A Massachusetts man has regained his voice after surgeons removed his cancerous larynx and, in a pioneering move, replaced it with a donated one.
Transplants of the so-called voice box are extremely rare, and normally aren’t an option for people with active cancer. Marty Kedian is only the third person in the U.S. to undergo a total larynx transplant — the others, years ago, were because of injuries — and one of a handful reported worldwide.
Surgeons at the Mayo Clinic in Arizona offered Kedian the transplant as part of a new clinical trial aimed at opening the potentially life-changing operation to more patients, including some with cancer, the most common way to lose a larynx.
“People need to keep their voice,” Kedian, 59, told The Associated Press four months after his transplant — still hoarse but able to keep up an hourlong conversation. “I want people to know this can be done.”
Mayo Clinic via AP
In this photo provided by the Mayo Clinic, Marty Kedian greets his dog, Baxter, on his first trip outside the Mayo Clinic Hospital after his surgery.
He became emotional recalling the first time he phoned his 82-year-old mother after the surgery “and she could hear me. … That was important to me, to talk to my mother.”
The study is small — just nine more people will be enrolled. But it may teach scientists best practices for these complex transplants so that one day they could be offered to more people who can’t breathe, swallow or speak on their own because of a damaged or surgically removed larynx.
“Patients become very reclusive, and very kind of walled off from the rest of the world,” said Dr. David Lott, Mayo’s chair of head and neck surgery in Phoenix. He started the study because “my patients tell me, ‘Yeah I may be alive but I’m not really living.’”
Lott’s team reported early results of the surgery Tuesday in the journal Mayo Clinic Proceedings.
The larynx may be best known as the voice box but it’s also vital for breathing and swallowing. Muscular tissue flaps called vocal cords open to let air into the lungs, close to prevent food or drink from going the wrong way — and vibrate when air pushes past them to produce speech.
The first two U.S. larynx transplant recipients — at the Cleveland Clinic in 1998 and the University of California, Davis, in 2010 — had lost their voices to injuries, one from a motorcycle accident and the other damaged by a hospital ventilator.
But cancer is the biggest reason. The American Cancer Society estimates more than 12,600 people will be diagnosed with some form of laryngeal cancer this year. While today many undergo voice-preserving treatment, thousands of people have had their larynx completely removed, breathing through what’s called a tracheostomy tube in their neck and struggling to communicate.
Although the earlier U.S. recipients achieved near-normal speech, doctors haven’t embraced these transplants. Partly that’s because people can survive without a larynx — while antirejection drugs that suppress the immune system could spark new or recurring tumors.
“We want to be able to push those boundaries but do it as safely and ethically as we can,” Lott said.
Head-and-neck specialists say the Mayo trial is key to helping larynx transplants become a viable option.
“It isn’t a ‘one-off,’” but an opportunity to finally learn from one patient before operating on the next, said Dr. Marshall Strome, who led the 1998 transplant in Cleveland.
This first attempt in a cancer patient “is the next important step,” he said.
Other options are being studied, noted Dr. Peter Belafsky of UC Davis, who helped perform the 2010 transplant. His patients at high risk of larynx loss record their voice in anticipation of next-generation speech devices that sound like them.
But Belafsky said there’s “still a shot” for larynx transplants to become more common while cautioning it likely will take years more research. One hurdle has been achieving enough nerve regrowth to breathe without a trach tube.
Kedian was diagnosed with a rare laryngeal cartilage cancer about a decade ago. The Haverhill, Massachusetts, man underwent more than a dozen surgeries, eventually needing a trach tube to help him breathe and swallow — and struggled even to muster a raspy whisper through it. He had to retire on disability.
Still, the once-gregarious Kedian, known for long conversations with strangers, wouldn’t let doctors remove his entire larynx to cure the cancer. He desperately wanted to read bedtime stories to his granddaughter, with his own voice rather than what he called robotic-sounding speech devices.
Then Kedian’s wife Gina tracked down the Mayo study. Lott decided he was a good candidate because his cancer wasn’t fast-growing and — especially important — Kedian already was taking antirejection drugs for an earlier kidney transplant.
It took 10 months to find a deceased donor with a healthy enough larynx just the right size.
Then on Feb. 29, six surgeons operated for 21 hours. After removing Kedian’s cancerous larynx, they transplanted the donated one plus necessary adjoining tissues — thyroid and parathyroid glands, the pharynx and upper part of the trachea — and tiny blood vessels to supply them. Finally, using new microsurgical techniques, they connected nerves critical for Kedian to feel when he needs to swallow and to move the vocal cords.
Mayo Clinic via AP
In this photo provided by the Mayo Clinic, Dr. David Lott, surrounded by multi-disciplinary team of doctors, operates on Marty Kedian.
About three weeks later, Kedian said “hello.” Soon he’d relearned to swallow, working up from applesauce to macaroni and cheese and hamburgers. He got to say hi to granddaughter Charlotte via video, part of his homework to just keep talking.
“Every day it’s getting better,” said Kedian, who moves back to Massachusetts soon. His tracheostomy remains in place at least a few more months but “I’m pushing myself to make it go faster because I want these tubes out of me, to go back to a normal life.”
And just as Lott had assured him, Kedian retained his beloved Boston accent.
Family photo via AP
In this photo provided by the family, Marty Kedian holds his granddaughter.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
