Swallowing and breathing are easy, right? We do it hundreds of times every day without thinking. However, for head and neck cancer patients it’s anything but easy. “We use over 25 pairs of muscles to swallow,” said Loni Arrese, PhD, Department of Otolaryngology - Head & Neck Surgery at The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute (OSUCCC – James). “And, when you have to start thinking about it, you realize how complex it is.” This can be especially true for head and neck cancer patients. “The number-one thing I tell patients is that everyone takes swallowing for granted until you or a loved one can’t do it,” Dr. Arrese said. Chemoradiation is one of the primary treatments for head and neck cancer, while some patients also undergo more invasive surgical procedures to remove cancerous tumors. Chemoradiation (a combination of chemotherapy drugs and radiation treatments) is effective in killing cancer cells, but the side effects can include a reduced ability to swallow, which is called dysphasia. These patients with airway impairments and swallowing issues are susceptible to aspiration pneumonia and can become malnourished. But now, with funding from a Pelotonia Idea Grant, Dr. Arrese is studying the impact of a device, the Expiratory Muscle Strength Trainer (EMST), that could help head and neck patients who have undergone chemoradiation (but have not had surgery) breathe easier and more efficiently. Dr. Arrese’s research is in the early stages, however, “anecdotally, I’m already hearing from patients that it’s helping them cough-up thick mucus,” she said, adding this is good news. Dr. Arrese earned her PhD at Ohio State in speech and hearing sciences with a specialty in dysphasia, and has helped increase the staff and number of treatment options for patients with swallowing issues. The EMST has been used with patients with Parkinson’s disease and ALS (amyotrophic lateral sclerosis), but has not been tested on head and neck cancer patients, according to Dr. Arrese. The EMST is a small, hand-held device. “It’s calibrated and spring-loaded and patients blow hard into it to release the spring as they work their expiratory muscles,” she said. As patients are able to blow harder into the EMST, Dr. Arrese and others can then increase the calibration. Dr. Arrese and her research coordinator, Martina Tate, collect data and track each patient’s improvement. Patients do their exercises on the EMST at The James and at home. “My goal is to prove that this is feasible, that people with head and neck cancer undergoing chemoradiation can use the EMST to get better and breathe easier,” Dr. Arrese said. Once this study is complete, the data could lead to larger clinical trials on a regional or even national level that will help thousands and thousands of head and neck cancer patients. The career path for Dr. Arrese initially seemed to be heading toward speech pathology and working with children. But then, while working on a master’s degree at Columbia University, she had an externship at a VA hospital. “I started working with veterans with head and neck cancer, who had difficulty swallowing, and that changed my career path,” she said. “I liked the medical aspects of it and I liked the collaboration with physicians.” Dr. Arrese splits her time between the clinic, where she sees patients, and doing research, such as her Pelotonia Idea Grant study. Another area of research she is working on is the connection between breathing and swallowing. “There’s an intricate pattern between respiration and swallowing,” she said. “When we’re swallowing, we’re not breathing, otherwise, things would go down the wrong pipe. Our breathing stops.” The pattern is: exhale slightly, swallow, exhale a second time – and then resume a normal breathing pattern. “Some research has shown that, post treatment, some patients have a sub-optimal breath-swallow-breath pattern and are more prone to having things go down the wrong pipe,” Dr. Arrese said, adding she has begun research into this area. The ability to make her patients' lives better is what drives Dr. Arrese. “When they’re first finished with chemoradiation, the goal is to just help them get through the day,” she said of her patients. “But, it’s also, ‘let’s come up with a long-term goal.’ And when they come back and tell me about the first time they took a drink of water without choking or about the first big holiday meal they had with their family, that’s so rewarding to have played a role in that.”