The United States has emerged as the latest threat on Australia’s Super Rugby stocks after Queensland Reds identical twins Ruan and JP Smith’s exit to play in Los Angeles next year.
The forwards will play for the Venice Beach-based LA Giltinis in their inaugural season from March next year in what will be the competition’s fourth instalment.
The USA Rugby-sanctioned competition has swollen to 13 teams split between two conferences, defying the governing body’s claim for bankruptcy earlier this year and significant behind-the-scenes dramas for a host of clubs after their third season was cut short by COVID-19.
The Giltinis are named after a yet-to-be released cocktail and owned by Australian Adam Gilchrist – a gym tycoon, not the cricketer – who also owns the Austin Gilronis.
The competition has already lured former Wallabies great Chris Latham, to coach Utah, while Stephen Hoiles is an assistant coach at LA and Drew Mitchell (New York) was poised to come out of retirement before the delay.
Springbok Tendai Mtawarira (Washington DC), All Black Ma’a Nonu (San Diego), France’s Mathieu Bastareaud (New York) have all featured while Matt Giteau and Adam Ashley-Cooper have been linked to the LA club run by former Wallabies hooker Adam Freier.
But the signing of the 30-year-old Smith twins shows there is interest among active, established Super Rugby players too.
And AAP understands more could follow them in a move that would put the privately owned United States competition alongside Europe and Japan as suitors for Australia’s best talent.
Ruan said playing in the USA was a “bucket-list thing” while his brother JP said “playing with a new club in one of the sporting capitals of the world has massive appeal”.
“Away from playing, I’m really interested in player development and coaching and I’d like to take any opportunity in that area in LA to help rugby keep growing in the local community,” JP Smith said.
The pair grew up in South Africa before moving to Australia, where they now boast citizenship and run a South African meat operation specialising in boerewors and biltong.
“JP and Ruan are both very good, experienced rugby players and popular off the field in their past teams,” Hoiles said.
“It’s a significant part of the way we’ve structured our squad that they will really help guys like Blake Rogers and Mafi Seanoa, two of our talented American props.”
DES MOINES, Iowa — Shorter than a Barbie doll and lighter than a football, Kambry Ewoldt entered the world fighting to survive.
Kambry and her identical twin sister, Keeley, were born Nov. 24, 2018, around the 22-week mark of the pregnancy of their mother, Jade Ewoldt. They weighed 15.8 ounces and 1 pound 1.3 ounces, respectively, and spent the first four months of their lives in the Neonatal Intensive Care Unit at the University of Iowa Stead Family Children’s Hospital before they could go home.
Guinness World Records has recognized them as the world’s most premature twins.
Today, the girls love singing “Baby Shark,” doing the Chicken Dance and painting pictures. They have their own personalities — Kambry is more of a tomboy and Keeley is very girly, Ewoldt said — and are excited to celebrate their second birthdays.
It’s a milestone they weren’t guaranteed.
Ewoldt, already a mother of two, knew having twins meant it would be a high-risk pregnancy.
At 16 weeks, doctors told Ewoldt her daughters had twin-to-twin transfusion syndrome, where they were sharing blood through blood vessels in the womb. If untreated, the syndrome can be deadly to babies.
″(TTTS) is also very rare,” Dr. Jonathan Klein, a neonatologist and medical director of the NICU at University of Iowa Stead Family Children’s Hospital, told The Associated Press in January 2019, about two months after the Ewoldt twins were born. “A lot of patients pass away before they are even born.”
At 17 weeks, Ewoldt underwent surgery at Cincinnati Children’s Hospital to seal and disconnect the twins’ aberrant vessels.
Most mothers deliver their babies within 10 weeks of the surgery, and Ewoldt was no exception — Keeley and Kambry were born about a month later on Nov. 24.
For the next five months, Ewoldt was split between two worlds: the hospital and home.
She made a two-hour round-trip commute almost every day from her home in Dysart — and her two older children, Koy and Kollins — to her newborn daughters. Constantly driving back and forth, she said, put her in “survival mode.”
“It was hard to leave the NICU knowing that I was having to compartmentalize life,” she said. “Leaving behind the twins, knowing I couldn’t take them home was painful and then (I was) going home to be with my other kids and shutting off thinking about the twins when I was with them.”
As tiny infants, Kambry and Keeley were diagnosed with severe bronchopulmonary dysplasia, a chronic lung disease that makes breathing difficult. They have had to receive oxygen through nasal cannulas almost their entire lives, but were able to be taken off oxygen earlier this month.
Klein told the Des Moines Register, part of the USA TODAY Network, that even though the babies missed most of their lung development in utero by being born so early, they have done “extremely well” in their development.
“I would consider anytime babies like this on the cusp of viability survive, that it’s a pretty amazing situation, and it’s a huge dedication to a large team,” he said.
Life didn’t stop throwing obstacles in the Ewoldts’ path when Jade was able to bring her babies home. The twins are more susceptible to illness and last year had six hospital stays for the common cold.
“Something you or I would get the sniffles over would put them in the ICU,” Ewoldt said.
Although COVID-19 poses a significant risk to the twins, she said the family was already taking precautions against any sickness by staying indoors most of the time. It’s not perfect, but at least her family is together.
“I still feel torn between the two sets of kids, but at least I know, at the end of the day, the older kids get to do normal things where the twins get to stay healthy and I don’t have to decide between the two,” she said.
November is a month full of meaning for the family. It’s the twins’ birthday month, and the birthday month for their older sister, Kollins, who will turn 5 on Nov. 30. World Prematurity Day, a day created by March of Dimes to support families of premature babies, was Nov. 17, and November is Prematurity Awareness Month.
It’s also the month Ewoldt said goodbye to her sister Baylee Hess, who died in a crash last year on Kollins’ birthday as she was driving to her parents’ house to watch movies with her mom. Hess, 26, collided with a tractor-trailer, and died at the scene.
As the family celebrates the twins at home this year, their birthday will be dedicated to Baylee, Ewoldt said.
“This is a month of many emotions, but I want to practice Thanksgiving,” she wrote in a Nov. 1 Facebook post on her page called “Keeley and Kambry’s Tribe.” “I’m thankful for the uneven road that brought us here even when I do not understand.”
With nearly 10,000 Facebook followers, Ewoldt hopes their story can reach and support families going through similar struggles.
Years before she was pregnant with twins, without knowing the information may help save her future children, Ewoldt saw a story about a family that did not have the opportunity to intervene when they received a twin-to-twin transfusion syndrome diagnosis and lost their children.
When she received the same diagnosis, that story affected her decisions, she said. She hopes to pay it forward by sharing the knowledge she has gained.
“If our story can help save another baby, then it’s really important to continue to share,” she said.
An Olympic gold medal-winning gymnast long rumoured to have had twins with Russian President Vladimir Putin has disappeared from public view.
Alina Kabaeva had glittered under a spotlight for two decades. She was an Olympic gold-medal athlete in her teens in the 2000s, a member of Russia’s parliament for years, and now, in her 30s, remains the boss, at least in name, of a major national media company, the New York Post reports.
But it would be as Putin’s reputed love interest for the past dozen years — and quite possibly the mother of four of his children — that the spotlight would glare its brightest.
Since 2008, Europe’s tabloids have pored over her pregnancies, public appearances and online postings, speculating over a rumoured romance that remained stubbornly unconfirmed by both Putin and Kabaeva.
Then suddenly — after she wore a billowing red dress to her last public appearance, in the fall of 2018, prompting rumours of yet another pregnancy — the spotlight clicked off, and she disappeared from public life.
She has been raising her new twin boys, born in May 2019, and two older children also rumoured to have been fathered by Putin, in secrecy ever since.
“He is obsessive about the security of his family,” a Moscow source told the Sun newspaper of the Russian strongman.
“Putin is an intensely private man. He has been hiding his two adult daughters under fake IDs for years.”
“Even now, though he talks about them occasionally, he never names them,” the source added. “If Alina gave birth to his children, her hiding away might be one of the strongest hints pointing to this.”
Kabaeva became a Russian superstar in the early 2000s as a fresh-faced, gold-bedecked rhythmic gymnast.
She collected two gold medals in 2004, and before that won 14 World Championship medals and 25 European Championship medals.
Kabaeva retired from gymnastics in 2006, later joining Putin’s United Russia Party, becoming a member of Russia’s parliament.
Rumours of a romance between Putin — who at 68 is twice Kabaeva’s age — began popping up soon after.
The European tabloids speculated that Kabaeva’s two children, born in 2009 and 2012, were fathered by the strongman.
But the Putin-Kabaeva rumours ran rampant in 2013, when the then-prime minister divorced his wife of nearly 30 years, Lyudmila Putina, a former Aeroflot flight attendant and mother of the strongman’s two acknowledged children.
No sooner had he divorced than the European tabloids claimed that he intended to marry Kabaeva.
“I like all Russian women,” the new bachelor quipped in brushing off the rumours then.
The tabloids went wild the next year, for the 2014 Winter Games in Sochi, when it was rumoured — wrongly, it turned out — that Kabaeva would light the Olympic flame.
Kabaeva, apparently, was otherwise occupied.
In April 2015, she gave birth to twin boys in Moscow.
This story originally appeared in the New York Postand has been reproduced with permission.
Two pregnancies gave Kerri-Louise Hooper four beautiful children, but carrying two sets of twins also left her struggling to lead a normal life.
Abdominal separation can cause back pain and incontinence for women who suffer the condition after pregnancy
Private health insurers won’t pay for surgery to correct the condition because there’s no Medicare item number for it
A Sydney woman has started a petition to Australia’s House of Representatives to restore the Medicare item number for the surgery
The Hobart mother’s abdominal muscles separated normally during pregnancy, but they didn’t rejoin afterward, leaving her with a condition known as diastasis recti, or abdominal separation.
“I have a hole in my abdominal wall that is bigger than my fist and my stomach muscles will not join again,” Ms Hooper said.
Women who have multiple births like twins or larger-than-average babies are more prone to abdominal separation after pregnancy, which can lead to problems including chronic back pain and incontinence.
Ms Hooper suffers from both.
“I’m a real estate agent, I’m running around, I don’t have access to bathrooms all the time, and when that urge happens, I have no support. There is nothing,” she said.
“My kids say, ‘Mummy you’re not the same anymore.’ My elder children [say], ‘You can’t play with us anymore, you’re always saying be careful of my back, you can’t stand up with us, you can’t go walking for long distances.’
“It just aches; my lower back aches, my stomach aches, everything just hurts.”
Mild abdominal separation after pregnancy can usually be fixed through physiotherapy and core-strengthening exercises, but in severe cases it must be repaired by abdominoplasty, also known as a “tummy-tuck”, a surgery during which a plastic surgeon sews the abdominal muscles together.
Ms Hooper has tried all the non-surgical treatments without success, but she will have to pay at least $12,000 if she wants an abdominoplasty.
Woman starts petition to make surgery cheaper
Abdominoplasty for women with abdominal separation after pregnancy was removed from the Medicare Benefits Schedule in 2016 because it was considered primarily a cosmetic procedure.
Without a Medicare item number, private insurers will not pay for the surgery or the hospital stay afterward.
Sydney woman Kerrie Edwards has started a petition that will be presented to Australia’s House of Representatives, asking for the Medicare item number to be restored.
The mother of twins, who also suffers from abdominal separation, said the surgery to fix the problem was unaffordable for most Australian women.
“It costs upwards of $15,000 out of pocket. There’s very few people who can afford that,” Ms Edwards said.
Ms Edwards said it was unfair there were Medicare item numbers for abdominoplasty following significant weight loss and to correct abdominal separation caused by a tumorous mass in a person’s abdomen, but not for pregnancy-related injury.
“Medicare recognises that injury occurs if you have an intra-pelvic mass, and so there’s an item number that covers them to have abdominal repair surgery following an intra-pelvic mass,” she said.
“But we’re discriminated against when that intra-pelvic mass is a foetus, which does just as much damage to your abdominals.”
“It’s definitely unfair that women aren’t looked after following pregnancy.”
Surgeon says many women endure unnecessary pain
Melbourne plastic surgeon Dr Kim Taylor has performed abdominoplasty on more than 100 women suffering abdominal separation following pregnancy.
She said women are often shocked to learn their private health insurers won’t pay for the surgery.
“Sometimes it’s really hard to explain that whilst I believe that they have symptoms from the muscle separation, there’s no way that we can let them use their insurance because there’s no Medicare item number for that,” she said.
Dr Taylor said the cost of the surgery often leads women to delay having it.
“Sometimes when I see women that present for this, their kids have left home and they’ve been suffering for 20 years maybe or more with issues and are finally at the point where they’re like ‘okay, I can afford to get this done now’.”
Dr Taylor is on the executive of the Australian Society of Plastic Surgeons (ASPS), which has tried unsuccessfully to get the Medicare item number restored, and plans to try again next year.
Study finds abdominoplasty relieves back pain and incontinence
The ASPS is hopeful the Medical Services Advisory Committee (MSAC) will consider recent evidence about how abdominoplasty can help women with abdominal separation after pregnancy.
Canberra-based Dr Alistair Taylor was one of nine Australian plastic surgeons who took part in a trial in 2018 that collected data about women’s level of back pain and incontinence before and after abdominoplasty.
“We had a significant improvement statistically between back pain and urinary incontinence,” Dr Taylor said.
He said one of the reasons the Medicare item number was eliminated was because of a lack of data at the time about the medical effects of the surgery.
“It was judged to be a cosmetic operation because we didn’t really understand the functional benefits of it, but now that we do, we think that it should be included in the Medicare schedule again.”
“Not necessarily all abdominoplasty, but if patients are suffering from significant back pain post pregnancy, and urinary incontinence, it should be included for those patients.”
Dr Taylor said when the MSAC reviewed previous applications to restore the Medicare item number it did not consider there was enough demand for the surgery.
In a statement the Commonwealth Department of Health said MSAC appraises new medical services and provides advice to Government on whether they should be publicly funded based on an assessment of its comparative safety, clinical effectiveness and cost-effectiveness, using the best available evidence.
“The committee found that although abdominoplasty had benefits for weight loss patients, there was insufficient evidence to justify Medicare funding of abdominoplasty for diastasis recti at this time.”
DETROIT – Sarabeth and Amelia Irwin were locked in an embrace when they were born at 11:06 a.m. June 11, 2019.
Conjoined from their chests to their bellies, the identical twins’ arms wrapped around one another as they were carefully lifted from their mother’s womb at Michigan Medicine’s Von Voigtlander Women’s Hospital in Ann Arbor, said Dr. Marcie Treadwell, director of Michigan Medicine’s Fetal Diagnosis and Treatment Center.
About 14 months later, the twins returned to Ann Arbor, where they underwent an 11-hour surgery Aug. 5 at C.S. Mott Children’s Hospital, becoming the first known set of conjoined twins to be successfully separated in Michigan.
“‘They’re so rare,” said Treadwell, explaining that just 1 in 100,000 to 1 in 250,000 pregnancies involve conjoined twins. Few survive delivery, and even fewer live long enough to be discharged from the hospital and go home, like Sarabeth and Amelia did.
Two teams of surgeons — one for each girl — and more than a dozen other medical staff spent months planning how they’d safely separate Sarabeth and Amelia, giving them a chance at independent lives.
Just a few weeks after the first-of-its-kind surgery, Sarabeth sucked on a pacifier, leaning against her father’s leg on a blanket in the grass outside their house in Petersburg, about 10 miles north of the Ohio state line in Monroe County.
Amelia spotted a cell phone on the ground and began to crawl for it. She looked up at her big sister, Kennedy, who was running across the lawn, and said, “Sissy.”
“Other than taking our word for it, you would almost never know that they were conjoined,” said their father, Phil Irwin on a warm mid-September day.
Their mom, Alyson Irwin, smiled, and said, “They’re doing great.”
But neither Alyson nor Phil could ever have dreamed they’d be able to say that about their twins when they fist discovered they were conjoined in late February 2019.
A concerning ultrasound
Something about the pregnancy was different, but Alyson, 33, who works in agricultural industry, selling feed and fertilizer to farmers, couldn’t pinpoint what it was.
“I thought we were going to have a boy,” she said. “It felt different” than her previous pregnancy, when she carried Kennedy, who’s now a spunky 3-year-old who loves animals and playing on her backyard jungle gym.
The Irwins looked forward to the 20-week prenatal appointment, set for Feb. 27, 2019. They were eager to see ultrasound images of their growing baby. They agreed they wouldn’t find out the gender, and instead wanted to let it be a surprise at delivery.
Still, Alyson was pretty convinced her hunch was right.
“I thought we were just pregnant with a big old boy, so that’s why I even bought a boy onesie and everything for a boy,” Alyson said.
None of their previous prenatal doctor’s visits gave them any inkling that they were having twins or that they might be conjoined.
The ultrasound technician moved the wand around on Alyson’s belly, but then quickly excused herself to get the doctor.
“It may have been five minutes, but it seemed like forever,” before the doctor came into the room, Phil said. “That’s when we found out they were conjoined.”
“It kind of felt like the worst news you could receive, you know?” Alyson said. “Especially because the statistics are not good.
“They had never seen anything like that before. So they said their hearts were breaking for us, … but there wasn’t anything they could do.”
Their doctor referred them to a high-risk obstetrician, and within 24 hours the Irwins were in Ann Arbor, meeting with Treadwell at Michigan Medicine.
“I tend to always try to be hopeful, but I also have to be realistic,” said Treadwell, who also is a professor of obstetrics and gynecology at the University of Michigan. “Giving people false hope is not particularly helpful for anyone.”
Another ultrasound and a later MRI showed that the twins each had their own arms and legs. The girls were joined at the chest and abdomen, which can be a dangerous place for conjoined twins to fuse because the heart and other vital organs can be affected, Treadwell said.
“We had a long conversation that day, and then they knew that we have a multidisciplinary conference every week to discuss cases that are more challenging for things that have been found on ultrasound,” she said.
“They left with a very good understanding that we weren’t sure what was going to happen and there was some evaluation that was going to need to take place that would hopefully give us more information but that there was always going to be just a little bit of uncertainty most likely until delivery.”
Still, absorbing the news was hard for the Irwins, who learned the odds were incredibly slim that their babies would survive delivery, let alone make it home or live long enough to see an eventual separation surgery.
But soon after, glimmers of hope began to shine through.
Dr. George Mychaliska, a pediatric and fetal surgeon at Mott, said he first met the Irwins in March of 2019.
“Even at that time, we had pretty good prenatal imaging, which indicated that they really had all separate organs, except a liver was fused in the midline,” Mychaliska explained.
“I told them separation of the two babies seemed possible but much more evaluation and planning would be required. … I remember it very well. I didn’t want to be too optimistic because this was (going to be) a really long journey for us. We had never done it before. But I do remember being very hopeful with the family, that it’s something that certainly was possible.”
It was hope the couple desperately needed.
“We kind of went the whole time mentally prepared for the worst,” Alyson said.
“We had one meeting where we had a neonatalogist who asked, ‘Have you talked about pediatricians or car seats?’ And we both looked at each other and started laughing because that was the first time we’d heard that” they should prepare to bring their baby girls home.
They tried to explain to their daughter Kennedy that her new baby sisters would be different from other babies. The team at Michigan Medicine stitched together two dolls, connecting them in the middle just like Amelia and Sarabeth would be, so she could understand how her special sisters would look when they arrived.
“They gave them to her so she could get used to seeing two dolls together,” Alyson said. “She understood it before we had them, and then it was never a big deal to her at all.”
‘This is not an ordinary C-section’
Although the plan was to perform a cesarean section to deliver the twins between 35 and 36 weeks gestation, Treadwell said the babies were showing signs of distress at 34 weeks.
“Because we were following them closely, we were following the blood supply to the girls from the placenta,” Treadwell said.
Amelia and Sarabeth shared an umbilical cord, which Treadwell said, had “a lot of different blood vessels in it, more than what you normally would see. We started noticing that some of the blood flow was no longer normal in the umbilical cord. And that’s why we decided to move the delivery up a little bit from what we initially planned.”
A 3-D model of the twins was made to simulate the delivery, and a team of doctors nurses and other medical staff was assembled.
“As you can imagine there’s challenges with taking care of two babies that are attached. Where do you put IVs? And how do you help them breathe if they need help breathing? Those kinds of things,” Treadwell said.
The models allowed Treadwell and her team to accurately estimate how big the incision in Alyson’s abdomen would have to be to safely pull the twins from the womb.
“This is not an ordinary C-section because with an ordinary C-section, you just have to make an incision big enough to deliver one at a time,” she said. “This surgery would require making an incision not only in her abdomen, but also in her uterus, that can accommodate the delivery of two kids simultaneously without pulling on those shared organs or causing any kind of disruption to them.”
Mychaliska said the medical team planned for every possible outcome.
“We practiced what resuscitation would be like right after they were delivered,” he said. “We had to figure out a process for monitoring two separate patients that were conjoined and have electronic medical records that had to capture two separate babies.
“We had to completely reconfigure a room in the neonatal ICU to not only have two sets of monitoring equipment, but to also have separate data capture so that we would know what’s happening with Sarabeth and what’s happening with Amelia. So at every stage of the journey, we had to modify what we normally do.
“That took a huge collaborative effort by so many people.”
Defying the odds
June 11, 2019 dawned, and the Irwins made a 45-minute drive to Ann Arbor to finally meet their baby girls, knowing that as many as 60% of conjoined twins don’t survive delivery, and even fewer live long enough to be discharged from the hospital.
Amelia and Sarabeth defied those odds.
“I remember them briefly putting the girls on my chest. It was very sweet and special being able to hold them and see them for the first time,” Alyson said. “It was just very surreal. There was so much adrenaline from everything that led up to that point.”
Alyson’s sister stayed with her in the operating room while Phil followed the twins to the neonatal intensive care unit immediately after delivery.
The girls weighed a healthy 9 pounds, 4.5 ounces together — more than 4 1/2 pounds apiece.
“They were both vigorous when they came out,” Treadwell said. “What I remember is the joy of seeing them, and the fact that they both looked good.
“I went down and saw them in the NICU and they were doing amazingly well. And I remember that much more than I remember the details of who was intubated or for how long.”
Although the outlook was exceptionally good given the odds, being born prematurely and as conjoined twins, Sarabeth and Amelia remained hospitalized for 85 days.
Everyday life accommodations
How do you put conjoined twins in a car seat? This was among the challenges Phil and Alyson faced in the months following Amelia and Sarabeth’s healthy delivery.
“We had to do a car bed,” said Alyson.
Phil explained that it looked like a big box.
“It’s got a couple handles that you can run on the seat belts through, a couple attachment points to reach up to the mounting points on the front seats,” said Phil, 32, who works for NLB in Wixom as a controls technician and electrical apprentice.
A manufacturing company created a custom swaddle sack for the girls that was built into the car bed.
“It had some zippers and a buckle attachment. And then there is a cummberbund that had super sticky Velcro that would reach across them. And that was great.”
A Michigan Medicine team made a special swing for Amelia and Sarabeth that the Irwins brought home, so the girls could sit upright together.
When they outgrew it, Phil modified a four-hole rubber bucket swing.
“I looked at the girls and I looked at the swing and then I ended up just cutting the leg holes slightly bigger, and they loved that.”
It’s taken that kind of creative thinking to make it all work.
“When they were little, we were able to use just a regular baby carrier, too,” Alyson said. “While were still in the NICU, one of the nurses was like, I think that would work. And so we tried it at the hospital and if you put them sideways, you could put both legs of each girl through one of the leg holes” in the carrier.
Both girls had nasogastric tubes that fed them, so Alyson and Phil had to quickly learn how to place the tubing back in the girls’ noses if one or the other pulled out her sister’s line.
“They just never quite picked up how to bottle feed right from the get go,” Alyson said. “We’ve worked with it but this is the best way for them to get nutrition right now.”
Sarabeth also needed supplemental oxygen.
“Our car is a rolling medic supply,” Phil said. “We’ve got emergency respirators, extra oxygen and extra tape and tubes and everything you could need.”
As the girls grew bigger and stronger, they began to talk more about how and when separation surgery might occur.
Planning for separation
Dr. Steven Kasten, pediatric plastic surgeon at Mott, began working with the Irwin family soon after the twins were born to plan how they’d create enough skin to be able to cover the abdomens of both girls once they were separated.
Amelia and Sarabeth were initially scheduled for surgery Feb. 13 to separate them. Months before that — in September 2019 — the girls underwent an initial surgery to add tissue expanders on both sides of their bodies.
“It is basically a silicone balloon, and we put one on each side of the twins, right along the area where they were joined,” said Kasten said. “It gets put in with nothing in it. And then we let it heal up for a few weeks.”
Phil and Alyson were taught how to inject saline into the expanders several times a week.
“It slowly blows up the balloon and creates extra skin,” Kasten said.
But a week before they were scheduled for separation surgery, Sarabeth and Amelia got sick, and ended up back in the intensive care unit at Mott. The tissue expanders were deflated.
“It was bad,” Alyson said. “They ended up being in the PICU (pediatric intensive care unit) for 40 days. And then COVID hit, and we canceled everything.”
As the girls recovered in March from their illness — a cold that progressed to pneumonia — the global coronavirus pandemic made every decision more complex.
“There were a lot of a lot of conversations about it,” Phil said. “We asked, do we stay in the hospital? Is it safer for the girls to stay in the hospital to guarantee that they do have an ICU bed? Because if they were to get sick again, how do we make sure that they can get back in?
“The general consensus among the team was, ‘Get out of here. Go home. Isolate.”
Amelia and Sarabeth were discharged March 17, just as the state entered a COVID-19 lockdown.
Back at home in Monroe County, the twins continued to grow and heal and Phil began to fill the tissue expanders again to prepare for separation surgery.
Just as they’d been used to prepare for Sarabeth and Amelia’s delivery, the hospital’s radiology team worked with bioengineers to create 3D models of the twins and their livers and other body structures to help the surgeons simulate what would happen in the operating room.
It was like orchestrating a complex medical ballet where every move, every step had to be choreographed and precise, Mychaliska explained.
Even the electrical capacity in the operating room had to be considered as two separate teams of experts would require duplicate medical equipment to work on each girl the moment they were separated.
Mychaliska led the surgical team on the morning of Aug. 5, along with Kasten and pediatric heart surgeon Dr. Richard Ohye for a procedure that they estimated could take as long as 16 hours, Phil said.
The couple waited outside the hospital in the car, getting constant updates about their girls, who entered the operating room at 7:30 a.m.
Some good news, at last
Sarabeth and Amelia shared a chest wall, but each twin had her own diaphragm muscles, said Mychaliska, who also is the co-director of the Fetal Diagnosis and Treatment Center and the Dr. Robert Bartlett collegiate professor of pediatric surgery at U-M.
They had one small, shared sternum bone that would have to be divided, and separate livers that were fused, he explained.
Although the twins had individual hearts, they shared an outer membrane or protective sack, called the pericardium.
Both girls needed an artificial sternum, which the cardiothoracicteam built out of titanium bars to stabilize their chests, Kasten said. Gore-Tex fabric was used to place a patch over the holes in the pericardium around each of their hearts.
“One thing that we really didn’t know until they were separated and the breathing tube came out was what their chest wall mechanics would be like,” Mychaliska said. “Breathing is a complicated thing that involves your lungs, your diaphragm muscle and your chest wall, and it has to all kind of work in sync.
“We really didn’t know how well their chest wall would work, but it worked actually beautifully.”
The team used an innovative intravenous fluorescent dye to guide them when they separated their livers, Mychaliska explained.
“There were not too many blood vessels that went from one baby to another,” he said ” … An innovation that we observed on their CT scan is that when one baby received IV contrast in her vein, it outlined the edge of her own liver, and marked the middle. We thought to ourselves, it would be great if during the operation, we would know exactly where that line was, so we could divide it.”
The process worked during surgery just as they’d hoped.
The first incision was made at 11:19 a.m., Mychaliska said. And by 1:11 p.m., they had been separated and placed at opposite ends of the same operating room table while surgeons began reconstructing their chests and abdomens.
Their teams were color-coded. Amelia’s was pink. Her fingernails were painted to matched her surgical hat. Sarabeth’s was yellow.
“I feel like my brain ran through every scenario forward and backwards,” said Alyson as she contemplated what was happening in the operating room.
But Phil was very optimistic going into the procedure.
Sitting on the deck of their home by the fire pit, he told her, “I can’t possibly begin understand what how terrible it could be … but I can understand how great it’s going to feel if things go well. So I’d rather focus on how great it’s going to feel than be negative.”
Because of COVID-19, the couple waited in the car outside the hospital during their surgery, getting frequent updates. They were thrilled when they got the news that it had gone so well, doctors even had time to construct a belly button for each of the girls.
Sarabeth came home from the hospital first, in late August. Amelia followed soon after, joining her family, their dog and two cats at home on Sept. 5.
Six weeks post surgery, Amelia and Sarabeth have matching scars that run down the center of their chests, forming a question-mark-like shape over their bellies that is likely to fade but might never completely disappear as they adjust to their newfound independence.
They may need additional surgeries as they grow and their bodies developed, but doctors are optimistic that Sarabeth and Amelia will grow up to be just like any other kids.
“Their outlook is really quite good,” Mychaliska said, “especially with their parents. Their parents are really special people. They got the perfect parents for being conjoined twins. Not only because of their commitment, love and support, but because they’re just very innovative and optimistic people. I think that really made a big difference.”
Life for the Irwins is busier than ever now as they juggle occupational therapy and physical therapy appointments for the twins along with diaper changes and feedings, Sarabeth’s oxygen tank and preschool for Kennedy.
But they wouldn’t have it any other way.
“For us it’s been a whirlwind, an absolute whirlwind,” Phil said. “You look back at it, and it’s like man, remember what used to stress us out? It’s perspective.”
As this pandemic continues, “people are realizing how much positive we really need.
“This has been a giant experiment in the power of positive and the power of prayer. You know, so positive news, people need that. People live on that.”
Follow Kristen Jordan Shamus on Twitter @kristenshamus.
A surrogate gave birth to the couple’s daughters six weeks ago
The woman fell pregnant in November, before COVID-19
The couple have been separated from their young sons since July
The pair travelled to Kiev in July for the birth of their twin daughters, who were carried by a surrogate who became pregnant in November before COVID-19 hit.
Mr Dix said Australia’s international flight cap was blocking them from returning home, with airlines saying they could not get the family a flight to Australia any time before December.
“We really need to see if they can get the flight caps adjusted, changed, lifted, so we can start getting some Australians home and back onto home soil so they can be reunited with their families,” he said.
Ms Dix said she felt “abandoned” by the Federal Government.
“What country leaves their people in these situations, you know we’re Australian, I always thought that meant mateship and compassion and empathy?” she said.
The Dix’s sons, Arlo and Beau, aged two and five, have been living with their grandparents in Perth for months.
‘There’s a lot of anxiety’
Grandmother Shirley Dix said she was “absolutely exhausted” and worried about the children’s mental health.
“They go through stages, there’s a lot of anxiety, I see it in the five-year-old, he always asks when he’s going home,” she said.
“The little one is of the greatest concern, in the mornings when I go to pick him up … he just says go away granny, I want mummy.
The Dix’s had their daughters, Starla and Odessa, via surrogacy after Candice Dix almost died giving birth to Arlo.
She said doctors had to remove her uterus to save her life.
“So I couldn’t have any more children and that hit me really hard, so I ended up going and seeing a psychologist and in the end landed down the path of surrogacy because I still had my eggs,” she said.
Ms Dix said she was desperate to return home to look after her sons.
“You know when I look at them they feel abandoned and that makes me feel really guilty as a parent, you know that I can’t get there to make them feel better,” she said.
“Our two-year-old really doesn’t understand why we’re here and often he’ll get upset and cry if he sees us, especially if he sees the babies, he really doesn’t understand this.
“It’s just not a natural process at all.”
When asked to comment on the Dix’s case the Prime Minister’s office referred the ABC to statements Scott Morrison made after a national cabinet meeting last week, in which he said state premiers had agreed more Australians needed to be able to come home.
“We noted that New South Wales has been doing all the heavy lifting on this, and they really are at their capacity for the time being,” Mr Morrison said.
“And so, as I discussed with Cabinet during the course of this week, the Transport Minister will be working with others to see if we can get flights that currently all seek to come to Sydney, to see if we’re in a position to try and get them to go into other ports, whether that be in Perth, in Adelaide, in Darwin, the ACT, or elsewhere, even Tasmania.
“Almost 4,000 Australians are coming home every week, but we know there are many more who are trying to get home, and further support has been provided to DFAT to assist those Australians, particularly in hardship, overseas.”
Awestruck Sydney Roosters coach Trent Robinson says the NRL premiers are close to re-signing Brett and Josh Morris for another season after the ageless twins penned an historic chapter to their storied careers on Saturday night.
The most prolific tryscoring siblings in premiership history – who turn 34 on Sunday – each bagged a double in the same game for the first time in the Roosters’ 38-16 rout of Wests Tigers at Leichhardt Oval.
“Obviously if Josh gets one out there on the field, I am going ‘well I need to get one now’,” Brett told AAP after his brace drew him level with Canterbury legend Terry Lamb in equal fifth on the all-time tryscorers’ list with 164.
“So there is that rivalry there but it has never been anything more than a bit of fun.”
He’s now just one behind Andrew Ettingshausen and trailing only the Sharks great plus Steve Menzies (180), Billy Slater (190) and seemingly untouchable all-time tryscoring leader Ken Irvine (212).
Josh is 18th on the list after surpassing Steve Renouf with his 143rd try and within sight of rugby league Immortals Frank Burge (146) and Bob Fulton (147).
“We are both competitive guys and obviously we enjoy scoring tries but we don’t look at the records or that sort of stuff,” Brett said.
“We are footballers and we go out there to try and do our job to the best of our ability and if scoring tries is part of it that is what you are going to do.
“Obviously we are still enjoying our footy and love getting out there and ripping in. Those tries are bonuses.”
They’re much more than that to Robinson, who admitted he thought 2020 would be the twins’ swan song.
But, hailing them as must-viewing marvels, the Roosters coach feels compelled to extend their careers for another year.
“That’s the plan. I think we’re pretty close to getting that sorted,” Robinson said.
“I love watching them play. It’s a real pleasure. For any young footy player that wants to be an outside back, come to the game and watch them; don’t just watch them on television.
“Watch them move, watch them make decisions. When other people are walking, they’ll make these decisions that will put them in good positions to score tries, to save tries. They are the ideal guys to watch play footy.
“It looks like they have grown up playing footy since they were four and it looks like they have watched a lot of footy along the way.
“They have thought about it, put it in the memory bank and they have bought it out along the way.
“They just know how to find the try line and they just get into positions and do that. There is a little bit of space and the ball bounces and they are there to pick it up and score.
“It’s a real credit to them to keep it going. I said in the box tonight, I wish I had them when they were 25.”
Instead, Robinson will have them at least until they’re 35.
“I expected this season to probably be it for them,” he said.
“I’d like to think that we gave them a new lease of life as well, in the way they enjoy their footy and they gave us a way in which we play outside backs in a certain way.”
Brett said a new lease of life was exactly what the Roosters had given the brothers.
“Nothing has been finalised at this stage but we are both enjoying our footy,” he said.
“We love going into training every day. We have got a really great group of fellows there and obviously the staff there make going to work every day a pleasure.
“The end is only around the corner so you want to enjoy as much of it as you can.
“For myself personally, it has probably been the favourite two years of my rugby league career.”
Aug 18, 2020; Minneapolis, Minnesota, USA; Minnesota Twins shortstop Jorge Polanco (11) celebrates a win against the Milwaukee Brewers in twelve innings at Target Field. Mandatory Credit: Marilyn Indahl-USA TODAY Sports
August 19, 2020
Jorge Polanco drove in two runs, including the winner with one out in the 12th inning, and Kenta Maeda took a no-hitter into the ninth inning as the Minnesota Twins edged the Milwaukee Brewers 4-3 on Tuesday night in Minneapolis.
Polanco drove in Byron Buxton from third with a broken-bat dribbler past losing pitcher David Phelps (2-2) to win it.
Maeda set a team record with eight consecutive strikeouts but failed to garner the win as the Brewers rallied for three ninth-inning runs and force extra innings. Keston Hiura hit a run-scoring single, and Twins second baseman Ildemaro Vargas committed a two-run throwing error to tie the game.
Eric Sogard broke up the no-hitter to start the ninth with a soft liner over the glove of shortstop Polanco for a leadoff single. Maeda then departed after throwing a career-high 115 pitches. He struck out 12 and walked two.
Phillies 13, Red Sox 6
Bryce Harper crushed a three-run home run as part of a seven-run sixth inning, and Philadelphia sent host Boston to its ninth consecutive defeat.
Jay Bruce (four RBIs), Rhys Hoskins and Phil Gosselin also homered for the Phillies, who ran their winning streak to four. Philadelphia will seek to finish a two-game sweep Wednesday afternoon.
Rafael Devers had three hits, and Xander Bogaerts drove in a pair for the Red Sox, who have been outscored 86-41 during their skid.
Diamondbacks 10, Athletics 1
A five-run first inning set the stage for Arizona’s sixth consecutive win, a rout of Oakland in Phoenix.
Arizona’s Nick Ahmed drove in five runs in the first two innings, and Kole Calhoun hit his sixth home run this month. Luke Weaver (1-3) earned the victory after pitching a season-high five innings and allowing a run on three hits and a walk while striking out six.
Ahmed’s three-run home run highlighted the big first inning, which included a wild pitch from A’s starter Frankie Montas (2-2) that allowed the first run to score, plus an Eduardo Escobar sacrifice fly with the bases loaded.
Astros 2, Rockies 1 (11 innings)
Myles Straw hit an RBI single in the bottom of the 11th and host Houston beat Colorado.
Straw finished with two hits, Yuli Gurriel also had two hits and Andre Scrubb (1-0) pitched the 11th for the win. Raimel Tapia had an RBI single for the Rockies.
Houston starter Zack Greinke and Colorado’s Antonio Senzatela both pitched eight shutout innings before departing.
Nationals 8, Braves 5
Juan Soto continued his torrid pace with two more hits and a key RBI to help Washington win at Atlanta.
Soto finished 2-for-4 with a walk, and he scored a run after driving one in as the Nationals took the lead with a four-run rally in the fifth inning. Over the past nine games, Soto is batting .441 (15-for-34) with a double, six homers, 14 RBIs and 14 runs. He upped his average to .417.
Soto was one of seven Nationals with multiple hits, including rookie Luis Garcia with three. Wander Suero (1-0) pitched a scoreless inning for the win. Daniel Hudson, victimized by the Braves for two ninth-inning homers in Monday’s loss, worked a perfect ninth for his fifth save.
Padres 6, Rangers 4
Wil Myers hit a grand slam and former Ranger Jurickson Profar added a two-run homer to lead San Diego to a win at Arlington, Texas. Cal Quantrill came on with two on and two outs in the ninth to retire Todd Frazier on a fly to center for his first major league save.
Joey Gallo highlighted a four-run Rangers fourth with a three-run homer. Neither team scored over the final five innings.
San Diego’s Adrian Morejon made his first start of the season and allowed only one walk with four strikeouts in three hitless innings. Craig Stammen (2-1) was credited with the win, allowing only one hit in two scoreless innings after the Rangers scored four runs (three earned) against Javy Guerra.
Rays 6, Yankees 3
Brandon Lowe hit a three-run homer, and visiting Tampa Bay continued its surge by recording a victory over New York.
The Rays improved to 4-1 in the 10-game season series with the Yankees and also handed New York its first loss in 11 games this season in games played at Yankee Stadium.
Blake Snell (2-0) benefitted from the Rays’ run support while allowing three runs on four hits in five innings. Gary Sanchez hit a solo homer and Luke Voit hit a two-run homer out of the leadoff spot for the Yankees, whose 10-0 start in games played at Yankee Stadium matched the team record set in 1951 and equaled in 1987.
Cubs 6, Cardinals 3
Ian Happ and Kyle Schwarber each clubbed home runs, and Chicago held on for a win over visiting St. Louis.
Jason Heyward added an RBI triple for Chicago, which earned its second win in a row over St. Louis. The teams are scheduled to meet for a doubleheader Wednesday to cap off a stretch of five games in three days.
Cubs starter Yu Darvish (4-1) picked up his fourth straight victory after allowing one run on eight hits in six innings. Paul Goldschmidt and Matt Carpenter drove in one run apiece for the Cardinals.
Dodgers 2, Mariners 1
Corey Seager hit a go-ahead RBI single with two outs in the eighth inning to lift streaking Los Angeles to a victory over visiting Seattle.
Austin Barnes scored twice and joined Seager with two of the six hits for the Dodgers, who have won seven in a row.
Kyle Lewis scored on a groundout in the seventh inning and Marco Gonzales matched a career high with nine strikeouts for the reeling Mariners, who have lost seven consecutive games.
White Sox 10, Tigers 4
Tim Anderson, Yoan Moncada and Jose Abreu combined to go 8-for-12 with a home run and eight RBIs as the top of the order powered host Chicago past Detroit.
Detroit sputtered to its seventh straight defeat as left-hander Tarik Skubal (0-1) struggled in his major league debut. Anderson blasted the third pitch of Skubal’s career into the left field seats for his second leadoff home run against the Tigers in as many nights and third leadoff homer this season.
Chicago right-hander Dylan Cease continued his early-career dominance of Detroit, limiting the Tigers to two runs on five hits in 6 1/3 innings with three walks and three strikeouts. Cease improved to 4-1 this season and 5-0 in five starts against Detroit as the White Sox won their third straight game.
Mets 8, Marlins 3
Brandon Nimmo homered, tripled and singled while leading New York to a victory at Miami.
Nimmo, who was robbed of a hit on a line drive into a shift and also flied out to the warning track, went 3-for-5 with two RBIs while raising his on-base percentage to .431. He has four homers this season and has tripled in consecutive games.
The Mets, who have won two straight games, also got solo homers from J.D. Davis and Amed Rosario, and the latter totaled three RBIs. New York has seven homers in the past two games.
Indians 6, Pirates 3 (10 innings)
Carlos Santana’s three-run homer in the 10th inning gave visiting Cleveland its fourth straight win.
Against Pittsburgh reliever Sam Howard (1-1) in a game that had been tied 3-3 since the fifth, and with Cesar Hernandez placed on second, Francisco Lindor drew a one-out walk. Santana blasted a shot to left, his second homer, and it survived a review to see whether it was fair or foul.
Josh Bell hit a two-run double and Colin Moran an RBI single for the Pirates, who had played just two games in eight days because of COVID-19 concerns with their scheduled opponents.
Blue Jays 8, Orioles 7 (10 innings)
Toronto scored the tie-breaking run on a throwing error in the top of the 10th inning and held on to beat host Baltimore.
Lourdes Gurriel Jr. hit a shot that Orioles first baseman Chris Davis dove and stopped. While still on the ground, Davis tried to throw out Travis Shaw at the plate, but the throw was wild, and the Jays took an 8-7 lead off losing pitcher Cole Sulser (1-2).
Anthony Bass (1-0) received the win for Toronto. Randal Grichuk drove in four runs for a second straight night, including a two-run homer. Shaw hit a three-run homer and knocked in three. Anthony Santander had three hits, including two home runs, and drove in three for the Orioles.
Giants 8, Angels 2
Mike Yastrzemski and Pablo Sandoval homered, Trevor Cahill and five relievers combined on a five-hitter and San Francisco beat Los Angeles in Anaheim, Calif.
Yastrzemski led off the game with a home run off Angels starter Dylan Bundy, who has been the Angels’ best pitcher this season. Bundy (3-2) also allowed a homer to Sandoval in the second, and he was done after four innings, having yielded four runs on four hits and three walks.
Cahill, who pitched for the Angels last season, gave up a home run to Tommy La Stella in the first inning but nothing else in four innings, giving up four hits and walking one. Caleb Baragar, Sam Selman, Wandy Peralta, Jarlin Garcia (1-1) and Shaun Anderson combined to hold the Angels to one run and one hit over the final five innings to close it out.
Cincinnati’s scheduled game at Kansas City was postponed “out of an abundance of caution,” Major League Baseball announced.
The final two games of the Reds’ weekend series against the Pittsburgh Pirates were called off in response to a positive COVID-19 test that was revealed after Cincinnati’s 8-1 win on Friday. One of the Reds players tested positive.
The two-game Reds-Royals series will be contested in a doubleheader on Wednesday.