The Story of Mr. and Mrs. Dance

Milton J. "Laddie" Dance, Jr. developed cancer of the larynx in 1975. Fearful that his livelihood as a horse auctioneer might be ended, he entered treatment. Five months after completing radiation therapy he developed cervical lymph node metastasis and underwent a radical neck dissection. He remained cancer free thereafter, until he succumbed to heart attack in 2002. While today there are many sources of support groups to aid cancer patients in their search for further education, alternative therapies, hope and comfort, thirty years ago, when Laddie and his wife, Jeanne Vance, discovered that he had throat cancer, there seemed to be little support available. "Back then, you went to the doctor, obtained the diagnosis, had your surgery or therapy and that was about it," explained Ms. Vance. "It seemed so cold. We felt so alone, with no recourse, no support, and no hope. But we accepted it. You didn't ask any questions, you just did what you were told. The realm of our understanding of the scope of the disease, how to deal with it, and the course it could take was so limited back then. We needed more." By nature, Laddie was a mover, a shaker and even a bit of a rabble-rouser at times, many would say. For a man who traveled in the circles of high society, politics and influential people, he was very well grounded- an enigma, several have called him. But that's what made him unique. That's what made him Laddie. He couldn't stop moving. Nothing seemed to stop or dampen his spirit and certainly not a bout with cancer, or so it seemed. Cancer has this way about it, eating away at your heart and gnawing at your soul, unless of course, you do something about it. And that's what Ms. Vance and Laddie did. "No one should endure these feelings alone without understanding and a helping hand," said Mrs. Vance. She founded an endowment that helped open a center in her husband's name. Since 1980, the Milton J. Dance, Jr. Head and Neck Center at the Greater Baltimore Medical Center has provided comprehensive care to patients with head and neck cancer and their families. Today the Center includes the Johns Hopkins Head and Neck Surgery at GBMC, a historic practice started in 1924 by Dr. Grant E. Ward; multidisciplinary head and neck rehabilitation services, a full range of speech-language pathology services and a highly specialized voice center. Disciplines of head and neck surgery, laryngology, maxillofacial prosthodontics, oral medicine and pathology, nursing, speech-language pathology, nutritional services, and social work reside within the center. There is close collaboration with radiation oncology, medical oncology, occupational therapy and physical therapy. "We work hard to integrate as many disciplines necessary to offer a full complement of services with the goal of optimizing our patients recovery process and quality of life." Barbara Messing, M.A., CCC-SLP, BRS-S, the center's clinical-administrative director, leads a staff of professionals including speech language pathologists, oncology social workers, nurse specialist and oncology-registered dietitian. The center sponsors cancer research in the areas of salivary gland malignancies, tumor genetics and HPV studies through close collaboration with Johns Hopkins and outcomes research in the area of head and neck rehabilitation. Laddie Dance saw life and the world as an opportunity...time that shouldn't be wasted on feeling sorry for oneself. "This was frequently evidenced by the spirit in his voice when he called an auction and the gleam in his eye when he saw a great horse, beautiful women or fantastic business opportunity," remarked his wife Jeanne. Laddie knew horse breeds and lines better than some people know their own relatives. He was good at it because he did his homework. A 45-year employee of the thoroughbred auction firm, Fasig-Tipton, he loved and knew the art of auctioneering inside out. Auctioneering came to him naturally though, probably because his father, Milton J. Dance, Sr. was also a veteran of the profession. Mr. Dance was involved with horses throughout his life but special horses come around once in a lifetime. That occurred in 1999 for Laddie and Jeanne when their horse, Lemon Drop Kid, won all five New York stakes races including the Belmont Stakes in 1999. Laddie Dance knew first-hand what it meant to be a head and neck patient. It was his goal to make it easier for those who would follow his path. Jeanne Vance's and Laddie Dance's dream for cancer patients to see their future as an opportunity for hope and peace of mind is realized every day by the patients at the Milton J. Dance, Jr. Head and Neck Rehabilitation Center.

Self Exam

A quick and easy way to help you help yourself.

Finding oral cancer early is important so that it can be treated promptly. Some forms of oral cancer can be seen during monthly self-examinations. Warning signs of head and neck tumors include:

• A sore, lump or thickening in the mouth
• A white or red patch
• A sore throat that does not heal
• Difficulty chewing or swallowing
• Hoarseness that does not go away
• A feeling that something is stuck in the throat
• Difficulty moving the tongue or jaw
• A lump in the neck
• Numbness in the mouth, face or neck
• Seat yourself in front of a well-lit mirror. Remove any partials, dentures, or dental retainers that may be in your mouth.

1. Check your neck for lumps or swellings.
2. Look at your lips. Pull your lower lip down, then lift your upper lip.
3. Pull back both cheeks and look inside.
4. Gently bite down and look at your gums. Note any swelling, growths, or areas of discoloration.
5. Open your mouth widely and look at the back of your tongue and roof of your mouth.
6. Stick out your tongue and look at the top and sides. Move the tongue side to side. Touch your tongue on the roof of your mouth and look undereneath your tongue.

If you have noted anything unusual during this exam, please contact your primary care physician, otolaryngologist, or other oral health specialist.

March 27th, 2013 - Oncology Nutrition Lecture on Fiber

Wellness Wednesdays

Oncology Nutrition Lecture and Cooking Demonstration

Learn from a registered dietitian about nutritional topics and why they are important for cancer prevention and a healthy lifestyle.

Patients and family members of the Sandra & Malcolm Berman Cancer Institute, Sandra & Malcolm Berman Comprehensive Breast Care Center, and Milton J. Dance, Jr. Head and Neck Center are invited to attend

Sessions are held on the 4th Wednesday of each month:

• March 27: Fiber
• April 24: Prebiotics/ Probiotics
• May 22: Red Meat
  

11:30-12:30 Physicians Pavilion West, Third Floor Conference Room

Space is limited, so an RSVP is requested

Keri Ryniak 443-849-8186 or kryniak@gbmc.org

Lunch and parking passes will be provided. Each attendee will receive copies of the demonstrated recipe as well as tips on how to incorporate the information learned into their daily lifestyle.

Radical Neck Dissection

In August last year my 23 y.o. son had what was described to us as a radical neck dissection. He had melanoma in the lymph nodes on the right side of his neck. They removed 80+ lymph nodes. He did not require radium or chemo. I have 2 questions, on reading your description I don't believe they removed the spinal accessory nerve, internal jugular or the muscle you mentioned, so not sure if it was a complete RND. First question is he has noticed that around his neck and shoulder area where he is still quite numb he does not sweat....is this common? Second question is he has just begun physio because he has limited use of his shoulder....cannot lift his arm very high and the physio has said that a muscle has been moved and is now pulling his shoulder blade in the wrong direction...is this correctable?

JOHN SAUNDERS JR, MD replies...
A neck dissection the removes or injuries (it may lose its function even when it is preserved) the spinal accessory nerve results in weakness of the trapezius muscle and the sternocleidomastoid muscle. Of these two, the trapezius is more important. Without this muscle one cannot raise his arm about 90 degrees when extended laterally. It also causes winging of the scapula. When this is a permanent condition of the muscle, physical therapy to strengthen the other surrounding muscles can be helpful. Surgical procedures to help this condition are less effective. They include a procedure that "fixes" the scapula to some of the ribs so that it is rigidly held inward to facilitate the raising of the arm above the shoulder. This is a rarely performed procedure and would be done by an orthopedic surgeon.

Lateral Neck Myxoma

November 2011, I noticed a lump on my neck that was sore.  I went to the doctor and was referred to a general surgeon who diagnosed the lump as lipoma.  She conducted what she thought would be routine surgery in February 2012, but could not find the mass.  A couple weeks later, I had an MRI that showed a persistent oval-shaped lobulated soft tissue mass arising deep to the distal right trapezius muscle and 3.8 x 1.5 x 2.2cm in size.  I just recently had another MRI done (almost 1 year later) and the mass has not changed in size or position.  The radiologist suggests that this may be myxoma.  My doctor was confused as this usually occurs in the heart.  She recommended I go to the a specific cancer center for a 2nd expert opinion from their sarcoma team.  I did some research today on my own and found a presentation on Lateral Neck Myxomas at the Head and Neck Tumor Conference.  I saw that there were many similarities between what the radiologist noted in my MRI's and his presentation.  For example the heterogenerous appearance, mistake for lipoma and slight enhancement displayed in MRI on T2 weighted image.  I was hoping that maybe you could let me know if this was something you had experience working with or had any advice for me in the next steps.  My doctor seems to be concerned with the location of the mass as it would require going through the trapezius muscle to remove or possibly even obtain a sample. Any guidance or insight would be greatly appreciated!

Patrick Ha, MD FACS replies...

The appearance of lipomas can be quite variable, and the radiologist will often bring up the fact that a heterogeneous appearance on MRI can be a sign of something more than just a straightforward lipoma, though this is not always the case.  Given the appearance, one option would be to obtain a needle biopsy under radiographictrapezius muscle.  Despite this, it should be resectable, and this would provide the ultimate sampling and determine whether any further therapy would be necessary.

Neck Dissection

I have a relative who went through neck dissection (left side) and now has migraines almost every day. The pain begins at the base of the neck, moves up past the ear and settles in the head. He was given pain medications (which are not very effective) and was told that the migraines are a result of auricular nerve damage. He has been taken to the ER twice with excruciating head pain and seizures. Can you advise of a treatment/surgery to alleviate the pain and would you recommend getting a second opinion? Thank you 

Barbara Messing, MA, CCC-SLP, BRS-S replies...

It is not possible to recommend a treatment or surgery. The symptoms you describe should be evaluated completely by a head and neck surgeon. I would advise going back to the head and neck surgeon who performed the neck dissection. If your relative feels a second opinion is needed for a full understanding of the underlying problem and for symptom management then yes a second opinion is always helpful.

Prolonged Swollen Tonsils

My son is 10 years old and has suffered from extreme swollen tonsils for over 2 months. He has had repeated strep tests, which all came back negative and the doctor said no other bacteria showing up on test when it comes back from lab. However, antibiotic helps them to shrink, then within 10 days of being off antibiotic they are extremely swollen again. Lymph nodes in neck are swollen as well. He saw an ENT who put him on steroids while on antibiotic, they did shrink down, but again within 10 days were swollen again. One of his neck lymph nodes did go down while on steroid, but other was still swollen. He is on his 4th antibiotic since the end of November. Tonsils first time when didn't start antibiotic right away did get yellow pus on them, now we start antibiotic when they are extremely swollen but before pus appears on them. No other symptoms, no fever. His voice is very muffled when they get swollen, and that is usually how I know. He doesn't complain of a sore throat. I am worried about what could be causing this, and if there are any tests we should do to try and rule out anything too serious. No other health related concerns. He did test positive for the EBV several years ago, so the doctor said we know he must of had mono at some point in the past. ENT is comfortable to just keep watching and prescribing antibiotics and see if cycle eventually stops. I am OK with this, as long as we are not missing something more serious, such as a lymphoma. Any suggestions is greatly appreciated. Should he have a CT scan of his neck? Thank you for your time.  

Patrick Ha, MD, FACS replies...
It sounds like he is having recurrent low grade infections of the tonsils that are causing them to 'swell.' We are usually less concerned about the threat of a malignant process such as lymphoma when they are symmetric, if they enlarge and shrink, and if he doesn't have any persistent lymph nodes elsewhere in his neck. 

Ultimately, if he is on repeated courses of antibiotics, or missing school frequently, or if he is symptomatic in other ways, it may be worthwhile to discuss removal of his tonsils with your physicians. However, it doesn't sound like at this time that much further workup is required.

Patrick Ha, MD FACS
Associate Professor
Johns Hopkins Department of Otolaryngology
Johns Hopkins Head and Neck Surgery