Wednesday, October 12, 2011

Conjoined Twins

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For many parents around the globe, having children is the most exciting and happy time in their lives. The anticipation, preparation, and anxiety over having a child, however, can be overbearing. Every ultrasound and test they run sends parents into panic attacks. What if your baby has Down syndrome? What about crippledness, undeveloped fetus’s or spina bifida? A whole slew of other worries can pop up when an ultrasound reveals you are having twins. Underdevelopment, miscarriages, and a large pregnancy are the most common occurrences during a twin birth. However in the back of all parents mind is that scary thought, What if my children are crippled, or even worse, conjoined? When parents fear this they don’t even scratch the surface of what conjoined twins are really about. At first I hardly knew anything about them either. I, like everyone else judged him or her at face value. I knew that they were simply twins that were attached to each other at some point of the body. I knew from reading articles in the past that they were considered freaks and traveled in circuses. I knew that most of all the live conjoined twins did not live long lives, nor happy ones. I always assumed that they were almost impossible to separate, and that they were always of the same sex. Also, from a young age like my friends I believed most if not all conjoined twins were joined at the hip, though I now know better. As you can see, going into this topic I knew next to nothing and coming out, I know that I have learned so much and know the full extent as to the who, what, where, when, and how of conjoined twins. Coming into this paper, I had so many questions that I wanted to be answered. I wanted to find out and share with others the common types of conjoined twins, and how many classifications there are. I wanted to discover how the term Siamese twins came about, and if it was named after a certain famous set of conjoined twins. I wanted to acquire not just that set of twins, but all other famous conjoined twins in history. I was interested in the advances we’ve made in separation of twins, what it’s all about, how far we can trace it back, and the ethical issues surrounding separation. I was also very interested in the history of conjoinment. This includes a large range of questions including; their age expectancy, what type of jobs they could achieve, their social status, and what other options were open to them. I wanted to take a glimpse into the future and see what kind of medical break-throughs doctors are planning for preventing conjoined twins, and for separation. My brain was bursting of questions that I was more excited about answering as time went on. Iset out to gain my new knowledge.


In this day and age there are so many ways to get information on any given topic. The Internet is loaded with facts and knowledge about anything imaginable. For my search, I set out in the library for printed materials. Though I only found only one book, it was loaded with material. However, where I really lucked out was the Internet. There was website upon website bursting at the seams with information. I also caught a documentary on 0/0 about a family birthing conjoined twins, and then having them separated. I took all three of my sources and laid them out in separate piles of what relates to what. With all my information out and ready, I only then started to delve into the mountain of information I had collected.


I was excited to find that mostly all the questions I had set out to answer were answered. The first thing I set out to learn was the history behind the term Siamese twins. I found out that the term came about from the conjoined twins in Siam, now Thailand, who was very successful and lived to an old age. Chang and Eng Bunker were just one of the famous sets I found. The others I uncovered are as follows


ɨ Radica and Doodica ~ These were the twin girl born in India joined at the chest. Their town thought them an evil omen from the gods and locked the whole family in jail until they came to their senses. The girls were later separated due to disease yet they both died within two years of that.


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ɨ Violet and Daisy Hilton ~ These two unfortunate girls were raised by a cruel midwife and forced to perform at a young age. At age they gained their independence, though continued performing, even starring in two movies.


ɨ Francis and Jacques ~ These were a rare case of parasitic twins. This is a term used when one of the conjoined fetuses develops, but the other doesn’t. This leaves the grown twin with an unformed fetus attached to it.


Though these are only a few cases I came across in my research, others including the Biddendid maids and Lori and Dori Schaller. I think each case represents many others and what happened to them. Another question answered was the common joining points. Contrary to what I believed, only about 5% are joined at the hip, like people assume they are. There are dozens more that can be funneled down into seven main types. As you can see, each term ands with the suffix “pagus” which means the point at which it is fixed. Twins are defined by the point at which they are joined.


ɨ Cephalopagus this is a very rare and sad case when the twins share a head and sometimes a torso. There is only one brain and a face on either side of the head. They also may share a heart. Obviously these twins can not be separated and do not live very long.


ɨ Parapagus this is the term used for when the bodies are one up until the chest area where it branches of into two separate heads. They usually each have their own spinal cord. This accounts for 5% of all conjoined twins.


ɨ Thoracopagusthis is the most common form of conjoined twins whish accounts for 5% total. This is when a thick band of cartilage at the chest combines the twins.


ɨ Pygopagus this accounts for 1% of all conjoined twins. This case involves attachment at the rump, sometimes fusing the two twins’ lower spines.


ɨ Omphalopagus 0% of all twins. This occurs when the twins’ torsos are combined; yet they each have there own two legs.


ɨ Ischopagus This is a sad case where the twins are attached at the groin, or lower half of the torso, with their legs sticking out to the side. Accounts for 5% of all twins.


ɨ Craniopagus this occurs when the twins are fused at the back of the head. This does not involve the brain, though the skulls are usually fused. This accounts for % of all conjoined twins.


In the past, conjoined twins were considered freaks and evil spirits. They could only get jobs at the circus as a freak, or performing musically. A person actually thought that they symbolized the end of the world was near. They were usually isolated to themselves, though nothing prevents them from getting married. In fact Chang and Eng Bunker, each married and between them had children. However being attached to one person at all times can be trying. Almost all conjoined twins need psychiatric help. Sometimes their hate for each other grows so strong they say they’d rather die in operation than live with their twin. They usually develop drinking problems, and depression. However, some twins follow the opposite route. They actually demand not to be separated because their bond is so intense. However you can not just separate twins voluntarily. If they share a heart, brain, spine, large intestine, or pelvic bone, they can not be separated. It is also hard to separate twins with conjoined nervous systems. They eat sleep and get sick at the same time and would be paralyzed if separated. There are many ethical issues surrounding separation. However, both the twins and doctors feel is equal if not less to how the parents feel. Some parents refuse t separate for many reasons. One is that you usually sacrifice one for the other during surgery, and the parents consider that murder. However, if it is best for the family and children, a judge will step in and order separation, which reminds me of Jehovah’s witnesses, who refuse to do some things even if it benefits the children. However there have been some very modern surgeries, led mainly by Dr. Ben Carson. One of which was performed in Germany on twin girls fused at the head. The Doctor drained the blood from both bodies and basically stopped their life and separated them, then pumping the blood back in. Luckily, there have been no found cases of conjoined triplets, or higher multiple births.


However what people don’t understand is that even though they are attached, their personalities, academics, athletic ability, and talents are entirely unique. Nevertheless all these facts about conjoined twins do not apply to the ones who don’t make it. Conjoined twins occur once in every 00,000 live births. However of this number, 75% are either stillborn or die within 4 hours. Out of this small percentage, about 1 or % actually make it past their 10th birthday still conjoined. Usually the sad part of being attached is if one twin is sick or hurt, you share their pain. If one dies, the other will follow usually within the next 7 hours if they are conjoined. These twins are always the same sex, race, and obviously age. At this point and time, I could find nothing on future breakthroughs in separations or prevention. However all my other questions were fully answered.


A baby, no matter what size, shape, or color is a gift. I hope that through this paper people will no longer judge Siamese twins for their face value, but look inside to find out how they feel. This paper has brought me a lot of new knowledge, which I need and enjoy due to my desire to be a pediatrician, and perhaps major in maternity and become an O.B.G.Y.N. Also, this paper has really opened my eyes for the fact that someone in my neighborhood when I was five thought she was pregnant with conjoined twins. (I later learned it was a false alarm) When I learned this I ran screaming, afraid of the “freaky babies”. Though my mother tried to explain to me, I had never learned anything about this condition, and so I judged this lady based on outward appearance and the stereotypical “Siamese twins”. I hope this paper is a real eye opener to all that don’t know about this subject and would like to. So whether someone’ s babies come together or separate, they are each still their own special person.





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