After losing her speech more than a decade ago, Brenda Jensen became isolated from friends and was teased for using an electronic device that made her sound like a robot.
Today, the 52-year-old has her voice back thanks to a rare transplant surgery at the University of California Medical Center in Sacramento.
An international team of surgeons replaced Jensen's larynx, or voice box, in an 18-hour operation in October.
It was only the second successful larynx transplant documented in medical literature. The first was at the Cleveland Clinic in Ohio in 1998.
The surgeons could not tell if their delicate work was a success until 13 days after the operation, when they went to Jensen's hospital bed and asked her to speak.
"I want to go home," she said in a hoarse voice and then broke into a smile.
Friends and family members now are amazed when she speaks, including 12-year-old granddaughter Samara Versteegh, who had never heard the sound of Jensen's voice.
"When she called me from the hospital and I talked with her for the first time, I bawled," said Kathryn Versteegh, Jensen's daughter. "It was amazing for her to produce sound and actually talk."
Jensen reunited with the surgical team at a news conference Thursday morning at the University of California Medical Center.
Her speech is still raspy, but she has shown steady improvement. Doctors hope the natural tones of her voice will return in the next several months.
Jensen also is enjoying the smell of food again -- the operation opened damaged airways in her neck, which had kept her from breathing through her mouth and nose. She has a breathing tube at the base of her neck and puts a finger over it when she speaks.
Open door for others
Gregory Farwell, a University of California Davis associate professor of otolaryngology and the lead surgeon, said he is delighted with the results of the operation, which could open the door to transplants for people who have severely damaged vocal cords.
The surgeons had to knit together the complex anatomy of the larynx, with its nerves and muscles that work to produce the voice and assist with swallowing and breathing.
"By far it was the most complex thing the team has ever done," Farwell said. "She thought long and hard about the surgery. It is not without risk, and it is a testament to how brave and motivated she was."
Jensen, a diabetic since her childhood, was sedated during a 1998 hospital stay for kidney failure, when she repeatedly pulled out a ventilation tube in her throat, causing irreparable harm to her larynx.
Losing her voice was torture for the sociable Jensen. She was given an electronic device that generates mechanical speech when held to her voice box. The unusual sound turned heads when she tried to talk with store cashiers or her pharmacist.
She once left a phone message with an old acquaintance and the recording fell into the hands of young people who harassed her with prank calls for the next month.
"People made fun of that," she said. "They called me the robot lady."
Jensen went to every ear, nose and throat specialist in the phone book and asked specialists at Stanford University if she could get her voice back. But no one gave her hope.
She had a kidney and pancreas transplant at the University of California at San Francisco Medical Center in 2006, which freed her of dialysis treatments and insulin.
Two years ago, a Modesto doctor referred her to the UC Davis Voice and Swallowing Center. Jensen's first transplant -- and the medication she takes to keep her body from rejecting the organs -- made her a candidate for surgeons looking to make advancements in throat surgery.
Ethics concerns
The medical world has shied away from voice box transplants for ethical reasons.
Damaged vocal cords are not life-threatening, but a transplant commits the patients to taking anti-rejection drugs for life and the weakening effect on the immune system puts them at higher risk for certain cancers and potentially dangerous infections.
Jensen, however, was already taking those medications.
The UC Medical Center planned the surgery for two years, while Jensen's case was submitted to an ethics board for approval.
Peter Belafsky, associate professor of otolaryngology at UC Davis, pulled together a surgical team that included Farwell, as well as Martin Birchall, a London specialist adept at repairing nerves in the throat; Paolo Macchiarini of Sweden's Karolinska Institute, a pioneer in windpipe transplants; and Quang Luu, a UC Davis assistant professor of otolaryngology.
The surgeons went to Italy to practice on pigs and returned to UC Davis for more training with cadavers, Farwell said.
Jensen said she was informed of the risks -- that the donor organ might not restore her voice, or that she could lose the movement in her eyes and face if the surgery went terribly wrong. But she decided to accept the risks.
"I wanted to be able to talk again and not have to worry about using a mechanical voice sounding like a robot," she said.
Working in separate operating rooms Oct. 16 and 17, the surgeons removed the donor's fist-sized larynx, with the thyroid and a section of the windpipe, and tested them in a saline solution for viability, and then took out Jensen's damaged larynx.
The organ came from a Sacramento-area woman who was an accident victim, UC Davis officials said.
Further regeneration
Surgeons implanted the donor organs, using an operating microscope to connect the blood vessels and nerves. Blood vessels one millimetre to three millimetres in diameter were connected with sutures a third the size of a human hair.
Since the surgery, Jensen has twice returned to the hospital for complications but is recovering well, her doctors said. Over the next six to 12 months, they hope for further regeneration of the slow-growing nerves so the natural tones of her voice return.
According to UC Davis press materials, Jensen's voice does not sound like the donor's. A person's voice is not defined by the vocal cords, but is made by sound resonating in the mouth and nose and the movement of the tongue and lips.
Jensen practices her ABCs and vowel sounds, and also does swallowing exercises to restore sensation in her throat.
In time, doctors hope to remove her trachea tube and a feeding line in her abdomen. If that comes to pass, she wants to start swimming and savouring food again. "After the feeding tube is out, I am going to every restaurant in town," she said.
Farwell said the surgery could be considered for others with trauma injuries to the larynx. But it won't be recommended for throat cancer sufferers because they need strong immune systems to impede the growth of cancer cells.
