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While Richard Smith was helping his sister move back to their hometown in Oregon, he felt a twinge in his neck. When he returned to Los Angeles, the discomfort became a lump.

Richard is a University of Southern California music professor and former chair of Studio/Jazz Guitar at the His Trojan connections include getting his care at 喵咪社区.

He made an appointment with his primary care doctor, who immediately referred him to Uttam Sinha, MD, a specialist in head and neck cancer surgery for the   With a PET CT scan and needle biopsy, Dr. Sinha confirmed a diagnosis of squamous cell carcinoma of the head and neck.

From his first appointment, Richard noticed that not only was Dr. Sinha an expert in treating this type of cancer, but also the entire team at Keck Medicine was at the top of their game.

鈥淒r. Sinha has put together this amazing group of people,鈥� Richard says. 鈥淭hey were so great. I never felt spoken down to, and I always felt like I was in the room with people who were a team.鈥�

Richard worked to prepare his body for surgery and treatment

Prior to his surgery, that team helped Richard give himself the best possible shot at a full recovery. His background as a musician and teacher means that he loves to practice 鈥� and they put him to work doing vocal exercises to make his throat stronger, along with physical and swallowing therapy.

He gained weight in order to prepare for the inevitable loss that comes with post-surgical chemotherapy and radiation therapy. 

鈥淭here can be a lot of collateral damage with surgery and radiation, which can cause scar formation, which in turn can compromise quality of life in terms of the function of the muscles,” Dr. Sinha, who is an associate professor of otolaryngology 鈥� head and neck surgery at the , says.

“If the patient does therapy before and during treatment to combat this, there鈥檚 less scar formation, resulting in a better functional outcome.鈥�

If the patient does therapy before and during treatment … there鈥檚 less scar formation, resulting in a better functional outcome.

Uttam Sinha, MD, otolaryngologist, 喵咪社区 Norris Comprehensive Cancer Center

As Richard was hard at work preparing himself for surgery, preparations began at , where the approach to cancer treatment is multidisciplinary and includes a weekly head and neck tumor board to discuss treatment approaches and how to address each patient鈥檚 care on an individual basis.

Radiation oncologist Adam Garsa, MD, joined Richard鈥檚 care team and was essential to making sure Richard had a better chance at a full recovery. 

鈥淥ne of the main reasons our patients have great outcomes is our team approach,鈥� says Dr. Garsa, who is also an assistant professor of clinical radiation oncology at the Keck School.

鈥淲e work together to develop the optimal approach to treat the cancer and minimize the effects of treatment.鈥�

In January 2020, Dr. Sinha performed a transoral robotic surgery procedure to remove the tumor, along with the lymph nodes in his neck that were affected by the cancer. The surgery was successful, but there was still a long road to recovery.

To fight the side effects of chemo, Richard joined a clinical trial

Medical oncologist Jorge Nieva, MD, was a big part of Richard鈥檚 care team and pointed him in the direction of a clinical trial that addresses the problem of treating and preventing the side effects of chemotherapy and radiation for patients with head and neck cancer.

鈥淧atients with head and neck cancer often need the combination of chemotherapy and radiation given at the same time,鈥� Dr. Nieva, who is an says.

鈥淭hat鈥檚 because with surgery in many of the areas of the head and neck, it鈥檚 difficult or undesirable to remove too much tissue from an area because there are so many vital structures nearby. Chemotherapy and radiation helps to clean up any cancer cells that may be around after surgery.鈥�

The trial involved a class of drugs that help make the effects of the radiation even more pronounced on the tumor but protective of the normal tissue, and at this point, the as-yet-unpublished study is showing good results.

This is one of the benefits of being a patient at an academic medical center like Keck Medicine.  Access to clinical trials can lead to better outcomes for patients who are undergoing cancer treatment.

But it was a time commitment of three hours a day, every day, for 45 days. Much of this took place during the initial days of the COVID-19 lockdown.

“The nursing staff became family,鈥� Richard says. 鈥淚 would go in, as sort of a zombie, and they have to weigh you every day. I was down about 30 pounds, and sometimes I would leave my cell phone in my back pocket because I just didn鈥檛 want to see more weight loss.”

“But the nurses never, ever lost their flow of positivity and kindness,” he says. “They were just so incredibly cool.鈥�

Richard is back to teaching with his hearing intact

Chemotherapy can cause loss of appetite, weight loss and changes in the ability to taste. Head and neck cancers can increase these side effects just by the nature of their location in the body.

This is where the preparations Richard made to strengthen his body before surgery really came into play.

鈥淚 had no sense of taste or smell, and there was a chance that only a small percentage of my taste would come back. And there was also a chance that I鈥檇 lose my hearing.鈥�

As a music instructor, this would have been particularly devastating to him.

鈥淏ut, it鈥檚 all coming back. I鈥檝e got 99% of my taste back. I never lost any hearing, whatsoever. I lost 45 pounds, but it鈥檚 all coming back. It鈥檚 incredible, the recovery arc of every week your body coming back.鈥�

I feel like grace is a huge part of my new life.

Richard Smith, patient, 喵咪社区 Norris Comprehensive Cancer Center

Richard鈥檚 loved ones credit his positive outlook for his recovery. 鈥淓qually important was Richard鈥檚 good attitude and resolve to do what was necessary to save his life,” one of them says. “He never once complained or resisted any of it. He allowed the process to happen with trust, courage and grace.鈥澛�

Richard鈥檚 attitude is apparent when he talks about what getting back to teaching has been like for him.

鈥淒uring my treatment, whether I would be able to teach again was a big part of my anxiety. I was thinking that if I couldn鈥檛 teach, it was going to be pretty bad,” Richard says.

“At first, I couldn鈥檛 talk before noon, because my voice was gravelly. But then I started getting my voice back, and doing the exercises, and it came back so quickly that I knew I could teach again.鈥�

COVID-19 caused him additional worry. 鈥淭eaching music ensemble is like a team sport, and I thought that teaching online would be the end of the game. Instead, I love it. We鈥檙e developing new ways of teaching online 鈥� and just communicating 鈥� it鈥檚 a really incredible way to teach.鈥�

Richard adds thoughtfully, 鈥淪o that, I think, is a metaphor for so many things that I thought could go wrong, but have turned out to be right. I鈥檓 so full of gratefulness and I feel like grace is a huge part of my new life.鈥�

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