Sleep disorders, head and neck cancer "capture" Dr. Jimmy Brown
As a child in Jamaica he had the tenacity to play midfield on a soccer team, streaking up and down the field trying to get the ball, make a goal or help a teammate score. But going to the dentist gave Jimmy James Brown pause.
(Media-Newswire.com) - As a child in Jamaica he had the tenacity to play midfield on a soccer team, streaking up and down the field trying to get the ball, make a goal or help a teammate score. But going to the dentist gave Jimmy James Brown pause.
He would work for weeks on an excuse to bow out and went only with his mother dragging him '"kicking and screaming."
Then American dentist, Dr. Katus Blakey, came to the island. Before he ever touched his mouth, he asked the 12-year old who fashioned trinkets for tourists what he did with his days then reciprocated with tales of how he worked. "He just captured me," says Jimmy.
On a subsequent visit, Jimmy asked his new dentist why he almost "jumped off the table" when he touched a spoon to a filling. Dr. Blakey pulled out pen and paper and showed him about the transfer of electrons called electricity.
Captured again, Dr. Blakey suggested Jimmy might want to study some of this stuff. A soccer scholarship brought Jimmy to the United States where the former "truant" finished up undergraduate school at New York University in two and a half years before heading to dental school where a National Cancer Institute dental oncology clerkship at Memorial Sloan-Kettering Cancer Center "captured" him again, prompting him to pursue a medical degree as well.
Flash forward a few years and you'll find the graduate of Howard University College of Dentistry and George Washington University School of Medicine is now in Augusta specializing in head and neck surgery at the Medical College of Georgia and Charlie Norwood Veterans Affairs Medical Center.
Now's he got the pad and pen
Upon arrival at either of Dr. Brown's offices, patients likely will find him pulling out pad and pen to help them understand how he'll modify the soft tissues of the upper breathing passages or reposition a recessed jaw that contributes to their sleep disorder. "Some of my patients can tell you how to do their surgery, when I am through explaining," says Dr. Brown, who recently joined the faculty of the Department of Otolaryngology-Head and Neck Surgery in the MCG School of Medicine.
Putting to rest sleep disorders is a primary passion for the surgeon who specializes in complex procedures for pulling the upper and lower jaw forward to open up the airway and eliminate obstructive sleep apnea. Sometimes one or more causes, which also include obesity and too much soft tissue inside the throat, is superimposed on another and snoring and sleepiness are common resulting symptoms.
"When you lie on your back, totally relaxed, that's when the problems start," he says. Often, Dr. Brown can tell just by looking at someone, if their nights are wracked with snoring and fitful sleep. "It's a variance of normal and it tends to run in families," he says of jaws that just don't jut out far enough. The loss of muscle tone and a few extra pounds that typically come with age can be the breaking point for some.
Surgical treatments starts with the easier options: removing tonsils and excess airway tissue and straightening and widening nasal passages, then waiting months to years before moving on to the more invasive jaw repositioning. But Dr. Brown is thinking that may not always be the best course for patients with severe obstructive sleep disease. He wants to pursue comparative trials to see whether those patients, particularly when obesity is a factor, would be better off with a more aggressive, one-stop approach that includes surgery at the outset. "One of the reasons why some of the surgical techniques have become so popular is it is so difficult to lose weight," notes Dr. Brown. The good news is that surgery itself often kick-starts weight loss.
Cutting out cancer
The enormity of head and neck cancer that captured him in dental school lives with him today as he also strives to find better ways to diagnose and treat the aggressive cancer. Dr. Brown has seen improvements in survival in his relatively short career: "I have patients that I operated on in 1995, that are alive today," he says, even though five-year survival rates of 55 percent are still rather grim. There have been quality of life improvements too, such as reconstructing head and neck areas at the same time they are removed. "The reconstruction improves the patient's state of mind and helps with their sense of worth, as well as ensuring some functionality,” he says. It's a laborious route for patient and surgeon that typically include multiple surgeries and adjuncts such as chemotherapy and radiation.
Smoking and drinking are major risk factors for these cancers, although Dr. Brown has seen patients that did neither. The ubiquitous human papillomavirus, best known for causing cervical cancer and genital warts, also has become a risk, particularly for cancers of the tonsils and tongue base. While it's making the cancer more common, the HPV-related disease seems more amenable to chemotherapy and radiation.
Earlier detection likely would improve survival rates for head and neck cancer, not matter what the etiology, which has Dr. Brown looking for biomarkers, or early signs. Oddly, even a large tumor at the base of the tongue can go a long time undetected. "We believe that cancer elaborates different chemicals, mediators and if we can find those in the blood or saliva, we can help detect cancers."
Dr. Jimmy Brown at a Glance:
Native Jamaican and naturalized U.S. citizen
Professor, MCG Department of Otolaryngology-Head and Neck Surgery
Howard University College of Dentistry, Washington, D.C.
George Washington University School of Medicine, Washington, D.C.
Residency and fellowships:
King/Drew Medical Center, Los Angeles, otolaryngology-head and neck surgery residency
Stanford University Medical Center, Stanford, Calif., advanced head and neck oncological surgery
University of California, Los Angeles, Mentored Clinical Pharmacology Research Scholarship Program
Stanford University Medical Center, chief, Division of Sleep Surgery
Charles R. Drew University School of Medicine & Science, chair and program director of the residency training program, Department of Otolaryngology.
This story was released on 2009-11-17. Please make sure to visit the official company or organization web site to learn more about the original release date. See our disclaimer for additional information.