Thursday, August 28, 2014
YOLO COUNTY NEWS
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With rare larynx transplant, woman gets her voice back

By
January 21, 2011 |

SACRAMENTO — “Good morning,” Brenda Charett Jensen said, 13 days after surgeons at UC Davis performed a larynx transplant surgery — the second ever done — that gave her back her ability to speak, smell and taste.
For 11 years before the October operation, the 52-year-old Modesto woman had been unable to speak without using an electronic larynx. She suffered teasing from children, stares from adults.
On Thursday, Jensen reunited with her surgeons and took questions about how her life has changed from a room filled with reporters at the UC Davis MIND Institute.
“I talked with a mechanical machine and I sounded like a robot (so) everywhere I was, people turned their heads,” Jensen said. “It was frustrating, but I had to live with it. When this opportunity came up, I wanted to do it. I wanted to talk again, and I’m doing it.
“When I talk on the phone, people don’t hang up on me (anymore) because I have a real voice. They don’t think I’m a telemarketer or an answering machine.”
The team at UCD replaced Jensen’s larynx, or voice box, thyroid gland and a 6-centimeter segment of trachea with those taken from a female accident victim.
Jensen, who is diabetic, irreparably damaged her larynx and closed off her airway by repeatedly pulling out her ventilation tube while under sedation during a 1999 hospital stay for kidney failure.
Surgeons Gregory Farwell, Peter Belafsky and Quang Luu of UCD performed the 18-hour surgery alongside Martin Birchall of the University College London Ear Institute and Paolo Macchiarini of the Swedish medical university Karolinska Institutet.
Jensen’s surgeons said there have been no signs her body is rejecting the transplant. She is slowly regaining sensation in her voice box and movement in her vocal cords. She is learning to swallow again, too, and hopes to drink and eat without a feeding tube.
When she speaks, she uses her finger to cover the tracheotomy tube, which her surgeons hope to someday remove.
Though Belafsky said Thursday he’d been receiving e-mail and text messages from interested patients, similar transplants are unlikely to become common anytime soon.
Because Jensen’s condition was not life-threatening, the transplant is considered an elective procedure. As such, it would not be covered by private or government insurance.
UCD funded much of the hospital-related costs for Jensen, a single mother of one and grandmother of two who, before going on disability, worked at various times as an auto mechanic, construction worker, waitress and secretary.
Those costs were not immediately disclosed. Most of the surgical team donated their time to the project, according to a news release.
The surgery also requires a lifelong regimen of immunosuppressant medication to guard against organ rejection. Such drugs increase the chances of developing cancer and other medical complications.
Ideal candidate
Putting patients at risk presents doctors with an ethical problem, Macchiarini said. Jensen, however, was an ideal candidate in part because she was already taking immunosuppressant drugs following a kidney and pancreas transplant four years ago.
Added Farwell, “As our technology has improved, our medications have improved. As our ability to suppress the immune system becomes less toxic, the trade-off between having a voice box and the risks of immunosuppression may make this a more viable option.”
Farwell called Jensen a “living laboratory,” helping provide a better understanding of the viability of such transplants and patient rehabilitation.
Macchiarini and Birchall said her case also provided them with more insight into how they might be able to use stem cells to repair the voice box. In 2008, Macchiarini transplanted a tissue-engineered windpipe without immunosuppression.
Belafsky said that, not long ago, performing such a surgery seemed an “insurmountable challenge.”
“In my lifetime, I never thought we’d be able to put something like this together,” he said. “The logistics alone — just to coordinate a team of this size to perform a surgery like this, was not something I thought we could accomplish. But with the support of the university, from the top down, it really gave us the confidence that we could pull this off.”
Only one other successful larynx transplant had been previously been performed, in 1998 at the Cleveland Clinic.
Lengthy process
Planning for Jensen’s surgery took two years. The result of all those meetings: four printed pages, hung on the walls of two operating rooms, guiding each step. Farwell said a more typical surgery, even one 12 hours long, would result in only a half-page plan.
Working with the assistance of nearly two dozen doctors, nurses, technicians and other medical personnel, it took the team six hours to remove the donor’s larynx, thyroid and trachea. They tested the larynx with a saline solution to ensure it would permit blood flow.
Next came the painstaking, 10-hour process of reconnecting five nerves that, on average, are just two millimeters thick, as well as three arteries and two veins. Two surgeons did the work simultaneously, working with a high-powered, double-sided microscope, using sutures smaller than a human hair.
“We were very fortunate,” Farwell said. “Everything went completely as expected.”
Macchiarini said he practiced “daily” for six years on animals to be able to perform such a surgery on a human being.
“I was very, very much afraid,” he said. “When we just released the connecting of the artery that we saw this beautiful organ (filling) with blood and working properly, that’s the biggest emotion that I had.”
80 surgeries
After Jensen’s larynx transplant surgery — her 80th surgery, in all — she tried out her voice for the first time on Oct. 29. She followed her “good morning” with an announcement that she wanted to go home, which she finally did on Nov. 11.
Though a bit more raspy, her voice is her own. That’s because a person’s voice is a product of the way sound travels and resonates through the mouth and nose and is formed by the movement of the tongue and lips.
“To me I sound raspy and gurgle-y in the mornings but I’ve heard myself on my answering machine and other people’s telephone recordings and it sounds pretty good,” she said.
Jensen does daily exercises, practicing her vowels, sometimes with her 2-year-old granddaughter’s help.
“She’s learning how to talk and I’m learning how to talk, too, so we’re helping each other,” Jensen said.
She has also enjoyed taking in scents from the breeze again, like fresh-cut grass. On Thanksgiving she allowed herself the scent of her neighbor’s cooking, even if she can’t eat anything just yet.
A trip to the grocery stores brings another buffet of scents, Jensen said.
“The bakery — God, that kills me.”
– Reach Cory Golden at cgolden@davisenterprise.net or (530) 747-8046. Track him at http://twitter.com/cory_golden

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Cory Golden

Cory Golden

The Enterprise's higher-education and congressional reporter. http://about.me/cory_golden
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