Last December, infant development specialist Anne Shachal took a day off work for an unusual reason. Two of her patients, conjoined twins Erika and Eva Sandoval, were being surgically separated. The girls’ parents, Aida and Arturo Sandoval, had invited their friends and family to wait with them through the long surgery at Lucile Packard Children’s Hospital Stanford, and Shachal, who had cared for the twins since they were newborns, came to show her support.
“I’ll never forget when Aida came in and said ‘They are two!’” Shachal said. “There were tears, laughter, excitement, hugs. It was pretty amazing.”
For all the joy, that moment on Dec. 6 also had its share of uncertainty. Before separation, Eva and Erika faced each other, joined from the rib cage down. They had a total of three legs, one of which was unlikely to function. During the separation, tissue from the third leg was used to help close Erika’s surgical site, leaving each child with a large surgical wound and one leg. As they adapted to the huge physical change, they also had to get used to life without each other’s constant company. How would they react?
Today, there’s no question Erika and Eva are faring extremely well, as a television story about their case that aired yesterday on ABC Nightline described. Watch part 1 of their story.
On a recent weekend trip with their parents, the girls reached their latest big milestone: Using her arms on a low table for extra support, each twin can balance on her leg and hop sideways for one or two hops.
“They took two steps and were tired, but those are two steps that meant everything because they’re on the right path,” Aida Sandoval said. “They’re just thriving and amazing me every day.”
“They’re doing better than we expected,” said pediatric surgeon Gary Hartman, MD, who led the separation. The girls’ separation sites healed months ago, and they have required only one minor surgical revision each. They have been home with their family in Antelope, California since April.
When they are not hopping, both girls are scooting quickly around on three limbs, playing and talking with gusto, and expressing themselves as individuals. At their third birthday party in August, they dressed up as their favorite cartoon characters: Erika was Woody from Toy Story and Eva was the Disney princess Sofia the First.
The separation has had positive physical and emotional effects for both sisters. Before separation, Eva was larger and the twins’ doctors worried Erika was not getting enough nutrients.
“Erika has caught up to her sister in size and strength,” Hartman said. “Our concern about her growth delay has disappeared.” Erika and Eva still get most of their calories from tube feeding, but also eat regular foods, including such favorites as tortillas and chocolate milk.
Shachal, whose role was to support the girls’ physical and emotional development in infancy, was unsure how they would handle the emotional impact of separation. Experts from the hospital’s team of child psychiatrists worked with the girls to ease the transition.
“They really just took it in stride, and were able to develop more strongly into their own persons once they had their own physical space,” Shachal said. Eva once dominated the duo, but Erika has become more outgoing and their relationship is now more equitable, with both girls checking in with each other but also maintaining their own independence.
Although questions remain about their mobility — since current technology in prosthetic legs requires hip bone structure that the girls lack — their caregivers are excited about their forward progress. Erika and Eva have customized wheelchairs, and their physical therapists are helping them develop the strength they’ll need in their legs, arms and core muscles to be able to use crutches. Advances in prosthetics may someday make it possible for them to move even more freely.
The next milestone for the twins is preschool: They recently started attending a school near their family’s home. Hartman is confident that Erika and Eva can handle the challenges ahead.
“They’re advanced in terms of their language and verbal skills,” Hartman said. “I see a bright future for them. They’ve healed both physically and psychologically, and they’re focused on being kids.”
“They’ve come a long way in the months since their surgery,” added Shachal. “It’s been pretty incredible to watch.”
