Catherine Rosenberg walked through the brightly lit atrium leading to the women’s cancer center wing at Fox Chase Cancer Center in northern Philadelphia at 7:30 a.m. Tuesday.
It may be an early start for some, but for Rosenberg, a former Little Egg Harbor Township teacher who holds degrees in mathematics and computational science from Stockton University, the morning drives from Camden to the cancer center are part of her daily routine three days a week.
She set down her travel coffee mug once she arrived at her physical therapy room and greeted her therapist like an old friend. Rosenberg then shed her black sweatpants and red Rutgers University sweatshirt to reveal a soft cotton t-shirt and workout shorts. Her left leg looked slightly swollen, and healed scars of different shapes and sizes decorated both limbs. Some are the result of cancer surgeries and a hip replacement. Others are related to a condition called lymphedema.
One in 1,000 Americans suffer from lymphedema, a chronic medical condition that occurs when the lymphatic system cannot properly drain fluids back into the bloodstream. Blockages in the lymphatic system often form after cancer treatments such as radiation.
Rosenberg, 33, is a survivor of a rare soft tissue cancer that she was diagnosed with as a child. Her cancer treatments led to lymphedema.
But Rosenberg is a little different from most people with lymphedema. She is using her background in mathematics and computational science to help doctors find better ways of treating the condition.
Rosenberg said she feels driven to help other patients with chronic conditions. “Completing research on a medical condition that does not receive great amounts of research has been a passion of mine from an early stage of being a cancer survivor,” she said.
Rosenberg sat at a machine and stretched her leg out 90 degrees from her body. Jenna Balaicuis, her physical therapist at Fox Chase, operated a perometer, which measures the circumferences of her legs and records the measurements on a computer.
With lymphedema, calculating circumferences and fluid volume in the legs is vital to diagnosing, treating and monitoring the condition. But every lymphedema specialist, therapist, surgeon and hospital may calculate these numbers differently, causing a lack of consistency across the board.
“The problem is we don’t know as much about lymphedema as we’d like to,” said Dr. Eric Chang, a Fox Chase surgical oncologist specializing in lymphedema patients. “Treatments are so new and there’s no good measure to determine what’s effective and what is not. There’s no good way to document accurately and consistently even within one institution, much less institutions across the country.”
Chang accompanied Rosenberg to her early morning therapy session. It was the first time since they met at her initial consultation in 2014 that he was witnessing how her legs were being measured. The relationship between the two is less doctor-patient now and more that of friends.
“Sometimes I’ll hear from Catherine a couple times a day,” Chang said, laughing. “Her enthusiasm is refreshing. Sometimes you get some med students interested in a study, but they eventually go do other things. I think our work with Catherine will help a lot of people.”
Early in her lymphedema treatments, which included lymph node transplant surgery, Rosenberg broached the subject of working with Chang to change the way lymphatic volume is measured in patients.
Chang said he knew Rosenberg had been a special education teacher, but he did not know about her background in math and science. Rosenberg bluntly told him that they were inaccurately measuring her fluid volume and she thought she could find a better way.
The two are now writing a paper on a method to standardize the calculation of leg volume for lymphedema. In the long run, both hope that physicians all across the country, and eventually the world, will accept this calculation.
“I said to my mom, the formula is wrong. I couldn’t get the calculations to match up with the results they were getting,” Rosenberg said. “When I first mentioned this to Eric, he was initially skeptical and didn’t know if a change was needed. But then he got on board when I showed him the problem.”
Rosenberg recently started a Ph.D. program in computational integrative biology at Rutgers-University Camden and began teaching pre-calculus to undergraduate students.
She and Chang often fill their free time with exchanging notes and emails, performing water displacement experiments on the weekends, preparing for presentations and researching the most recent developments in lymphedema therapy and treatment. Professors from Stockton have also helped in her research.
Rosenberg may be responsible for a second future medical study, one involving Chang and Dr. John Abraham, an orthopedic oncology surgeon who performed a hip replacement on Rosenberg at Thomas Jefferson University Hospital in 2013.
Abraham gave Rosenberg a hug when they saw each other in the lobby of Fox Chase on the morning of her therapy session. “They’re different than most doctors,” Rosenberg said of Abraham and Chang. “I couldn’t work with better people.”
Abraham was the doctor who recommended that Rosenberg see a lymphedema specialist after she dislocated her hip in his office during a post-operation surgery appointment.
“I don’t think there’s ever been a case of lymphedema-related dislocation,” Abraham said, everyone in the room laughing about Rosenberg’s penchant for having rare medical conditions.
They eventually concluded that excess weight on her leg from lymphemdema was preventing her hip from staying in the socket. Since Rosenberg started treatment with Chang, the two physicians started working side-by-side with more patients.
Abraham even started working at Fox Chase one day a week and said there might be a joint paper with Chang in the future. Chang said Abraham helps bring in lymphedema patients such as Rosenberg who might not have come to Fox Chase before.
“I didn’t know some types of procedures were even available before for lymphedema,” Abraham said. “I’ve definitely learned a lot from working with Eric.”
Rosenberg hopes to one day work as a computer programmer at a cancer center, where she can help physicians model cancer trajectories and outcomes. For now, she’s taking it one scientific study at a time.
“This project was a match made in heaven for me, leading to the fulfillment of a lifelong dream of researching oncology conditions in collaboration with various medical professionals,” Roseberg said. “Sometimes you need to see things from a different point of view and understand what questions need to be asked.”