DivaCare speaks to Rehabilitation and Women’s Health specialist Dr. Atira Kaplan about post-treatment complications and exercising after breast cancer treatments.
What is your role at Montefiore and what kind of patients do you see?
I am currently a fellow in the Women’s Health Rehabilitation program at Montefiore Medical Center, in the Department of Rehabilitation Medicine. In this capacity, I focus on the diagnosis and treatment of a variety of conditions that particularly affect women. To name a few:
- Rehabilitation for patients suffering from or recovering from breast or gynecologic cancer
- Pelvic floor dysfunction, especially urinary and fecal incontinence, as well as constipation
- Musculoskeletal dysfunction and pain during pregnancy and after delivery
- Rehabilitation for patients with osteoporosis and other Rheumatologic conditions
Tell us about the most frequent complications you see in breast cancer patients?
The most common complication that we see is lymphedema of the arm and hand on the treated side. Many women experience swelling of the breast as well. In addition, we see many women with pain in the shoulder and limited range of motion of the shoulder after treatment. Axillary web syndrome, also known as lymphatic cording, is also a common condition and is sometimes responsible for these symptoms.
What questions do you think physicians should be asking the women who undergo breast cancer treatment? What questions should women be asking their doctors?
At every visit, physicians should ask their patients who are undergoing or have undergone, treatment for breast cancer questions that would raise a suspicion for the development of lymphedema – such as whether the patient notices clothing or jewelry fitting more tightly, swelling or a feeling of heaviness of the arm or leg. Physicians should also ask patients if they are having shoulder pain, difficulty moving their arm, or trouble performing routine activities, such as combing their hair and pulling shirts on overhead – to indicate the possibility of a frozen shoulder developing.
Women should ask what complications to look out for, and what they can do to reduce the risk of complications. If women notice any swelling or change in their range of motion, they should ask their doctor about starting occupational, physical, or lymphedema therapy.
Share with us what you wish patients knew about rehabilitation after breast cancer?
Given the many health benefits of exercise, I want women to know that it is safe to exercise after breast cancer – with precautions. Women should speak with a physician or therapist to learn how to exercise safely before, during, and after cancer treatment.
It is very important for women to be aware of the signs of developing lymphedema as the treatments are much more effective in the early stages. Women should be informed of the options for managing lymphedema – including compression garments, pneumatic compression pumps, and manual lymphatic drainage. Women should also be aware of conditions that can exacerbate lymphedema, such as heat or airplane travel, and consider taking precautions in those situations.
What do you think are the biggest obstacles for women to have access to rehabilitation? Education? Insurance? Location?
I think that being vigilant for potential complications and knowing that there are rehabilitation management options available increases the chances that patients will obtain the needed rehabilitation services. Nevertheless, I see that access to these resources is often limited by cost or long wait times. It is my understanding that most insurance companies don’t pay for compression garments, which is a crucial component of preventing the progression of lymphedema. While several insurances do provide coverage for a lymphedema pump, which is an excellent tool in the management of lymphedema, there are other insurance companies that don’t. Given the time-intensive nature of manual lymphatic drainage, there is often a long wait time to get an appointment with a therapist who accepts insurance.
Atira H. Kaplan, MD specializes in Physical Medicine & Rehabilitation at the Montefiore Medical Center in Bronx, NY.