Formerly conjoined twins returning to Sacramento

Formerly conjoined twins Eva and Erika Sandoval are one step closer to going home. The 2½-year-old sisters, who were surgically separated at Lucile Packard Children’s Hospital Stanford on Dec. 6, moved yesterday from Palo Alto to UC Davis Children’s Hospital in Sacramento. There, they will receive a few weeks of inpatient rehabilitation before returning to their family’s home in Antelope, California.

“Erika and Eva look really great,” said pediatric surgeon Gary Hartman, MD, professor of surgery at the Stanford University School of Medicine. Hartman led the 50-person team that separated the twins in a 17-hour operation and has closely monitored their recovery. “The girls have just blossomed in terms of personality,” he said. “They’re very engaging and chatty.”

At a March 6 hospital farewell party, parents Art and Aida Sandoval were excited. “I’m over the moon,” Aida said. “It’s still surreal seeing them separate, knowing that it’s still them as two individual bodies. Now we’re just waiting for their next chapter to begin, and the anticipation is indescribable.”

Eva was discharged from Packard Children’s on Thursday, March 9 after a three-month healing period in which her doctors closely watched the condition of the wound at her separation site. For a while, the plastic surgery team thought she might need a skin graft, but Eva’s wound is now healing well, and a graft will not be necessary.

Erika healed more quickly, allowing her to be discharged from Packard Children’s on February 13, when she left the hospital for the first time since the separation. However, Erika was readmitted on March 4 to monitor some vomiting that was persisting over several days. Aside from that bump in the road, for the last few months, both girls have been receiving physical and occupational therapy at Packard Children’s to help them learn new movement patterns that are suited to their individual bodies. They have also participated in play therapy to help them adapt psychologically to the separation.

“Neither girl seems to have trouble adjusting,” said Packard Children’s child psychiatrist Michelle Goldsmith, MD, who has worked with the sisters. “They’re both rolling with what’s going on very well.”

The healing process has even had its share of light moments, Aida said. “The other day, Eva said ‘feet,’ and I told her ‘foot.’ I said, you have one foot and your sister has the other foot. And then I showed her that she has one leg, and that Erika has the other leg. And she pointed at Erika across the room and said ‘Erika took it! Erika took my leg!’”

In addition to their recent hospitalization, the twins were born at Packard Children’s and spent 6 months there as infants. To date, more than 100 hospital staff from a large variety of departments have helped care for them.

At UC Davis Children’s Hospital, the twins’ caregivers will focus on helping their mother and home care nurses learn to take care of them safely at home, and will keep building skills the girls still need, such as eating by mouth. As infants, Erika and Eva required tube feeding. They still receive most of their nutrition via nasogastric tubes.

The team at UC Davis will also use specialized equipment to improve the girls’ mobility. Before separation, the twins’ anatomy was like that of two people above the sternum, gradually merging almost to one below the diaphragm. They had a total of three legs, one of which was unlikely to ever be functional. Tissue from the third leg was used as part of Erika’s reconstructive surgery, meaning that each twin now has one leg.

Both girls are now sitting on their own for short periods and will need to learn to use customized wheelchairs to move around. Because they each lack some pelvic bones on the side without a leg, it is unclear if they will be able to receive prosthetic legs in the future. But whether they use prosthetics or not, physical and occupational therapy will help them gain more independence.

“Improving their functional mobility will be really important in getting them to continue adapting to their new bodies,” said Kelly Andrasik, an occupational therapist who has worked with the twins at Packard Children’s. “The specialized equipment that an inpatient rehab like Davis offers will really help them with this.”

Erika and Eva will continue to receive regular checkups with Hartman and other caregivers at Packard Children’s after they go home to Antelope.

“They’re doing really well and they’re ready to go,” Hartman said.  “It’s a great thing for everyone on our team to see.”

Photo Gallery: Erika and Eva Sandoval >