DES MOINES, Iowa (AP) — Mike Mallaro spent the better part of last year touring office… Some of our songs may be old, Joyce writes, but the technology to play together is new and I’m excited to try it. Nearly 40,000 utility customers across metro Phoenix owe cities about $14 million in past due water, sewer and other fees as of Sept. 1. Sarabeth and Amelia Irwin are believed to be the first set of conjoined twins in Michigan to be successfully separated. The market may be all over the place, but these stocks are still great long-term bets.
DES MOINES, Iowa (AP) — Mike Mallaro spent the better part of last year touring office space to lease or purchase for his growing company, VGM Group Inc., in Waterloo.
The plan was to expand into at least 50,000 square feet of additional space, with the goal of adding hundreds of employees. Then the coronavirus pandemic hit, and, as with workplaces across the country, 90% of VGM’s staff began working from home. VGM is an employee-owned company that offers professional services to help businesses grow.
As businesses reopened, Mallaro started planning his staff’s return to the office, and “came to a realization that I didn’t have before that: ‘Jeez, just about all of our jobs can be done remotely.’”
The Des Moines Register reports Mallaro’s plans to expand the company’s office space are on hold — indefinitely.
“We’re still a growth business so I believe we’ll continue to add positions, and I can’t say we’ll never need more office space,” said Mallaro, CEO of VGM Group. “Whereas I would have said by 2021 we would definitely have additional office space, now I would say definitely in the next five years we will not have it.
“We can accommodate a lot more employees without having to add space.”
As the U.S. marks the Labor Day weekend, the way Americans work is undergoing a massive change. Companies across the country are announcing plans to reduce the size of their offices in favor of a remote workforce, even if a coronavirus vaccine becomes available and other aspects of life return to their pre-pandemic normal.
The value of teleconferencing software company Zoom has increased almost seven-fold this year, and tech companies like Facebook, Twitter, Square and Shopify have unveiled plans to let a majority of their employees work from home in the long term.
So has Nationwide, which in April announced a “hybrid” model where some employees will work primarily in the office at its four main campuses, including in downtown Des Moines, while others across the country will permanently work from home.
While the insurer is planning to bring Des Moines workers back to the office, it also is shedding an entire building downtown. A majority of the five-story, 372,000-square-foot office at 1200 Locust St. — built by Nationwide just 12 years ago — is up for lease.
Nationwide will move employees into its main downtown office at 1100 Locust St. “over the next couple of years,” said Joe Case, associate vice president of corporate communications.
“This will allow us to maximize associate collaboration, ensure health and safety and be efficient with our facilities,” he said.
Nationwide employs 3,000 people in the Des Moines metro.
Commercial vacancies in the Des Moines metro have ticked up slightly in the second quarter to 13.6%, according to CBRE/Hubbell Commercial, which tracks the real estate market. Downtown vacancies are higher, at 16.1%, up from 12.5% at the end of 2019.
In addition, new lease deals are down 30% over this time last year.
Bill Wright, senior vice president and managing director of CBRE/Hubbell Commercial, said he expects vacancies to gradually increase over the next year and a half as companies continue to make decisions about the future of their workforces.
Because most companies have long-term leases in place, “We really feel as though it’s going to be a slow, more gradual increase in vacancies because, frankly, a lot of corporate office users, it’s not as though they will immediately dump space on the market,” he said.
“They’re taking this time to evaluate,” Wright said.
Should more decide to have employees work from home, it’s likely they will need less square footage in offices across the metro and in Iowa.
That change could have ripple effects: With fewer workers downtown and elsewhere, nearby stores, restaurants and coffee shops will suffer. So too will commercial property values.
“There’s going to be kind of a multiplier effect of no longer having those employees on site,” said Tracy Turner, associate professor of finance at Iowa State University.
When it became clear that the coronavirus was easily transmittable, companies around the world that didn’t provide essential, in-person services shut down their offices and transitioned to a work-from-home model.
According to a Stanford University study, 42% of U.S. workers are now working from home full time, accounting for more than two-thirds of all economic activity in the nation.
That’s up from just 3.6% who were working from home either full- or part-time in 2018, according to Global Workplace Analytics, a consulting firm that researches the future of work.
The question is how much of the work-from-home model will continue post-pandemic.
Based on how many U.S. jobs feasibly can be done from home, Global Workplace Analytics predicts 25% to 30% of the workforce — upwards of 47 million people — will be home for at least part of each week by the end of 2021.
Kate Lister, president of Global Workplace Analytics, said she believes people who were working remotely a few days a week before the pandemic will likely increase their time at home, possibly to full time. Those who were new to remote work will want to increase their proportion of at-home work post pandemic.
“The genie is out of the bottle, and it’s not likely to go back in,” she said.
Given the expected shift, Moody’s Analytics predicts commercial vacancies will reach historic highs of nearly 20% in the next two years — levels not seen nationally since the recession of 1991.
Wright said it’s unlikely the Des Moines market will see such high vacancy rates. Historically, the metro has had fewer vacancies than the national average because it’s a “more conservative market,” with less new construction and a stable workforce grounded in industries such as finance, home mortgages and insurance, he said.
“There will be space available, that’s true,” Wright said. “It’s going to take a little bit of time because you need companies to start growing again.”
For JLL Commercial Real Estate in Des Moines, 2020 was shaping up to be a record year for leasing and sales, said Justin Lossner, managing director.
When the pandemic hit, “our activity pipeline was at a record level,” he said. Many clients were looking to make “big business decisions” on expansion or capital expenditures. Now, given that real estate can account for 15% to 20% of a company’s budget, that’s on hold.
“Last year was a very strong year, and we had anticipated 2020 to be even stronger,” Lossner said.
Things screeched to a halt in March, and have slowly started to regain traction as companies look to bring employees back to offices.
JLL recently helped usher in a lease for a call center in West Des Moines for an out-of-state company that has yet to publicly announce its plans. The company didn’t reduce square footage, but it did negotiate a shorter lease — two years instead of the typical seven to 10 years for this market.
Lossner predicts that will become more common as companies face uncertain futures, particularly when it comes to their in-person head count.
As such, the Des Moines market likely will see a reduction in rents to help fill newly vacant space or encourage negotiation of lease terms, Wright said. And construction of new office space in the metro will halt in the short term, he said.
“I’d be surprised if anyone is going to come out of ground right now with spec construction,” Wright said. “It would be an extremely bold move, and you’d have to have a lender on your side saying ‘go, go, go.’”
But as far as shedding existing swaths of space, local experts say publicly that’s unlikely to happen on a large scale in the metro. At least, leaders are reluctant to share plans or are taking their time to make a final decision.
Local companies, especially, like having the brand recognition that comes with having a physical location, Turner said. Quite often, they occupy landmark buildings from which their departure would have broad consequences for the community — and many understand that.
Mallaro, the CEO of VGM Group, said his employees have expressed interest in a hybrid model, working in the office a few days a week and at home the others. They have particularly mentioned child care and online education as reasons to stay home.
Others want to leave behind their commute — about a third of VGM’s 1,000 employees live in small towns about 30 minutes outside Waterloo.
“For them to not have to drive that, it matters,” Mallaro said.
Author: KIM NORVELL
Join the New Horizons Band online to get yourself through ‘a bad fall and a bad winter’
And the band played on…
A venerable and all-round classy guy, Dr. Fauci said this past week, “We need to hunker down and get through this fall and winter because it is not going to be easy.” If the concept of hunkering down puts your mind in a dark place, here is the light that you need: music. More specifically, the New Horizons Band. Of course, we can’t meet in person and blow ourselves silly in the Senior Center. What we can do is utilize a program called SmartMusic along with Zoom to gather virtually and play together even though the only one actually hearing you play is you. There is real beauty in that. If you have ever wanted to join a band but felt that your skills were too rusty, this is the perfect time to get back in the game.
Here’s the plan: We meet on Tuesday and Thursday mornings at 9:30 a.m. as a large group on Zoom. There is also a Monday night rehearsal for more beginning musicians and for those who work. For Zoom, you need a device such as an iPad or an iPhone, something with sound, and a camera. Then we are led by our conductor in the SmartMusic program, where your music is on your computer screen (that’s the second device you need — a computer or large screen device with sound) and you follow the notes as they light up. Can’t keep up? You can slow the music down for practice. Halfway through rehearsal, we hope to have a short break-out session, where people are randomly thrown into a chat group to get to know each other better.
I confess to being a technophobe and the thought of this working for me when I push computer buttons is daunting. The good news is most of us feel that way. Our band started this past Thursday just with Zoom because we don’t yet have a SmartMusic license. If you think you would like to join us to lighten up “a bad fall and a bad winter” (Dr. Fauci again), just google Iowa City New Horizons Band and check out our website, IowaCityNHB.org. On the homepage, it says the band “will encourage entry-level group-music opportunities for members and nonmembers alike.” The founder of New Horizons Band, Roy Ernst, says that “anyone can learn to play music at a level that will bring a sense of accomplishment and the ability to perform in a group.” Also, “the style of instruction must be completely supportive and free of competition and intimidation.” Ready to play? Email me at [email protected] with your name, instrument, contact information and any questions and we’ll add you to the mailing list. Please do this soon because the license needs to approximate the number of players.
Last Sunday, Psalm 40 was read, but this is what I heard: “I’ve been in the pits, wanting help, and help came to me. From my mouth now comes a new song.” Some of our songs may be old, but the technology to play together is new and I’m excited to try it until it works for me and for the whole band.
Joyce Marner plays flute in New Horizons Band. She coordinates the weekly community music column. If you would like to participate as a columnist please email her.,
2 metro Phoenix cities will resume shut-offs for delinquent utility customers. Here’s a rundown by city
Nearly 40,000 people in the Phoenix area are behind on utility bills, according to cities.
The 38,840 residential and commercial customers across the Valley owed about $14 million in past-due water, sewer, solid waste and other city fees as of Sept. 1.
Residential customers make up the bulk of delinquent accounts.
The number of delinquent customers isn’t significantly higher than before the novel coronavirus pandemic — some cities actually reported fewer delinquent accounts than the same time last year — but the amount owed and the length of time accounts have remained in the red has climbed, municipal utility officials said.
Almost all metro Phoenix cities halted water and other utility shutoffs in March, although past-due balances continued to accumulate.
Now, as the money owed continues to rise, at least two Valley cities will reinstate disconnections as a means to collect on bills.
Mesa, which has offered a utility assistance program for months and will continue to work with customers to set up payment plans, will reinstate disconnections on Oct. 1.
Scottsdale will follow suit in November.
Other cities are holding off for now but encouraging customers to reach out for assistance so that they can chip away at the amount owed before disconnections resume.
“No one really wants to be the first person to start disconnecting,” said Dawn Lang, Chandler’s management services director. However, she said at some point cities will have to recoup some of the money owed or face long-term impacts on water services.
Among the Valley’s two largest electric providers, Arizona Public Service will halt power shutoffs through the end of the year while Salt River Project will resume shut-offs on Oct. 1 if customers don’t follow through on repayment plans spread over eight months.
Nearly 9,240 delinquent household utility customers in Mesa owed a total of about $3.8 million as of Sept. 1, according to spokesperson Kevin Christopher. Mesa bills customers for water, sewer, solid waste, gas and, in some cases, electric.
Beyond residential, 350 commercial accounts owed $551,654, he said.
The city suspended disconnections on March 9 but will resume enforcement for nonpayment on Oct. 1. Not all of the past-due customers are on the brink of shut-off as accounts must be 15 or more days past due with a balance greater than $150before the city moves to disconnect.
Christopher said utility employees are reaching out to the customers with past due accounts to inform them of three options they must pursue by Oct. 1 to avoid having services turned off:
- make a payment.
- make a payment arrangement.
- apply for utility assistance.
“We’re very concerned about what’s going to happen come Oct. 1 and into the fall as we have to start shutting off utilities, as SRP starts shutting off the power,” City Manager Chris Brady has told The Arizona Republic.
Brady said the city would rather residents come in for aid or a payment plan, but he said a large number won’t do anything until their accounts are actually shut off.
Mesa set aside $8 million in federal coronavirus relief aid to provide utility assistance to residents but so far little of the money has been disbursed. The city expects applications for assistance to increase as residents face looming payment deadlines.
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Residents can apply for help through Mesa Community Action Network.
Scottsdale will reinstate disconnections on Nov. 1 on accounts that have a past due balance for more than two billing cycles.
The city suspended disconnections in March and waived late fees during the public health crisis.
There were 1,422 delinquent residential accounts owing $335,581 and 160 commercial accounts owing about $547,952 as of Sept. 1, said spokesperson Kelly Corsette.
Scottsdale is offering financial assistance to customers who have been impacted by the pandemic. City employees are connecting customers seeking assistance to the city’s Human Services Vista Program and nonprofits for help.
Customers who don’t qualify for aid can set up payment plans, Corsette said.
Avondale, one of the only Valley cities that did not suspend water shut-offs during the pandemic, has been working with customers to set up payment arrangements. The city is referring struggling residents to the city’s Neighborhood and Family Services Department for aid, the city said.
Avondale had 116 delinquent residential accounts and 11 commercial accounts that owed around $49,100 as of Sept. 1.
Other Valley cities have not set dates to resume disconnections.
Many are encouraging customers to reach out to work out a payment plan. City employees are helping connect customers with financial hardships because of the pandemic to nonprofits and other agencies that can provide aid.
Chandler is starting to send soft notices to customers whose balance is more than $150 and two months overdue to encourage them to contact the city before the situation worsens.
Chandler had 4,557 household accounts and 171 commercial accounts with overdue balance totaling $1.5 million as of Sept. 1, according to the city’s Utility Services Division.
Utility employees are working with the city’s Neighborhood Resources Department to provide customers with information on financial assistance. Staff also is working with customers to establish flexible payment plans.
“We certainly want to be very sensitive to what’s happening with our residents in our community,” Lang said. “We’re looking for ways of trying to help.”
Gilbert similarly is reaching out to customers to encourage minimum payments, if possible, so that the amount owed doesn’t keep growing. The town had 1,134 residential accounts eligible for disconnection as of Sept. 1 and customers owed anywhere from $200 to $1,000, said spokesperson Jennifer Harrison.
Harrison said town officials are working to determine when normal operations will resume. Disconnections likely will resume in late fall but the town will be flexible and offer payment plans, she said.
In Surprise, utility employees will work with customers to set up payment plans when shut-offs resume. A date for when that will happen hasn’t yet been set.
“This practice is really no different than how the city of Surprise has always worked with customers,” Aisha Alexander, a city spokesperson, said. “As long as our customers work with us, we work with them and won’t disconnect their water service.”
The city recently set aside $15,000 in coronavirus relief funding to provide water utility assistance to customers.
Glendale does not plan to begin disconnecting water services on the nearly 2,000 delinquent residential accounts until temperatures cool, said spokesperson Jay Crandall. The city actively contacting customers to collect payment, however, and working to establish payment plans before disconnections resume, he said.
The city’s Water Services Department set aside $50,000 for utility assistance payments for qualified customers and city employees are helping connect customers to other help, Crandall said.
Phoenix is permanently eliminating water shut-offs for single-family residential customers.
The city had temporarily halted disconnections in March and has been working with customers to arrange payment plans.
Customers who couldn’t be reached or didn’t agree to a plan were put on a low-flow plan that provides enough water for basic sanitation and cooking.
The low-flow plan grew out of a water equity initiative led by a citizen’s advisory board and the city had begun implementing the plan even before the pandemic, said spokesperson Athena Sanchez.
On Wednesday, the Phoenix City Council unanimously agreed to approve a change to the city’s water code that makes the practice permanent. The code change allows utility workers to install the low-flow devices at single-family homes with delinquent accounts rather than face disconnection.
All other utility customers — including those in apartment complexes — still will be subject to disconnection.
Phoenix had 8,884 residential, commercial and industrial delinquent accounts owing $3.4 million as of Aug. 27. The majority — 8,479 — were residential accounts.
Sanchez said the city doesn’t have a timeline for when disconnections for customers not in single-family homes will resume. Prior to the pandemic, customers who owed more than $75 for more than two billing cycles could have services shut off.
Phoenix is offering financial assistance through its Project Assist program, which is administered by the Human Services Department.
The city also set aside a portion of its coronavirus relief funds for utility assistance and qualified residents can receive a one-time, $300 grant to pay utilities. Outside agencies are handling grants and more information can be found online.
Other utility providers also are trying to help customers during the pandemic.
Arizona Public Service, one of the largest providers of electricity in the state, announced on Tuesday that it would extend its suspension of disconnections for past due bills to both residential and commercial customers through the end of the year.
The company will continue to waive late fees, too.
“APS wants to ease the burden for those struggling to pay their electric bills,” the company wrote on its website.
APS suspended disconnections and waived late fees in March because of the pandemic. A state-mandated hold on disconnections for residential customers during the summer went into effect on June 1 but was scheduled to expire on Oct. 15.
APS is encouraging customers to reach out to set up payment plans or to see if they qualify for financial assistance.
Salt River Project, the other large electric provider in the Valley, will resume power shutoffs on Oct. 1 for both residential and small-business customers. SRP, which is considered a political subdivision in Arizona, is not required to follow the state-mandated hold on disconnections during the summer.
SRP customers with a past due balance of $80 or more who aren’t on a payment plan will be automatically enrolled in an eight-month plan, according to the company’s website. If customers fail to follow the plan their power could be shut off.
Reach reporter Paulina Pineda at [email protected] or 480-389-9637. Follow her on Twitter: @paulinapineda22.
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Rare conjoined twins, born locked in embrace, successfully separated in Michigan
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.
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.
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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.”
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.
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“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.”
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.
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.
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.
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“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.
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 cardiothoracic team 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.
3 Tech Stocks to Buy in the Market Correction
The stock market has been a bit disconnected from the U.S. economy as of late. The economy is still reeling from the effects of the coronavirus, resulting in an unemployment rate of 8.4%. And yet, the S&P 500 has gained more than 12.5% over the past 12 months, driven mostly by tech stock gains.
But with the economy and the stock market out of sync, some investors wonder if another significant market correction — like the one we saw back in March — is around the corner. If, and when, that happens, a few Motley Fool contributors have put together a list of a few companies you may want to buy. Here’s why Roku (NASDAQ:ROKU), Slack Technologies (NYSE:WORK), and Fastly (NYSE:FSLY) make the cut.
Image source: Getty Images.
Danny Vena (Roku): Streaming services are everywhere these days, and it seems as though new ones are popping up every month. Not only that, but existing services are expanding their offerings to bolster their chances of standing out in the crowd. The battle for eyeballs is relentless and content takes center stage, with spending skyrocketing to feed consumers’ insatiable appetite for programming.
Roku has taken a different path by providing a platform where viewers can aggregate all their viewing choices in one place. The company offers thousands of apps including subscription services like Netflix, Amazon’s Prime Video, and Walt Disney’s Hulu and Disney+, as well as niche, ad-supported services including anime kingpin Crunchyroll, British programming from BritBox, variety movies and series from Viacom’s Pluto TV, or horror classics from AMC Networks’ Shudder. By being an agnostic one-stop shop, it can cater to the programming needs of a broader base of viewers.
Another prong in Roku’s strategy takes a page from Netflix’s playbook, by making its offering ubiquitous. Not only is the platform available on the company’s namesake streaming devices, but is also found in a growing number of smart TVs. Roku developed a smart TV operating system (OS) from the ground up that was specifically designed for the task, rather than using a repurposed mobile app. The company licenses the Roku OS to smart TV manufacturers who don’t want to reinvent the wheel. That strategy was so successful that one in three smart TVs sold in the U.S. and one in four sold in Canada in 2019 contained the Roku OS, boosting the company’s large and growing user base.
Roku’s approach is paying off in droves, as evidenced by its recent operating metrics. In the second quarter, the platform’s active accounts climbed to 43 million, an increase of 41% year over year. Even more importantly, viewers are more engaged than ever, with streaming hours of 14.6 billion vaulting 65%. At the same time, the average revenue per user continued to trudge higher, hitting $24.92, an increase of 18%.
These achievements are the foundation for Roku’s impressive financial results, even as the uncertainty resulting from the pandemic caused many marketers to cut back on advertising — which represents the lion’s share of the company’s revenue. Overall, total revenue of $356 million grew 42% year over year — in spite of the significant pullback in advertising. Its platform segment, which includes advertising, The Roku Channel, and its OS licensing, is growing at an even faster pace, up 46%.
Roku’s performance since earlier this year shows why investors should buy during a correction. After losing 42% of its value during the pandemic-induced slump, the stock has come roaring back, soaring 123% since bottoming in March. Roku’s impressive results show it will take more than a little market decline to stop this company’s growth.
Image source: Roku.
Brian Withers (Slack): A combination of what many viewed as a disappointing second quarter for Slack and the market pullback in tech stocks have pushed Slack’s shares down more than 30% from their high earlier in the year. With its valuation edging close to its all-time low, the company is providing patient investors an opportunity to buy the team collaboration platform at a discount. Let’s look at why you might want to join in.
There’s no doubt the coronavirus has been a double-edged sword for Slack. On the one hand, it has attracted twice the number of customers (20,000) in the first six months of this year than it did the previous six months. But its year-over-year billings growth, an indicator of new and existing customer growth in future contract value, dropped by half this quarter (from 52% to 25%). This is due to $11 million in year-to-date billings concessions to COVID-19 impacted customers and a trend of reduced contract lengths because of economic uncertainties. This reduction in billings growth spooked investors and overshadowed the company’s positive news.
Revenue grew 49% year over year in the most recent quarter that ended July 31, 2020. That’s not the growth of Zoom Video Communications, but it’s quite impressive given the current economic conditions, and it’s the first in a long list of key metrics that shined in the quarter.
Operating cash flows have improved 7 percentage points year over year to 7% of revenue and the balance sheet sports a solid base of $1.5 billion in cash and marketable securities. This cash hoard and positive cash flow will enable the management team to continue to invest heavily in growth efforts. Remaining performance obligations (RPOs) are at a record high of $388 million, an 80% year-over-year gain. RPOs represent what customers still owe on contracts that are longer than 12 months.
Large customers with greater than $100,000 in annual contract value grew 37% year over year.This is despite headwinds of reduced net dollar retention of 125% (down from 136% in the second quarter of 2020) and 50 customers dropping out of the $100,000-plus spending category this quarter due to reductions in their staffing. These big customers are becoming more important to the company, as they make up 49% of revenue, up from 43% in Q2 last year.
Finally, customers using Slack Connect, a feature that allows shared communications channels between companies, have grown 37% year over year to 52,000 organizations. Its massive network of 380,000 Slack Connect users is becoming a valuable marketing funnel to introduce new customers to the massaging platform.
With millions of workers trying to collaborate with a much-hated and antiquated tool called email, Slack has a tremendous runway of growth. The recent pullback in the stock gives investors a great opportunity, too. Don’t miss out.
Image source: Getty Images.
Chris Neiger (Fastly): Tech investors have been drawn to Fastly this year, but if you’ve never heard of the company, don’t fret — it’s not too late to benefit from this company. Fastly’s technology helps companies speed up their websites, apps, and videos (hence the “fast” in Fastly) and the company is growing like gangbusters.
In the second quarter (reported on Aug. 5), Fastly’s revenue grew 62% to $75 million and adjusted earnings per share were $0.02. Both of those figures easily outpaced analysts’ consensus estimates for the quarter. Additionally, Fastly improved its gross margin to 61.7%, up from 55.6% in the year-ago quarter, and the company added 114 new customers.
Fastly has experienced this tremendous growth as companies are looking to make their online offerings even faster and more reliable during the coronavirus pandemic. The lockdowns from a few months ago and the millions of workers now doing their jobs from home means companies are looking for any way possible to make online experiences the best they can be. That’s why it’s no surprise that Slack, TikTok, Shopify, GitHub, and Pinterest all look to Fastly to improve their online user experiences.
Slack’s share price is up 187% over the past 12 months, which is actually down from some of its meteoric highs from just a couple of months ago. But investors need to keep a long-term perspective with this stock. The company already has an impressive list of customers and it’s continually adding more. With the coronavirus forcing many people to work online more than ever before — and to spend more of their leisure time online, too — Fastly will likely continue to be a go-to service for many companies.
The market may continue to be volatile as the U.S. economy tries to find its footing in the coming months, but investors should remember that Fastly is already firmly established in its niche. The company will likely continue growing in the coming years and bring investors significant gains as it does.
Author: Chris Neiger, Danny Vena, and Brian Withers