The News Desk is a collection of news, notes and breaking items affecting the Fredericksburg community.
Woman comes from Texas for rare trachea procedure
BY JIM HALL
Dr. Timothy Sherwood remembers the first time he examined Laura Herbst’s airway.
She was having trouble breathing and had traveled from her home in Texas to see him.
Sherwood, a thoracic surgeon at Mary Washington Hospital, placed a scope down Herbst’s throat and watched as she exhaled.
“Her entire trachea and the right mainstem bronchus collapsed completely,” he said. “It was quite impressive.”
Surgery was the best option for Herbst, but no doctor in Texas would attempt the complex operation. In fact, Herbst’s pulmonologist told her that she could recommend only two surgeons in the United States.
One worked at Harvard Medical School in Massachusetts. The other was Sherwood.
And so it was that the 46-year-old Herbst, joined by her husband, Fred, and her daughter, Alyssa, drove 1,400 miles from Georgetown, Texas, to Fredericksburg.
Sherwood operated on Herbst in June. When she awoke in the recovery room, she realized she was breathing easily for the first time in years.
“It was a great day,” she said in a phone interview. “It was a total new beginning of a life.”
NOT A SMOKER
Herbst suffered from a rare, congenital condition of the trachea or windpipe called tracheomalacia.
Her trachea collapsed during breathing, especially when she exhaled. Because of that, she had a persistent cough as a child and a history of bronchitis.
“When I was a teenager, I used to be accused of smoking all the time,” she said. “I have never smoked in my life.”
Her father suffered from the same condition, she said and, her grandfather probably did also. He died of pneumonia in the 1930s.
In recent years, Herbst developed asthma, chronic respiratory infections and shortness of breath.
“I couldn’t carry a basket of laundry from my bedroom to our laundry room,” she said.
For the last 15 years, she’s worked as a schoolteacher, first in fifth grade and now kindergarten.
“At the end of each week, she often had nothing left. She would collapse in bed and cry,” Fred Herbst, her husband, wrote in an email.
But each Monday morning, his wife was ready to return to school, Fred Herbst said. He nicknamed her “my little piece of gristle.”
“I said this in total admiration,” he said.
At first, doctors either couldn’t find anything wrong with Herbst or misdiagnosed the problem. She was told she had acid reflux or was swallowing incorrectly.
Finally, Dr. Esther Fields, a pulmonologist in Herbst’s hometown, correctly diagnosed her. Fields put a stent, or piece of metal scaffolding, in Herbst’s trachea to prop it open.
“It made a huge difference,” Herbst said.
However, the stent caused its own problems, including a buildup of mucous.
Fred Herbst had to strike his wife sharply on the back each day to clear her airway.
“It was like being a cystic fibrosis patient,” Laura Herbst said.
The stent was clearly a temporary fix. Herbst needed a surgical repair called a posterior splinting tracheoplasty.
However, the operation is rarely done, since many doctors are not comfortable operating on the airway, Sherwood said. He estimates that he does the operation once or twice a year.
In March, Herbst and her family drove to Fredericksburg to meet Sherwood. He agreed to operate on her, and they returned to Mary Washington in June for the surgery.
In the operating room, Sherwood made a 7-inch incision that began on Herbst’s right side and extended to her back.
When he reached her trachea, he sewed a piece of polypropylene mesh along the length of the base on the outside. The operation took three hours.
The trachea is normally shaped like a “D” and held open with rigid walls of cartilage. When Sherwood reinforced the base of Herbst’s trachea, the arch became taut, similar to what happens when you string a bow.
To test what he had done, Sherwood pulled the breathing tube from Herbst’s throat.
“By gosh, it was beautiful,” he said. “There was a nice, tubular trachea. As we woke her up, it maintained its integrity and did not collapse.”
Herbst stayed five days in the hospital. At Sherwood’s request, she and her family remained in Fredericksburg for another week in case something happened.
The Herbsts spent the week touring the local battlefields and historic sites. They celebrated their 10th wedding anniversary on June 15 with a trip to Mount Vernon.
Each day, Laura Herbst also rode the stationary bicycle in the gym at their hotel. Before the operation, she had been unable to do any exercise.
“My husband just sat there in amazement,” she said.
The family is back in Texas now, and Laura Herbst said she’s doing well.
She recently bought Sherwood a thank-you card in which she also thanks Sherwood’s wife, Erin, and their four children.
“They give up a lot for him to be the doctor that he is,” Herbst said.
She said she has struggled to find the right words to say to Sherwood.
“I think of the man every day, every time I take a deep breath,” she said. “No one will ever know how special he is to me.”
Jim Hall: 540/374-5433