Dec 14, 2008 - 04:05:35 CST
Abby and Maddy Fitterer are small, pink whirlwinds.Though colds kept them - and their mother - from sleeping the night before, they launched their petite selves through 45 minutes of physical therapy on Thursday at Medcenter One in Bismarck.
The girls have physical therapy there twice a week with therapists Jackie Mrachek and Dannette Huber, and once a week at BECEP. Mrachek and Huber take the twins through a series of exercises designed to strengthen the little girls' torsos, which is where they were conjoined before their separation in January 2007 at Mayo Clinic in Rochester, Minn.
Born Aug. 8, 2006, to Stacy and Suzy Fitterer of Bismarck, Abygail and Madysen were conjoined for six months before their separation surgery. Because those months prevented the girls from going through the typical physical development, they both need strengthening exercises to develop that core, which provides the stability for the rest of their little bodies, Mrachek said.
Mrachek said their progress has been phenomenal. Suzy Fitterer agrees. They don't just walk, they scamper.
Furthermore, Maddy has come up with a clever solution to getting regular timeoutsfor plucking off Christmas ornaments at home: Put your hand inside your green cloth frog's head and have him "mouth" the ornaments off the tree.
Big brother Nick, who is 4 - "and-a-half," he adds - accompanies Suzy and the girls to the therapy sessions; dad Stacy Fitterer is a math teacher at Mandan High School. Nick is an amazing big brother, Suzy said; he's very sweet, very gentle with his little sisters. She and Stacy make sure that Nick gets his daily "alone time" with them, as well as with his grandparents, she said.
Mrachek and Huber began seeing the girls in February 2007, about four weeks after they returned from Mayo Clinic, at the Fitterers' home for the first year, and now at the clinic.
"Our roles as therapists is to create a fun environment," Mrachek said, a place where the girls are eager to come.
The 45 minutes go fast as the two physical therapists, assisted by aide Monica Yundt, ramp up their energy level to meet the girls'. Abby and Maddie lie back on large inflated balls to touch the exercise mat. Bringing themselves back up works those trunk muscles, as does leaning side-to-side to pop the bubbles Yundt blows. "Swimming" in the plastic ball pit and balancing on the big orange cylindrical "horse" gives the same benefits.
Mrachek, PT/DPT - physical therapist, doctor of physical therapy - said that the girls no longer need occupational therapy, which works mainly with fine motor skills. Physical therapy has focused on gross motor skills: sitting, crawling, climbing stairs, hopping, anything that strengthens the trunk.
Since they are missing a sternum, working on that trunk strength will give them a stable core to develop from, she said.
The asymmetry of their bodies means they have some weakness; Abby has a right "tilt," Maddy a slight left tilt, she said, due to how they were positioned in utero and conjoined for their first six months, Mrachek said.
"They've made amazing progress for two kiddos who, from August through January (2007) were conjoined at the trunk,"she said. For them to be at this stage of development, ambulating as they do, is phenomenal, she said.
In the months of working with the twins, their therapists have gotten to know each personality. Maddy is meticulous; Abby's a climber and a risk taker, Mrachek said. Both of them are users of the phrase, "I can do it myself," she said.
It's a blessing that both of them are go-getters, she said; "that's gotten them to where they are today." She gives their parents credit for not holding them back, for encouraging the girls to go for it, whatever the challenge might be.
Of her and Stacy's goals for the girls, 75 percent to 80 percent have been met, Suzy Fitterer said. They had just hoped the girls would walk by age 2, and they've come so much farther than that. Next milestone - potty training, she said.
Like any parent of three lively young children, Suzy said by 5 o'clock, when Stacy comes home from work, she's ready to turn over the reins for a while.
But whatever the energy and patience required, life is good: The girls are here, they're happy and growing and bright.
The Fitterers have adjusted to the fact that they're going to be the center of attention most places they go. When Suzy Fitterer eventually snags all three in one location after the therapy session is over, she zips up coats and gets the girls in their double stroller. The stroll out of the clinic becomes stop-and-go, big brother Nick leading the way, as people lean down to coo and smile at the girls.
The stroller full of pink - coats, pants, shirt, shoes, pigtail holders and blanket - trundles down the hall on the way out to the car, to back home and, Suzy Fitterer hopes, a nap.
As they approach the Christmas tree in the hall, glittering with stars, Suzy Fitterer slows down.
"Say 'Merry Christmas' to the tree," she says.
Two little hands reach out of their pink parka sleeves toward the starry tree.
"Merry Christmas," they say.
(Reach reporter Karen Herzog at 250-8267 or karen.herzog@;bismarcktribune.com.)
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