UMDNJ Magazine - fall 2004 VOLUME 1 NUMBER 1

Having three "top docs" in one department, at one medical school, is a remarkable achievement. Bragging rights go to the Department of Physical Medicine and Rehabilitation (PM&R) at UMDNJNew Jersey Medical School.

(Left to right) Joel DeLisa, MD, MS, professor and chair of physical medicine and rehabilitation at UMDNJ-New Jersey Medical School and chief of service of that same department at UMDNJ-University Hospital, with three "top docs" from his department: Steven Kirshblum, MD, John Bach, MD, and Kathleen Francis, MD.

The three physicians from the department who are featured in the 2004 edition of "America's Top Docs" are Kathleen Francis, John Bach and Steven Kirshblum. Francis attributes the department's success in part to "our chair, Joel DeLisa, an outstanding physician and administrator who has built a truly world-class department - one of the best, if not the best, in the country."

DeLisa returns the compliment, saying, "Dr. Francis is a very caring, compassionate physician who has been willing to develop comprehensive rehabilitation programs for patients whose disabilities are often progressive and for whom no cure is in sight."

Francis is nationally recognized for her work in treating lymphedema, the swelling of soft tissues, usually in an arm or leg, that is related to impairment of the lymphatic system. The result is an enlarged, sometimes very firm limb which can be painful and immobile. The most common causes in the U.S. are cancer-related. The name elephantiasis, conjuring up images of grotesquely swollen extremities, is given to the severest cases.

"There are so few doctors treating lymphedema that I've become the local expert," Francis says modestly, adding that she is aware of only one other physician in New Jersey specializing in it. "But the number of cancer patients alone who have it is huge - some 20 to 25 percent."

Francis arrived at her medical career late in life, after having three children. A graduate of Montclair State University, she says there were three career options open to women at that time: nurse, teacher and secretary. She opted for teaching.

Her husband's job took the family to Scotland for a few years. When they returned, she and her husband took turns going to graduate school. He went for business, she went for medicine. "I let him go first, because I was so busy with the kids," she jokes.

The New Jersey native (she hails from Cedar Grove and still lives nearby) stayed near home for medical school, enrolling at NJMS in 1985. "I had always loved biology and life sciences," she continues. "I thought being a doctor would be a way to make a positive, useful contribution." She graduated in 1989 and did her residency at Kessler Institute of Rehabilitation, a UMDNJ affiliate.

Following her residency, she remained at Kessler, where she began to see patients with lymphedema who had been referred there for physical therapy. She became very interested in its complexities. "The more I read about it, the more I wanted to learn," she says. "What I didn't learn from books, I learned from hands-on experience, since more and more patients were being referred to me."

DeLisa says, "She has been the clinical leader in cancer rehabilitation, and from this has developed the comprehensive treatment program for lymphedema."

Cancer patients are devastated when they develop the condition, says Francis: "They tell me, 'I've been through a lot, but this is the worst.' They survived cancer, but now have a lifetime reminder of it."

While lymphedema can't be cured, it can be managed, with great improvement in quality of life. The "gold standard" - the treatment Francis specializes in - is complete decongestive therapy, or CDT. It was developed in Europe and is not widely used in the U.S. It has four components: manual lymph drainage; compression bandaging or elastic compression garments; meticulous skin care; and exercises.

In August, Francis took a big step: She left Kessler to establish a private practice. She is now medical director of a lymphedema treatment center based at St. Barnabas Ambulatory Care Center in Livingston. "I had been an employed physician for years, and felt the time was right to do this," she says. "St. Barnabas has a strong cancer program with plenty of patients who will benefit from our services."

Francis, a tennis player, is very fit and moves with the grace of a natural athlete. So it's not surprising that she was drawn to rehabilitation as a specialty. "We're improving people's lives in a functional sense," she explains. "They come in with pain or movement issues, which can trigger a whole host of other problems, including anxiety and depression. By working with them to improve mobility, their quality of life improves."

The other top docs in the NJMS Department of Physical Medicine and Rehabilitation are as noteworthy as Francis. Bach is professor and vice chair of physical medicine and rehabilitation at NJMS. Rehabilitating patients with neuromuscular disease by improving breathing and coughing function has been his primary focus. As medical director of the Center for Noninvasive Mechanical Ventilation Alternatives and Pulmonary Rehabilitation at UMDNJUniversity Hospital in Newark, he is internationally recognized for his innovative work in noninvasive (nonsurgical) mechanical ventilation.

Kirshblum is associate professor of physical medicine and rehabilitation at NJMS and associate medical director and director of the spinal cord injury program of the Kessler Institute. An expert on spinal cord injury and rehabilitation, he is the primary investigator on several spinal cord injury grants, and serves as project co-director of the Northern New Jersey Spinal Cord Injury Model System Program. He is the author of numerous articles and textbook chapters and the editor of Spinal Cord Injury Medicine (Lippincott/Williams and Wilkins, 2002).