With their feet dangling in a tub of colorful balls, 2½-year-old twins Mohamed and Ahmed Ibrahim delight in sending a batch flying as they kick them away.
Smiling and laughing, the boys who were born conjoined at the top of their heads now move and play on their own, oblivious to the approach of a happy milestone: It was four months ago Thursday that surgeons gave them the chance to live separate lives.
“Every day they do something they didn’t do before,” said Linda Biesanz, one of the boys’ therapists.
The boys, born in a small Egyptian town on June 2, 2001, were separated Oct. 12 at Children’s Medical Center Dallas during a 34-hour surgery. About a month after the surgery, the boys returned to North Texas Hospital for Children at Medical City, where they had lived since arriving in Dallas in June 2002.
Exploring on their own
When conjoined, the boys would throw their arms over their heads to touch and communicate with each other, since they couldn’t look anywhere but up or down. Now, Ahmed and Mohamed can see each other face-to-face.
In an afternoon therapy session filled with singing, clapping and laughing, Ahmed tries out some tasting — first a green sucker, then a dry cracker, which he skeptically rolls around on his tongue. Out in a hallway, Mohamed is ready to move. With the help of a walker and leg braces and a therapist, he takes step after step, happily kicking a colorful toy car in front of him with his bright blue sneaker.
“Now that they’re not limited by being attached, they can explore and learn on their own,” physical therapist Jacob Makkappallil said.
Both boys are weaker on their right sides after the surgery, so that is one of the things therapists are working on, along with helping them learn to be normal kids.
“All of us are trying to get them to talk like children their age and eat and play with kids their age,” Makkappallil said.
The boys — who know words in English and Arabic — are quick to repeat words and sing along as therapists break out into songs like “Row, row, row your boat ...”
The boys’ ability to recover from such an invasive surgery was possible because of their young age, said Dr. Kenneth Salyer, the craniofacial surgeon whose non-profit group, World Craniofacial Foundation, brought the boys to Dallas for the surgery, which took a year to plan.
The risk of brain damage was a concern, but the twins appear to be doing well — “intellectually, totally with it,” he said.
“The boys are making progress on a daily basis, certainly on a weekly basis and they’re doing extremely well,” Salyer said.
While each day brings a new development, one thing that hasn’t changed is the boys’ personalities, said Ibrahim Mohammed Ibrahim, the boys’ father.
Mohamed is still the go-getter, more willing to jump in and try something new. Ahmed, the philosopher as he’s called, is more cautious, observing and watching before trying something new.
“Ahmed is very quiet and he doesn’t give us a hard time,” Ibrahim said through a translator. “Mohamed, he’s a very active boy. We have to watch for him all the time. We wait for him to go to sleep and we all relax.”
Mohamed now walks with assistance and sits up on his own. Ahmed, who had a shunt placed into his brain to drain fluid, was slowed by that and a few other minor surgeries. He is working on sitting and standing.
The boys face another surgery in about six months to reconstruct their skulls, Salyer said. The replacement skulls will be built using bone that will act as a framework and help stimulate the boys’ bodies to create new bone.
For now, their brains are covered by layers of tissue and skin and lots of curly black hair has sprouted. Ahmed is even regenerating some bone on his own, Salyer said.
After their skulls are replaced, they should be able to return home to Egypt, possibly sometime this year, Salyer said.
Meanwhile, the boys — who both are fed through stomach tubes — spend their days in physical and speech therapy. Their parents and 5-year-old brother Mahmoud join them, offering encouragement and help. Seven-year-old sister Asma stayed behind in Egypt with relatives, since she was in school.
The boys’ parents say as they watch their children develop and learn, they know the risk they took in separating them was worth it.
“When I look at them, I feel like I’m going to cry from happiness,” said their 24-year-old mother, Sabah Abu el-Wafa.