just trying that out once. Like that might be my baby step.

Vonda Wright (00:03:45) - Terrifying to me because my belly doesn't like to be cold in a swim.

*Sarah Milken * (00:03:51) - Okay, so today we're going to talk about frozen shoulder. Frozen fucking shoulder. I don't even know what to say about it because, well, actually, I do know what to say because I had it. Yeah.

Vonda Wright (00:04:04) - And you can't say the F word enough about it because.

*Sarah Milken * (00:04:07) - You can't.

Vonda Wright (00:04:08) - You can't.

*Sarah Milken * (00:04:08) - You can't.

Vonda Wright (00:04:09) - Sucks. It's like some evil trick. But look, because you're an actual doctor.

Vonda Wright (00:04:15) - I pulled an article for you.

*Sarah Milken * (00:04:16) - Are so good.

Vonda Wright (00:04:18) - Yeah, but you know what? This article was written by my mentor, Doctor Jo Hansen, who is the badass of the badass orthopedic surgeons, was an orthopedic surgeon before there were orthopedic women. And so there's actually science behind frozen shoulder. But it is a misnomer, isn't it, that it's frozen? Yeah. Because really, what's going on is hot, right?

*Sarah Milken * (00:04:40) - It's like a fucking javelin goes into an oven. Like there's no words for it, actually.

Vonda Wright (00:04:46) - And so frozen is wrong other than it just doesn't move. So yeah.

*Sarah Milken * (00:04:50) - Oh my god.

Vonda Wright (00:04:51) - Not been lucky enough to have it. Women come into me and I'm not kidding you. They can't raise their arm and they can't hook their bra.

*Sarah Milken * (00:04:59) - It's like, trust me, I lived it. So the proper fancy medical term is adhesive Capulets.

Vonda Wright (00:05:06) - That's right, that's right.

*Sarah Milken * (00:05:07) - So that's like sticky. It's like fucked up sticky shoulder that hurts.

Vonda Wright (00:05:12) - And it's actually, you know, if we biopsy the tissue, which Doctor Hannifin did, there's actually a progression of inflammation, if you can imagine that it goes from state.

Vonda Wright (00:05:24) - There are four stages. Bear with me, okay. Four stages. Just because you know what your women are going to want to know, to be able to throw around this information when they're talking about it.

*Sarah Milken * (00:05:33) - Especially to male doctors who are like, yeah, your shoulder hurts or your it's a rotator cuff problem. It's from pickleball.

Vonda Wright (00:05:41) - Well, listen. Highly, highly inflamed people. Most midlife women get this, but guess who else gets it? Highly inflamed people because they're diabetic. Imagine being a woman with diabetes. That is two insults and one anybody with a highly inflamed state, whether it's autoimmune, whether it's diabetes, whether it's women who have lost their estrogen are highly inflamed. So with frozen shoulder, it starts off insidiously like stage one. You have pain in your shoulder at night. You can't roll over and then you notice, oh, it hurts. And you do the normal thing. You stop moving it. Well, that's the worst thing we can do, because during phase one, which can be about three months, it's mainly just inflammation.

Vonda Wright (00:06:32) - But as it goes on, all the immune cells crawl into the inside skin of your shoulder. It's called the capsule and inflame it. And during inflammation, tissues in our bodies start to get stiffer and stiffer. So in stage two. So stage one is just the the pain phase. Stage two is the freezing stage meaning it's just not inflammation. Your. Your tissues are getting stiffer. And if that goes on up to 15 months, you enter the frozen stage. It is frozen. The capsule has contracted. So that's why I tell you to do some of the stuff. I'm going to tell you how to treat this, but you got to keep moving this thing because the actual tissue of your shoulder actually contracts, and then you can't move this. And then eventually stage four, which can come two years later, if you can imagine the misery of it, your body finally gets rid of the inflammation, finally gets rid of the fibrotic tissue. So stage 1234 thaw over two years. So when I tell people to get on this and get on it early, it's not because I don't, you know, I'm just like, oh, treat your injuries early.

Vonda Wright (00:07:56) - No, it's because the inside skin, the capsule of your shoulder will physically contract. And then literally I had four women last week come in in my office. They're like, I can't. I can't even.

*Sarah Milken * (00:08:08) - Oh my God, I know, I know that feeling because I lived it and it is something that's indescribable. But we're going to go through all the specifics of this. But when you said if you just let it run for two years and said, okay, I'm just going to sit here and take it, would it thaw out on its own eventually, or do you have to intervene?

Vonda Wright (00:08:32) - Eventually it will thaw out. But but two years really. Right.

*Sarah Milken * (00:08:38) - No, I, I, I the reason I'm asking is because I had people messaging me last night about it because I asked followers to ask questions, and one woman said, I'm kind of just grinning and baring it and sticking it out. And I thought to myself, well, I wonder if that works because I, I mean, I couldn't have done that.

*Sarah Milken * (00:08:58) - I don't have that kind of internal strength to just grin and bear it for two years.

Vonda Wright (00:09:03) - Well, yes. You've eventually most of these resolve. That's the bullshit answer many women get when they go to doctors with a frozen shoulder. They're like, you know what? Just hang with it. It'll get better. Well, those those men don't have ovaries. Those men don't have frozen shoulder. They don't know what it's like to to not be able to use their arm for any functional way for two years. So, eventually, if you if you give it two years, it usually resolves.

*Sarah Milken * (00:09:36) - But but how is that possible if you don't change any other things, like if we're going to get to the estrogen. Peace. But if you're not doing the things, how do you eventually how does the inflammation lower itself?

Vonda Wright (00:09:50) - Your body's immune system, will start to cool it off. It will start to, break down the scar tissue. Got it. So just a very long process, because by the fourth stage, the inflammation is over.

Vonda Wright (00:10:06) - So your body starts. Got it. Reclaiming tissue. Yeah.

*Sarah Milken * (00:10:10) - I heard you say on your Instagram that if you have women who are scheduled on your books to come and see you and you know that they're between the ages of, let's say, 35 and 55 and they haven't been into a car accident or fallen at the supermarket, you know, it's frozen shoulder.

Vonda Wright (00:10:29) - Yeah. If I see on my that age group it says shoulder and my athletic trainer usually goes in before me and I read the first line, no traumatic injury. I know it's frozen shoulder, so I don't let them talk about their shoulder too long before I get into their perimenopause. And that's why, and I've said this before, you may have heard it. That's why I am the nicest possible author I can be. But women weep in my office because they want to be heard. They've been told they're insane. There's nothing wrong with you. What do you mean, in your head?

*Sarah Milken * (00:11:02) - You'll be fine in a week.

Vonda Wright (00:11:04) - It's so not.

Vonda Wright (00:11:05) - And it's not because you're getting old. It's because your estrogen has declined and you're inflamed.

*Sarah Milken * (00:11:14) - Oh my God, I mean, there's actually no words for it. Okay, so we did the three stages 3 to 4 stages. Now let's talk about the causes. So one cause is you fucking fell. One causes, there's trauma. You're in a car accident. But the main, main culprit is estrogen declining. Yes.

Vonda Wright (00:11:36) - Right precipitously. Right? Every month you have a period or estrogen goes up and down like this. But then when your ovaries retire at 40, we have 1% of our eggs left, so that's not much egg left to make estrogen. And after that, your eggs are done. And. It goes like this. It men just kind of coast along with their hormone levels estrogen and testosterone. Women go zoop and then. So that's why all of a sudden these things arise. It's pretty quick, how these things can just come up. So when women come into my office and I know that's what's going on, we just talk about perimenopause because then they're heard, then they recognize they're not making it up.

Vonda Wright (00:12:23) - No, they didn't have a fall. They didn't bump their shoulder in the middle of the night on the closet door when they got up. This can just happen for no apparent reason. And once they know that I understand, then they're going to listen to what I say about what to do and know that I'm not shoving procedures at them or shoving therapy at them. I'm explaining to them the mechanism and why we gotta get on this early.

*Sarah Milken * (00:12:47) - Is there ever a case where somebody is on HRT or estrogen, but it's just not enough?

Vonda Wright (00:12:54) - Yeah, it can be because you can be highly inflamed from other reasons. Maybe you have a legitimate autoimmune disease, maybe you have thyroid problems, maybe you are diabetic or even though you're on HRT you're so lipid dysregulated, sugar dysregulated which happens. Our insulin and sensitivity rises during this time that you're just too sweet inside. That's why I tell people we must live in anti-inflammatory diet. And the number one thing to do that is get rid of sugar, which we all love because is so hard.

Vonda Wright (00:13:30) - So hard. I get it, I had half a brownie last night and full disclosure, because it was.

*Sarah Milken * (00:13:35) - I would eat two of the brownies. But yeah, it's so hard.

Vonda Wright (00:13:38) - My husband, he's like, I say to him, don't friggin cook those things. And it's like, just don't eat them. Oh, that is no.

*Sarah Milken * (00:13:44) - That doesn't cut it for women. No. If I know it's there, I'm going for it.

Vonda Wright (00:13:50) - Oh, and they were so good and gooey so darn for doing that. But but it's the sugar that inflames us more. So your question was can you be on our HRT and still have it? Yes, but here's what we know. There aren't that many studies about it. I showed you a really old one. This is from 2011, but Doctor Jocelyn Whetstone from Duke, who's a friend of mine, an orthopedic surgeon, partnered with Doctor Ford. I forget her first name, also from Duke, who's an ob gyn. And they looked at insurance databases for variables concerning frozen shoulder and HRT.

Vonda Wright (00:14:26) - And they found, lo and behold, women on HRT have less frozen shoulder. They didn't say they had none, but they had statistically significantly less. So we can, you know, we can draw a correlation. Oh, maybe they're less than I think.

*Sarah Milken * (00:14:42) - Now with more women kind of dealing with or first hearing about and then managing insulin resistance, since it's become like such a topic with metformin, the natural version of it, berberine and or the semi blue tides Ozempic, Wigo V Montero, all that stuff. Like, do you think that frozen shoulder could start to dissipate in some cases if women are taking those drugs?

Vonda Wright (00:15:14) - You know what Sarah? That would be a great study for someone to.

*Sarah Milken * (00:15:18) - Get right on that doctor, right?

Vonda Wright (00:15:20) - Yeah. To someone to mind the big ozempic databases and see if there's decrease. Actually, I have this brilliant, medical student. He's a data scientist. I may he he mines databases for me all the time. Maybe I'll ask him. And next time I talk to you, he.

Vonda Wright (00:15:36) - Because I haven't seen a study. I guess the short answer is I haven't seen that study, but it would be fascinating.

*Sarah Milken * (00:15:41) - Yeah, because I feel like if so many women now are using metformin for blood sugar, ozempic and all of these things, it would seem that if they were taking HRT, but it wasn't enough. But they also had the sort of blood sugar dramas to go with it that perhaps it would dissipate a little bit. Just a random thought. I have a PhD, not an MD. So there you go. Whatever. Let's see.

Vonda Wright (00:16:08) - that's you. PhDs love to analyze data. Weird stats. I can't stand it. That's why I have this kid.

*Sarah Milken * (00:16:14) - Yeah, but I'm not. I'm not cutting open shoulders, my friend. That is not going to happen. So let's talk about diagnosing, okay? Because from my own personal experience, I actually relisten to my episode where I talked about my frozen shoulder and I literally had PTSD. I was like, oh my God, this was just as bad as I remembered it was.

*Sarah Milken * (00:16:37) - I woke up one day and I said to my husband, like, I can't move my shoulder. And he, you know, men don't get it. Like he's like, yeah, whatever. And I'm like, no, no, no, no, I can't move it. And he's like, okay, put ice on it, heat it, take Motrin. I'm like, okay. But like I've already done that. Like, what are you talking about? and it. Took me. Pressing, pressing, pressing, like a lot of midlife women have to do on a lot of topics to get to the answer. A frozen fucking shoulder. And why is that? And what can we do better?

Vonda Wright (00:17:12) - Well, I think I think, number one, whether we're talking about frozen shoulder or a bloody nose or whatever. Women, no one's going to ride in and help you. I would love to tell you that every medical doctor is going to sit down and take the time. Listen, insurance only pays for 15 minutes and they're doing the best they can.

Vonda Wright (00:17:34) - Women must be the. The pusher, the health pusher in their own lives. I want to empower you. Keep asking the questions. If you don't like the answer your doctor doesn't give them to you, find another doctor. I want to empower you. Ladies listening, people listening to get in the driver's seat of your own health and know what you've gotten, who gave it to you, blah blah blah. Number two, I think we have to, Learn like from your podcast, from the from the mental posse that are talking about these things. I'll just be a student of your health because otherwise you're the victim of whatever anybody tells you. If you don't self educate, you're a victim. But was your question I got off on a rant. Is your question about treatment.

*Sarah Milken * (00:18:22) - Just diagnosing it because there's not a yeah, because there's not a.

Vonda Wright (00:18:26) - Test okay. There's no test. So if your shoulder will not move and you had no trauma. Just assume you have frozen shoulder. If you're in the age range, just assume you make an appointment with an orthopedic surgeon or an orthopedic sports doctor.

Vonda Wright (00:18:45) - Because there are medical doctors with a sports fellowship. They are not surgeons, but they do procedures. You walk right in and you say, here's what, here's what I want you to say. Hi. I'm a midlife woman. I had no trauma. My shoulder won't move. I think it's as he adhesive capsules as can I. Please get a steroid injection? Because I'm in phase one. It's in the highly inflamed stage, and I don't want it to progress. I mean, be aggressive like that. Just don't sit there and say, oh, my shoulder hurts.

*Sarah Milken * (00:19:18) - okay. There's a lot of people who are listening right now because I also got a lot of messages about it who are afraid of cortisone injections.

Vonda Wright (00:19:26) - I know, and I hate them. Listen, if it were your knee, I'd try everything else. If it were anything. I always try other things. I get it, you either need cortisone or I use a lot of platelet rich plasma, which is. And it has anti-inflammatory properties, which I.

*Sarah Milken * (00:19:43) - Which is when you take your own blood spin it injected.

Vonda Wright (00:19:47) - That's right. Because we have got to stop the inflammation. Inflammatory.

*Sarah Milken * (00:19:51) - How many times do you have to do PRP for it to work that isn't that different than like a cortisone injection where like it's slam bam. Thank you ma'am.

Vonda Wright (00:20:00) - Well, and it works differently right. But and I will tell you for sure, PRP has a lot of great uses that have amazing level one data, which is the best data for arthritis, for tendon problems, for rotator cuff tears. There is no data for frozen shoulder. But my women are so desperate to feel better. I know it has amazing inflammatory, proper anti-inflammatory properties, so I explain that to them and I usually use it after steroids or PT have not progressed them before. I'm saying, you know, the only other thing I have for you, you're so frozen, is to take you to the operating room and manipulate your.

*Sarah Milken * (00:20:38) - How many times would someone have to do PRP from your anecdotal office?

Vonda Wright (00:20:43) - I do three injections.

*Sarah Milken * (00:20:45) - Okay. Over how long?

Vonda Wright (00:20:47) - Over one a week for three weeks.

*Sarah Milken * (00:20:49) - Got it. Okay.

Vonda Wright (00:20:50) - All the while we're doing physical therapy.

*Sarah Milken * (00:20:52) - I feel like it's cheaper just to get the damn cortisone injection.

Vonda Wright (00:20:55) - Oh, it's much cheaper. Cortisone? A $60 PRP is $900, and that's cheap. Yeah, yeah. So. And I get you, I don't use steroids in my practice. This is the one exception. Shoulders are the one exception. So because we're just trying desperately to get rid of the inflammation you can also get rid of sugar. You can take ibuprofen I can prescribe something like Celebrex or Maalox cam which are the.

*Sarah Milken * (00:21:19) - Yeah I use the Maalox to calm one also. But you also add at some point, like what are you going to do? The frozen shoulder thing lasts for so long. I was like, I'm going to burn out the inside of my body taking all these anti-inflammatory drugs. I mean, you can't take Motrin every day for three years.

Vonda Wright (00:21:38) - Well, not that's dramatic, my love, but you're right.

Vonda Wright (00:21:42) - You don't want to be taking it forever. But if we can get you through the.

*Sarah Milken * (00:21:47) - Worst, I know, but the women who are kind of just grinning and bearing it, and they're taking it for six months, three times a day, I don't know, I'm not a doctor, but to me it just seems like.

Vonda Wright (00:21:58) - A lot. That's a lot. We got to be worried about your kidneys. Yeah.

*Sarah Milken * (00:22:02) - It just to me, it seems like a lot. I mean, look, I, I, I'm not anti-drugs. Like, I feel like there's certain things that I need to make my quality of life better. So when I had frozen shoulder, I immediately went to the orthopedic surgeon, and I was like, give me the cortisone injection. I am not tolerating this because I've already had this for 3 or 4 days. He gave it to me. I will tell you, I did not get relief. Oh, then I went back a week later. I went to a different doctor in the same practice, and I love both of them equally.

*Sarah Milken * (00:22:36) - But that doctor had more time because I paid extra, because it was a weekend and my husband was like, you're paying that? And I was like, if you were in this much pain, you would pay any amount. Like, I don't even want to hear about it. And he used a really quick ultrasound. Somehow I have no idea how I found the exact spot, which I still don't understand. Gave me another cortisone injection. I'm telling you, I listen to that episode. Like I said, within five hours I had 90% relief. Yeah, five hours. But he nailed the spot. So tell me how two doctors in the same office have different experiences with getting rid of my pain?

Vonda Wright (00:23:25) - Yeah, and I don't know what it did. I don't there are a lot of variables I don't. I use two kinds of numbing medicine lidocaine and mark canes. Short acting, long acting, and 80mg of steroids, which is twice the normal dose. And if you put that right below this bone called the acromion, the roof to bathe the entire capsule, that's the correct place to do it.

Vonda Wright (00:23:51) - And I put it in right back here, which I don't need an ultrasound to do because I've been doing this 30 years, however. It matters what you use. It matters where you put it. And, I don't have an answer other than, yeah, it.

*Sarah Milken * (00:24:06) - Was just such an interesting thing. I was like, wait, how did that work? But the one last week did it. Yeah. but then when people ask me how, like, I cured myself, I had that, so it brought the inflammation down. Then there was someone else in the office who does this weird red light therapy, and I did that for four days. And then I think I did physical therapy twice a week. I'm making this up for two months.

Vonda Wright (00:24:32) - Yes.

*Sarah Milken * (00:24:33) - And I really didn't want to do it because I didn't have the extraordinary pain anymore. But they really hammered me hard to do it. And I'm happy I did it because it really gave me my mobility back, which which was really impeded.

Vonda Wright (00:24:49) - Because, remember, part of inflammation is pain, but part of this syndrome is contracture of the capsule. So we you know, you avoided that thankfully.

*Sarah Milken * (00:25:01) - Oh my god. But what's interesting about it going back to the estrogen piece. The orthopedic surgeon didn't really get into any of that with me. He's male. Whatever.

Vonda Wright (00:25:14) - He didn't know. Imagine if only 25% of all OB GYNs have ever been educated about this. Imagine that Doctor Jocelyn Stein and Doctor von Der Reiter, the two orthopedic surgeons in the whole country, that that have taken the time. I mean, I mean, I'm pretty humble and honest about my huge social media gathering. I think I'm as funny as the next person. But the real reason that that's blown up is because there's such a a drought of musculoskeletal doctors talking about the way estrogen affects our bodies. And so that's why I had to come up with the nomenclature, the musculoskeletal syndrome of menopause, of which inflammation is one of the pillars and frozen shoulder is one of the most common manifestations.

*Sarah Milken * (00:26:03) - And the other term you used for that midlife clunk of a body is the alpha and thrilla arthralgia.

Vonda Wright (00:26:11) - Raja is total body pain. It can be joint pain, but it's just your whole body is so painful. This is one of my primary, symptoms when I became perimenopause. Here I am, this athlete who thinks it's fun to go do, Spartan races. Plus, I ballroom dance, so I'm not just sweating it out. I do find I elegant things, too, but. And I can't get out of bed. I do too. But is it.

*Sarah Milken * (00:26:38) - Because, like, I feel like sometimes with the perimenopause stuff, it's like, sometimes I just feel like ass. Like my body is just, like, tired and I feel like a slug in quicksand. But that's different than, let's say, my 80 year old dad, who, like, you know, his hand. He's a dentist. His hands ache and like, he can, you know, it's hard for him to, like, grip something really tightly anymore.

Vonda Wright (00:27:04) - And that's because of his arthritis. Yeah, right. From wearing out our joints. I'm doing that with this joint right here, wearing the mouth for multiple repetitions. Thousands of mouths, thousands of patients. Right. That is different than. You actually don't have physical arthritis or injury, although you might. Another pillar is rapid arthritis, but in general. You what you're describing. There's actually a study about this doctor Kahneman just posted twice about this study. It's the not feeling like myself. Yes, I saw that. I saw that it's an actual thing. I mean, you can't like the midlife.

*Sarah Milken * (00:27:41) - Clusterfuck is what it is.

Vonda Wright (00:27:43) - Oh, my God, that's great. It's just it's.

*Sarah Milken * (00:27:47) - Like it's all the Uggs in the pains. And I feel like I'm drowning in quicksand and I can't get my ass out of bed. And Doctor Vonda, right, is telling me to lift heavy shit and it's.

Vonda Wright (00:27:57) - All too hard. And you know what? I'm really proud of you. Because I do see what you're doing when you're in the gym.

Vonda Wright (00:28:03) - That, like, thing you were doing the other day with, I don't know, the inner thigh sweat. Yes. You're working hard. Oh, I know.

*Sarah Milken * (00:28:11) - But I but honestly, I tell people this all the time. I'm not one of those people who enjoys exercise. I said this in our last episode. Like, you know, people are like chasing endorphins. I feel like I'm missing the endorphins.

Vonda Wright (00:28:24) - You know what?

*Sarah Milken * (00:28:25) - I'm doing it because I have to do it. I hate it.

Vonda Wright (00:28:28) - But you know what? We are genetically predisposed to conserve our bodies. Don't know why we're exercising. They you know it. It's it's easier for us to sit around, but that will kill us. So you don't have to like it. From a preservation standpoint, probably sitting around is safer for us. But here's the deal. For any, you know, for all, for myself, for you. I say this tongue in cheek because I can't control everybody. But you are not allowed to be frail in 20 years because I didn't tell you that hating the gym was good for you because you're you look little on Instagram.

Vonda Wright (00:29:09) - You're like, yeah, I'm.

*Sarah Milken * (00:29:10) - Five foot two. No, you're little.

Vonda Wright (00:29:13) - You're fair, you're lean. If you don't stay in front of it like me, if I don't see in front of it, I'm going to be that frail little old lady. Who? Who has to? I am going to live with my kid because I told her I'm going to bug her until I die. But you know, I would have to, because I couldn't take care of myself.

*Sarah Milken * (00:29:32) - And I know my watch. Well, I'll tell you. In 2020, during the pandemic, we went to Hawaii. we went on this insane bike ride. I we shouldn't even have been on it with this tour guide. Whatever. Way out of my league. Totally. We go down these crazy mountains, whatever. We get to the bottom. It's like residential area. And of course, there's, like, work trucks and construction, and it's wet. And there was the tour guide, then my son, then me.

*Sarah Milken * (00:30:04) - They started pumping the brakes so I pump the brakes, but I didn't understand which brake was the right brake, so I flipped over the bike. You couldn't go to the emergency rooms because everything was closed because of Covid. So I had to go to some, like random sketchy urgent care that was like barely functioning. I had a broken wrist, a broken rib, and like this sort of weird fracture thing on my shoulder blade. Like, literally, I thought I was going to die. I will tell you, it took me almost two years to get my wrist back to where it was.

Vonda Wright (00:30:40) - Sarah. You have to get a Dexa scan if you have.

*Sarah Milken * (00:30:43) - I have one, okay.

Vonda Wright (00:30:46) - Are you kidding, honey, I have two. Advice. You have got to get a doctor. I have two of them. The problem is, is.

*Sarah Milken * (00:30:54) - When I go, he does it, he looks at it and he goes, you're fine. And I'm like, okay, but that's not helpful. I need someone to read it and interpret it.

*Sarah Milken * (00:31:04) - Telling me I'm fine doesn't help me.

Vonda Wright (00:31:07) - That's our next podcast. You bring you and I'll interpret them for all of your listeners. Everybody can bring their Dexa scans. And but he did say.

*Sarah Milken * (00:31:15) - He the one random thing he did say was it looks better than last time.

Vonda Wright (00:31:20) - Oh okay. Well that's good.

*Sarah Milken * (00:31:23) - But I thought we couldn't grow bone. So explain that to me.

Vonda Wright (00:31:27) - So we.

*Sarah Milken * (00:31:28) - Can grow muscle but not bone. So how is it better?

Vonda Wright (00:31:33) - Well, here's here's the deal about estrogen and bone is that you're still laying down bone during menopause. It's just that there's a mismatch that I use these little hands if you're watching this as the osteoclasts, which is the cell that that resolves bone and the osteoblasts that comes up behind it and fills the gap. Estrogen dampens the activity of the osteoclasts and keeps it in check. When estrogen is gone, the osteoclasts just goes. It does its thing without hindrance. So the little osteoblasts can't keep up. So you're still laying down bone. So if you do hormone replacement that control is back in place.

Vonda Wright (00:32:15) - If you do or don't do that, lifting heavy will build muscle that pulls on the bone, that sends stimulus to the bone to lay down quicker. So you can. I don't want to say you can build a ton of bone, but you can. You can even out the dysfunction. Now, maybe that.

*Sarah Milken * (00:32:35) - Maybe that's what I did and maybe that's what he was referring to. But it was interesting, is my Pilates teacher is really teeny tiny, smaller than me, and she doesn't lift a lot of weights, but obviously she does a lot of Pilates. She said that he that her doctor told her that her bone density wasn't great. So then it made me think, is Pilates is not enough?

Vonda Wright (00:32:58) - No it's not. I'm just going to say it on national. It's not. You have to build muscle, and to build muscle you must give your body enough stimulation. Do I think Pilates is bad? No. Do Pilates, but it's not going to build enough muscle for you to preserve your bones.

Vonda Wright (00:33:16) - Number one. Number two, here's what we have to understand. Title nine is now 50 years old, so we have an entire 50 years of women who have grown up playing sports. So if we were active enough during the restrict your food era of this country, and we starved ourselves and did a lot of aerobic exercise and missed three, six, nine months of periods a year, I.

*Sarah Milken * (00:33:42) - Didn't do I didn't do any of that.

Vonda Wright (00:33:48) - Well, sometimes people did and then missed a lot of periods. There's a lot of young women who come to me with bone density problems because not because they lost their estrogen. It's that they never laid down enough bone in the first place.

*Sarah Milken * (00:34:03) - I know, because didn't you say somewhere, is it 20 or third age 20 or 30, where you've laid down most of it? 30.

Vonda Wright (00:34:10) - So let's get it done. Like my older daughter's 29. I'm like, you better be laying down.

*Sarah Milken * (00:34:16) - Tock, tick tock.

Vonda Wright (00:34:18) - Yeah. Eggs and bones. That's what I'm for.

*Sarah Milken * (00:34:20) - My God. So you say that 71% of women in this age group will have joint pain without any structural abnormalities. Like you could go to the doctor all day long, get MRIs, X-rays, and they're going to be like, Sarah, Vonda, there's nothing structurally wrong with you.

Vonda Wright (00:34:37) - 41% of the time you will have so a big percentage. Now some people will have arthritis. Some of you will have a legitimate rotator cuff tear with freezing, but 41% of the time they're going to be like, yeah, normal. Nothing's wrong with you. Oh, and you're like, something is wrong with me. Yeah.

*Sarah Milken * (00:34:58) - The other thing that I found interesting about my situation is obviously the doctor didn't say, oh, you have frozen shoulder. I said it. And then because I had already been in the Google rabbit hole, but I had called my gynecologist and I had a month long bleed, I think I know this is I take birth control pills. I know that's controversial, but I've taken them since I was 14 and I haven't had the balls to switch over to HRT because no one has given me a foolproof plan that I'm not going to become a crazy person.

*Sarah Milken * (00:35:30) - In switching from birth control pills to HRT, lose all my hair and gain £500.

Vonda Wright (00:35:36) - Well, you've just got a lot of estrogen around. It's like it. You just have more than you need. It's okay. Right.

*Sarah Milken * (00:35:42) - And so. But what was weird about is even taking the birth control pills I bled through for a month because it was a really stressful time. We were moving, my husband had Covid like it was a whole thing, right? And I said, the gynecologist said to me, Sarah, you've been bleeding tremendously for a month, right before the frozen shoulder. Like that is an estrogen, I guess. Dump a huge hormone change because other than that, I hadn't changed anything.

Vonda Wright (00:36:18) - Yeah, it's a little. It's a little bit of chaos during Christmas. It's a little unpredictable, a little.

*Sarah Milken * (00:36:24) - And I had switched, so we'd actually. I switched birth control pills. I had a month long bleed. Obviously. I was probably semi anemic at that point because I feel like I had hemorrhage, half my body, blood out.

*Sarah Milken * (00:36:38) - And then I had frozen and then I had frozen shoulder. So it made complete sense.

Vonda Wright (00:36:44) - Your hormone your estrogen dropped low enough and you just got inflamed. Yeah.

*Sarah Milken * (00:36:48) - Yeah.

Vonda Wright (00:36:49) - The stress can make you more inflamed. I mean there are lots of reasons that we become inflamed. Chronic stress men can die of chronic inflammation and many do heart disease right. Yeah. So there's many reasons to become inflamed.

*Sarah Milken * (00:37:03) - So going back to the solutions for frozen shoulder estrogen which is hormone replacement essentially. Or you could do a version of it of birth control pills which I'm not recommending. It just happens to be what my plan. My thing has been a steroid injection PRP, platelet injections and eating anti-inflammatory. Did I miss something?

Vonda Wright (00:37:28) - Physical therapy.

*Sarah Milken * (00:37:30) - Okay.

Vonda Wright (00:37:31) - Because many women cannot. Move it themselves because it hurts too much. People can't themselves. I mean, I get that because a therapist is going to move it for you. They're going to do deep tissue work to help get your scapula to UN, to UN adheres to your back.

Vonda Wright (00:37:52) - So but most people can't hurt themselves like that. So you need a therapist to help put you through what you need. Because if all of those fail. And you're getting way out in time. In your arm is still stuck like this. Then at some point, we're going to have a discussion about manipulation under anesthesia or perhaps doing a capsule ostomy, which I got to tell you, does not happen very often in my hands. It doesn't. We don't get there, but those are options.

*Sarah Milken * (00:38:23) - What about the people who can't take HRT or won't take HRT?

Vonda Wright (00:38:29) - And you do all the other things? It doesn't excuse you from doing all the other things.

*Sarah Milken * (00:38:36) - Right. But you talked about one of your friends. I'm making this up. Is her name Minnie? No. There was a friend on Instagram that you talked about who did not take HRT but became a bodybuilder.

Vonda Wright (00:38:49) - Oh, her name is Susan Guidi.

*Sarah Milken * (00:38:51) - Okay, Guidi and Minnie. I don't know how my brain makes those two things together, but whatever.

*Sarah Milken * (00:38:56) - Yeah, but I'm not becoming a bodybuilder. But I do, and that's an extreme, obviously.

Vonda Wright (00:39:03) - So she was intentional. All those women who choose to become bodybuilders, that is a different kind of lifting completely than what I'm suggesting.

*Sarah Milken * (00:39:13) - Okay.

Vonda Wright (00:39:14) - I mean, you will not become intense and and big like that without. Without really weighing all your food, paying attention to macros like a body built that is an art to become a body builder. That literally it's an art.

*Sarah Milken * (00:39:30) - So when you have women come into your office who don't want to take HRT, what are their main reasons for it?

Vonda Wright (00:39:39) - they're afraid of the Women's Health Initiative, right?

*Sarah Milken * (00:39:41) - The breast cancer thing still, but anything else?

Vonda Wright (00:39:45) - I want to be natural. Okay. Which I say. Okay. Well. What does natural mean? You make estrogen. How much more natural is that? You make it. So it's not like we made up some chemical like metformin, which is a made up chemical. We're taking the chemical structure of estrogen and making it it's your body, so it is natural.

Vonda Wright (00:40:14) - But you know what I. They're afraid. They want to be natural. My mother never did it.

*Sarah Milken * (00:40:21) - a friend of mine told me last night that she's past menopause, but she doesn't take it because she's afraid to gain weight.

Vonda Wright (00:40:29) - you don't gain weight from taking.

*Sarah Milken * (00:40:31) - No, that's what I said. But in her mind, that's going to create, like, a muffin top in some in some shape, way or form. So I just feel like there's so many myths out there.

Vonda Wright (00:40:43) - Yep. That is misinformation. In fact, you know, there's this concept. I saw it, you know, one time. Did I say this to you already at some point? I don't know how I got them to do this, but at one point I got Mercedes Benz to send me to Fashion Week, and it's the first time I saw skinny fat.

*Sarah Milken * (00:41:00) - There were so.

Vonda Wright (00:41:01) - Many people there who were this big, you could not detect a muscle on them. So if you don't want to lift weights or take estrogen to compose your body because you don't want to gain weight.

Vonda Wright (00:41:15) - There is this concept of skinny fat. You can age your whole life, not gain £1 of fat or £1, but because you'll lose so much lean muscle mass, you won't see it unless you get a body composition. I'm making these numbers up, but you could go from a healthy 25% body fat to 35 or 40% body fat and look the same. It's just that you're skinny fat.

*Sarah Milken * (00:41:41) - It's so crazy. Muscle mass. It's so crazy. okay, so if estrogen leaves the body, you have low bone density. You're female, you've been a prior smoker, and your mom is shrinking or you're shrinking. You've basically kind of given yourself the cheat notes for. All sorts of bone drama.

Vonda Wright (00:42:04) - Yeah. You've you've laid out a plan for being osteoporotic, breaking your hip and being frail.

*Sarah Milken * (00:42:10) - Okay, so when people say, but insurance won't pay for the Dexa scan because I'm not 60 or over, what's your response?

Vonda Wright (00:42:19) - Buy it yourself. So here's the deal, right? My cup of coffee at Starbucks and I don't really get fancy coffee, but it costs $7.18.

Vonda Wright (00:42:28) - I never go anymore. I bought the little things at home, and I make, save up your $7.18 for a month, and then you can Google Dexa scan. In my town, gyms have clinical grade Dexa scans. There are now many type. There are other machines that don't involve any radiation whatsoever. get an awareness of what your bone density is. Or how about this one? Don't get a Dexa scan. Just assume because you're a woman and you're mid-life, you're losing bone density because you are, and then act like you have osteoporosis and do all the right things. Eat enough protein, lift weights. make sure you're not, you know, smoking anymore, for God's sake, and whittling your bones away. if you can get off chronic steroid use. Lots of women have medical problems. They need steroid which also breaks down bone. See what you can do about that. So I've got I've got an answer for every excuse.

*Sarah Milken * (00:43:33) - I know because I could think of every excuse known to man. Okay, what about those? I can't even think because I don't have any brain functioning left in me.

*Sarah Milken * (00:43:42) - But those, like supplements, the osteo whatever. And you know that they're supposed to help you with your bones, the calcium this there's a lot of anti of that. Why is that.

Vonda Wright (00:43:56) - So you know what. There are a lot of micronutrients I, I had pulled some papers on it a little while ago. There's probably 20 micronutrients that are helpful for mineralized bone. we would frankly rather you eat whole foods full of dark green leafy vegetables to get your micronutrients. But, at a minimum, we love for if you're vitamin D low, which most of us are to supplement up. I take 5000 international units right now because when I first tested my vitamin D, I almost didn't have any. So I took 10,000.

*Sarah Milken * (00:44:31) - And you live in Florida?

Vonda Wright (00:44:34) - Well, but I use sunscreen on my face. You know Ellen. I know, but.

*Sarah Milken * (00:44:38) - That's what I'm saying. It's amazing. Like, my husband plays golf outside all day and his vitamin D is low. My point is, is we all think that because we live in LA or Florida, that we're getting enough vitamin D.

Vonda Wright (00:44:52) - Just have it checked and supplement. It's that important. Vitamin D is then usually supplemented with potassium. That's what K is.

*Sarah Milken * (00:45:00) - Yeah I was going to ask you about the K. I buy the one that comes with the K because they say if you don't have the K you can't absorb the D.

Vonda Wright (00:45:08) - Yeah. So buy them together. You know there's lots of kinds. And then magnesium 500mg L three onate or magnesium glycine.

*Sarah Milken * (00:45:19) - Eight I take both.

Vonda Wright (00:45:21) - Do you not magnesium citrate. Avoid that. That's how we give people diarrhea for their colonoscopy.

*Sarah Milken * (00:45:29) - I just take glycine made in three and eight, because I feel like I've covered my bases.

Vonda Wright (00:45:36) - Absolutely. And take it at night. So you sleep better, I do.

*Sarah Milken * (00:45:39) - They're all my nightstand. Otherwise, if you don't have it stacked that shit, you are not going to go find the magnesium at 1030 at night.

Vonda Wright (00:45:46) - Oh, listen, Sarah, I do. I'm so paranoid about not being able to sleep. I get up and take it if I forgot.

*Sarah Milken * (00:45:53) - Oh, no. No, that's why I leave it on my nightstand. My husband's like, why does your nightstand look disgusting? I'm like, because I have to see it to do it.

Vonda Wright (00:46:02) - Yeah, I'm a little bit like that too. And then get your calcium from your food. Just do it. Get it from your food. So I just want you to eat well. Quit eating shit. That's that's pre Hebden boxes.

*Sarah Milken * (00:46:15) - What about this other thing you talk about? Visitin. What? What is that? Because I bought it and I take it. But I have no idea why. Just because you told me to.

Vonda Wright (00:46:24) - Yeah. Oh, I love that that you did that. So this is a completely different subject, but I'll tell you. So there are, 12 hallmarks of aging. Six are the ones we focus on a lot inflammation being one of them. Another hallmark of aging is this thing called senescence or zombie cells. So in your body, every cell has four destinations. It can be a stem cell which remains capable of becoming anything.

Vonda Wright (00:46:53) - You know, everybody's heard of stem cells. Stem cells that are properly stimulated become mature cells like a muscle cell. Let's just say it's stimulated to become a muscle cell that muscle cells working. It's doing muscle cell type things. And then when it's done, what it's supposed to do is turn on the genes that make it die. Death is a very active process in our cells. It's called apoptosis. So it's supposed to die, right? It's a stem cell. It's a working cell or it dies. There's a fourth kind of cell called a senescence cell a zombie cell. Zombie cells are neither living nor dying. They're just metabolically crippled cells that circulate around your body as we age, spewing off chemicals that can accumulate and cause cancer and cause you to age. A lots of things cause us to accumulate senescent cells, stress, bad lifestyle, simple aging. So in addition to lifestyle by C10, which if you wanted to eat enough strawberries, you could get it from strawberries. But who can eat that many?

*Sarah Milken * (00:48:03) - Where you're freezing.

*Sarah Milken * (00:48:04) - Wait, you're freezing for a second. Okay, spell. You froze for a second. Spell it in for everyone.

Vonda Wright (00:48:11) - F I s e t I n fi. Ten and I get mine. Do you want to know where I get mine? Yeah, I get mine from a company called do not age. Do not age.com. I'm hesitating because I'd have to look on my Instagram page.

*Sarah Milken * (00:48:31) - I think we'll find it.

Vonda Wright (00:48:33) - Yeah. And so, Pfizer tend to get rid of senescent cells, which are zombies. Neither living nor dead. Too much accumulation is.

*Sarah Milken * (00:48:42) - Oh, is that different than the autophagy thing?

Vonda Wright (00:48:47) - Autophagy is, I think you're thinking of programmed cell death, which is. Well, that's what cells are supposed to do. They're supposed to program, right?

*Sarah Milken * (00:48:58) - So I'm just saying, when you take this supplement, it's killing off the dead cells.

Vonda Wright (00:49:03) - It's killing off the cells that are should be dying.

*Sarah Milken * (00:49:06) - But they're not. Got it? Got it. And how much of it do you take?

Vonda Wright (00:49:10) - I take 500mg.

*Sarah Milken * (00:49:12) - Okay. And what about omega threes? Does that have anything to do with this project?

Vonda Wright (00:49:18) - omega threes are great anti-inflammatories. So, you know, omega three, make sure you get a pure, supplement. You don't want to be eating fish trash. I would get a capsule and just swallow it down with food, because, unfortunately, it can make you. Yeah. Your taste like rocks.

*Sarah Milken * (00:49:38) - Is there a brand that you believe in? And I've also seen. And I'm spacing on the woman's name. She's pretty well renowned. And she says that in order to be able to, to create the lean muscle mass you want and using omega threes that you would want a minimum of two grams a day, have you seen that two grams.

Vonda Wright (00:50:01) - Is the common dose actually.

*Sarah Milken * (00:50:02) - Okay.

Vonda Wright (00:50:03) - So you have to take it multiple times a day to get that dose. I got to be honest with you, I don't take it that much because I can't. It really makes me I need to take it. But it's the illness of smelling like fish all day that I haven't found a workaround, but it's just great.

Vonda Wright (00:50:20) - Yeah. Two grams. Good for you.

*Sarah Milken * (00:50:24) - Okay, so look, the bottom line is we're not making this shit up.

Vonda Wright (00:50:30) - Oh, it's real.

*Sarah Milken * (00:50:32) - Anybody. Because people are convincing themselves that they're making it up. Husband saying it's in your head. Doctors. Yeah. You'll feel better in a week. And we're here to say you guys. Bullshit.

Vonda Wright (00:50:49) - Exactly. Because. Listen.

Speaker 3 (00:50:51) - What?

Vonda Wright (00:50:52) - What's the gain from making up, how miserable you feel or what? What's the point of that? Right? It's like, I mean, we could get into all the things.

*Sarah Milken * (00:51:02) - Exactly.

Vonda Wright (00:51:03) - But with men, why do people fail to believe women? What are we, a bunch of liars? Why do you even question what we say? I don't get it. I don't get it.

*Sarah Milken * (00:51:15) - I don't know, I think I just think that when you're a guy, you don't understand all the nuances and intricacies that hormones play on a daily basis. Like, I wake up one day and I'm like, okay, I'm in a good mood the next day.

*Sarah Milken * (00:51:33) - I could really be like. Scary. But my husband understands that.

Vonda Wright (00:51:41) - Well, here's how I'm going to throw it back on the men. I have the best husband. It seems like you have the best husband.

*Sarah Milken * (00:51:49) - I do too.

Vonda Wright (00:51:50) - Just because you don't understand it. I'm speaking directly to the men. Yes, because you don't understand. It does not mean that it's not real. I don't understand for 1.5 seconds how you can be so interested in baseball statistics that you can talk about the World Series in 1947. And I'm a sports doctor. I don't understand that. But that's real to you. So you go, boy. I know.

*Sarah Milken * (00:52:13) - But there's something weird about men in pain. Let me tell you why. So my husband plays golf. He works out a lot, blah blah blah. He woke up one day and he was like, I can't move. And he was in so much pain. I've never seen him like this. And I, I'm not going to say I was happy he was in pain because that obviously not.

*Sarah Milken * (00:52:34) - But I said to him within a few hours, I'm not happy you're in pain, but I'm happy that you're understanding the level of pain that takes your breath away, because this is the level of pain I was in with Frozen Shoulder, or when I flipped off the bike and was in urgent care in Hawaii. And I never thought you truly understood what I was going through. But now you do well.

Vonda Wright (00:53:02) - And that's my whole point on this little tirade, and I'm glad you brought us to here, is that it doesn't matter if you experience it or understand it. You love this woman. Be sympathetic, be deeply pathetic and.

*Sarah Milken * (00:53:16) - Sympathetic of like, oh, I'm sorry you're feeling that way. And they're sympathetic, like, fuck, I've been there. And it's different.

Vonda Wright (00:53:24) - Yeah. It's different. You know, I have the former. I would want the I don't want the latter. But if you know, they understand. But I think everybody should expect the former.

*Sarah Milken * (00:53:33) - Yeah. No I agree with you.

*Sarah Milken * (00:53:35) - And then when he had that back pain, he sat on the sofa and in bed for three days and I go, so are we going to move on to the orthopedic surgeon or the back doctor, or we're just going to fucking sit here and drink water and take Tylenol I made. Yeah, I, I made him go and I made him get an MRI and do all the things that normal people should do when they're in pain. You you shouldn't just accept things for what they are. There are solutions.

Vonda Wright (00:54:03) - I'm laughing, Sara, because I make a joke that the only time men go to the doctors when they can't play golf or can have sex, it's not really true. But.

*Sarah Milken * (00:54:12) - But it is true because he couldn't do either of those things. I mean, I could live without the sex for ten minutes, believe me. I'm like, oh my God, thank God. But still I'm like, it's it's a different kind of thing for men. Okay, so tell us one more positive Vonda mantra.

*Sarah Milken * (00:54:33) - Then we're going to close this up and you're going to tell us where everyone can find you.

Vonda Wright (00:54:37) - Oh my God, I say so many things I know.

*Sarah Milken * (00:54:40) - What's the bottom line for us?

Vonda Wright (00:54:44) - Okay. I'm making this up today. but but your crowd is probably so empowered. Just. I don't want you to accept any bullshit. You are mid-life. You've done hard things your whole life. You get what you want when you want it. We're the 51%. We are the majority. We get what we want when we want it, so just go after it. That's what I want you to know, right?

*Sarah Milken * (00:55:11) - We fucking love you. We have to take this on the road. Everyone has to get their shit together. Ask for what they want. We're all tired. We're all cranky. We all have so many things to do. Everything is hard. I know everything is hard.

Vonda Wright (00:55:26) - But. But we're.

*Sarah Milken * (00:55:27) - Good. We can do it. And so many good things come from it. When we actually do it, it just feels.

*Sarah Milken * (00:55:35) - It's like me with the weights, the dumb fucking weights. I do them because I have to, and I'm doing it for the long haul for myself.

Speaker 3 (00:55:42) - Yeah, I'm.

Vonda Wright (00:55:43) - A lot older than you, Sarah. I love this time of life. I do. It gets better. It really does so.

*Sarah Milken * (00:55:50) - But it only gets better when we do.

Vonda Wright (00:55:52) - Act on.

*Sarah Milken * (00:55:53) - It. Exactly. Because a lot of times I'll be honest and I'm always honest. Unfortunately, is there are days where I wake up and I'm like.

Speaker 3 (00:56:04) - Are.

*Sarah Milken * (00:56:06) - I feel tired. Oh, this is hard. Oh, like I just want to stay in bed all day.

Vonda Wright (00:56:12) - It's very authentic of you. And then you get up and you do your thing.

*Sarah Milken * (00:56:16) - Exactly. And it's okay. And it's all okay. Okay. If anyone wants to find you, which is everyone, because your Instagram is so. Thoughtful, helpful, expert. Like quick. It's all the things. Where can we find you?

Vonda Wright (00:56:33) - I only want you to look two places.

Vonda Wright (00:56:35) - One is Instagram doctor Vonda Wright, doctor Vonda Wright, and then I have a website by the same name. Doctor, doctor. Vonda. Right. And via the website you can message me.

*Sarah Milken * (00:56:46) - Right? Right is wri ght. I absolutely adore you. Can you please come to LA and put my body back together and let's talk about that.

Vonda Wright (00:56:57) - I'll call you, we'll do lunch and.

*Sarah Milken * (00:56:59) - We'll have to do like a whole like Dexa scan review of like what's actually going on in my body because just you're fine doesn't do anything. I want to thank you for being a friend to me to the flexible Neurotic podcast, and we'll talk soon.

Vonda Wright (00:57:17) - All right. Have a great day, my friend.

*Sarah Milken * (00:57:19) - Hey peeps, it's me again. I listen to this episode with second time guest doctor Vonda Wright, top orthopedic surgeon, double board certified, so I could summarize the golden nuggets for you to have actionable items to start using today. I know that when I listen to a long episode, I'm like, oh my God, I love that.

*Sarah Milken * (00:57:39) - But then I can't even fucking remember the specifics. This is why I come back and do a golden nugget. Summary. In this episode, we dig deep with our golden shit shovels in a conversation, answering all of your questions about fucking frozen shoulder and just midlife body aches and Uggs, also called arthralgia. Golden nugget number one, the frozen fucking shoulder. Okay. The real term for it is adhesive colitis, which is a medical term. So if you're experiencing frozen shoulder, I am so sorry because it's the fucking worst. But adhesive capabilities, peeps, let the doctors hear that term because no, it's not a fucking pickleball injury. Sorry, I just realized I can't say enough about it. Frozen shoulder was seemingly so random and bizarre in my life that it really takes advocating for a treatment, solutions, and a real diagnosis. When I was experiencing Frozen Shoulder, no one really understood what I was going through, but I couldn't move my arm. I couldn't lift my arm. I was like, what is going on here? It didn't feel heard or seen by doctors, and I took myself on a Google rabbit hole to figure out what it was.

*Sarah Milken * (00:58:55) - I can't speak for all doctors, but from my experience, a lot of times male doctors are just not aware of. Maybe it's like the hormonal correlation between frozen shoulder and the actual hormones. Like because our estrogen is in like a deep dive downwards and we need that estrogen. We need to be aggressive advocates for ourselves. Peeps, I know I'm always talking about this, but we can't just listen to the doctors be like, oh yeah, just part of midlife. Just deal with it. It's fine. It'll just be a few more months, maybe a few more years. Just get over it. No, there are answers to certain problems. You don't need to be in pain when there are treatments. Golden nugget number two. The causes. There are several leading causes of frozen shoulder. The first and biggest component is inflammation. I am the queen of inflammation, which is you know, one of the main side effects of menopause is inflammation. And midlife women. We have high insulin resistance, potentially like borderline pre-diabetic.

*Sarah Milken * (01:00:03) - Some have moved into diabetes. So highly inflamed, stressed hormonal feeling a little cuckoo. And a lot of women who are actually diabetic or have autoimmune diseases are more likely to experience frozen shoulder. Other causes include physical trauma, like a car accident or a fall. And the other huge culprit is a decline in estrogen. I mean, I remember if you listen to my episode with me, I had changed birth control pills, I had a month long bleed, and my hormones were crazy. And then suddenly I had frozen shoulder. I mean, I think for me, it happened with that whole hormone drama combined with stress because we were moving houses. After 18 years, my husband had Covid. I had to take 3 or 4 teenagers to Utah for a ski trip, and it was just like an all around clusterfuck, hence frozen shoulder. So when you have all these things, it becomes the perfect recipe for frozen shoulder. Golden nugget number three. The four stages, stage one and frozen shoulder is an enormous amount of pain in your shoulder.

*Sarah Milken * (01:01:11) - It can start off feeling like pain in the shoulders, like just at nighttime. But for me, I woke up in the morning and I was like, motherfucker, I cannot lift my arm. It's so painful. You. You can't even, like, roll over in bed. You can't brush your hair. It's like pain. You can't imagine insidious pain. And Doctor Vonda says that this stage is most likely inflammation, which is caused by immune cells crawling into the inside of the skin on your shoulder, aka the capsule, and inflames it. This stage can last for up to three months. Stage two is more than just inflammation. In this stage, your tissues are actually becoming stiffer and this can last up to 15 months. Stage three is the frozen stage where the capsule has contracted. This is the stage where movement is crucial. We have to keep moving it, but you just can't because it hurts so much and it's so hard and it's excruciating. Oh my God, I live through it. Then stage four, which can come in two fucking years after the initial pain.

*Sarah Milken * (01:02:15) - This stage is when your body finally gets rid of the inflammation and the fried biotic tissue. That's such a weird word like is moving naturally. Okay, mine lasted, I would say six weeks. I did have a cortisone injection. If you listen to this episode, you can also go back and listen to one of my older episodes that literally covers every single second of my frozen shoulder, and I will put that in the show notes as well. Golden nugget number four treating frozen Shoulder. Thank goodness for doctors like Doctor Vonda Wright. She's giving us the answers you can't just find in a quick Google search. And beware, because the doctors might tell you to just let it thaw out for two years to wait it out. But just like all other circumstances, this is not an acceptable answer. And Doctor Vonda is quite literally urging people to do the opposite. We have to move it. We have to treat it. We have to get it going. There are options for frozen shoulder. One is getting a cortisone injection.

*Sarah Milken * (01:03:14) - I know there's I guess, controversy over it. I just had to do it because I thought I was going to die without it. And like I said in the episode, the first one didn't work, the second one a week later. Even though that's not highly recommended. I got a second one a week later, and within six hours my pain was 80 to 90% better. Another solution that Doctor Vonda Wright and other doctors offer is PRP, which is basically platelet rich plasma where they take your blood, your own blood, spin it, and re inject it into that spot where it's hurting. Doctor Vonda recommends three PRP injections, like three rounds of it, to see results. She did mention that the PRP shots are much more expensive than the cortisone, so opting for the cortisone shot is also a great treatment. But there are other options. You can also have a doctor prescribe you an anti-inflammatory medication, like I think it's called Celebrex or something like that, but we have to be careful with taking medications like these every day for three fucking years.

*Sarah Milken * (01:04:14) - Like that seems kind of hard on your body too. Again, I'm not a medical doctor, just my intuition. Treating frozen shoulder and solving the issues behind frozen shoulder are two very different conversations. The first step in conquering inflammation is an anti-inflammatory diet. That means kind of no sugar, removing sugar, reducing the carbs, eating more greens so, so hard. But it does give amazing results. Even though I just had some hot tamales. Don't tell Doctor Vonda. And the second one is starting hormone replacement therapy, which is still somewhat controversial for some women. Because of all we all know the past Women's Health Initiative study. and some women don't want to take it for whatever reason. But many doctors, including Doctor Vonda Wright, remind us that replacing the natural hormone of estrogen that is lowering in our bodies naturally as midlife women can really help our bodies, our brains, all of it. Obviously. Talk to your doctor about all of this because I'm not a doctor. I'm a PhD doctor. But I'm just telling you from my own experience and from researching this and from talking to Doctor Vonda.

*Sarah Milken * (01:05:29) - Right. Okay, you guys, you know the drill. The gold is dripping off these nuggets. Grab it, use it. There are three things you can do. First, subscribe to the fucking podcast. Second, share it with some friends who like midlife shit. And third, write an Apple review. Yes, it's kind of annoying. It's an extra step, but guess what? It really helps the podcast grow. You think your little review doesn't matter, but it does. If you went to a show and everyone said my clap doesn't matter, then there would be no clapping. You all matter. DM me. You know, I always respond. And of course follow my Instagram at the flexible neurotic duh. Love you talk soon.