School of Medicine

Wayne State University School of Medicine
Speech pathologist helps patients regain speech after larynx removal
In Headlines on June 5, 2013
Mark Simpson, Ph.D., speech and swallowing pathologist, talks with his patient, Nancy Miko.

Mark Simpson, Ph.D., speech and swallowing pathologist, talks with his patient, Nancy Miko.

Mark Simpson, Ph.D., speech and swallowing pathologist for the Wayne State University School of Medicine’s Department of Otolaryngology and the Barbara Ann Karmanos Cancer Center, is one of the few experts in metropolitan Detroit who helps people regain the power of speech after the removal of their larynx because of cancer.

The larynx, which lies between the trachea and esophagus, prevents the passage of food into the airway as a person swallows. It also regulates the flow of air into the lungs and functions in producing speech. In some circumstances, a person with laryngeal cancer must have the entire larynx removed. In that situation, surgeons must bring the trachea forward and place it on the person’s neck to completely separate breathing and swallowing functions.

Dr. Simpson’s role comes in after the patient has had surgery. He has been involved with speech and swallowing rehabilitation for almost 40 years, having retired from the John D. Dingell Veterans Administration Hospital in Detroit and then joined Karmanos three years ago. While at the VA in the 1970s, Dr. Simpson worked closely with Eric Blom, Ph.D., who created the Blom-Singer Voice Prosthesis with Marc Singer, M.D., F.A.C.S. Dr. Blom now works with various health centers and universities in the Indianapolis area.

Dr. Simpson recalls a time when voice rehabilitation options for cancer patients were limited.

“When I would enter a patient’s room with an electropharynx (a device that creates an electronic-sounding voice), it’s not really what they wanted to see,” he said. “It was a long time before I could say that this is temporary and that something better is coming.”

The Blom-Singer Voice Prosthesis, along with Dr. Simpson’s customization talents and one-on-one guidance, allows patients to speak again.

Dr. Simpson works closely with head and neck surgeons and the patients affected by head and neck cancers, as well those diagnosed with brain cancer. He implants a tracheoesophageal voice prosthesis, which restores the ability to speak. The prosthesis comes with a small flapper located on the side of the patient’s esophagus that remains closed during swallowing but is pushed open for entrance of air into the upper esophagus for speech production.

Since he is so specialized in what he does, Dr. Simpson spends most of his days in the clinic. He typically spends about 10 one-hour sessions with his patients to help them regain speech. He sees about 15 to 20 new laryngectomy patients each year at Karmanos and has additional laryngectomy patients from other facilities around the state referred to him.

“It isn’t that we insert the prosthesis and off they go,” he said. “I encourage doctors to refer patients to me even before the total laryngectomy surgery because it is so traumatic to lose the power of speech. We take the time necessary to answer the many questions that they may have and arrange a meeting with an individual who has already undergone this procedure.”

Those affected by laryngeal cancer, including other head-and neck-related cancers, are usually those who have been smokers and/or drinkers, those exposed to certain chemicals or those with the human papilloma virus.
Dr. Simpson said that nearly every one of his patients outfitted with a voice prosthesis is successful in learning how to speak again.

“I refuse to accept defeat when it comes to voice rehabilitation,” he said. “I develop a close and intensely personal relationship with each and every one of my patients and in the end we become friends.”

Nancy Miko, a 64-year-old woman diagnosed with laryngeal cancer in 2001, was able to regain her speech with relative ease after being fitted with a prosthesis by Dr. Simpson. Miko, who lives in Dearborn, Mich., is a retired third grade teacher who taught in the Crestwood Schools district.

“You can’t tell a teacher to shut up,” she said with a grin. “It was devastating to lose the ability to speak and it was frustrating not to be able to converse in a quick way.”

Miko said she suspected something was amiss when after a week of classroom teaching it took the weekend to recover her ability to speak. After meeting with her doctor, she learned that she had cancer. She underwent radiation therapy, but the cancer continued to grow. She then decided on surgery to remove her larynx.

She was then referred to Dr. Simpson by Robert Mathog, M.D., chair of the WSU Department of Otolaryngology-Head and Neck Surgery following the tracheoesophageal puncture procedure he performed on Miko to create an opening in the trachea for the voice prosthesis. Today, Miko’s voice is lower in tone but she is easy to understand when she speaks. She credits Dr. Simpson, who she called a “wonderfully dedicated” doctor.

“It was like New Year’s Eve, regaining my ability to speak,” she said. “It wasn’t that bad, learning how to speak again. It depends on how much you’re willing to do.”

A former smoker, Miko and her husband George now keep themselves healthy with a vegan lifestyle and by growing their own food at home.

Miko also does her part to support other cancer patients by serving as president of the Anamilo Monthly Support Group at Karmanos. The Anamilo Club, one of the nation’s oldest support groups, is for laryngectomy patients and their families and friends. It is facilitated by Susan Fleming, Ph.D., adjunct assistant professor in the WSU Department of Otolaryngology. The group meets the second Sunday of each month from 2 to 4 p.m. in the Wertz Classroom at Karmanos’ main location, 4100 John R, Detroit. Call 1-800-KARMANOS (1-800-527-6266) to register or for more information.

“Members of the support group are a wealth of information,” Miko said. “Family and support are the best therapy you can get. The culmination of the two helps to ensure a more successful recovery.”
WSU Family Medicine's Jinping Xu, M.D., gets $1.76 million to investigate care management decisions in prostate cancer
In Headlines on June 3, 2013
Jinping Xu, M.D., M.S.

Jinping Xu, M.D., M.S.

The American Cancer Society has awarded Wayne State University School of Medicine researcher and clinician Jinping Xu, M.D., M.S., a five-year, $1.76 million Research Scholar Grant (RSG-13-164-01-CPPB) to analyze how men with low-risk localized prostate cancer choose to manage their disease.

Dr. Xu, a School of Medicine associate professor of family medicine and public health sciences, and a physician with the Wayne State University Physician Group’s Family Medicine practice in Rochester, Mich., will lead the team on the project “Why Don’t More Men with Low-Risk Prostate Cancer Choose Active Surveillance?”

“We are all very excited about the opportunity to carry out this longitudinal, population-based cohort study of men with newly-diagnosed prostate cancer, which we believe has the potential for impact on both public health policies and clinical practices of taking care of men with prostate cancer,” Dr. Xu said.

The United States Preventative Services Task Force issued new recommendations last year against Prostate-Specific Antigen screening of healthy asymptomatic men, asserting that it caused more harm than benefit, primarily because of overtreatment. The new guideline sparked intense media coverage and a national debate on medical decision-making and the benefits of active surveillance as an appropriate management strategy for low-risk localized prostate cancer to decrease the harms of overtreatment, Dr. Xu said.

The study will identify determinants of treatment choice in men with low-risk localized prostate cancer, including the factors that affect the offer, acceptance and adherence of active surveillance as an initial management strategy. Localized cancer means there is no sign it has spread outside the prostate. Four out of five prostate cancers are found at this stage, according to the National Cancer Institute.

Active surveillance involves delaying treatment until test results show the cancer is growing or changing. The cancer is checked regularly, such as every three to six months at first.

Prostate cancer is the most commonly diagnosed non-skin cancer in men in the United States. One in six men will received the diagnosis in their lifetime, according to the most recent data available from the National Institutes of Health. The 10-year relative survival rate is 98 percent, according to the American Cancer Society.

“Active surveillance offers the opportunity to delay or avoid curative treatment and associated side effects unless the cancer progresses. Current practice guidelines identify active surveillance as an appropriate initial management strategy for low-risk localized prostate cancer. However, active surveillance is rarely chosen, and little research has addressed the reasons why men with low-risk prostate cancer receive aggressive treatment rather than active surveillance,” Dr. Xu said. “In addition, while black men historically have received less aggressive prostate cancer treatment than whites, they also report having more decision-making difficulty, decision regret and poorer quality of life.”

African-American men are twice as likely as Caucasian men to die from prostate cancer, according to the NCI.

The team also will survey urologists to understand how and why treatment decisions are made, with a focus on the urologist’s offer, and the patient’s acceptance and adherence of active surveillance. She expects the findings will provide a foundation for targeted efforts to optimize men’s treatment decisions and improve quality of life, while reducing racial disparity in prostate cancer treatment and outcomes.

The study will use a culturally-sensitive patient survey culled from a previous five-year pilot study on racial disparities in prostate cancer treatment decision-making, also funded by the American Cancer Society.

Co-investigators include the Department of Family Medicine and Public Health Sciences’ Professor Kendra Schwartz, M.D.; Assistant Professor and  Biostatistician James Janisse, Ph.D.; Professor and Biostatistician Joe Ager, Ph.D.; WSU Associate Professor Susan Eggly, Ph.D., of the Barbara Ann Karmanos Cancer Institute; WSU Assistant Professor of urology Jeffrey Triest, M.D.; and Michael Goodman, M.D., M.P.H, associate professor of epidemiology at Emory University, Atlanta, and medical director of Emory’s Georgia Center for Cancer Statistics.

Researchers will recruit about 2,000 men in Michigan and Georgia, identified from cancer registries sponsored by the NCI.
Study shows 'holy basil' plant inhibits breast cancer growth
In Headlines on June 3, 2013
The herb ocimum gratissimum is already used for its pharmacologic properties, including anticancer activity. Photo credit: Forest and Kim Starr

The herb ocimum gratissimum is already used for its pharmacologic properties, including anticancer activity. Photo credit: Forest and Kim Starr

Avraham Raz, Ph.D.

Avraham Raz, Ph.D.

In the realm of biotherapeutics and natural plant therapy, holy basil could be the next big breakthrough in the field’s bustling anticancer movement.

A team of Wayne State University School of Medicine and Barbara Ann Karmanos Cancer Institute researchers in Detroit has shown in an experimental tumor system that ocimum gratissimum, also known as African basil, inhibits the growth of human breast carcinoma cells.

The discovery could lead to clinical trials using the plant in concentrated form for treatment of breast cancer, and possibly other types of cancer.

Even cooking with the plant or eating it raw could have health benefits, said principal investigator Avraham Raz, Ph.D., a professor of pathology, radiation oncology and oncology in the WSU School of Medicine.

“We will know after the clinical trial. This drug can be consumed continuously, as it has no side effects and it is non-toxic,” Dr. Raz said.

The study, “Ocimum gratissimum retards breast cancer growth and progression and is a natural inhibitor of matrix metalloproteases,” is on the May cover of the science journal Cancer Biology & Therapy.

The plant, a dietary herb from the mint family Lameacea, is already used for its pharmacologic properties, including anticancer activity. It is absent in the continental United States but grows wild in Hawaii, according to the U.S. Department of Agriculture’s Natural Resources Conservation Service.

The WSU study shows that the herb inhibits the degrading enzyme responsible for facilitating breast cancer invasion and metastasis to other parts of the body, Dr. Raz said. The enzyme, matrix metalloproteases, or MMPs, is a family of at least 28 structurally and functionally-related zinc-dependent endoproteinases, which selectively degrade various components of extracellular matrix and lead to cancer cell growth according to the study article. Of the various MMP types thought to be involved in cancer, the WSU team focused on MMP-2 and MMP-9, because they are overexpressed in a variety of malignant tumors, and their expression and activities are often associated with aggressive tumors and a poor prognosis for patients. Elevated levels of both are found in breast, brain, ovarian, pancreas, colorectal, bladder, prostate, lung cancers and melanoma. The study reports that ocimum gratissimum inhibits cancer grow, partly due to its property as a natural, non-toxic inhibitor of MMP-2 and MMP-9.

The study is on the cutting edge of plant therapy and the biotherapeutics revolution, Dr. Raz said.

"Many traditional or folk remedies have a basis in reality – that is, they work – and are the backbone of modern medicine,” he added.

In addition to Dr. Raz, the study team included researchers from the WSU School of Medicine’s Department of Pathology and Department of Oncology; the WSU College of Engineering’s Department of Biological and Chemical Engineering; the WSU College of Liberal Arts and Sciences’ Department of Chemistry, as well as a researcher from the Chongqing University of Education in China.

The study was funded by a National Cancer Institute grant (R37CA046120-19).
Four students present at annual Michigan Family Medicine Research Day Conference
In Headlines on May 30, 2013
Mio Nakamura with John Boltri, M.D., chair of WSU Family Medicine and Public Health Sciences.

Mio Nakamura with John Boltri, M.D., chair of WSU Family Medicine and Public Health Sciences.

Kaitlin Seryak with her poster.

Kaitlin Seryak with her poster.

Jasmine Gaines and "Identifying Cancer Risk in Primary Care Based on Family History."

Jasmine Gaines and "Identifying Cancer Risk in Primary Care Based on Family History."

Jinmeng Zhang and her poster at the annual Michigan Family Medicine Research Day Conference.

Jinmeng Zhang and her poster at the annual Michigan Family Medicine Research Day Conference.

Four Wayne State University School of Medicine students presented five posters and one presentation at the 36th annual Michigan Family Medicine Research Day Conference.

The conference, held May 23 at Cleary College in Howell, Mich., once again saw University of Michigan, Michigan State University and Wayne State University faculty, residents and students come together to share family medicine research.

WSU students presenting the posters were mentored by Margit Chadwell, M.D., assistant professor in the Department of Family Medicine and Public Health Sciences. The student giving the presentation was mentored by Juliann Binienda, Ph.D., assistant professor of Family Medicine and Public Health Sciences.

The students and their presentations included:

Mio Nakamura, third-year student, “Clinical Skills in Student-Run Free Clinic Volunteers (oral presentation) and the poster “Monoclonal Gammopathy of Undetermined Significance And Fatal Polyarteritis Nodosa.”

Kaitlin Seryak, second-year student, “Money and Medicine in Motown: Managing an SRFC Amidst a Depression.”

Jasmine Gaines, third-year student, “Identifying Cancer Risk in Primary Care Based on Family History.”

Jinmeng Zhang, third-year student, “Excessive Mucosal Discharge of a Patient With Colon Vaginoplasty.”

Breast oncology team leader takes part in Witness Project presentation
In Headlines on May 30, 2013
Michael Simon, M.D., M.P.H.

Michael Simon, M.D., M.P.H.

Michael Simon, M.D., M.P.H., professor of Internal Medicine and Oncology for the Wayne State University School of Medicine and leader of the Breast Oncology Multidisciplinary Team at the Barbara Ann Karmanos Cancer Center, will participate in an educational presentation in partnership with Karmanos’ Patient & Community Education Department and the Witness Project of Detroit.

Dr. Simon is co-leader of the Witness Project, a faith-based education and outreach program focused on reducing racial disparities in breast cancer by focusing on African-American women.

The presentation will take place at 10:30 a.m. June 17 in the Wertz Classroom at Karmanos’ midtown Detroit location, 4100 John R. A genetic counselors also will be on hand to answer questions.

The Witness Project of Detroit is funded by proceeds generated by the Komen Detroit Race for the Cure. At the national level, the Witness Project promotes early detection of breast cancer among African-American women through screening and cancer risk management.

For more information about the Witness Project of Detroit or the educational presentation, call 800-527-6266, or visit www.witnessprojectofdetroit.org.
Dr. Sonnino earns Certified Professional Photographer designation
In Headlines on May 30, 2013
Roberta E. Sonnino, M.D., and samples of her photography (below).

Roberta E. Sonnino, M.D., and samples of her photography (below).

Roberta E. Sonnino, M.D., F.A.C.S., F.A.A.P., vice dean of Faculty Affairs for the Wayne State University School of Medicine, has earned the Certified Professional Photographer designation from the Professional Photographic Certification Commission.

Dr. Sonnino earned the designation after meeting rigorous requirements measuring her artistic and technical competence. The Professional Photographic Certification Commission recognizes less than 2,000 certified professional photographers.

The commission is the leading body for certifying imaging professionals. Certified professional photographers must complete a written examination, an image evaluation and adhere to a stringent code of conduct. Certification must be renewed on a periodic basis.

Dr. Sonnino has said that her first love after medicine and medical education is photography. She took all the photographs for the Accreditation Council for Graduate Medical Education 2007 monograph, “Journey to Authenticity: Voices of Chief Residents.”

She also volunteers as a photographer with the Now I Lay Me Down to Sleep Foundation, an organization that provides portraits for families of newborns who are not expected to survive.

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