PICTURES - Conjoined twins Maria & Teresa Tapia: Before and after
For the nearly daylong surgery on Nov. 8, doctors at the Children's Hospital of Richmond at Virginia Commonwealth University divided the twins' liver, pancreas, and other shared organs, and reconstructed their abdominal walls.
How are the twins doing?
"They are enjoying life now that they're separated," their mother, Lisandra Sanatis, said. "They enjoy seeing themselves as individuals."
But they're still getting accustomed to exploring their surroundings separately, and stay near each other and hold hands when they walk.
Dr. David Lanning, a surgeon and head of the girls' medical team, says both children have been recovering well.
Maria, the smaller of the two, weighs about 19 pounds, and Teresa weighs about 26 pounds. The disparity in their weight, caused by the configuration of their small intestines and blood flow from the liver, will gradually even out, Lanning said.
Maria's pancreas is slow to produce digestive enzymes, so she is taking replacement enzymes. Teresa is undergoing treatment on the incision where the girls were separated.
After being in Richmond for several months now, Sanatis says she and her daughters are more than ready to leave the confines of the hospital and are anxious to return to their family in their native country. "We're missing our family, and the girls miss their little brother, Lisander," she said.
The family also hasn't acquired a taste for American food - including hospital meals - and they order takeout Dominican dishes, including traditional beans and rice.
They will be staying at the Hospitality House, which provides temporary lodging for patients and their families while in Richmond to get medical care, while continuing physical and occupational therapy and medical follow-up before going home to the Dominican Republic, possibly by Christmas.
"It's great to see the girls happy and out the door," said physician David Lanning, the lead surgeon on the operation that took months to coordinate and plan.
In all, more than 100 people — doctors, nurses, therapists and other staff — were involved in the care of the girls and their family, said Leslie Wyatt, executive director of the Children's Hospital.
Other partners include the Rotary Club of South Richmond, which helped cover the family's living expenses while in Richmond.
"This is a tremendous culmination of a lot of teamwork," Lanning said.
The girls are adjusting to life as separate people. Their birth in April 2010 as conjoined twins was a medical rarity, occurring in one in every 50,000 to 100,000 births worldwide.
"All cases of conjoined twins can be very different even though on the outside they appear similar," Lanning said.
"Because the girls had a lot of organs that were conjoined, it really required a prolonged, complex operation with a lot of reconstruction, lots of different teams involved. I think we're really delighted with how they've done and to leave the hospital doing so well," Lanning said.
The girls are on aspirin therapy, a recommendation from the liver specialists, Lanning said.
"The aspirin is a little bit of a blood thinner" to minimize any risk of clotting, Lanning explained. "Even though they didn't have any liver tissue removed, they split it in half." They will be on aspirin therapy for a year, he said.
Maria, the smaller twin whose reconstructive surgery was more complex, is also taking oral medication that helps with digestion. Lanning said tests show that Maria's pancreas, the organ that produces insulin and other hormones, is working fine but may not be producing enough of some digestive enzymes.
"We anticipate it will recover, but in the meantime we are just giving her supplements," Lanning said. "They are enzymes that help break down carbohydrates. We think that will eventually recover because she has an adequate amount of pancreatic tissue."
The oral medications are cheap and easily available and will not hurt her, Lanning said. If lab tests on stool samples show inadequate digestive enzymes, she may be on the medication for several months while her pancreas ramps up.
There may be one more medical procedure, a surgery to create cosmetic belly buttons for the girls, Lanning said. Originally, they had one that was underneath their conjoined belly.
"Dr. (Jennifer) Rhodes could do it as an outpatient procedure with a little sedation," Lanning said. "Their focus was to get the belly closed, and they've done that."
The weeks leading up to their discharge have been marked by incremental milestones — first sip of water, first bowel movement, first bite of solid food, first independent step.
Still ahead for the girls is learning to get around on their own.
Before the surgery, the girls toddled around easily, with each twin providing balance for the other.
After surgery, they have had to relearn many things — to sit up, to go from sitting to standing, to stand assisted, to walk assisted. The girls, once on their feet, are good at pushing around a stroller.
"Once they are standing and holding on to something, they will walk forward," said occupational therapist Audrey Kane.
"They need to be able to get up and down from standing, from the floor. That's one where they are still trying to figure out what to do. When they are sitting on the floor, they are not quite sure yet how to go about getting up," Kane said. Both girls made gains in that area this week, Kane said Tuesday.
The girls still turn to their mother and aunt with outstretched arms for help, which is still there but in measured doses.
On Friday, Sanatis thanked everyone who made the surgery possible and who supported them but added that she was looking forward to going home.
"It is sad for me. I fell in love with everyone here," she said while holding Teresa, who grabbed at the microphone and, when prodded, leaned over and gave Lanning a kiss on the cheek.
Lanning, who has taken care of other children while on World Pediatric Project missions to Caribbean countries, said there is satisfaction in caring for children who might not get needed medical care otherwise.
At the same time, what they learn from such cases allows them to help many others.
"We may not necessarily have another set of conjoined twins come along, but we certainly learned a lot from this operation to take care of other kids," Lanning said.
"Just a month or so ago I had a baby born here with … all the intestines outside the belly. I knew I could close it a certain way because of a baby I had taken care of in St. Vincent on one of my mission trips. … We learn a lot … when we do these complex, unusual operations."
No comments:
Post a Comment