ARWYP MEDICAL CENTRE SEES TWINS SUCCESSFULLY SEPARATED

The following article appeared in The Star newspaper on 15 January 2007
“Bad news turned good for parents of conjoined twins
Babies have yet to go home as they await complete separation
When Danika and Danielle were in the womb – and only slightly bigger than a pea – their parents knew they were conjoined twins. They also knew that conjoined twins don’t normally survive. If they do they could have respiratory problems or various abnormalities and depending on the severity of the join, they might never be separated. Nitesh and Kribashnee Lowton had a hard decision to make. Doctors advised Kribashnee to have an abortion. The cons outweighted the pros, they said, the risks were too great.

When Kribashnee had been five weeks pregnant, they were told they would be having twins. They were overjoyed but their joy did not last. “Two weeks later; a scan showed that something didn’t look all that clear,” said Nitesh. It was bad news. The twins were conjoined. A study of the scan showed the Lowton twins were joined at the head, a condition doctors refer to as craniopagus. This type of join only occurs in one in every 2,5 million live births. Separation could be very risky as the twins could share parts of the brain as well as blood circulation routes.

An MRI scan done at 19 weeks showed that the twins – now about 15 cm – didn’t share any major arteries or vital organs. A successful operation seemed possible. It was news the couple relished. There would be no abortion. At about 10pm on 21 June 2006, Danielle and Danika – named after their late grandfather, Dan – were born at the Arwyp Medical Centre in Kempton Park. Kribashnee who was put under general anaesthetic for the delivery, got to see her babies only the following day in the nursery. “They were so tiny, I was really scared. They had all this stuff attached to them,” she said. The doting parents were not allowed to carry the girls and they had to be told how to touch them.

They had to wait two weeks before they could cuddle them and even then it was with the assistance of nurses in the nursery. “Now they are bigger and much easier to hold,” Kribashnee said. Danika and Danielle have spent six months in the hospital and during that time they have been closely monitored by an arsenal of specialists. Last month they underwent the first of a series of operations on the road to complete separation. In a three-hour operation, surgeon Danie Hoffman and his team of anaesthetists, neurosurgeons and plastic surgeons inserted a tissue expander between the children’s heads. The expander, which is positioned under their scalps, consists of a silicone balloon that will be gradually filled with saline solution in order to stretch the skin covering their scalps. Once the twins are separated this stretched skin will be used to cover the defect in the area where they are joined.

But the separation operation is still months away. In the meantime they will stay at the hospital, their parents at their sides. “They are developing such different personalities. If you walk into the room and you don’t say hello to Danika first, she turns her sister over to see who is there,” Nitesh said. Kribashnee agreed, saying: “Danielle is such a livewire, while Danika is more reserved.” One thing is for sure though, the little girls recognise their parents. “They cry when we leave. It is very hard to just walk out,” Kribashnee said.

Since the birth of the twins, Kribashnee and Nitesh go to the hospital at least twice a day. They get up at 5am every morning and are at the hospital by 6.40am. At about 7.15am they leave for work and return to the ward at 5pm. “We stay till about 7.30 or 8pm but if they are niggly we stay later,” said Kribashnee. On weekdays the couple try not to spend every waking hour at the hospital. “We have to try maintain a level of normalcy in our lives and that means doing things like the grocery shopping or cleaning the house…just to be sane” Kribashnee said. For the next few months normal for the Lowtons is twice-daily hospital visits even though all they want is for our babies to come home.”

Siamese twins undergo phase one of separation procedure
The following is taken from an article published on the front page of the Star newspaper on 18 December 2006.
“This weekend, Danielle and Danika Lowton who are joined at the back of the head, underwent the first of a series of operations to separate them at the Arwyp Medical Centre in Kempton Park. In a three-hour operation, surgeon Dr Danie Hoffmann and his team of anaesthetists, neurosurgeons and plastic surgeons inserted a tissue expander between the children’s heads.
“We are happy to report that the procedure went smoothly and the twins are recovering well” said Dr Henry du Plooy the centre’s spokesperson.

The tissue expander which is positioned under their scalps consists of a silicone balloon which will gradually be filled with saline solution. The process of expanding the balloon will commence only 30 to 60 days after insertion. Once the twins are separated this stretched skin will be used to cover the defect in the area where they are joined. Du Plooy said “All the specialists are confident that the complete separation will be done in early 2007. The girls are healthy in all respects and have reached all the developmental milestones appropriate for their age. They have reached a combined weight of 13.1kg and are getting increasingly active in their customised bed.” The twins have not experienced any health complications since their birth at Arwyp in June this year.”

The following article is from the front page article in Kempton Express dated 31 August 2006. The Beeld newspaper carried a similar article.
“Siamese twins Danielle and Danika Lowton were two months old on August 21. The twins’ weight has shot up during these two months from a combined weight of 3,96kg to a healthy 7,9kg. They are free from all advance life support systems. The babies, joined at the heads, are both developing well and each has her own personality.
Their parents Nitesh (29) and Kribashnee (31) Lowton visit the hospital daily and their visits have become a special part of Arwyp Medical Centre’s daily activities according to Dr Wian Stander, superintendent of Arwyp.”

Siamese twins in South African Medical History - August 2006
Arwyp made South African medical history when craniopagus Type A conjoined twins were delivered at the hospital on 21 June 2006. The babies are joined at the head and they face in opposite directions. Their condition is stable. Medical specialists have indicated that a join of this nature is uncommon and have recorded no other incidence such as this one in the country before.

Twins in general occur once in every approximately 80 births. Siamese twins occur in approximately 50 000 to 100 000 births. Siamese twins joined at the head, known as conjoined twins, occur in 1 in every 2,5 million births worldwide.

The Arwyp twins, Danielle and Danika Lowton, the first set of Siamese twins recorded to be born in the country since 1994, were born at 8 months by caesarean section. Siamese twins, so named because the first time this medical condition was recorded was in the case of Eng and Chang Bunker, twins from Thailand then known as Siam, occur incredibly rarely.

Independent tests have indicated that save for the join at the skull, the children currently share no vital organs and both the parents and doctors are optimistic that the prognosis of the babies’ health is satisfactory. Independent tests have indicated that the twins appear to be in good health. The hospital management and staff have actively been involved in ensuring the comfort of both the mother and the minor children.

The appointed spokesperson on behalf of the parents and hospital, Dr. Wian Stander, when asked about the separation operation, indicated that this would be performed at any time from directly after the birth until six months of age, depending on the babies’ condition. Ideally the twins will be separated when they are old enough and strong enough to best survive such an operation. This would be when they are about six months old. Siamese twins should be separated while still in the infant stage. Allowing the twins to stay joined for longer than six months would be detrimental to their general physical development. The operation would be done sooner, however, if the babies’ lives were in any way threatened or if an unhealthy or dying twin was threatening the life of a healthy one.

Siamese twins have previously been separated in South Africa on four other occasions. In 1986 Siamese twins Mpho and Mphoyana captured the hearts of South Africans. They were successfully separated but Mphonyana died a year later. Mpho has gone on to live a relatively normal life. Professor Mokgokong who heads up the team of specialists which will be separating the twins at Arwyp successfully separated twin boys from Zambia in 1996. In his opinion the successful separation of such infants occurs when the experts in every medical field related to the situation put their knowledge and expertise together. The decision as to when to separate has to be one taken by the medical team, the parents and the community itself with the welfare of the children being the all-important deciding factor. A one-stage operation with limitless time in which to complete the procedure is the ideal in this situation with slow, meticulous surgery being the answer. However unforeseen complications do occur and, should this be the case, a second stage operation may be necessary. Further operations related to the growth stages of the children may also have to be done.

Miracle Twins keep improving – September 2007 Press release
Danielle and Danika Lowton, the Craniopagus Type A Siamese twins, who were successfully separated are Arwyp Medical Centre on Friday 7 September 2007 have steadily improved since the operation. The babies who are interacting like most toddlers of their age are a joy to behold. They continue to wear the little ‘crash’ helmets designed especially for them to ensure that they do not injure their heads. Their condition has met, if not exceeded everyone’s hopes and their parents are looking forward to having them home as soon as possible.

A team of 36 medical personnel including professors, specialists, doctors and nursing staff performed a 16 hour operation to separate the babies. The operation, which entailed complex neurosurgical and reconstructive procedures, was successfully accomplished at 20h45 on Friday 9 September 2007 when the babies lay separately for the first time.

Post-separation special investigations including CT scans which were done on 10 September 2007, revealed no complications. Dr. O.A. Adedipe, the neurosurgeon, and Dr J. de Witt, the paediatrician, are happy with the twins’ recovery thus far and with the results of the scans and of the special investigations.

On 11 September 2007 the twins were extubated and by then were no longer dependant on mechanical ventilators. All sedation and muscle relaxants were stopped and the girls slowly emerged from their induced sleep. By noon Danielle has already enjoyed a bottle and uttered her first word since the separation when she called for her ‘Mamma’.

Doctors honoured for separated twins
The following is taken from an article which appeared in the Beeld newspaper on 20 November 2007:
“The doctors who made history this year by being the first in Africa to separate a set of Siamese twins at a private hospital, namely Arwyp Medical Centre, were honoured at a breakfast held at the Intercontinental Airport Sun Hotel in Kempton Park on 17 November 2007. Blissfully unaware that they themselves were the subject of all the attention, the twins Danika and Danielle Lowton played contentedly whilst the doctors surveyed their handiwork. The girls’ condition has exceeded everyone’s hopes and they have, thus far, shown no signs of brain damage. ‘We hope for a happy and healthy future for them’ said their mother Kribashnee Lowton. Dr. Wali Adedipe, Arwyp’s resident neurosurgeon, describes his experience with the twins as a great privilege which made him feel humble. He said that the girls will receive reconstructive surgery in three years’ time to the parts of their skulls where they were joined. Until then they are wearing helmets to protect their heads. The girls are undergoing physiotherapy and their balance and ability to hold their heads upright is developing well. Prof. Rasik Gopal says that the outlook for their life expectancy and future quality of life is good.
The children are still being cared for at the hospital but have been allowed to go home on weekends, when, according to the nursing staff, the ward becomes very quiet without them.”

Farewell to Miracle Babies
From Arwyp Medical Centre Newsletter, 30 November 2007
There was hardly a dry eye to be seen when the staff members of Arwyp Medical Centre came out to bid little Danielle and Danika Lowton goodbye. Hospital employees lined the foyer of Arwyp Medical Centre to say farewell to the little girls whom they had come to know so well. Many had thought that perhaps the girls would never see this day. All had hoped and prayed that they would. The twins’ journey to the moment when they finally left the hospital as individual little people to go home to their parents had begun almost two years before when the diagnosis that they were Siamese twins was made.
After spending the first 18 months of their lives there, Danielle and Danika Lowton were officially discharged from Arwyp Medical Centre on 30 November 2007.

Two peas in a pod lead their own lives
The following is taken from an article which appeared in the Rapport newspaper on 14 September 2008:
The sound of voices of two children echoes through the house. Initially the two-year old Boksburg twins, Danika and Danielle Lowton are just curious at the new guests but when they see the cameras, they turn into real little models.

The twins were born on 21 June 2006 at the Arwyp hospital. They were joined at the head and were separated on 7 September last year during a long operation.

Their parents, Mr. Nitesh Lowton and his wife Kribashnee, held a service of thanksgiving at their home with friends, family members and their pastor. ”We cannot thank God enough for our children’s health and for the fact that He has brought them this far,” says their mother.

In the playroom both girls are vying to be first to have something to say or show off. The room is strewn with pairs of kiddie bikes, baby dolls and all manner of toys. A year ago the floor of the playroom was covered with mattresses to prevent them from bumping their heads and injuring themselves. At the time they also wore helmets for added protection to their heads.

Now these two ‘chalk and cheese’ children romp around their playroom, without helmets and mattresses, amongst the piles of toys. Danika is the more outspoken of the two and takes the lead with each new game. She is also the one who decides how they should pose for photographs. “My name is Danika. I like two minute noodles,” she says matter-of-factly.

“They don’t sit still for a moment. I have to keep reminding them not to run or jump off anything,” says Mrs. Lowton.

Although they no longer wear helmets, their heads are still sensitive on the side where they were joined. Danielle knocked her head against a window seat last week and had to go to hospital. But that hasn’t made her want to stay still. “Come, Sis,” she calls and rushes to the climbing frame.

“Pick up your toys,” says their mother. “You’re causing chaos,” and as if from one mouth comes the reply: “Dad will pick them up.”