Once-conjoined twins now living life to the fullest
One look at 24-year-old Peter and Paul Clemeña and you know that they are twins, but it will take a long conversation to know that they used to literally be joined at the hip, and that they can be considered — more than two decades after their historic surgical separation — modern-day medical miracles.
Twenty-two years ago, in 1995, two years after Peter and Paul were born, Makati Medical Center and its team of more than 20 doctors performed a historic operation to separate the twins fused at the hip and help them live as normal, healthy, and productive life as possible.
They were born via Cesarean section as Ischiopagus tetrapus conjoined twins. What this means is they were conjoined at the pelvis (“ischiopagus” or “ischio” meaning pelvis plus “pagus” meaning “that which is fixed”) while having a complete set of legs (“tetrapus” or “four feet”). Conjoined twins are rare, occurring once every 100,000 births. Ischiopagus Tetrapus conjoined twins are even rarer.
Dr. Raul G. Fores, MakatiMed founder, and president and medical director of the hospital at the time, oversaw the twins’ transfer to the Pediatric ICU, where the twins stayed until they were ready to be operated on. The operation was like a grand orchestra performance, as Dr. Jose Dante B. Dator, a urologist who was part of the team, described it. Several meetings and rehearsals with several specialists were done before the actual surgery, which was led by the late Dr. Luis Rivera, who became the unofficial “conductor” of this orchestra.
“This is not a single individual’s achievement alone,” says Dr. Dator. “Without the rest of the team and each and every single component, this wouldn’t be successful.”
Pediatric surgeon Dr. Wilma Baltazar shares, “We first did a lot of research — mostly from foreign journals — although there was a dearth of materials because of the rarity of the condition.”
They then formed the different teams. “We actually got the help of PGH (Philippine General Hospital) consultants, many of whom were also MakatiMed medical staff, especially pediatric surgery and pediatric anesthesia, pediatric orthopedics, pediatric urology, and plastic surgery, since they had the experience of separating conjoined twins, although not Ischiopagus Tetrapus Twins,” she adds.
She said the team had the full support of the MakatiMed Department of Pediatrics, PICU (Pediatric Intensive Care Unit) and Pediatric Pulmonology, with the assistance of the MakatiMed Departments of Radiology, Urology, and Clinical Pathology.
“We even referred the twins to Psychiatry/Psychology, and we made dolls which were attached at the perineal area with Velcro. We showed the twins that these dolls can be separated so they will know what to expect,” she says. “We then did a mock rundown from the bringing of the twins to the operating room, the intubation, the separation and transferring the other twin to the other OR table.”
“The successful separation of conjoined twins would never be complete without reconstructing the tissue defects in each twin brought about by the separation,” adds Dr. Ponciano D. Manalo, Sr., a plastic surgeon who was part of the team. “The expertise and knowledge of reconstructive surgical techniques for conjoined twin separation was my humble contribution as head of the plastic surgery team which separated the Clemeña twins. Through God’s grace, everything went as planned, and seeing the twins leading normal adult lives will always be a testament to MakatiMed’s expertise and genuine care.”
Dr. Manalo was joined in the team by his son and fellow plastic surgeon, Dr. Francisco Manalo.
The team had the all-out and full support of Makati Medical Center both financially and emotionally.
The separation was only part of the more than 12-hour-long surgery. The conjoined twins were considered one patient when they were wheeled into the operating room. After the separation, MakatiMed’s medical team had to deal with two individual pediatric patients who had to undergo further reconstructive surgery at the same time.
“After they were separated, everyone was yelling and cheering,” recalls Dr. Dator. “The whole team was so happy, but that was only the first part.”
Today, the twins are highly functional and independent with regard to activities of daily living (ADL). ADL is a term used in healthcare to refer to the tasks of everyday life. That, according to Dr. Dator, means “they can bathe and dress themselves, they can eat on their own, and so on.”
Today, Paul and Peter are just like your average teenagers .“We can swim, we go to the gym, we drink, we go out with friends. We don’t even have to keep taking medication anymore,” shares Paul.
Other than the usual adolescent issues of fitting in, Paul says there’s not much that their condition hinders them from doing.
Both boys are about to finish up their bachelor degrees, Paul in Psychology and Peter in Business Management.
The twins didn’t fail to assert the role of MakatiMed in their lives, the institution which took care of all their medical needs. Coming back to the hospital is always like a reunion, seeing those doctors who have been with them since their early years up to their adulthood.
“We’re so grateful to them for all the care they have given us in the past years, and I’m sure even in the future,” says Peter. “Even when we just visit, they find the time to check on us.”
For more information, contact MakatiMed On-Call at 888-8999, email mmc@makatimed.net.ph, or visit www.makatimed.net.ph.