Monday, January 25, 2010

Our NICU Experience Part I

January 25, 2010
Drew's labs continued to show signs of infection this morning and it was decided that they would perform a lumbar puncture, spinal tap, to examine his spinal fluid for bacteria. They assured us that they would use a local pain med and that because he was so young he wouldn’t remember a thing. They would wait a few hours to perform the procedure. His breathing had been fine during the night so they decided not to administer the surfactant. We were both happy about that. The happiness didn’t last long. Later in the morning the Nurse Practitioner felt that Drew was having a harder time breathing and ordered a chest x-ray. The film showed that there were pockets in the lungs where the alveoli weren’t open. They would want to intubate him for about twenty minutes while they administered the surfactant to each side of the lungs. Our nurse for the day shift told us she thought it would have been better for him to have had the procedure the night before because often times it will help immensely with the babies breathing. Since they don’t want to stress Drew out too much they would postpone the spinal tap till tomorrow. Michelle’s mom came to visit while we waited for them to start. Glenn was on his way in the hospital when they started. They thought it best for us to leave. After it was all complete they allowed Glenn and I to give Drew a blessing. Last night we decided on Drew’s middle name. He will be called Andrew Rawson Cardon. Rawson is my Grandpa Gaisford’s middle name and his mother’s maiden name. We both think it fits. After the blessing we let Drew rest since he had been through a lot. The rest of the night we just sat around.

January 26, 2010
This morning Drew is breathing better than before. The treatment must have worked yesterday, but he is still on the CPAP. We hope not for much longer. Today they will perform the spinal tap. I know how hard it can be for a practitioner to do a good job on an adult and am scared to think how much harder it is on a baby. We must have confidence in those taking care of Drew and hope that they know what they are doing. While they perform the procedure we will take a break and hang out upstairs in Michelle’s room. When we returned from our break Drew looked peaceful. He only had a small Band-Aid on his back and the nurse said they only had to poke him once. I guess we will just have to believe them. After a few hours Drew’s preliminary CSF results came back. They looked good. The graham stain was negative and there were no white cells in the fluid. We will have to wait another two days before we are sure it is clear for bacteria. Even if there is no infection in his spinal fluid he could still have it somewhere else in the body. You never know what is going to happen. We can just hope for the best. Drew is being a trooper and we know he will be a strong one if he can get past all of this. He has been such a good baby and rarely cries at all. We still can’t believe he is ours. Both of us need our rest, because I have to be up so early Michelle told me to go home and get some good rest. I will just be a few buildings down from her tomorrow at work.

January 27, 2010
So today was a bad, but very good day. Michelle spent several hours watching while they poked Drew 10 different times to start an IV. Then on top of that some labs improved, but others continued to make them think he might have an infection still somewhere in the body. Because he had bowel loops they thought it could be the beginnings of Necrotizing Enterocolitis, which we do not want. I had tried calling Michelle earlier in the morning, but she didn't want to leave his room to answer the phone. A few hours later she texted me wondering if I was coming to visit, I did during my break. Michelle was a little upset over the whole situation. I returned to work only to be told by my co-workers that I should just leave for the day and I returned to Baby Drew. In just about the 45 minutes I was gone they were less concerned about the infection, decided to remove the CPAP, put him on a nasal canula, insert a PICC line, and begin to start his feedings all throughout the afternoon and evening. To add to the good news, Michelle was discharged from the hospital and we were about to go home for a few hours and eat, thanks to some ward friends, and Michelle took a nap. We are now back with Baby drew for a little while. He is doing really well and at this moment he is laying skin to skin with his mommy in Kangaroo time. He loves it so much. We hope you really enjoy these pictures, because we begin to see his face a little more. He had his eyes open for almost an hour and it was so cute. Thanks for all of your prayers and concerns. We won't complain if they keep coming.

January 28, 2010
When we got in this morning the nurse said he had done really well during the night. We missed being able to take his temperature and change his diaper, but I was able to hold his syringe while we fed him 7ml of Michelle’s milk. She is a champion pumper. To help him associate this time with real feedings we gave him a binky at the same time. He sucked on it really well and he held my finger almost the whole time. His labs continued to improve this morning so during morning rounds they discussed taking him off of the bilirubin lights and also decreasing his oxygen flow from 4 to 3. After we had lunch the Respiratory Therapist came in to change his oxygen flow down and we stopped his bili lights. During his afternoon feed, he was wide awake and stared at Michelle and I the whole time while we held his little hands. The nurse, Jennifer, was nice enough to take some pictures for us. We loved it and so did he. Tonight while Michelle finished having fun with her friends, I got to do all of his p.m. cares (diaper change, temperature check, feeding gauvage style). It was nice to have some time with him. Later on Michelle came back and he had some labs drawn, but then I was able to have my Kangaroo time with him for an hour. It was great, except for his dried out umbilical cord pressing into me. By the time I was done it was time to do his midnight cares and feeding, he’s up to 11 ml, and then off to bed for me and Michelle. All in all it was a good day.

January 29, 2010
Today Michelle and I slept in. I actually woke up before her to take care of some bills and finances. I was surprised she could sleep in so long, but it was some much needed rest. We hurried to get ready so we could be there for his noon cares. We made is just in time and the nurse had some really good news for us. He had handled his oxygen really well through the night so they moved the flow from 3 to 2. With that adjustment they decided they could start doing non nutritional breast feedings. That means Michelle would pump first and then have him latch on so that he didn’t get any milk. This helps him adjust to and practice sucking and breathing at the same time and get use to Michelle. His cares went well as usual. He always does better when we are close to him. After his 3pm cares Michelle attempted to do non nutritional feedings. He had been sleeping and didn’t want to latch on. There was a little crying involved, but in the end he just ended up being held. He might not be ready for that just yet. For dinner Michelle and I walked to Costco and got some pizza and then decided to buy a camera since we had been borrowing one from our friends (Matt and Vicki if your reading this we hope to be giving it back this weekend once we exchange the one we just bought today for the better one). When we returned I noticed they had turned his oxygen flow back to 3. He had had some troubles with the level 2 and since it had been a fast transition down felt good about the transition back up. After returning from a break at home we came back for his 9pm cares. He was doing very well and was wide awake. I changed his diaper once again and it was poopy. I always seem to get those ones. His feedings are now up to 16 ml and he’s still holding strong, in fact he is now 1860 grams (about 4 lbs 1 oz) when he was originally just 1790 grams (about 3 lbs. 15 oz) at birth. At this rate he might be a football player. It was hard to leave him, but at least he looked very comfy all wrapped up as we left. I hope he understands that we need our sleep too.

January 30, 2010
We actually got up in time for his 9 am cares. While Michelle was pumping I took a trip to Costco to return our new camera from yesterday with a different new camera. They gave me a little hassle because Michelle wasn’t present, but none the less I was able to purchase it. After I got back Michelle’s parents stopped by. Michelle was trying to do non nutritional feedings with Drew. She held him like a football and he handled it much better, but still didn’t do much sucking. The nurse practitioner decided that even though he was still on an oxygen flow of 3 she could continue with those feedings and also increase holdings to twice a day. They even discussed moving him out of his incubator and putting him in an open basinet. Michelle was very happy as was I. After a visit with the parents Michelle and I took a lunch break along with Tina, her sister, who was doing some clinicals in the Neuro ICU. We had a great chat. At Drew’s 3 pm cares I was able to dress him in his first outfit. He looked pretty good except for the arm with the PICC line that has to stick out of the clothing. With little time to spare, we then took another break and joined Grandma and Grandpa Woolley, and their friends at the Hale Center Theater. We had bought season tickets with the group and were excited to join in on this tradition that has lasted over 30 years. After the show we went to a diner off of State Street for some dinner. As we returned to the hospital we were glad to see that a basinet was placed next to Drew’s incubator all ready for him to use. He had been bundled up really tight and when we took his temperature he had maintained his temperature quite well. Michelle tried her non nutritional feeding again and Drew was a champ. He was actually sucking this time and it lasted for at least ten minutes. The nurse was both surprised and impressed. We were proud of him. At the same time we fed him his 20 ml of breast milk. He is moving up so fast on his feedings and all of the milk is paying off. When we weighed him tonight he was 1910 grams. That is 4 lbs 3.5 oz. He is getting bigger and bigger every day. By next week he could be five pounds. The best part of the evening was for me to be able to hold him again. The last few days Michelle has been the only one to hold him since he was only given one holding a day. He was very happy to be with daddy. Once again the night came to an end and we had to re-dress him, wrap him up, and place him in his new open basinet. He loved it so much. He had a very good day. We are so proud of his progress.

January 31, 2010
Michelle tried non nutritive breast feeding again during his 9 am cares. He didn’t take quite as well as last night, but he tried. Later in the morning we were able to take the sacrament just down the hall from the NICU. They have couples called to do this service for both employees and patients/parents. During morning rounds they decided to change his flow from 3 to 2.5, along with that he is now able to be held during each feed. That means if we stayed for 24 hours we could hold him 8 times a day, but we are usually only around for 4 to 5 of those times. It is just great to have the chance to hold him. His temperature continues to hold strong in the open basinet and he is already bigger than some of the preemie clothes they give us to dress him in (length wise that is). His feeds are continuing to increase. By tonight he will be on 26 ml of breast milk and they are also considering changing his fluids from TPN to a regular IV fluid by tomorrow. At this rate he will be on full feeds and off fluids by Tuesday. After his 3 pm cares we went to Rachael’s apartment for dinner and then brought her and Steve back to see Drew. They got to see me in action while I took his temperature, changed his sat probe, changed his diaper, and all of his clothes and blankets. They said I was a pro. Drew’s 9 pm feeding was another try at non nutritive feeding. He seemed a little more tired than usual and just latched on without much sucking. They say this can happen when he has to start using more energy to keep his body temp up. Now that he’s not in the incubator they used a portable scale to weigh him. We were afraid that maybe his weight would go down because the differences in scales, but he surprised us. He is now a whopping 1925 grams (just shy of a full 4 lbs 4 oz). When it was time to feed I got to hold him. We, me and him, liked it very much. At the end of the night, when it was time to go, we put him back in his basinet and his stomach was very, very, very full. So full he had difficulty breathing, but before we left his vitals looked good. The nurse is going to try him on a flow of 2 for his oxygen during the night. We hope he does well. It is hard to leave him at night, but we are amazed at the progress he makes each morning when we return.

February 1, 2010
This morning the nurse told us that Drew had a little green emesis in two different spit ups. He spit up about 4 ml of his meal after we left last night and had a lot of air in his stomach. They decided to take an x-ray of his stomach, but everything looked good. When the nurse practitioner came by she said they weren’t really worried about it because it looked light in color and milky and everything else looks really good. His non nutritive feeding went about as well as yesterday, a lot of latching on, but only a little sucking. Because of his possible reflex last night they had decided not to move him down to a flow of 2, but this morning during rounds they decided he was ready and as of now he is handling it like a champ. No doubt he’ll be at a 1.5 tomorrow. They also increased his feedings once again. By 6pm he will be getting 31 ml of breast milk which is just over an ounce. They also just brought out his new IV fluid and will take him off of the TPN and lipids later tonight. It looks like he will reach full feeds by tomorrow based off of 150 Kcal per Kilo. Our family friend, Toodie, stopped by the hospital for a short visit. We appreciate everyone’s thoughts and concerns. Drew continues to control his own temperature, all day he has been around 37.2 -.3 degrees Celsius. We may have one too many blankets on him. I am sorry to report that tonight Drew lost weight. He ended up being 1890 grams (4 lbs almost 3 oz), but he working on learning to do a lot of things himself. Michelle had another opportunity to non nutritive breast feed and this time it went great. Before she even started he was trying to put his whole hand in his mouth. He was wide awake and loving it. He kept sucking away for at least 20 minutes. Since we didn’t want him to use too much energy we decided to just let him lay down while he was fed. I have to go into work tomorrow, but hope to be done before his 3pm cares. Then I have another seven days off. I appreciate the support of my work for giving me five days off this past week. I appreciated it and I know Michelle especially has. It will be fun to find out all the changes they might make to his care tomorrow morning. It will be nice to have fewer and smaller tubes coming out of his body. We will see what happens.

February 2, 2010
While I was at work Michelle kept tabs on baby Drew. He non nutritive breast fed once again like a pro. Maybe he did it so well because he knew it could be his last chance before the real deal. During morning rounds they moved him up to full feeds, 36 ml. That would mean no more IV. They also changed his flow to 1.5 from 2 with a possible change to 1 later in the evening. With the full feeds and the lower flow Michelle was told she could start actually breast feeding. Before any attempts Michelle met me for lunch over at the lab. Later she made two attempts at breast feeding. Both attempts she made weren’t a huge success. He seemed tired, but she still enjoyed holding him. As soon as I was off of work I made my way to the NICU. He really loves his dad a lot and always behaves himself. After his 6pm cares and feeding, and while to NICU was closed for shift change, they took out Drew’s PICC line. He is now free from IV’s and can actually put on his clothes completely. We tried to get the respiratory therapist and nurse to change his flow to 1 and also change to a smaller nasal canula, but the nurse practitioner wanted him to be on 1.5 for at least 12 hours. She had no good explanation for that number, but there was nothing we could do, so that means at midnight tonight they will be changing him to a 1. We asked the nurse to take pictures of him when they changed it so we could see his face without any tubes, except the NG tube. Little by little he is improving each day. The last few nights we have had fun guessing his weight for the night. Tonight I won with a guess of 1905 grams. He turned out to be 1910 grams, up 2/3rds of an ounce from yesterday. He continues to open his eyes more and more during each feed and makes the cutest expressions ever. Michelle has a hard time giving him up when it’s my turn to hold him. We are excited to see him tomorrow. Each new day is a new adventure.

Sunday, January 24, 2010

Here Comes Baby..... Welcome Andrew Rawson Cardon

January 24, 2010
*** WARNING: Contains Images Not Suitable For Those With Weak Stomachs***
At around 1:30 this morning the baby’s heart rate dropped to the 60’s. Michelle had just fallen asleep a few minutes earlier when the nurse opened the door and flipped on the lights. They told her to lie on her side, gave her an oxygen mask, and administered IV fluids. When Michelle realized what was going on, she wanted to scream out loud. She now just wanted the baby to come out. From that moment on there wasn’t any sleep at all. His heart rate went down several other times during the night. After one episode the nurse had us sign a consent form just in case they needed to do a c-section, and when we asked the nurse when would they decided that they were doing a c-section she said that his heart rate would have to get a little lower and decrease more frequently. Since our doctor was off this weekend one of her partners would take care of Michelle. She came in to visit us and assured us that this was the right thing to do. Michelle's placenta was at its end and he wouldn't grow any more inside of her. We had hit the point where we could do more for the baby outside of the womb than inside. I think after the night's events Michelle was more than happy to let him come out. At around 10 am they removed the cervix softener and allowed Michelle to take a shower. She loved it so much. The nurse had originally told her she could have a short shower, but she took advantage of the opportunity and took her time. Before she got out of the bathroom she was sure to put on a little makeup. It made her feel so good. Around 11 am they started per Pitocin. The doctor had ordered a higher dose, but the nurse decided to start her on a smaller dose and see how the baby reacted. The nurse also suggested Michelle get her epidural early in case they had to do a c-section. That way I would be able to go in with her. Not to long after that the anesthesiologist came in and gave her the epidural. Michelle didn't think it was bad at all.

Within the first hour of administering the Pitocin, the baby wasn't handling it well. His heart rate dropped several times within a short amount of time so the doctor decided to get Michelle ready for a c-section. They cathed Michelle and I got into the hospital jump suit, cap, and mask. Before we left for the OR I asked about taking in a camera. They said it was OK to take still shots, but that I couldn't take any video of the procedure. Luckily for us our friends Matt and Vicki lent us their good camera.

At about a quarter to 1 PM we got to the OR. During the whole procedure I was taking pictures.

After a few cuts through the various layers of tissue the doctors were well on their way getting to our son. With just a little more time he would be here.

At 1:01 PM baby Drew was pulled out of his mother and I took his first picture. He gave a little cry as the doctor held him in the air. Although Michelle couldn't see him she had a sense of relief when she heard his voice. The moment didn't last long. Before I knew it they had passed Drew through a window right into the NICU.

They saw how interested I was at getting some shots that they made sure that I got a good one of Michelle's uterus.

Michelle looked tired, but not in pain. She said she could only feel the tugging, but it wasn't painful. I guess the Meds worked. We wheeled Michelle back to her room to recover for a moment.

I was then taken to see Drew (short for Andrew, we don't have a middle name yet) along with Michelle's mom Carol. They had him in an incubator with a variety of tubes and monitors coming out of him. He had a hard time breathing so they put him on CPAP, luckily the week before they were able to give Michelle steroid shots to help in Drew's lung development. We couldn't see his face because the CPAP covered it and then he had a hat on to help hold the CPAP in place. He was so small and skinny. He was born at 1:01pm, he weighed 3 lbs. 15 oz, and he was 17.25 inches long.

After about an hour Michelle was wheeled into his room before she was moved to the maternity floor. Michelle was able to put her hand through the little incubator doors to touch his little body. After all she had been through the last few days, weeks, and months, it was worth it to be able to see him.

He has a lot of hair for being so young. I hope he will be like his father and keep it as long as he can.

Michelle was then taken up to her new room and we visited with a few of her family members. Later in the afternoon I took my sister Rachael down to see Drew and the nurse wanted to talk to me privately. Some of Drew's labs showed signs of a possible infection and his gastric fluid had a pink tint to it which could be caused by ingestion of Michelle's blood during birth or he could have a bleed of some sort. To add to all of that, he was having a harder time breathing and if he didn't improve they would have to intubate him for a short time and give him a treatment of surfactant. I returned to Michelle and told her what was going on. Having medical backgrounds can be both a good and bad thing. It is nice to understand what the doctors are saying and what the labs mean, but sometimes your mind can go straight to the worst possible outcome. Later in the night Michelle was tired so I went down to the NICU by myself once again to visit little Drew. I just sat there with my hand firmly on his body through the incubator door looking at him while talking to his nurse. It is hard to believe that we are parents. I will now try and get some sleep. The couch is Michelle's room isn't the comfiest and having people come in and out throughout the night doesn't help.

Thursday, January 14, 2010

Pre Baby Drama

January 14, 2010
Yesterday we had Michelle's first doctor's appointment of the year. It has been three weeks since the last one. She was 32 weeks along and other than the weight and the edema, she was feeling great. Since her last check-up, she had continued to get more edematous (something she thought was just a Martin trait), but like I said before she felt fine. When we got to the appointment, Michelle's blood pressure was slightly elevated from the last appointment, about 130/84, and she had some protein in her urine. This was enough for the doctor to suggest running a few liver and kidney function tests including a 24 hour urine protein (you collect all of your urine for a 24 hour period) to see if she might be developing preeclampsia. Michelle got the labs drawn and was instructed to rest and return the next day to turn in her 24 hour urine sample and have her blood pressure taken again. This morning all of her labs looked normal, her 24 hour protein was slightly above the normal range, but her blood pressure was 150/98. She called me balling, at first I wasn't sure if she was crying, but then I could hear it in her voice. I got scared and thought that something was wrong with the baby or we had lost him or something, but when I asked her what was wrong she said they had put her on bed rest. Not an easy thing for my wife. When the doctor originally told her she was on bed rest Michelle got emotional and the doctor told her not to cry because that would just increase her blood pressure. She was told she couldn't go to work any more and she would have to have non stress tests performed twice a week along with a normal OB/GYN appointment each week. They also set up an appointment for a growth ultrasound for next Friday to check the size of the baby. My coworkers were nice enough to let me go home for a longer break to console Michelle. When I arrived home she was putting away dishes and doing a few other things. I had to ask her what the doctor meant by bed rest because she wasn't doing much resting. Dy came by to be with Michelle and I had one of our home teachers come over to give her a blessing. I returned to work while Michelle and Dy visited their mother in Orem. When she got home we had a discussion to clarify what bed rest meant. The doctor said she couldn't go to work; she needed to be lying down or in a reclined position all the time, unless she was getting food or going to the bathroom. They wouldn't even let her go to church because they don’t want her putting pressure on her cervix for long periods of time. The goal was to keep her blood pressure down and to get her to at least 37 weeks and then they would induce her. Although Michelle seemed like she was OK, she had her moments of tears. When most people would love to be able to sit around doing nothing and not have to go to work, Michelle would be miserable because she isn't one to just rest and relax. She likes to do things. We will see how it turns out. The only good thing we could think of that came of this was knowing she wouldn't have to go past 37 weeks. She could handle that.

January 18, 2010
This is Michelle….. Well, it has been almost a week since I was put on bed rest and I am surviving thanks to the love and support of my family and friends. I am so grateful for Andrew. He is such an amazing person. He does not complain about anything and has been such an amazing help. I am also grateful for my family. They have been calling and visiting with me frequently to help the time pass. My mom came and cleaned my house from top to bottom and my dad brought 2 delicious meals. I am also grateful for my friends. The phone calls and visits mean so much to me. I really appreciate everyone’s love and support.

January 19, 2010
Michelle had her OB/GYN appointment this morning. I have enjoyed being able to be at all of her appointments except for the bed rest one. I guess it helps to work at the same hospital as her doctor. Her blood pressure was 148/82 and she still had protein in her urine. The doctor thought that the baby might be measuring smaller than he should, but we have the ultrasound on Friday to tell us his actual size. The good news was that Michelle lost 8lbs. It was all water, but she enjoyed seeing the numbers get lower each time she stepped on the scale. Michelle had another NST after her appointment and the baby wasn't very active. We figure this is either an indication of how he will be, calm and very easy going, or he is just going to wreak havoc when he gets out. I would prefer the first option, but will love him either way. He has never been an active baby and I have only felt him once, but her placenta is attached anteriorly and the doctor said that creates a large cushion. Michelle is doing better with her bed rest, but it is still hard for her if she thinks about it too much. I told her she can't look at the clock every five minutes. We are both anxious about the ultrasound on Friday and hope everything is OK.

January 22, 2010
Michelle and I went to her NST this morning and Drew didn’t pass even though he did much better than the previous two times.

After the NST we had a normal ultrasound to check the growth of the baby. They found that his head and femur measured at 33 weeks, but that his stomach was about 3 weeks behind. When they measured the blood flow through the placenta and umbilical cord they also found that the pressure was high meaning it was struggling to do its job. After having the doctor come in and doing her own evaluation it was decided to admit Michelle to the hospital for further evaluation and continuous monitoring. Michelle was devastated, but admitted that she had a feeling this morning that something would be wrong.

After about five hours of monitoring the doctor didn’t feel there was an immediate concern for having to deliver so we were sent up to the Maternity floor. I took a quick trip home to gather some things for Michelle and promptly returned. The rest of the evening we just sat in her room and watched TV, a movie, and watched as nurses and CNAs came in to take her vital signs every two hours or so. Her blood pressure was still elevated, but not too bad. At about 11pm I ended up going home to sleep.

January 23, 2010
When I arrived this morning Michelle was just finishing an NST. Teri, her nurse, had worked in Labor and Delivery and knew how it all worked. Again he didn’t do as well as they liked so the doctor decided to order another NST for the evening. Michelle and I just sat around all day trying to pass the time. Michelle wanted to crochet some hats for the baby so she attempted to teach me how. We both were making the same hat and were at the same point in making the hat, but neither of the hats looked right. Mine looked like it was for a cone head baby and it had tight stitching, while Michelle's looked like it was for a toddler. Her stitching was too loose. If we did something in between the two of ours it would look great. Later in the evening we had the second NST. Once again he didn't pass so the resident performed a biophysical profile. The profile is scored on a 10 point scale, 2 points for each of five categories. The first category is the NST. Since he didn’t' pass he lost 2 points. The second was the amount of amniotic fluid. He only measured at a 6, the normal range is 10-25, and so he lost another 2 points. The last three categories are based on the baby's body movements. 2 points for whole body movement, 2 for small body movements like hands and feet, and then 2 points for chest movements (like he's practicing breathing). He had 30 minutes to perform these movements and he only got 2 points. We still aren't sure where the two points came from, but are sure the resident thought two sounded better than zero. The resident suggested Michelle be induced and would discuss it with the attending and unless the attending had a good argument against inducing, it would start that night.

Within a half an hour Michelle was moved to labor and delivery. After hooking her up to the fetal heart monitor and contraction monitor they started her on a cervix softener around 10 PM. They would leave it in for 12 hours before starting her on Pitocin. They also told Michelle to get as much sleep as possible tonight before the real fun begins. The baby's heart rate looked great and Michelle wondered if we were doing the right thing, but I assured her that the doctors probably knew what they were talking about. The baby wouldn't be able to stay inside her till 37 weeks and although 34 weeks was just a few days away at this point it didn't look like it would do any good. He might be ready to come out.