If her life had taken a different turn, she could have been digging ponds to raise fish in Asia. Instead, Dr. Jo Hannafin, Director of Orthopedic Research at Hospital for Special Surgery (HSS) in New York, ended up in a lecture hall at medical school.
“I was raised in Fall River, Massachusetts, an old mill town, ” says Jo Hannafin. “Our family was Irish Catholic, and both of my parents were born in the town and lived there all their lives. It is a town of traditions, and as such, I was baptized in the same church as my father. Education was hugely important to my parents, and my siblings and I were the first ones in the family to attend college. My dad worked as an X-ray technician and my mom stayed home to care for me and my two siblings. Because my dad worked with physicians and had them as mentors, he understood the importance of education for his children.”
Far from human patients, Jo Hannafin began her scientific adventure in the realm of freshwater algae and plankton. “As an undergraduate at Brown University I considered premed, but it seemed overwhelming. So I became an aquatic biology major, something which opened doors to science that I might not have otherwise pursued. My faculty mentor, Dr. Leon Goldstein, invited me to spend the summer in his lab at the Mt. Desert Island Biological Laboratory (MDIBL) to study the physiology of osmoregulation in skates and dogfish sharks which were used as models for human disease. It was a life enhancing experience and I subsequently had the opportunity to spend several summers there.”
Eager to apply her lab work to the field(s), Jo Hannafin considered joining the Peace Corps. “I wanted to sign on as a fisheries biologist, but there were no available openings in the Peace Corps at the time. I was fortunate to secure a position working with Roy P. Forster in the Department of Biology at Dartmouth College. Dr. Forster also taught in the medical school physiology program and invited me to attend physiology lectures in the medical school. While I had grown up seeing medicine through the eyes of my father, I thought it would be useful to see an approach based on science.”
Embarking on a Career in Medicine
When Jo Hannafin decided to see medicine through her own eyes, she looked for a program where she could build upon her previous biological research. “After working in a research lab for two years I decided to apply to a M.D., Ph.D. program, and was pleased to be accepted at Albert Einstein College of Medicine in the Bronx. I had set my sights on this program in part because of the opportunity to do my thesis research with Dr. Rolf Kinne, whose work I knew from MDIBL. I decided to pursue a Ph.D. in physiology, and did my doctoral thesis in Dr. Kinne’s lab where I studied membrane transport systems in mammalian kidney and the rectal gland of the dogfish shark.”
Her head was still in the lab…then came the rotations. “Once I hit the wards, any thoughts of pursuing a career in nephrology or a related area began to fade. I was first exposed to internal medicine, but, while I intellectually enjoyed the complexity of the diseases that we were treating, I didn’t like managing chronic disease. I then did an elective rotation with Dr. Martin Levy, an orthopedist who had operated on my knee when I was in medical school. I had been in training for the national rowing team and had a significant injury that he treated. Several years later I had to schedule an elective which overlapped with the trials for the world championship team. I called Marty and he said that I could rotate with him and take time off to race in the trials.”
The sports medicine rotation opened my eyes to a potential career in orthopedic surgery. It was then that I realized it was possible to combine my intellectual side with my love of athletics. It was a visceral decision after just one elective…a leap of faith.
Dr. Hannafin continues, “I raced at the world championships that year, then returned to medical school and began my surgical electives. I was struck by the many different kinds of personalities there were in surgery. The surgeons and medical students I had met thus far were very strong willed and outspoken. I, on the other hand, was rather quiet. But no matter. I could see that I had found a field where I could correct patients’ problems…and I knew that it was going to be in the realm of sports medicine.”
Award-Winning Research
After completing medical school in 1985, Dr. Hannafin continued her surgical and orthopedic training at Montefiore Medical Center and the Albert Einstein College of Medicine. “It was a very busy residency as we staffed two public hospitals (one level 1 and one level 2 trauma hospitals) in the Bronx, as well as two private hospitals. Our surgical training was trauma intensive, and we rarely slept when on call (this was before the 80 hr work week). I was one of eight residents in my year and the only woman; it was a great bunch of guys who I remain friendly with to this day. The program was unusual for its time in that there were eight female residents spread out over the four year program. Ed Habermann, our chairman, was forward thinking in that way.”
She continues, “My primary mentor was Martin Levy, who was also my medical school mentor. My other significant teachers were Leonard Seimon (spine and pediatrics), Neil Cobelli (trauma), David Hirsch (arthroplasty) and Neal Macy (pediatrics). They all had a very good balance between teaching us how to care for the patients in the clinic and hospital and developing our surgical skills.”
Dr. Hannafin then began a two-year sports medicine and shoulder fellowship at HSS. “The first year was dedicated to research, during which time I worked with Dr. Steven Arnoczky in the Laboratory for Comparative Orthopedic Research developing models to examine the effect of mechanical load on soft tissue. My second year there set the stage to remain at HSS. Dr. Russell Warren, the Chief of the Sports Medicine and Shoulder Service and Surgeon in Chief of the hospital, offered me a position as the first clinician-scientist at the hospital. He could see that I was dedicated to research, and that the future of sports medicine would involve basic, translational and clinical research.”
The visionary Dr. Russell wasn’t the only one to take notice of Dr. Hannafin’s achievements. “My first major award at HSS was the Philip D. Wilson award for excellence in fellowship research. The Orthopaedic Research Society also honored me with a Young Investigator Award for that research. This particular work was among the first to demonstrate that collagenous tissues respond to the surrounding mechanical environment. Application of mechanical load to tissues such as tendon and ligament are critical for the normal maintenance of tissue—and the tissue can maintain its strength and elasticity. This work opened the door to several grants, including a Development and Feasibility grant from the NIH.”
Four years ago, I was awarded an R01 grant to look at the cellular responses to mechanical loading. Using both an animal model and 3D cell culture based systems I have studied ligament fibroblast response to loading and the possibility of improving the potential healing response of a ligament that doesn’t heal on its own. That grant, which is in its final stages, has been significant for my own sense of personal success and the results of our work will set the stage for future grant submissions.
With 40% of her week spent in the lab, Dr. Hannafin has time to take the ideas churning in her head and say, “what if…?” Detailing her other research, she notes, “I am also interested in the pathology and treatment of adhesive capsulitis, also known as frozen shoulder. This condition occurs primarily in women between the ages of 40 and 60, and involves the development of inflammation in the shoulder joint. This gradual process results in scarring and loss of motion in the joint. My students and I are interested in trying to characterize what happens to that tissue, why there is scarring, and what inflammatory mediators are involved.”
She continues, “We have a study underway now looking at the efficiency of ultrasound guided cortisone injections in the shoulder joint at different stages of the disease. At this point we are collecting surgical biopsy specimens from those patients to look at what pathways are activated in the capsule (in the synovium) that cause the scarring. Our results thus far indicate that early injections in stage one can stop the progression of frozen shoulder. We have studied this area for many years, but in the past did not perform the injections under ultrasound or x-ray guidance. In order for these results to be accepted for publication, it is necessary to document that we are in the joint and that medication is being delivered to the site of the pathology.”
An Expert Communicator
The only guidance she needs for her other work, however, is her gut instinct and the power to observe how others communicate. Dr. Hannafin: “I tend to be drawn to mentoring female medical students and residents because there are still different issues that women in medicine face that men don’t usually have to deal with…such as about the timing of starting family. It also strikes me that there are real cultural differences in the ways that men and women convey information and receive information. This is often the case for patients, as well as medical professionals. It does not necessarily apply to all men and women, but we still need to be aware of the differences in all of our patients.”
To generalize, it appears that women often expect more detailed information concerning their condition and their options for treatment. They often will arrive having done an internet search or will be seeking additional opinions because they do not feel that they have received adequate information to make an informed decision. My thoughts in this area have changed dramatically over the years. If you had asked me 20 years ago about the differences between men and women, I would have said that we are all the same.
Whether guiding male or female students, Dr. Hannafin insists on a patient first approach. “It may be tempting to crank through the voluminous number of patients, but they deserve our undivided attention. I also emphasize to students that they shouldn’t prejudge patients. When people come to see us, they are often in pain, and may be angry. And yes, it’s harder to be kind and take time with someone like that. I try to teach by example and take the extra time to let someone vent—they usually feel better once they are heard. Then you can get down to the underlying problem and map out a plan.”
And Dr. Hannafin makes sure that the patients understand that plan. “I try to educate patients about anatomy, as well as the underlying cause of their problem. If I come up with a treatment plan that doesn’t fit in with their schedule, then they won’t do it because they don’t understand why it is important. You might be a technical genius in the OR, but if the patient doesn’t understand what you did, they may not approach their postop period correctly. For example, they may not make the appropriate lifestyle modifications, they might remove their sling prematurely, or they might use their arm or knee before they should. All in all this means that you and the patient didn’t get a good result. Teaching the technical skills of surgery is fairly straightforward…it’s the communication area that often gets us into trouble.”
Preventing Injuries
Her breadth of knowledge also still makes its way to the water, field, or court. “I covered the 2004 Athens Olympic games for the U.S. rowing team, an amazing, once-in-a-lifetime experience. Just going to the dining hall and being surrounded by the best athletes from all over the world was incredible. I continue to provide care for the US Rowing team on an intermittent basis and stay involved in rowing through my position on the Board of Trustees of the National Rowing Foundation. This year I was honored by the US Rowing team when the Women’s 8 was named for me. The women raced the Hannafin at the 2009 World Championships…winning the gold!”
Closer to home, I spend time working with young athletes who experience sports injuries. My hope is that high school athletes will begin to move away from a single sport. I take care of a lot of female soccer players who often began the sport around the age of five. By the time they are 8 or 9, they’re in a travel league, on regional teams, etc. From the frequency of play alone, the risk of injury is greatly increased. And if, for example, a 13 year old tears her ACL, that’s the beginning of a lifetime of change for that kid.
Speculating about a “wish list” for her program, Dr. Hannafin notes, “If I were ever awarded a substantial amount of funding, I would target a portion of the funds to support our sports medicine patient registries at HSS. The members of the Sports Medicine Service at the Hospital for Special Surgery have committed time and resources to establish a series of prospective patient registries in the areas of ACL reconstruction, cartilage restoration, rotator cuff repair and shoulder instability.”
“These registries over the years to come will provide an extensive data base to answer research questions concerning patient outcomes following the surgical procedures under study. I would target the remainder of the funds to the support of community rowing programs and injury prevention programs. Rowing programs such as Row New York and The Foundation for Rowing Education are designed to bring the sport of rowing to communities and students that are underserved. The Row New York program is a model for others as it combines rowing, mentorship, tutoring and SAT prep for their athletes.”
There is another program that is turning Dr. Hannafin’s head. “The American Orthopaedic Society for Sports Medicine (AOSSM) is developing a program entitled STOP: Sports Trauma and Overuse Prevention. It will be a comprehensive public outreach program focusing on the importance of sports safety—specifically as it relates to overuse and trauma injury in children and adolescents.”
Dr. Hannafin is concerned that some in her field are forgetting an old aphorism…An ounce of prevention is worth a pound of cure.
I think that the field of orthopedic sports medicine is evolving toward the surgical care of the injured athlete and that less emphasis is being placed on the non-surgical care and the prevention of sports related injury. As sports medicine orthopedic surgeons we need to remain involved in all aspects of the treatment of our athletes.
Dr. Hannafin lives by the motto, “Find your balance between work, family and fitness and enjoy each day as it comes.” She adds, “I am part of a family of athletes, having met my husband John Brisson while training as a competitive rower at the New York Athletic Club. John is now the Director of Youth Rowing at the Pelham Community Rowing Association in Pelham, NY. We have three children, Andrew, a collegiate swimmer and artist at Alfred University, Caitlin, a collegiate rower and student at Brown University and Connor, a high school diver and student at Greenwich HS.”
Dr. Jo Hannafin…preventing injuries and researching new solutions.
