Sunday, January 12, 2014

29 Weeks Tomorrow



It's crazy to think that Eli will have been in the NICU for three weeks on Wednesday. Time has gone by extremely slow, and has also whizzed by us at the same time. 

Good news:

1. His arterial line came out and he's pretty stable, so Emily gets to hold Eli tomorrow!
2. The ophthalmologist checked his eyes for yeast today and found nothing.
3. His blood gases are getting better little by little.
4. They started giving him pedialyte yesterday and he tolerated it well, so today they are giving him breast milk.
5. He is now weighing in at 2 lbs 12 oz! (His birth weight was 2 lbs 7 oz.)

We did have a little scare Friday that had to do with Eli's Ileostomy. Ever since the surgery meconeum has been leaking out of the mucus fistula. This is normal, but we started noticing that the stoma was getting darker and darker which is really bad. When the stoma gets darker, that could mean that the intestine is beginning to necrose.  A surgeon was called in to check it out, and what he found made us all breath a sigh of relief. The darkening of the stoma was caused by a build-up of dry meconeum, and the stoma underneath was pink and looked great! 

Reading back over the last paragraph, I realized there are a lot of words that I myself just learned. So I'm going to provide some definitions. Just in the last 3 weeks, we have learned SO much. 

Definitions:

Ileostomy - a surgical operation in which a piece of the ileum is diverted to an artificial opening in the abdominal wall.

Ileum - the third portion of the small intestine, between the jejunum and the cecum.

Meconium- the earliest stool of an infant. Unlike later feces, meconium is composed of materials ingested during the time the infant spends in the uterus: intestinal epithelial cells, lanugo, mucus, amniotic fluid, bile, and water

Mucus Fistula - The non-working stoma in a loop ileostomy. The mucous fistula can be the second of two stomas in a temporary ostomy, or the second opening in a single loop ostomy stoma

Stoma - an artificial opening made into a hollow organ, esp. one on the surface of the body leading to the gut or trachea.

Necrosis - the death of most or all of the cells in an organ or tissue due to disease, injury, or failure of the blood supply.

There is another couple in the NICU in a similar situation to ours. They are from Colorado and were visiting family here in Dallas for Christmas. The wife started feeling contractions, so they went to hospital and later that night/morning (26th) their baby girl was born. She was only at 25 weeks. She has been doing great until yesterday when she had a similar surgery to the one Eli had, except her was a lot more severe. We're hoping and praying that she gets through this. 

This week has been filled with little improvements and little setbacks, but overall the trend has been towards improvement. Thanks to all our friends and family who have been such a great support over the past few weeks. This past Fall I interned at Southwest Airlines and my last day was the 19th of December, but my work group has continued to be a great support. They threw a baby shower for Emily before she got admitted to the hospital, and just this past week they took Emily and me out to lunch. You've probably heard that Southwest is a great place to work, and I think that explains why. 

Let's hope this week is another good one!





Wednesday, January 8, 2014

No News Is Good News



Sorry we haven't written in a few days. Just know that "no news is good news"—most of the time. Eli has been doing well recuperating from his surgery. His ventilator levels go up and down depending on how tired he is. Today his levels went up a little bit, but that's not the end of the world. The trend is good, so if he continues on like this, he will most likely be off the vent in a week or so and back on CPAP. Emily won't be able to hold him again until next week.

We're crossing our fingers, but there haven't been any more positive fungus cultures! If one or two more days pass without a positive culture, Eli's PICC Line can stay in. If a positive culture does come back, he will need a Broviac Catheter.

Today Eli was very alert and looking around a lot. His skin color looks really good, and he seems very active and content. Ever since his umbilical arterial line came out, he's been getting almost daily IV's (IV's don't last very long in premies). They usually put the IV's into his feet, but today they gave his feet a break and put the IV into his head.

Right now things are pretty calm. He has great doctors, and has been receiving excellent care from the nurses.


Sunday, January 5, 2014

Recovery

January 5, 2014
27.6 weeks

It has been pretty calm the past 2 days since Eli has had his surgery. He has been on pain medication which has kept him fairly sedated. The doctors told us to expect that he would be more dependent on the ventilator as he recovers. His belly looks a little distended, but it has only increased in size by a few centimeters. They still aren't giving him any food; they will start feeding again when he's a little more stable. 

The quantity of blood coming out of his lungs is decreasing quite a bit. We're thinking the closed PDA is helping with that. The lab is continuously checking his yeast cultures, and today another one came back positive. The doctor told us that if another culture comes back positive, they are going to remove the PICC line. This is going to be problematic, because it is through the PICC line that Eli gets his TPN (nutrition). 

Eli's PICC line doesn't go to the heart. His goes just past the shoulder.
For a few days, Eli will get his nutrition through IVs, but IVs only last a day or two. The next central line they are going to try is called a Broviac Catheter:


It is an IV line placed into a vein in the chest by a pediatric surgeon. It is designed for long-time use so that many painful needle sticks can be avoided. It is used to give medicines, blood transfusions, fluids or nutrients. We hope the infection clears soon so he doesn't have to have the Broviac, but it sounds like it's inevitable. 

Considering all that Eli has gone through, he is doing very well. We hope the infection clears soon so he can focus more on breathing and getting bigger. 

Jason and I have been listening to this song called "Happy" by Pharrell Williams on the ride home from the hospital recently:


Stay happy, and positive. That's what we're going to do.

Friday, January 3, 2014

Look for the Silver Linings

After hearing about Eli's fungal infection I was a little bit in shock. How could his health change so quickly? I was just holding and snuggling him last night and he seemed so calm and content. I was emotional and overwhelmed by the news. On top of that, my parents (who had been here all week; they drove all the way from Michigan, and we're so grateful that they came!) were leaving this morning so my dad could be back in time for meetings on Monday. I received a priesthood blessing from my dad and felt some comfort, but was still overcome with worry. I spent the next hour laying in bed, almost feeling numb and wondering how and why this was happening to us. I wished more than anything they could put Eli back inside of me where he would be safe. My heart ached for this little boy. I honestly didn't think I could take anymore bad news.

Then we got another phone call from the neonatologist. During all of the testing to find out the origination of the fungal infection, the doctor noticed something strange in an X-ray of Eli's abdomen. There was a pocket of "free air" outside of the bowel. Not good. She had already contacted a surgeon because she suspected that there was a hole in the bowel that would need to be fixed—immediately. She asked us to come to the hospital as soon as we could. Jason and I looked at each other, speechless. I felt like I had just been hit with a ton of bricks. It seems like this sweet little boy who has been fighting so hard can not catch a break.

After spending a few minutes with Eli, the neonatologist came to speak with us. She laid so much information on us; it was completely overwhelming. She said Eli had tolerated the spinal tap really well and they had performed an ultrasound of his kidneys. Both procedures did not have conclusive results yet. Another interesting comment the doctor made was that even though Eli was definitely fighting an infection, he had no manifestations in his behavior of being sick. He was still an active baby and his vitals were excellent. The neo doctor said the surgeon was making a call at another hospital, but would be coming by in a few hours to evaluate Eli and perform exploratory surgery to find the source of the free air.

In the NICU wing they have a room for parents to use for a night before they take their babies home so they can be near nurses and doctors in case they have questions or worries. The NICU staff was kind enough to let us stay (and try to relax) in that room while we waited to speak with the surgeon, anesthesiologist, and neonatologist. After 2 hours, the neonatologist told us that Eli had pulled out his ET tube and had to be re-intubated. I have to say, I can't blame him for wanting to pull something out—I would want to! He has so many tubes and wires all around him. Luckily, he was stable during the whole re-intubation process and there was no problem. She also informed us that the spinal tap they took earlier came back with preliminary results as being negative and the ultrasound of his kidneys was clear of infection also. We definitely needed some good news to hold on to! She informed us that the surgeon would be at the hospital within an hour and would talk with us then.

We went to see Eli before all of the operating team arrived. They would be doing the procedure right there in his NICU bed so they would need us to leave earlier so they could prep the room for surgery. Everyone left the room and Jason took the opportunity to give Eli a blessing. Eli looked so peaceful and content when we left him in his little isolette. He even opened his eyes and looked right at Jason and me with big, innocent eyes almost as if he were trying to tell us, "I'm still fighting!" We have the cutest baby ever. 


Before surgery

We spoke with the anesthesiologist who listed all of the medication he would be using to sedate Eli. With these little babies they also give them a paralytic so they don't move during the procedure. After signing our consent for anesthesia, the surgeon came in and spoke with us. He seemed very confident that they would be able to find the problem and fix it. Jason and I knew Eli was in good hands. As we were leaving Jason turned to me and said, "I have a feeling that there are people in that room that we can't see." I thought, that's so true. My sweet Aunt Marilyn just left us a few weeks ago, my Grandma passed away just over a year ago, Jason's Grandpa passed away a few years ago, and I know they were there comforting our little guy. We could feel the love and support of family alive and deceased. We went back to our little room, prayed and waited. The surgeon told us that it could be anywhere from 15 minutes to an hour and a half depending on what they found.

After surgery - he's still under anesthesia and was paralyzed so the ventilator was doing all of the breathing for him.
We waited for about 30 minutes before the doctors came back to speak with us. They found a teeny perforation in his intestine—only 3mm was removed. To ensure healing, they placed the intestine on the outside into an ostomy bag. When Eli is about 4.5 pounds, they will do another surgery to reconnect the intestine. It will probably be at least 8 weeks until that happens. For the next little while they are going to stop feeding him so he can heal and just focus on breathing and fighting the infection. They will continue to give him nutrition through his IV fluids (TPN). When he does get to eat again, he should be able to absorb a lot of nutrition from my milk because the ostomy bag is lower down in the intestine.

After being at the hospital for about 8 hours, we went home feeling glad it was all over and hopeful for Eli to make a full recovery. We immediately felt gratitude and said another prayer thanking God for all the miracles we saw today. Among all of the chaos, I tried to look for those silver linings. I had to find the small blessings that have happened so far. If Eli didn't have the fungal infection, the doctors would have never done an X-ray and the bowel perforation would not have been found until it was much more serious. I have truly learned that the Lord works in mysterious ways. We only expected to stay here in Dallas for the Fall semester during our internships, but we're happy we're here. We are also so blessed to have such supportive friends and family. It has been such a blessing living with Jason's parents; they are so kind and supportive. I knew this before, but this experience has reaffirmed to me that everything happens for a reason. Heavenly Father is always mindful of our circumstances and wants the best for us.

The first day we visited Eli in the NICU, the neonatologist told us that the next few months would be a roller coaster. When he said that, Jason and I both thought to ourselves, "yeah, yeah, not for us; Eli will be in and out of there in a few months and be just fine." One week and two days later, I can say it really has been one of the craziest roller coasters we've ever been on. We still have faith that Eli is going to be "just fine," but we hope that today was the biggest, scariest loop the roller coaster has to offer. If not, I think my hair is going to be as gray as my dad's by the time this baby comes home!

High White Blood Cell Count

For the past three or four days Eli's white blood cell count has been higher than normal. It hasn't really been worrying the doctors that much because of El's normal disposition. Babies that young don't get fevers, so there are really only two ways to tell whether or not they have an infection: 1.) observe their actions; sick babies usually don't move around very much; 2.) grow a blood culture. Eli has been moving around as much or more than he did while he was in the womb, and the blood culture wasn't showing anything—until today.

We got a call this morning from the neonatologist informing us that yeast had grown on Eli's blood culture. When this happens there are many tests that need to be done in order pin point the location(s) of the infection. Today they will be doing a spinal tap to test for meningitis, an echocardiogram to test for infection around the heart, a head x-ray to test for infection around the brain, an ultrasound to test for infection around the kidneys and other parts of the body, and an ophthalmologist is going to check his eyes for infection.

We really don't know anything right now; we're just praying that they are able to locate the infection and treat it quickly.

There have been so many prayers said on Eli's behalf, and we've seen many miracles. We're positive and optimistic that he will make it through this.


Thursday, January 2, 2014

Happy New Year

January 2, 2014
27.3 weeks

Eli holding Jason's wedding ring.

Lots has happened over the past two days. Eli did so well on CPAP! After having the tube out for just a few hours his levels were about the same as they were while he was on the vent. Every few hours the nurses take a blood gas reading. To do this they have to take about .3 ml of blood and put it through a machine. Through this test they measure the levels of carbon dioxide, oxygen, and the pH in the blood sample. There used to be an arterial line through the umbilical cord that they could simply draw blood out of, but they had to take that out yesterday. So now they have to prick his heel every time they need to take blood gas. It's sad to see his little feet all bandaged up.

We were obviously so excited that Eli was off the vent, but the nurses and doctors warned us that it is very normal for little babies to go on and off the vent. But any time off the vent is helpful and good for the baby. Last night we went and saw Saving Mr. Banks. I was already feeling guilty that we were out having fun while Eli was all alone in the hospital when a preview of the Disney Nature movie Bears played. It's a movie about the life and struggles of a little bear family. When I saw the tiny bear paws, I thought of my sweet little boy and started crying. I think I worried Jason because he kept looking over at me during the movie making sure I was ok. Halfway through the movie I took a bathroom break and happened to get a call from the neonatologist. It's always scary to look down and see the NICU calling—especially at night. The doctor informed me that they re-intubated Eli because his carbon dioxide levels were too high. It was a bummer, but we knew it was most likely going to happen at some point. Being on CPAP is a time for babies to exercise their lungs. During development, they sometimes need to take a rest and be on the ventilator before trying CPAP again. Already, we have seen improvement as he has been back on the ventilator. 

Yesterday, we got some exciting news. With the umbilical line out, we would be able to hold Eli!! In the NICU they have something called Kangaroo Care which is a time for skin-to-skin contact with a parent. It helps with bonding, increasing mother's milk supply, calming the baby down, aiding in digestion, increasing oxygen intake and regulating temperature. I got to hold him for 2 hours and the time flew by.














First family photo!




Best way to start the new year!




Wednesday, January 1, 2014

Improvement



We have seen improvement after improvement over the past few days. Eli's jaundice is decreasing, he is being given more food, his blood gases look great—basically all his numbers are improving.



Even though he can't see anything yet, he still tries so hard to open his eyes and look at Emily when he hears her voice.


His IV was moved from his hand to his foot. He likes to hang his foot over the edge of the bed.


He has so many wires all over his body: the orange is the feeding tube, and the others are respiratory, heart rate, and temperature trackers. 


This is the PICC Line that was put in a few days ago. This is where he gets his TPN (Total Parenteral Nutrition).
He was doing so well today that they opened the isolette for a while and let Emily give him a kiss.

We heard some great news today.... the nurse practitioner told us that his numbers were looking so good that he was going to be taken off the vent! He was placed on CPAP which is a breathing system that has prongs that are placed up his nose. They say there is a chance that he may be re-intubated, but for now his blood gases show that his CO2 levels are coming down. Actually, when we visited tonight at 9 pm his levels were back down to what they were when the took him off the ventilator. At the start of the second shift, the nurses said they were almost certain he would have to be put back on the vent by 9 pm, but Eli surprised everyone and improved instead!

I know it almost looks worse than before, but CPAP is SO much better than being on the vent long-tern. Being on the ventilator is good, but doesn't come without side effects. On the one hand, the vent is necessary to sustain life, but it also damages the growing lungs and slows maturation. However, if he does end up having to go back on the vent, it is OK. Any rest he can get is progress and will help his development. The good thing about the lungs is that they continue to grow and develop. Most of the time, damage caused by the vent is resolved fairly quickly.

Needless to say, the last few days have been awesome. We have seen some radical improvements which really are miraculous. We are so grateful for modern medicine, the careful attention of the nurses, and all the prayers and support from family and friends. He's made it a week now!