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thedrifter
05-17-09, 09:01 AM
Former Marine works hard at making hand transplant function

By Luis Fabregas
TRIBUNE-REVIEW
Sunday, May 17, 2009


Josh Maloney moves his right wrist up and down, staring at the fingernails of his new hand.

It hurts, but he smiles.

"I smile because pain goes away," Maloney says on this late spring morning in an occupational therapy room at University of Pittsburgh Medical Center in Oakland. "Actually, to a certain point, pain feels good. Pain means I will eventually feel something."

It's been two months since Maloney, 25, underwent a historic hand transplant at UPMC, a medical feat done only five times before in the United States. His surgery was the first in Pittsburgh, where surgeons since performed a double hand transplant on a Georgia man.

The March 14 transplant marked the beginning of a tedious journey for a headstrong man who completed two tours in Iraq uninjured. He lost his hand in a training accident afterward.

Now, Maloney wants to touch, grab, hold and feel with a hand that belonged to someone else. Such a goal will demand willpower and commitment, as he endures a year of five-hour rehabilitation sessions five days a week.

The hand, about a quarter-inch smaller than his own, matches Maloney's light skin color almost exactly. Most of it is visible, except for a bandage just above the wrist and a splint protecting the bottom of his fingers. He keeps the hand upright when he walks, his wrist and fingers bent like a hook.

Once unable to feel anything below the scar on his lower arm, Maloney is beginning to gain sensation around his wrist. He can't feel or straighten his fingers but can bend them about an inch toward his palm.

Pain, a sign of healing nerves slowly regrowing, is constant.

"It's like my pinky is curled up into my palm and someone is trying to crush it," he says.

Maloney's routine often annoys him. He wakes daily at 6 a.m. to go to the hospital for blood work and therapy. He naps on the hourlong drive to Oakland from his Bethel Park home while his mother, Patti, drives. The former Marine with cropped dark hair often wears a Marines ballcap, T-shirt and jeans.

Strangers stop him in the elevator: "Are you that guy with the new hand?"

"It's my job to come here every day and suffer," he says.

Other than trips to the hospital, he hardly leaves the house, afraid to catch an infection that would set him back. He doesn't drink sodas or eat chocolate because caffeine can constrict circulation in his blood vessels. He takes a minimal, 10-milligram dose of OxyContin every 12 hours for pain.

He pushed himself so hard since the therapy started that his doctors and therapists warned him to take it easy.

"I"ve given up some of my Marine Corps mentality of not worrying about pain," he says as he takes off the splint that protects his fingers from tightening. "Now when it hurts, I stop. If I push too hard, with my luck, something's going to happen."

Maloney, a combat engineer, was in the middle of a military training exercise on Jan. 31, 2007, at the Marine Corps base at Quantico, Va., when a stick of TNT blew up in his hand, 20 seconds after he grabbed it.

The left side of Maloney's face — from his cheek down to his neck and shoulder — bears a trail of blue pockmarks from shrapnel. Blast tattooing, he calls it. Five months after the accident, Maloney was fitted with a prosthetic hand. He wore it for 10 seconds. A second one lasted two months. They were bulky, painful and irritated his skin.

Maloney, who is right-handed, learned to use his left hand. One day he surprised his mother. "Look, Mom, I just did a crossword puzzle," he told her. He learned to play pool with one hand.

The lack of a hand never dominated conversation, but he joked about it with family and co-workers at American Eagle Outfitters in South Hills Village. If he needed help carrying a box at the store, he'd ask no one in particular: "Can someone please give me a hand?"

Maloney yearned for a permanent solution. And he wanted to feel again. He heard about UPMC's just-begun hand transplant program from the aunt of his girlfriend, Erin Maxa of Dormont. The transplant offered the potential of someday playing baseball and working in carpentry, long his ambition.

In an 11-hour surgery, two teams of surgeons from UPMC's division of plastic surgery attached the hand of Henry Ball, an 18-year-old West Virginian who died. Doctors connected two major bones with titanium plates, and used hair-thin sutures to connect one artery and three veins under a microscope.

With circulation established, they finished the job by connecting tendons and nerves. They enrolled Maloney in a clinical trial aiming to reduce doses of anti-rejection drugs he will take for life.

Like his surgeons, the therapists at UPMC Montefiore prepared for 18 months. Workers in the maintenance department customized instruments so Maloney can flex his wrist, strengthen his fingers and work his muscles at the right rate. The therapists say his case is not as complicated as others they have encountered, such as the man whose hand was stuck in a meat grinder or another whose hand was crushed when a 10,000-pound machine fell on it.

On this late April morning, Maloney lines up a half-dozen plastic cones on a table. He struggles and closes his eyes. In frustration, he grabs the cones with his other hand.

Minutes later, occupational therapist Marie Pace rubs a small massager up and down his hand. After pain, vibration is one of the first sensations a person feels when nerves heal.

"When a patient says it hurts, that's good," she says. "That means the nerve is regenerating."

It could be a year or longer before Maloney completes therapy. As the hand's nerves heal, he eventually will move his fingers individually. For now, his forearm muscles are regaining strength, and he can pick up cotton balls and Styrofoam peanuts and place them in a bowl.

Those small steps are a result of the drive and determination he learned as a Marine, Maloney says. He won't fail, if only because he doesn't want to spend another day on a hospital bed.

"I just got my new hand," he says. "I don't want to ruin it. Not yet, anyway."

Luis Fabregas can be reached at lfabregas@tribweb.com or 412-320-7998.

Ellie