People

Why cancer rehabilitation?

During my intern year, I was assigned not one but two inpatient oncology rotations (including heme/BMT). After watching many of these patients sit in the hospital getting weaker and more debilitated, I started my residency here at Michigan where Sean Smith was beginning to build our formal cancer rehabilitation program. I liked the idea and stuck with it. The patients are amazing to work with and we are definitely helping fill a massive gap for the cancer survivors.

Clinical interests within the sub-specialty?

Neuromuscular effects of cancer and its treatments, balance disorders in cancer survivors, rehabilitation services for acute care cancer patients, pelvic floor disorders in cancer survivors.

What is the future of cancer rehabilitation?

I think there are several short to medium-term goals cancer rehabilitation should work toward. One is ACGME accreditation as a subspecialty. We also need to increase our research base to provide outcome data that the work we are doing is valuable. Oncology is a very data-driven field, and without good data we will struggle to make clear to our impact on patient care and outcomes to our referral base.

First concert/best concert?

I grew up in rural East Texas far from any bigger cities. The first concert I ever went to was an opera (I don’t remember which) by the Stephen F. Austin State University music school. I had just started taking violin lessons and my mom (who had zero interest in any classical music at all) wanted to encourage me to explore my interests.

My best concert was a Dallas Symphony Orchestra concert when I was in college. My best friend and I drove to Dallas and rented a hotel room for the weekend. Hilary Hahn, my favorite violinist (then and now) performed.

Favorite Ann Arbor restaurant?

Original Knight’s all the way. The twice baked potatoes are amazing.

Favorite trip?

I’m a long-time Pokemon fan. A couple of years ago, a couple of friends and I took a spontaneous weekend trip to Saskatoon, Saskatchewan, to catch a specific Pokemon in Pokemon GO. We ended up eating the best brunch any of us had ever had and got to explore a city we’d have never gone to otherwise.

Why cancer rehabilitation?

I enjoy meeting my patients and coming up with an individualized plan for whatever their needs are. Our patients have impairments or a decline in function that spans the scope of rehabilitation medicine, but with the added complexity of cancer/cancer treatment. I find that we can provide a service that fills a major gap in cancer care that other hospitals may not be able to cover. I’ve never regretted going into this field and I’m constantly inspired by our patients and my colleagues to continue to look for ways to improve and expand our care.

Clinical interests within the sub-specialty?

I enjoy managing all facets of cancer rehabilitation, but often manage neurologic and musculoskeletal effects of cancer treatment, including pain, radiation fibrosis, weakness, spasticity and more. We have been expanding our care for cognitive impairment that can arise from cancer treatment and I am excited to bring more to that aspect of rehabilitation.

What is the future of cancer rehabilitation?

I envision early, integrated rehabilitation into some aspects of care – survivors at high risk of adverse chronic effects (e.g. high-dose radiation, aromatase inhibitor arthralgias, etc), as well as at-risk populations we can identify through state-of-the-art assessment tools. In other words, I think we will become better at knowing when to triage a patient to rehabilitation services.

First concert/best concert?

Kris Kross(!) and first row at Bruce Springsteen in 2009.

Favorite Ann Arbor restaurant?

Frita Batidos

Favorite trip? 

New Zealand - we visited a bunch of different places and could’ve spent years exploring it.

Why cancer rehabilitation?

Cancer rehabilitation as a specialty is relatively new, as cancer treatments have become increasingly successful at helping people survive this disease. Now we can focus on helping people thrive, which is exactly what rehabilitation neuropsychology is all about- understanding a person’s strengths, identifying what changes in cognitive functioning (thinking, memory, attention, etc.), emotional adjustment, or behavior require new strategies and new kinds of support, and guiding people towards what is most likely to be helpful for them. It is exciting to be a part of such a meaningful area of growth in medicine, and to be part of the learning process for identifying treatments that can make a difference for so many people. On a personal note, cancer has impacted my family and close friends in many ways, and this is one way I can honor them and serve others going through similar challenges.

Clinical interests within the sub-specialty?

I am very interested in the interplay between cognitive functioning (thinking, memory, attention, language, etc.) and emotional adjustment, and helping people find ways to meet the goals that are most valued for them despite changes in functioning caused by cancer and cancer treatments. This interest has lead me to working a lot with people dealing with brain tumors, but also people experiencing “brain fog” after treatment for other cancers. I’m especially interested in finding new ways to identify and measure these problems to improve our ability to develop effective treatments.  

What is the future of cancer rehabilitation?

I think the ideal future is one in which the standard of care across the country involves teams of specialists from multiple disciplines specialized in cancer, well-coordinated and providing treatments that have a significant positive impact on functioning. Ideally these teams treat the whole person and work in concert with each other so that we don’t miss an important issue that is impacting quality of life. There should be resources available to assist patients with implementing the strategies after treatment, and accessing what they need in their own homes and communities, as well as follow-up consultations with the team to adjust the plan as needed over the long term. We strive for this level of care at Michigan Medicine, and are fortunate to have so many talented and dedicated care providers working together.  I would like to see this kind of programming become more accessible and widely available, particularly to underserved populations.

First concert/best concert?

Music has always been a big part of my life. My mother worked in the music industry when I was a kid, and we used to go to shows all the time. My first concert was probably seeing George Michael on the Faith tour when I was maybe 5 years old. Pretty scandalous! I don’t think I can give one answer for best concert. I spent time in NYC for graduate school, and I think the coolest thing I may have ever seen while I was there was Iggy Pop playing the Bowery Ballroom, climbing the speaker stack and crowd-surfing over us like he was still 20 years old.

Favorite Ann Arbor restaurant?

Blue Llama Jazz Club, if you’re feeling fancy.

Pets?

We rescued a big, goofy bicolor cat during the pandemic. His name is Arturo, and he loves chasing ping pong balls!

Favorite trips?

During a break in grad school, my husband and I swapped apartments with a person in Berlin for a month. We bought cheap bicycles at a flea market, and spent the month riding around the city, exploring. I have an abiding love now for currywurst. 

Why cancer rehabilitation?

I started my training in emergency medicine and gained significant experience in critical care. Through this experience, I solidified my interest in hospice and palliative medicine (HPM). I found that emergency medicine was not a good match with my personality and professional goals, so I changed specialties to physical medicine and rehabilitation-a much better fit. During my fellowship in HPM at UPMC in Pittsburgh, I took an away rotation in cancer rehabilitation at Memorial Sloan Kettering in New York. This rotation clarified for me that cancer rehabilitation would be my practice focus. My practice enables me to provide rehabilitation care to patients with serious illnesses and a wide variety of functional impairments. These patients also frequently labor under a significant symptom burden. After almost 10 years of this practice, I continue to feel that this is what I was meant to do.

Clinical interests within the sub-specialty?

I am particularly interested in managing symptoms of cancer patients so that they are better able to participate in and benefit from their rehabilitation therapies, which allows them to make their best functional progress possible. I also enjoy teaching advanced symptom management to residents and fellows.

What is the future of cancer rehabilitation?

The future of cancer rehabilitation is very exciting. Cancer and its treatments can take a big toll on patient function. Historically, cancer patients with functional impairments have been underserved in rehabilitation care. What is exciting is that cancer rehabilitation is in essence an elaboration of core rehabilitation knowledge and skills. All rehabilitation professionals can gain the additional knowledge and skills to competently care for patients with cancer who have functional impairments. More and more, rehabilitation teams are able to support and assist cancer patients in making meaningful gains in function, independence, and quality of life. It is very satisfying to be a rehabilitation clinician who focuses on cancer rehabilitation and who teaches others to be able to provide this important care. 

Pets?

We have a rescue Australian cattle dog mix, Lucky. He is tricolor with a blue ticked coat, "peanut butter" brows, and a black ring around the base of his tail. We say that Lucky is 200% dog in a 100% world. We also have a rescue grey and white bicolor cat, Ariadne. With Ari, there is a thin line between love and murder. The two are frenemies, with very clear rules for their games of tag. 

First concert/best concert?

Best concert: It's a toss-up. Gustav Mahler's Ninth Symphony, performed by the San Francisco Symphony, directed by Michael Tilson Thomas. Or when my spouse and I sang as members of the chorus in Gustav Mahler's Second Symphony, performed by the New Albany Symphony with the New Albany Symphony Chorus, directed by Luis Biava. 

Favorite Ann Arbor restaurant?

So far, it's The Last Word. I'm always on the lookout for an honest poutine.

Favorite trip?

Our second trip to Ireland. We brought my son, Dan, and my father-in-law, George Kernohan. We went to Northern Ireland and met a McMichael cousin I found through Y-DNA testing. We also located the auld homestead of the Kernohans and perused a churchyard full of their headstones. It's a beautiful place with lots of history. 

In addition to the core faculty, the University of Michigan Cancer Rehabilitation program features numerous physical therapy and occupational therapy staff members with expertise and advanced training in managing cancer rehabilitation patients. You would have the opportunity to spend time with therapy team members who manage lymphedema, trismus, post-mastectomy pain, radiation fibrosis, and more.