Many orthopedists can thank a human being or two for sparking their interest in medicine. Dr. Leesa Galatz, Associate Professor of Orthopaedic Surgery at Washington University in St. Louis, can thank a few horses. “I grew up in Las Vegas and spent much of my youth as a competitive equestrian. Spending summers traveling to horse shows, and caring for the horses taught me a great sense of responsibility. It also taught me that anything is possible if you work hard. I can thank riding for helping me develop a strong sense of confidence…because of these experiences I never shied away from challenges. A lot of people are afraid of failure, but when you are competing you are going to have downturns and must learn to ‘take your licks.’ The lesson I learned early on is that these downturns are opportunities, and educational experiences that can lead to self improvement.”
After briefly considering veterinary medicine, Leesa Galatz turned her attention toward medical school. The first doctor in her family, she spent family dinners discussing her future with her father, an attorney, and her mother, an administrator in his office. “I was always interested in the sciences, and in particular enjoyed laboratory experiences. I was especially fascinated by the scientific process and how one discovery led investigators to the next…it was the logical thinking and application of new technology that captivated me.”
Also intrigued by E=mc2, Leesa Galatz began seriously considering medical school in her senior year of high school. “During an advanced physics course I found an insert on the practical application of physics. My interest was really piqued by an explanation of how the patella functioned as a pulley. I realized one could figure out how to move joints by solving physics problems. I began to see a way forward.”
Leesa Galatz’s forward movement would take her through a premed curriculum at the University of California at Berkeley. Then in 1989 it was on to medical school at George Washington University (GWU) in Washington, D.C. “I had some preliminary thoughts about orthopedic surgery…then I met Dr. Ken Yamaguchi, who encouraged my interest and mentored me through my last few years of medical school. I wanted to do research, and Ken, along with Dr. Dan Riew, needed someone to work on their rotator cuff project. I recruited a large portion of my medical school class to volunteer to have EMG’s of their suprascapular and musculocutaneous nerves. It was a great chance to work with Ken, who gave me suggestions as to where to apply for residency, and Dan, who helped me think critically about my career plan. Dr. Robert Neviaser, the Chair and senior author on the project, sparked my interest in the field of shoulder surgery. He was an inspiration because of his extraordinary drive for perfection.”
She would begin two institutions at once—residency and marriage. “David was on a military scholarship; we decided to stay in Washington, D.C., where he went to Walter Reed Army Hospital and I began an orthopedics residency at George Washington University Hospital. It was an incredible experience, with the downtown campus being more of an academic environment, and Washington Hospital Center being a high volume, inner city facility with a tremendous trauma experience. After a few years, I felt like there was not much I couldn’t handle. These experiences gave me a lot of confidence as I progressed through the program. I owe a lot to my faculty who invested time and effort into my education.”
Under the tutelage of Dr. Robert Neviaser she would blossom into a clavicle/scapula/humerus aficionado.
The shoulder is particularly interesting because it functions as a combination of bone and soft tissue. For example, in a fracture, you can fix the bone and make it perfect, but if the rotator cuff isn’t working, the shoulder will not function. These multiple consideration, namely, bone, soft tissue, and joint stability make it challenging, interesting and a compelling subject for research.
“Along the way, Dr. Tom Neviaser—the brother of Dr. Robert Neviaser—also influenced me. We residents were fortunate to work with him in his private practice setting, a busy shoulder and elbow practice. He helped me develop a common sense approach to evaluating and treating patients. It was at Dr. Tom Neviaser’s hospital and under his mentorship that I did my first research project involving the shoulder—an anatomical study of the subscapularis and underlying capsule. During this time I was doing a lot of reading and learned that shoulder was quite a new subspecialty with a lot of potential—but, unfortunately, without many fellowships.”
Facing a limited number of fellowships and a high level of competition, Dr. Galatz could have backed down. But being a natural competitor, she knew a test when she saw one. “Dr. Neviaser, although intimidating at times, was and continues to be incredibly supportive of my career. I chose to pursue fellowship training at the University of Pennsylvania in Philadelphia, in part because of Drs. Joseph Iannotti and Gerald Williams, two well known and respected surgeons. When I interviewed, I had a strong feeling that this fellowship would be a great fit for me. They worked hard—very hard—but loved their work and had a passion for research. They had a vision for the future of their program in the world of shoulder surgery. Drs. Iannotti and Williams, along with Dr. Matthew Ramsey, were terrific mentors, and had a strong influence on my ultimate career path.”
It was “Fridays with Lou” that would deepen her understanding of the tendons and muscles of the shoulder One of the strongest reasons I chose ‘Penn, ’ was because of the large basic science lab that was under the direction of Dr. Louis Soslowsky. Each Friday I worked in his lab where I learned a significant amount about not only the basic science of the rotator cuff, but also about the scientific process and the value of strong collaboration with others. Along with Steve Thomopoulos, then a Ph.D. candidate, I developed a rotator cuff repair rat model of injury and repair. While this model is now widely used, in retrospect few people were studying tendon healing in that context.”
Recruited by Drs. Ken Yamaguchi and Richard Gelberman after fellowship, Dr. Galatz gladly accepted this academic position. “By then I decided that I really wanted to practice in an academic setting. This job gave me the opportunity to have a shoulder practice and to pursue basic science research, which I did with the chief of the orthopedic lab, Linda Sandell, Ph.D. Using the rat model, we looked at the biomechanics involved in healing of the rotator cuff. Specifically, we were interested in what happens to the structure and mechanical properties of soft tissue as it heals. We found that the rotator cuff tendon will heal, but it heals with a scar and doesn’t have normal biomechanical properties. Even in rats you never get back the qualities that are as good as normal tendon…it’s a reparative rather than a regenerative process.”
“Steve Thomopoulos later joined our department at Washington University, and has been one of my strongest collaborators. We created a delayed healing model in which we cut the tendon, repaired it three weeks later, and found that there were changes not only on the tendon side, but also on bone side. Even with a single tendon injury, bone density decreased after injury. We studied the effects of nicotine on cuff healing, and found decreases in cell proliferation and collagen production. It was greatly rewarding to be involved in such clinically relevant work.”
At present, ” says Dr. Galatz, “I’m studying the effects of growth factor delivery, specifically looking at TGF-beta 3, which is associated with scarless soft tissue healing. We are working on delivering growth factors using certain scaffolds and have begun delivering stem cells to the healing site. My research truly enriches my clinical practice because in the lab I get to study problems that I see in the office and the OR every day.
Dr. Galatz recently completed a term as Member at Large on the Board of Directors of the American Academy of Orthopaedic Surgeons (AAOS). She learned the complexities of the organization and was impressed by the depth of the services it offers members. “Through board meetings, as well as the voluminous amount of reading material they give us before each meeting, I am learning a tremendous amount about how AAOS works and grows to meet the needs of its members. My particular strengths are probably maximized by working on the educational efforts of the AAOS. I have already been heavily involved in education programs for practicing surgeons and hope to be involved in these efforts on a larger scale at some point.”
Her society participation is focused on the American Shoulder and Elbow Surgeons (ASES), where she brings her insight to several committees. One insight she offers researchers? Don’t take grant writing skills for granted. “The most interesting activity I have been involved in with the ASES is the research committee, where we reviewed grant applications and manuscripts for research awards. Grant and manuscript writing skills are learned, so anyone planning on submitting should take a course or identify an appropriate mentor or both. Why? Because you will be competing with people who are very good at it.”
Dr. Galatz has benefitted from the guidance and inspiration of her colleagues at Washington University. “I am fortunate to work with such a talented group of individuals. In particular, Richard Gelberman, our chair, and my partners on the shoulder service, Ken Yamaguchi and Jay Keener, who motivate me by setting examples of excellence and leadership. Working here has allowed me to build a career that has opened the doors to incredible opportunities such as the American British Canadian (ABC) Travelling Fellowship of the American Orthopedic Association. I often think back to my early life experiences, where with hard work and persistence I achieved things I didn’t always think were possible. The hard part now is to identify and focus on what is really professionally meaningful to me.”
And despite her having some power on the home committee, she can’t get her son in a saddle. “My husband is a vascular surgeon who practices in nearby Belleville Illinois. We have one son who is six and who, despite my encouragements, has no interest in riding. Although he loves to go to the barn and travels with me to horseshows, he’s happy to leave it at that. ‘It has no motor, ’ he protests. We spend time as a family biking, hiking and otherwise enjoying the outdoors.”
Dr. Leesa Galatz…learning—and creating—the how’s and why’s of the field.
