Over the summer, Richard Mangino tossed a football on the beach with his two young grandsons, swam the crawl in his backyard pool, and mowed the lawn. Unremarkable events in most people’s lives, but Mangino did them with two new hands and forearms he received in a 12-hour transplant operation a year ago.
He drives, throws and catches a Wiffle ball, paints, and even plays “Pretty Woman” on the guitar, all with the two limbs donated from a New Hampshire man who was struck by a fatal brain hemorrhage last October.
“It’s been what I hoped it would be,” Mangino said during an interview at his Revere home this week. “The doctors say I can do anything.”
Dr. Bohdan Pomahac, leader of Mangino’s transplant team at Brigham and Women’s Hospital, said his patient is “doing remarkably well and better than expected’’ at enjoying his hands and using them for everyday activities. The muscles in Mangino’s new hands have developed more slowly than predicted, so he cannot yet easily button shirts and grasp small objects with his fingers.
Since Mangino feels heat, cold, pain, pressure, and other sensations, Pomahac expects his fine motor skills to follow soon. “That will open new horizons of what he will be able to do with the hands,’’ said Pomahac, director of plastic surgery transplantation at Brigham.
The surgeon said it may be taking longer than average for the nerves that control the muscles to regenerate because Mangino is 66, making him one of the oldest hand transplant recipients.
“But most important is that he feels very, very happy with what he has,” Pomahac said.
The best feeling, said Carole Mangino, Mangino’s wife of 43 years, is “to put a jacket on and have hands hanging out of the sleeves. He thinks he’s the coolest thing. . . . It’s been a miracle every day.’’
A study published in 2010 that analyzed 49 hand transplants involving 33 patients worldwide found that most recovered enough muscle movement to eat, drive, grasp objects, ride a bicycle or motorbike, shave, use the telephone, and write. All patients developed “protective sensibility,’’ such as pulling away from a hot stove, and more than 80 percent developed “discriminative sensibility,’’ the ability to distinguish between smooth and rough, for example.
Mangino lost his lower arms and lower legs to a terrible bloodstream infection in July 2002. But even as a quadruple amputee, he became a prolific artist, holding a brush in the prosthesis he attached to his left arm, and taught himself to dress and play piano. Surgeons at Brigham put Mangino on the waiting list for a hand transplant in August.
On the morning of Oct. 1, Steven Lloyd of Troy, N.H., was stricken by a massive brain hemorrhage on the day before his 44th birthday. Lloyd’s wife, Jodi, decided to donate his hands in honor of her husband, who skillfully restored their home and cars.
After his illness, Mangino did not swim in his large in-ground pool. “He could get in and stand there” on prosthetic legs, said his wife.
One day in July, Mangino told his family, “I’m going to try to swim, go get the camera,” he recalled. Carole Mangino said she held her breath as he took his strokes. “I said, ‘Oh, my God, he’s going all the way to the end!’ ” Her husband easily swam the length of the pool and then held up his arms in victory.
“It was like watching someone taking his first steps,’’ said Carole, who was so moved she cried.
Mangino did drive before the transplant, using a device on the steering wheel his prostheses fit into, enabling him to turn. Playing football with grandsons Trevor, 6, and Nicholas, 4, is new, and that is when the boys, who had not known their grandfather with his original hands, finally realized the transplant had changed him, Carole said.
Her husband, she said, “is on a cloud,’’ and the bumps in the road have been relatively minor.
Mangino takes medication for nerve pain in his arms, which bothers him especially at night.
Pomahac said doctors do not have a good explanation for this type of pain. “The nerves are regrowing, and they not only provide sensations but provide some random pain stimulus,” he said. “It will eventually go away.’’
Mangino had a follow-up operation in May to remove internal scars that had formed around the tendons in his lower arms, preventing them from moving freely. He has never suffered an episode of rejection, which occurs when a transplant patient’s immune system attacks the donated tissue, but that is always a worry.
He went to Brigham last week because he developed redness and a rash on both his hands, symptoms of potential rejection. Doctors increased his antirejection medication as a precaution but Pomahac said the rash ebbed and was probably just an allergic reaction to something Mangino touched.
He still travels to Brigham once a month for rehabilitation and does hand exercises, such as squeezing clay and stacking blocks, every day at home.
The scars that circle his forearms are still visible but they have faded and the swelling is gone. Mangino, who plans to write a book about his experience, said his hands no longer feel heavy.Liz Kowalczyk can be reached at firstname.lastname@example.org.