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Sunday, January 16, 2011

Former Pennsylvania guardsman is hand transplant pioneer
By David Wenner - The (Harrisburg, Pa.) Patriot-News via AP

HARRISBURG, Pa. — Chris Pollock practices picking up small objects with tweezers with his left hand during therapy.

After a corn picker destroyed his hands, Chris Pollock wondered if it also ruined his life.

An introduction to a pastor helped put those feelings to rest.

The Harrisburg area resident eventually received a pioneering double-hand transplant.

Two weeks ago he bought a pickup. He drives it with no modifications beyond a homemade ignition key extender.

“It’s amazing what you can do going from one end of the spectrum to the other, going from no hands to two hands, in less than two years,” says Pollock, 42.

One of his goals is to drive a stick-shift by next summer.

Pollock received the transplants in February 2010 during an 11-hour operation at the University of Pittsburgh Medical Center.

He was the second person to get a double-hand transplant in the United States. Two more have been done since then.

Pollock stands out even among them — his transplanted right hand includes the forearm and elbow.

He spends 28 hours a week in physical therapy. It will take years for his hands to reach their full potential. They won’t be perfect. But Pollock is elated by his progress.

With his left hand, attached at the wrist, he can give a firm handshake. He can feel when someone’s hand is cold from being outside.

A natural righty, he has trained himself to write with his left. He picks up small objects with his fingers or tweezers. He texts.

His right hand, attached above the elbow, needs more time, and probably won’t ever function as well as the left.

Nerves in Pollock’s upper right arm must connect to nerves in his hand and fingers. The connections are needed for feeling and activating muscles.

Nerves grow about a half-inch per month. Or at least they do in a nontransplanted limb, where broken connections emit a chemical “beacon” to guide returning nerves.

This is a new frontier.

“The thing you hope for is that the muscles can still accept the return,” says Jana Poole, a Penn State Milton S. Hershey Medical Center hand specialist who works with Pollock.

It happened the day after Thanksgiving in 2008. Pollock was helping harvest corn at a friend’s farm in Cumberland County.

He was driving a tractor and pulling a corn picker that deposited corn in a wagon.  The 1950s-vintage picker made him nervous.  Late in the day, he hopped off the tractor to check the wagon.  He noticed corn stalks caught in the chute of the picker. He batted at the stalks to get them moving.  A conveyor chain snagged a sleeve and pulled his hand into the picker. Pollock reflexively reached with his other hand. It too became caught. He knew immediately his hands were lost.

He was alone for 30 minutes.  Hands stuck in the machine, Pollock wanted to die.

His father had recently joined the Evangelical Lutheran Church of the Good Shepherd, near Harrisburg.

He asked his pastor to visit the hospital, where Pollock would spend 20 days.

Talking to her, Pollock’s outlook began to change.

Over time, he realized prosthetic hands could enable him to do things such as drive.

He was a career member of the Army National Guard. He wouldn’t return to his occupation as a mechanic. But he could teach or do many jobs.

Now he’s a regular at Good Shepherd, usually attending on Sunday and Wednesday, his day off from therapy.

He views his accident as something that happened for a good reason, maybe to guide him to church.

He also views it as an event that made him a better person.

Pollock describes himself as formerly “skeptical.” He used to dream of winning the lottery.

“With that kind of wishing, you don’t know what you’ll get. I tend not to wish anymore. I take things day by day. And when a situation comes up, I deal with it,” he says. “God put me on earth to be this way, and I’m happy.”

His prosthetics — artificial hands — amounted to hooks.  They enabled him to drive. But they allowed no sense of touch.

People who have lost limbs tend to long for the ability to feel. Doctors consider it one of the best arguments in favor of hand transplants.

One day Pollock saw a Parade magazine article about the first double-hand transplant, done at UPMC.

He called the next day.

The first hand transplant was done in 1964 in Ecuador. But they weren’t considered practical until recently.

Drugs needed to suppress the immune system to prevent the body from rejecting the foreign part are a major reason. They can open the door to infections and a range of diseases including diabetes and cancer.

Unless someone needed a life-sustaining organ, it wasn’t considered worth the risk.

Doctors at UPMC, with the help of pioneers such as Pollock, hope to open the door to more hand transplants, as well as other transplants such as face transplants.

They inject bone marrow from the donor to “re-educate” the recipient’s cells not to react to the transplanted part as foreign. This lessens the need to suppress the immune system.

Additionally, limb transplants pose challenges beyond those of organ transplants.

“When you put in a kidney, once you put it in, it’s essentially working. That’s also fairly true of a liver once you set up the plumbing, blood coming in an out, etc., it starts to work,” says Dr. Shane Johnson, a Penn State-Hershey plastic surgeon involved with Pollock’s care.

A hand transplant involves careful connections of skin, bone, tendons, muscle, blood vessels and nerves.

For the patient, the hard part begins after the transplant is over.

Jeff Kepner is struggling.

He was the first person to get a double-hand transplant in the U.S., receiving it at UPMC in early 2008.

His story is the one that caused Pollock to seek a transplant.

Kepner is a former pastry chef who once lived in Lancaster and now lives in Georgia. He lost his hands and feet in 1999 following a bacterial infection.

A year after his transplant, a CNN story quoted Kepner as saying he regretted the transplant. He had attained very little use of his hands and still was unable to drive, which he could do with his prosthetic hands.

Kepner was discouraged by the endless hours of therapy, saying it was far more than he expected.

His surgeon and his family remain optimistic the therapy will pay off.

Pollock keeps a spreadsheet of hours devoted to therapy. He’s nearing 900.

He’s been told to plan on 2,000. He intends to reach that mark next summer.

Yet he doesn’t envision that as the end. Doctors tell him that, with effort, he can gain feeling and function for years, maybe a decade.

During a recent therapy session, Pollock first worked his left hand. One exercise involved using tweezers, then fingers, to pick up an assortment of marbles, beads, washers, paper clips, etc.

Then he worked with spring clips, plucking them off one rod and lining them up on another.

On the right hand, the one attached above the elbow, much of the work is performed by Poole, the therapist.

She kneads and stretches it, and applies electrical current to stimulate and exercise the muscles.

Pollock can gesture with the hand, and recently used it to help hoist a case of water into his shopping cart.

He says he can feel the sensitivity slowly returning.  In November, he first sensed cold in his right palm. Washing his hands last week, he had his first sensation of warmth in his right forearm.

The injury forced Pollock’s retirement from the military after 21 years.

Later this month, he’ll be the guest of honor at a Wounded Warrior event in Florida.

One purpose of his appearance is to provide inspiration for war veterans dealing with limb loss.

Pollock says he doesn’t crave the attention it takes time away from therapy but he’s happy to help.

“I want people to realize you have to put your mind to this. You don’t just get a transplant and it works. You have to put a lot of time into it,” he says.

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