On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Jonas Sokolof, DO, a physician specializing in physical medicine and rehabilitation at NYU Langone’s Rusk Rehabilitation to talk about the importance of exercise therapy in cancer care.
In this episode we discuss:
What is Oncological Physiatry Use of exercise in improving function and quality of life Lifestyle Medicine in Oncology Dr. Sokolof's baseball diamond analogy for rehab The importance of collaboration in the treatment of patients live with and through cancer Common side effects from cancer treatments And more!
Resources from this episode:
Round Table Talk: Cancer Rehab and Survivorship
NYU Langone Oncology Rehabilitation Summit: Optimizing Rehabilitation Outcomes Through Exercise
More About Dr. Sokolof:
I am a physician specializing in physical medicine and rehabilitation at NYU Langone’s Rusk Rehabilitation. After completing my residency training at Harvard Medical School, I subspecialized in musculoskeletal/sports medicine and interventional spine care. During this time, I acquired additional skills in the nonoperative treatment of various musculoskeletal conditions, including arthritis, lower back and neck pain, coccygodynia, neuropathy, dystonia, and tendinitis.
As a physiatrist, my goal is to help my patients regain function through various nonoperative treatments, including rehabilitation, injections for spine and joint pain, and medication. Whenever possible, I try to avoid prescribing medications for long-term use and prefer a more holistic approach to patient care.
For instance, I have expertise in osteopathic manipulative medicine treatment (OMT), also known as manual medicine. OMT is “hands-on care”; I use my hands to diagnose, treat, and prevent illness or injury, through stretching, applying gentle pressure, and using resistance. I often find this modality useful as a supplement to other treatments. If needed, I can also provide people with image-guided injections for the spine and peripheral joints. Additionally, I perform electrodiagnostic testing to diagnose and guide treatment of various neuromuscular disorders.
A major focus of mine is the rehabilitation needs of cancer patients and survivors. My goal is to help individuals, from diagnosis to cure, improve overall function and quality of life. I have expertise in diagnosing and treating a variety of cancer treatment–related side effects, such as chemotherapy-induced peripheral neuropathy, radiation fibrosis, lymphedema, and post-mastectomy pain syndrome. As the need for physical rehabilitation grows in the field of oncology, I find it exciting and rewarding to help restore function in anyone who has experienced cancer. I’m also certified in sports medicine, so I’m experienced in treating sports-related injuries in cancer survivors and helping them return to sports and exercise routines.
I am passionate about lifestyle medicine, an evolving field that focuses on lifestyle interventions, such as diet, exercise, stress reduction, and smoking cessation, to treat and prevent various chronic conditions and improve function. In my research, I explore lifestyle interventions to improve the lives of people who have had cancer. I also speak at the local and national level about rehabilitation programs for people with cancer. I am a co-chair of the lifestyle medicine counsel for the American Congress of Rehabilitation Medicine and a co-chair of the medical fitness working group for the American College of Lifestyle Medicine. Additionally, I sit on the executive committee for the American College of Sports Medicine’s Task Force on Exercise Oncology.
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Read the full transcript here:
Speaker 1 (00:07):
Welcome to the healthy, wealthy, and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information. You need to live your best life. Healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, Dr. Karen Litzy. Hey everyone.
Speaker 2 (00:36):
Welcome back to the podcast. I am your host, Karen Litzy and this month, which is the month of April, 2021. We have focused our attention on cancer, survivorship, and oncological rehabilitation. To that end. I am thrilled to announce that on May 11th at 8:00 PM Eastern standard time, this is a Tuesday evening. We will have our round table talk focused on that subject. Oncological rehabbing cancer survivorship. All of the guests from this month will be on that round table talk. So that includes Kristin Carol Jillian Schmidt, Dr. Lisa van Hoose, and our guest today, Dr. Jonas Sokoloff. This is your chance to ask these four amazing experts, any question you want. And I know being a physical therapist going to conferences, I always want to try and get the person's attention to ask them a question. Sometimes you never get the chance. This is your chance. So if you have questions on oncological rehab on cancer survivorship, whether you're a physiotherapist, a healthcare professional fitness, professional, learning more about how to treat this population is imperative because a hundred percent of us are probably going to see someone who has cancer, who has lived through cancer in their lifetime.
Speaker 2 (01:55):
So how do you sign up? Go to podcast dot healthy, wealthy, smart.com click on the link that says round table talks, and you can sign up right there. And again, it's going to be Tuesday, May 11th, 8:00 PM, Eastern standard time. Now onto today's episode, like I said, today's guest is Dr. Jonas Sokoloff. He is a physician specializing in physical medicine and rehabilitation at NYU Langone Rusk rehabilitation. After completing his residency training at Harvard medical school, he sub-specialized in musculoskeletal sports medicine and interventional spine care as a physiatrist. His goal is to help his patients regain function through various non-operative treatments. And he also has expertise in osteopathic manipulative medicine treatment. Also known as manual medicine it's hands-on care. So he does use his hands to diagnose, treat and prevent injury or illness through stretching, applying gentle pressure and using resistance. A major focus of his is the rehabilitation needs of cancer and survivors is goals to help individuals from diagnosis to cure, improve overall function and quality of life.
Speaker 2 (03:06):
He has expertise in diagnosing and treating a variety of cancer treatment related side effects, such as chemotherapy induced, peripheral neuropathy, radiation, fibrosis, lymphedema, and post-mastectomy pain syndrome. As the need for physical rehab grows in the field of oncology, he finds it exciting and rewarding to help restore function in anyone who has experienced cancer is also sort of certified in sports medicine. So he's experienced in treating sports related injuries in cancer survivors and helping them to return to sport exercise and routines. And he is also passionate about lifestyle medicine as am I and ever evolving field that focuses on lifestyle intervention, such as diet, exercise, stress reduction, and smoking cessation to treat and prevent various chronic conditions and improve function. And we talk about that in the podcast today. What else do we talk about? Well, we talk about exactly what a physiatrist is and how they work in the field of oncology.
Speaker 2 (04:06):
We talk about some common side effects that people may experience from cancer related treatments. We also talk about the, his baseball analogy on rehabilitation and getting people back to their sport or back to life, which I love because I'm a softball player. So I had anything with a baseball analogy I'm all in. And he also talks about the importance of lifestyle medicine and why that's important, especially with cancer patients. And he lets us know exactly why that's so important. So a huge thank you to Dr. Socolow for coming on the podcast. And everyone don't forget to sign up for our round table on May 11th, by going to podcast at healthy, wealthy, smart.com and clicking on the round table tab. Enjoy everyone.
Speaker 3 (04:59):
Hi, Dr. Sokoloff welcome to the podcast. I'm happy to have you here this month, where we're talking all about cancer survivorship. So thank you so much for coming on. Oh, thank you very much for having me. It's really great to be with you. Yeah, this is really exciting. I'm definitely familiar listening to your podcast or floor gray while you're doing and you guys, my pleasure. Awesome. Well, thank you so much for that. And like I said, in your bio, you're a physiatrist and you're here at NYU. And we'll talk about that a little bit later, cause you guys have an oncology summit coming up and we'll talk about how people can sign up for that, but they have to listen to the whole, they have to listen to this whole podcast to get all the goods. So before we get into the meat of the discussion today, can you tell the listeners what oncological physiatry is? So uncle logical desires, you, maybe I should start by what is desire?
Speaker 4 (05:58):
You know, there's, I'm sure most of your listeners are well aware of what the field of desire tree is all about, but there may be a few that aren't so desire tree also known as physical medicine rehabilitation is a sub-specialty of medicine that involves essentially working with patients to enhance quality of life and physical function for patients that may be suffering from whether it's a an illness or an injury traumatic brain injury, spinal cord injury, or musculoskeletal injury. And it's a, it's a very multi-disciplinary field that overlaps a lot with orthopedics neurology, internal medicine rheumatology sports medicine, and, you know, several others. So you kind of have to know a little bit of everything, but basically the main goal of [inaudible] is to enhance quality of life and physical function. Now in oncological, physiatry is, is sub specialty.
Speaker 4 (06:57):
So we are experts in neuromuscular and musculoskeletal and other functional impairments that directly affect you know, people living with the beyond cancer, whether it's from the actual cancer itself or from the treatment of cancer. So surgery, radiation, systemic therapies, chemotherapies, immunotherapies, targeted therapies, et cetera. So in a nutshell, that's, that's, that's essentially what the field is about and what drew you to this subspecialty. So I am a sports medicine trained physiatrist. I did three years of a physical medicine rehabilitation residency. Before that you have to do a, a year of a general internship. And then I went on to do a three-year residency in PMNR. And then after that I did another year long fellowship and what's called spine and sports care or spine and sports medicine. So I received training in sports medicine care. So sort of like non-surgical orthopedics, interventional spine psychiatry, injections under fluoroscopy and under ultrasound.
Speaker 4 (07:59):
And, you know, I thought I was going to, you know, treat, you know, weekend warriors and, you know, athletes and, you know, yoga moms and so forth. And you know, essentially non-surgical orthopedics. But for me, I learned kind of early on in my fellowship year that, you know, I, I tend to kinda get bored doing the same thing, you know, over, over and over. And I, I really liked the variety and really like the challenge. And there was an opportunity to major cancer center in New York where they were looking to hire another physiatrist. They already had two physiatrists and they were looking at another physiatrist who actually had more of a sports medicine, interventional background. And I ended up applying for the position and it was, I was so impressed with the institution, but more importantly, I was, I was really impressed with this opportunity to really make a big impact in the field of oncology and really help like enhance the quality of life for people living with and beyond cancer.
Speaker 4 (09:03):
I just felt for me, that was more meaningful because there's such a huge need. Unfortunately, people who have the disease of cancer and go through treatment through the whole continuum, they have a lot, a lot of problems with, you know, getting back to the way, the level of functioning and quality of life that they had prior to their diagnosis. There's just a tremendous need, but we've gotten so much better at treating a variety of different types of cancers keeping people alive longer. Unfortunately a lot of these treatments do have a lot of sequelae that, you know, the oncology field, it's just not, they're just not well equipped to deal with these issues. And that's where we really shine as rehabilitation professionals because we are the experts in physical function and quality of life, and we really can make a difference. And I liked that feeling of really being able to make a big difference in the lives of these people.
Speaker 3 (09:59):
And you had mentioned in there that a couple of things that stood out to me, one that there are more people living after and beyond cancer than before, because of I'm assuming better treatments, better detection. Correct. And you also mentioned that there are side effects from some of these treatments and interventions. And I think oftentimes people think physical therapists alike think, Oh, someone had cancer, they survived it, they must be fine. So what do you see as the most common side effects and where can rehabilitation physical rehabilitation make a difference with those side effects?
Speaker 4 (10:44):
I would say probably amongst the most common side effects that I see, for example. So I see a lot of breast cancer patients and survivors in my practice and a lot of head and neck cancer survivors, a lot of prostate survivors. I'd say, you know, sequentially after surgery, for example, after mastectomy, or even in breast conservation, surgery, lumpectomy, and so forth. Whereas like you're, you're right. Patients, essentially in many, in many cases they're diagnosed early. They are, you know, very high success rate. The achieved cure is very often, but unfortunately a lot of these people, these individuals are left with a lot of pain and dysfunction, everybody heals at their own pace or rate. So their ICL, I see a great deal of patients who, whereas it it's expected that they're going to sail through their, their treatments. And men, many instances, they have achieved the events they have achieved you know, complete remission, but yet in some way, they're, they're left kind of broken and they're not able to get back to their baseline level of functioning.
Speaker 4 (11:50):
They have, they may have prolonged pain that lasts longer than what would be expected. They may have more scar tissue. And there's there. These factors may be, are usually multifactorial lifestyle factors come into play. Underlying premorbid conditions come into play you know, whole host of factors. And in many instances they are not, they don't recover as fast and they need a lot of help. So I'd say the biggest, you know, impact. I think the, in my practice, I would say in our breast cancer patients, we see a lot of patients with post-mastectomy pain syndrome pain that lingers way past the recovery period with scar tissue that often results in shoulder dysfunction adhesive capsulitis rotator, cuff dysfunction and impingement, bicipital tendonitis, various other factors that really adversely affect people's abilities to get back to like their life. That's one example that comes to mind, radiation fibrosis.
Speaker 4 (12:55):
So, you know, chemotherapy, radiation being the cornerstone of treatment for head and neck cancers, a great deal of morbidity there, you know a lot of scar tissue that forms after radiation, that impairs neck range of motion, ability to open your mouth trismus swelling, lymphedema in the head and neck population. Nobody, nobody knows how to handle these types of issues, but as rehabilitation professionals are really well equipped in you know, are able to really make a big impact in the lives of these folks. So I'd say those, those two populations really stand out to me and they are, they do make up a majority of my practice.
Speaker 3 (13:37):
And one thing that rehabilitation professionals are really proficient as in is exercise. So how can exercise help with these patients to improve their function and quality of life?
Speaker 4 (13:49):
Right? So we do have very robust data in the form of randomized controlled trials that exercise both aerobic training and resistance chaining can actually help improve several different cancer-related health outcomes. And that includes overall physical functioning lymphedema, anxiety, depression, overall, quality of life and wellbeing. And this comes from, you know, a tremendous amount of rigorous, you know well-designed clinical trials. So we do have, we now have really great evidence supporting this. We actually know that it, that it can be used as medicine, and we all know, I'm sure your listeners are well aware that exercise is medicine and really in oncology, this is actually even more apparent.
Speaker 3 (14:39):
And when we think about these patients living with and living beyond and through cancer, one of the things at least that I've seen with a lot of my patients that I have seen is that fatigue is an issue. And so when we're thinking about exercise, so as physical therapists, you're sending your patients to us, fatigue is a big issue. Do we center our treatment approach around a graded approach to exercise or to a paced approach to exercise? Or is it one of those answers that it depends.
Speaker 4 (15:11):
So it's all it's should be a personalized approach, right? It's really not a one size fits all. And that's why, again, it helps to be, you know, it helps for a patient to work with a highly skilled trained rehabilitation professional so that they can really hone in, do a full comprehensive assessment and really understand, you know, what exactly that particularly low patients struggling with with the impairments may lie what their history has been and order to come up with a real, you know, comprehensive, structured, personalized program. Oftentimes we use in rehabilitation, we're using a therapeutic exercise program. So for example, patient has, let's say rotator cuff dysfunction, right? They have imbalance of their scapular scapular stabilizing muscles, right? And they may have altered glenohumeral mechanics that are promoting this condition of impingement, let's say of the supraspinatus tendon and that leads to pain, loss of range of motion.
Speaker 4 (16:14):
And then that then progresses to let's say, adhesive capsulitis or frozen shoulder, for example. So we would, we would construct a therapeutic exercise program specifically honing in on that specific dysfunction, right. The shoulder. But we can also use, you may say generic exercise. We could use aerobic training and strength and conditioning on top of the therapeutic program, all from a personalized standpoint for what meets the needs of that specific patient in conjunction with a therapeutic exercise program. And that's where I think really where the field is headed is really being able to the goal should not just be, to get the patient out of pain, would get them back to, you know, being able to do some of their life specific activities, but also getting them to an exercise program that should be one of the main goals of ecological rehabilitation program.
Speaker 3 (17:10):
And I think that's great advice for all the physical therapists and physiotherapists out there listening is that when these patients are coming to you, like we'll take the example of shoulder pain post-mastectomy or post some sort of treatment that we don't want to just focus on. Let's just do exercises and rehab around the shoulder, but let's take it broader and try and make this into like a lifestyle change for the patient.
Speaker 4 (17:40):
Exactly, exactly. There's a there is a diagram that I often use on a lot of my talks when I lecture on this subject. And it's
Speaker 5 (17:50):
The baseball diamond approach to rehabilitation is a approach that is utilized in sports medicine. It was it was passed on to me by some folks some physiatrists at the Mayo clinic. It's very simple way to think about it, but essentially your goal is to get, get to home plate, get back to return, to play, you know, so to speak or return to life, do advance through all the bases to get the first space you have to restore range of motion from first base to second base. And you have to start to work on strength from second base, third base. Now you're starting to work on the neuromuscular kinetic chain on the pitcher's mound. You really want to put an exercise program that they should be able to be able to do for the rest of their lives. Because what it's going to do is actually going to, it's going to improve survival.
Speaker 5 (18:32):
It's going to improve cancer related you know health outcomes. Okay. So it's gonna help them to improve. It's going to help to improve anxiety, fatigue, physical functioning. And this is another thing that I really love about the field of oncological rehabilitation, because not only are we helping to restore quality of life and overall physical function, but we actually have the opportunity to make an impact on the disease itself. We actually can, as rehabilitation professionals can actually change the course of the disease by getting our patients back to a safe and effective exercise program. So it really needs to be incorporated into rehabilitation. It really should be all part of what we're doing as rehab professionals.
Speaker 3 (19:14):
I really liked that baseball diamond analogy. And, and oftentimes when we think of that return to play, I know the first thing that comes to my mind is as an athlete. So you're getting them back to their sport, whether whatever that sport may be, but you're absolutely right, that that same framework can be used for all of our patients. They have to get back to, it may not be back to the soccer pitch or the baseball field, but they are getting back to returning to play, which is their life
Speaker 5 (19:49):
That's correct. And even back to their familial roles, there's societal roles, there are vocational roles really getting them back to the things that they want to be doing, the things that they need to be doing to live out the rest of their life.
Speaker 3 (20:06):
Yeah. I love that baseball diamond going to be using it all the time. I love it. Especially as a former softball player and a former pitcher, I can definitely relate to that. Now we've been saying this word a couple of times throughout the interview, and that is lifestyle. So there is this lifestyle medicine, branch of medicine. So how does that fit into the oncology patient in the world of oncology?
Speaker 5 (20:34):
So two thirds of the world's cancers, according to the world health organization can actually directly be linked to lifestyle, right? So smoking alcohol dietary intake lack of physical activity, increased stress levels and so forth. So we have as rehabilitation professionals, the opportunity to intervene to provide lifestyle interventions and again, help restore physical function, but also have a major impact on the, the course of the disease itself. So I believe that lifestyle medicine actually should be, is a very important aspect of what we offer in rehabilitative care, especially in on-call oncological rehab. So I try to incorporate it into my practice counseling patients and educating patients on proper nutrition, certainly exercise. We do a lot of cancer counseling and exercise. We offer stress reduction techniques. Certainly when, when patients are smoking we, you know, get them as soon as we can plugged in with smoking cessation programs and so forth and so on. So because there is such a direct relationships to lifestyle and cancer it, it has to be a key component of the rehab plan as well.
Speaker 3 (21:51):
Yeah. And that, that is all in our lane.
Speaker 5 (21:54):
Exactly, exactly. Yeah, I mean, you know, the F really up until, you know, recently the thought process, you know, cancer essentially had a very strong genetic component. But right. The it's the way the, the environment or lifestyle is affecting those genes, which we know that, that poor lifestyle can actually turn on a lot of those oncagenes and promote you know, promote cancer growth. So yeah.
Speaker 3 (22:26):
Yeah. And so what is it coming from you from your position as a physiatrist? What are some things that you really want physical therapists to know when it comes to treating patients that have, or have lived through cancer,
Speaker 5 (22:43):
Physical therapists that it's, it's safe to put these folks through an exercise program it's safe to put them on a resistance training program as long as it's, you know supervise and as long as, you know, if you're working with a physical medicine rehabilitation physician or a physiatrist, it's really great to partner up so that you can learn, you know, what would be a safe way to approach, for example, a patient with metastatic disease in the spine or metastatic disease somewhere else. You know, in the, in the skeleton, for example, cause I think a lot of therapists may be apprehensive. They don't want to, you know, cause a fracture, for example, they may not want to injure a patient and they're not sure what would be safe. Just know that it is safe when it's done, you know, under the supervision of someone who's as skilled, as trained as yourself, but also helpful if you have members of your oncology community that you can communicate with and determine you know, what would be the great, the best plan for that patient and what would be the safest plan?
Speaker 5 (23:57):
I mean, therapists were, we, we were in constant communication about the patients programs in our, in our at our site as to what, how you can progress them through an exercise program safely based on, you know, review of imaging and based how, and then how they present clinically. So yeah, I mean, I, I would, I would just say, I think, you know, a lot of these patients can tolerate probably a little bit more than what's been previously done in the past.
Speaker 3 (24:29):
Awesome. Well, thanks so much for that. And hopefully all the physical therapists and physios and even other healthcare professionals listening or taking notes on all of this, cause this was great. Let's talk about the NYU Rusk rehab. They have an oncology summit coming up. Is it in October,
Speaker 5 (24:49):
October 1st, it's going to be
Speaker 3 (24:51):
Featuring our very own Nicole Stout as a keynote. We love her here. Love her, love her so much. So go ahead and talk a little bit more about that.
Speaker 5 (25:00):
So we are having our first you know, annual uncle logical rehabilitation summit Ruskin suit, NYU school of medicine on it's gonna be October 1st, it's going to be a hundred percent virtual. Eventually as we come out of the pandemic, we will hopefully transition to an in-person program. But this year we're going to starting off as virtual. And the theme of this year's symposium is going to be exercise oncology. So we are going to have oncologists lecturing, certainly physical therapists, speech therapists, occupational therapists Dr. Katie Schmidts, the CSM round table leader in luminary in the field of exercise oncology as well as Nicole Stout, excited to have them are two keynote speakers are really looking forward to providing a robust program for anyone interested in how to implement exercise into a rehabilitative care plan for oncology patients.
Speaker 3 (25:58):
Yeah. And it's like total coincidence. I got the email for that. Like a couple of days ago, I was like, Oh, this is perfect because here we are doing this interview. So this worked out very, very well. And now where can people find you, if they want to ask you questions, they want to connect with you? Where can they find you?
Speaker 5 (26:17):
My email probably is the best. I'll definitely find putting it out there. It's my first and last name, so that's Jonas, J O N a S dot SoCal off that's S like Sam. Okay. O L like Larry off, likeFrank@nyulango.org, one word, NYU llangollen.org.
Speaker 3 (26:37):
Perfect. And we will have all of this links to sign up for the summit and your email in the show notes for this episode at podcast at healthy, wealthy, smart.com. And last question that I ask everyone, is that knowing where you are now in your life and in your career, what advice would you give to yourself as let's say, fresh out of medical school?
Speaker 5 (27:05):
What would the advice would I give myself fresh out of medical school? I would say, you know, I would say, probably go with your gut. Right. You know, there's a lot of pressure. I think when you're, when you're going through medical training and medical school you know, pulling in different directions on planning your career you have a lot of different factors, financial and I think, you know, I always had wanted to, into going to have a medical career that was going to make a big impact. I think I got a little bit sidetracked along the way, and I, I kinda may have been chasing a different dream, but then when I finally realized what I think what I was meant to be doing, it really kind of brought me back in line on my path. So I'd say, you know, just really follow your gut, you know, pursue your dreams. You know, really go with what you feel is right deep down in your heart, and now you really can't go wrong. So
Speaker 3 (28:06):
I love it. Great advice. And, and frequently heard advice here on this podcast. So it must be a good one. So, Dr. Sokoloff thank you so much for coming on today and look forward to seeing you at our round table discussion in a couple of weeks. So thank you for that as well. So thank you. Thank you. Thank you.
Speaker 5 (28:26):
Thank you. I'll look forward to the round table.
Speaker 3 (28:28):
Yeah. As in everyone for listening everyone out there listening. Thanks so much. Have a great couple of days and stay healthy.
Speaker 1 (28:34):
Be wealthy and smart. Thank you for listening. And please subscribe to the podcast at podcast dot healthy, wealthy, smart.com. And don't forget to follow us on social media.
