Prather is ''missing link'' among a variety of orthopedic specialists

By Jim Dryden, Washington University Record, September 13, 2007

In her office at the new Washington University Orthopedics and Barnes-Jewish Hospital Outpatient Orthopedic Center in Chesterfield, Heidi Prather, D.O., first lowers her eyes, then looks at the ceiling for a moment as she recalls her decision to go into physical medicine and rehabilitation as a specialty and to focus a part of her practice primarily on women.

"I've never told this story," she says. "My mentor during residency, who happened to be male, once looked at me and said, ''Since you're going into academic medicine, you'd better figure out these things about women because we men aren''t going to.'' That's honestly when I thought, ''OK, that can be my issue.''

That was during her residency at the Rehabilitation Institute of Chicago, which is home to the Northwestern University Feinberg School of Medicine''s Department of Physical Medicine and Rehabilitation. Her mentor, Joel M. Press, M.D., says he was mostly telling her things she already knew.

"She always understood that it''s about the patient," says Press, director of the Rehabilitation Institute''s Spine and Sports Rehabilitation Center in Chicago. "By focusing on patient needs, both women and men, she''s become a leader in our field. She''s also been able to build one of the best musculoskeletal fellowship programs around and helped improve the already outstanding reputation of Washington University Orthopedics."

Prather, an associate professor of physical medicine and rehabilitation, is the first woman president of the Physiatric Association of Spine, Sports and Occupational Rehabilitation. In that capacity, she''s getting a chance to raise awareness nationally among physiatrists (those who specialize in physical medicine and rehabilitation) regarding issues involving women and injuries.

She says when treating an injured woman, doctors — and physiatrists in particular — must consider the continuum of the lifecycle for women and where the woman is along that timeline when she experiences an injury or impairment.

"There are pre-pubertal women versus post-pubertal," she explains. "Then there''s before babies, during pregnancy, immediately post-partum, pre-menopausal, post-menopausal and aging. Where a woman is on that timeline will greatly influence her musculoskeletal function. Men simply don''t undergo the same kinds of changes."

For example, when a pre-menopausal woman has a compression fracture of the spine, Prather immediately worries about early osteoporosis. A similar fracture in an older woman also might be due to weakened bones, but determining the cause of such a fracture — an important factor in determining treatment and rehabilitation — is especially urgent for a woman of 40.

"I might easily see what the problem is, but figuring out why a woman has the problem is key," she says. "If I don''t learn the cause, there''s a good chance she may face that same problem in the future."

Choosing physiatry
Prather got her first exposure to the field during high school and college when she worked as a nursing assistant in a rehab hospital. That experience helped her decide on medicine as a career and physiatry as a specialty.

"I wanted to do something meaningful to me that I could be passionate about," she says.

The field began to develop during and after World War I as a means of providing care for people with impairments and disabilities, particularly amputees. Later, patients with head injuries, spinal cord injuries and stroke began to be treated by physiatrists. Since the early 1980s, physiatrists have become involved in problems with the musculoskeletal system.

"I think part of what''s great about this specialty is that patients sometimes need a doctor who can cross lines," she explains. "If I see a patient complaining of neck and shoulder pain, is it the neck, or is it the shoulder? Well, sometimes it''s both. A physiatrist can focus on how the pain affects a person''s daily life. I work with the shoulder specialists. I work with the spine specialists and the hip specialists, and I end up being a kind of ''missing link'' among those providers."

A particular area of overlap involves working with hip surgeons to better recognize and classify hip injuries in young people. There''s often not much that occurs between the time when all seems fine and the time when a patient becomes a candidate for total hip replacement.

"Dr. Prather has been a driving force in the development of our multidisciplinary clinical research group that investigates the diagnosis and treatment of pre-arthritic and early arthritic hip disorders," says John C. Clohisy, M.D., associate professor and director of the Adolescent and Young Adult Hip Service for Washington University Orthopedics. "There are a variety of musculoskeletal problems in the hip that can cause symptoms in young patients, and it''s been through Heidi''s efforts in large part that we''ve been able to develop a team that provides a complete spectrum of treatment options from non-surgical physiotherapy through major reconstructive surgery."

Another project Prather is launching involves neck, shoulder and chest pain in women undergoing breast cancer treatment. She''ll work with women — after surgery and chemotherapy, but before radiation therapy begins — to learn about problems that cause upper-quadrant pain in these women.

"They can have nerve injuries or soft-tissue injuries or rotator-cuff problems in the shoulder that may or may not be related to the cancer," she says. "Many have different types of problems, but they tend to be lumped into a single group. We''d like to look more closely and find ways to change that."

Performing arts is another area of concentration. Prather and Devyani Hunt, M.D., assistant professor of orthopaedic surgery, are co-directors of WUSTL''s program that works with injured performing artists, primarily dancers.

"Dance is just a sport of a different nature," she says. "Dancers can injure themselves in a number of ways, and again, if the dancer is a woman, we have to determine where she is on her timeline. If she is a young girl, has she reached the point of bone maturation? Or is she in her 30s and dealing with the kind of arthritic conditions that can arise after years of dancing? Those types of issues are key both to successful treatment and to prevention of future injuries."

Music and tennis
Prather herself has been happy to avoid injuries lately. Because she''s been injury-free, she''s been running quite a bit. She says she rarely exercises when injured.

"I don''t overdo it because when I work with my patients, I see what can happen," she says. "I''m pretty good when I''m hurt. I rest, and then I usually go around and ask other physicians and physical therapists to look at me. I find it''s usually better to trust someone else than to try to diagnose yourself."

She grew up in Kansas City in a family of musical tennis players. Her father, Carl Prather, was a band director. Her mom, Becky, played drums. Heidi herself took up the trumpet and attended Drury College in Springfield, Mo., on a music scholarship, playing in the symphonic band and other musical groups, including the professional symphony in Springfield. But she never wanted music to be "work," hoping instead to use it as an outlet.

These days, she plays piano to relax after long nights of dictation. She''d like to return to music more seriously someday, but that will have to wait until her kids Ethan, 10, and Emma, 6, are a little older. Much of her spare time these days is spent as a "soccer mom," attending games and practices and taking turns shuttling them to Tae Kwon Do and dance lessons with her husband, Jeffrey D. Bradley, M.D., associate professor of radiation oncology at the Siteman Cancer Center.

She calls herself the least talented tennis player in the family, but she still managed to compete at Drury. Her younger sister, Gretchen, was the star, however, and still competes in sanctioned tournaments, recently playing in a national event.

In addition to running, Prather also rode her bike across Missouri this summer, accompanying her mentor, Joel Press. She was with him for 213 miles of his cross-country bike trip called the Ride for Rehab. Missouri was only a small portion of his total trip, but Prather made enough of an impression to receive official recognition as the Ride for Rehab''s "top female physiatrist rider without twins."