Well, today was the one step back after two steps forward. Everything I said yesterday is on hold because Andrew didn't have a great day. First, he spit up a bit and they stopped the feedings. All his other digestive indicators look fine (bowel sounds, stool, clean x-ray, etc), but they want to be extra cautious. They put him on medication to help with his reflux (Prilosec) and will probably try again tomorrow.
He also had a bit of a setback on his respiration. His first sprint went fine (he slept through it) and the second one was okay, though they stopped five minutes early. They increased the duration to an hour and a half, and his third sprint was scheduled for today at 2:30pm. He was fine for the first hour and fifteen minutes, then got upset. His numbers went wild, especially his CO2. It took a couple of hours to come all the way back down, during which time they upped his breathing rate (to 15 breaths per minute). Everything was calm quickly enough that they didn't need a chest x-ray or anything similar, but they canceled his scheduled sprint for tonight.
As we've been told many times, we need to take it a day at a time, and I think that's never been more true. A day or two should do wonders on getting him stronger, and they'll probably re-think the method they're using for his sprints. I'm not worried about him long-term, but it didn't make for a very fun day.
Jul 31, 2007
In Her Arms (Take Two)
Think Mommy's enjoying this?
Asleep and comfortable.
You lookin' at me?
Cozy in bed.
Showing off his guns.
They say that clothes make the man...good thing he can finally wear them.
Medical Update
Here's a quick update on Andrew's progress, from a respiratory and digestive perspective.
On the ventilator front, they have started something called "sprints." Instead of coming off the vent immediately, they're going to let his lungs (and associated muscles) get some exercise first. Twice a day, they turn off the normal ventilator and hook his tube up to a CPAP machine, which provides oxygen at a constant pressure. Instead of giving ten breaths per minute, it doesn't give any full breaths. Andrew has to do all the work of breathing, without any help beyond the constant flow. He came through is first sprint perfectly, sleeping through most of it and having no problems breathing. After a day or two at this rate, they would then increase the duration, frequency, or both. After a few days, he may be on sprints of three hours, three times a day. At some point, they'll be happy with his workouts and try him completely off the ventilator again. The exact timing will depend on which doctor is making the decision on any given day.
On the digestive front, he's also doing very well. The bile completely cleared up from his stomach secretions two days ago, they removed his nasal tube yesterday, and they started feedings through his G-tube today. They're starting with very small quantities, 1cc per hour, every hour. They call these small amounts "trophic feeds," used to stimulate his digestive system without actually providing any nutrition. They will keep this up until they decide to increase the volume; the timing again will depend on how he responds and which doctor is making the decision.
The surgeon came by this morning and removed Andrew's bandages. His new scar looks great and is healing nicely, though we noticed something a little strange. Since the incision included his belly button and was sewn back together straight, without taking his navel into account, I'm pretty sure he won't have a belly button when everything heals. In fact, if it heals well enough, maybe he'll look like this when he's older:
There's a lot happening all at once, but so far it's all good.
On the ventilator front, they have started something called "sprints." Instead of coming off the vent immediately, they're going to let his lungs (and associated muscles) get some exercise first. Twice a day, they turn off the normal ventilator and hook his tube up to a CPAP machine, which provides oxygen at a constant pressure. Instead of giving ten breaths per minute, it doesn't give any full breaths. Andrew has to do all the work of breathing, without any help beyond the constant flow. He came through is first sprint perfectly, sleeping through most of it and having no problems breathing. After a day or two at this rate, they would then increase the duration, frequency, or both. After a few days, he may be on sprints of three hours, three times a day. At some point, they'll be happy with his workouts and try him completely off the ventilator again. The exact timing will depend on which doctor is making the decision on any given day.
On the digestive front, he's also doing very well. The bile completely cleared up from his stomach secretions two days ago, they removed his nasal tube yesterday, and they started feedings through his G-tube today. They're starting with very small quantities, 1cc per hour, every hour. They call these small amounts "trophic feeds," used to stimulate his digestive system without actually providing any nutrition. They will keep this up until they decide to increase the volume; the timing again will depend on how he responds and which doctor is making the decision.
The surgeon came by this morning and removed Andrew's bandages. His new scar looks great and is healing nicely, though we noticed something a little strange. Since the incision included his belly button and was sewn back together straight, without taking his navel into account, I'm pretty sure he won't have a belly button when everything heals. In fact, if it heals well enough, maybe he'll look like this when he's older:
There's a lot happening all at once, but so far it's all good.
Baby Transport
D got to hold Andrew again today, for about an hour and a half...it'll be my turn the next time we have the opportunity. I'll post more pictures at some point, but here's a bit more description.
Getting him onto your lap is a pretty difficult process, because of the various tubes in and around him. First, D sits in the chair, with several blankets built up on her lap to raise him up a bit. A nurse and a respiratory therapist (RT) come perform the actual transfer; the nurse lifts Andrew and moves him while the RT holds his breathing tube in place. They usually have to disconnect his tube, which is routed through the bars of his crib, to reconnect it outside the railings for easier access. While they move him, I have to stand on the other side of the crib and make sure that his other tubes (arterial, IV, and PICC lines) don't get tangled, stretched, or pulled out of his arms. When we first held him last night, they also had to add some additional tape to his arterial line. Once he's in place, though, it's all worth it. Both times D has held him, he stared intently into her eyes for 10-20 minutes, then went right to sleep. He's obviously very comfortable in her arms. It's a very positive experience for both of them (and me), and we hope to take advantage at every possible opportunity.
Getting him onto your lap is a pretty difficult process, because of the various tubes in and around him. First, D sits in the chair, with several blankets built up on her lap to raise him up a bit. A nurse and a respiratory therapist (RT) come perform the actual transfer; the nurse lifts Andrew and moves him while the RT holds his breathing tube in place. They usually have to disconnect his tube, which is routed through the bars of his crib, to reconnect it outside the railings for easier access. While they move him, I have to stand on the other side of the crib and make sure that his other tubes (arterial, IV, and PICC lines) don't get tangled, stretched, or pulled out of his arms. When we first held him last night, they also had to add some additional tape to his arterial line. Once he's in place, though, it's all worth it. Both times D has held him, he stared intently into her eyes for 10-20 minutes, then went right to sleep. He's obviously very comfortable in her arms. It's a very positive experience for both of them (and me), and we hope to take advantage at every possible opportunity.
Jul 30, 2007
The Conversation
Apparently, it's all about talking to the right people. We ran into the head of the NICU last night:
- D: "Who's going to be the gatekeeper on when we can hold him?"
- Dr. K: "You've never held him before?"
- D: "No."
- Dr. K: "Oh, you're going to hold this baby."
- D: "Sometime soon?"
- Dr. K: "No, now! It's been 44 days...this baby needs to be held!"
- D: (tears forming) "Really?"
- He was extubated again.
- His arterial line was taken out.
- He was tolerating full feeds through his G-tube.
Look, We Have A Baby!
For the first time, I'm going to let the pictures speak for themselves...they really don't need any explanation.
"I Think He Likes Me"
It has been a very long day. It started in LA and the OC, and ended in San Diego...by the time we got home, it was already after 8pm. We thought about staying at home and going to bed, but instead decided to head down and see Andrew for a little while. We planned on leaving the hospital by 10pm, yet somehow managed to stay until 11:30. Fortunately, they made it worth our while...
At 10:21pm, 63,683 minutes after Andrew's birth, D held him for the first time. Thirty-five minutes later, I joined the club. It was a really wonderful moment for both of us, and completely unexpected. He seemed to feel very comfortable with us (mostly with D) and even managed to fall asleep in her arms. When I was holding him, he decided not to fall asleep....instead he threw up on me. The image of Andrew in D's arms was very sweet, as it was when she looked up at me and said, "I think he likes me."
I really have to go to bed now, so I'm going to post a few pictures and leave the rest of the description (as well as a medical update) until tomorrow.
At 10:21pm, 63,683 minutes after Andrew's birth, D held him for the first time. Thirty-five minutes later, I joined the club. It was a really wonderful moment for both of us, and completely unexpected. He seemed to feel very comfortable with us (mostly with D) and even managed to fall asleep in her arms. When I was holding him, he decided not to fall asleep....instead he threw up on me. The image of Andrew in D's arms was very sweet, as it was when she looked up at me and said, "I think he likes me."
I really have to go to bed now, so I'm going to post a few pictures and leave the rest of the description (as well as a medical update) until tomorrow.
Jul 29, 2007
Resting Comfortably
A full day on the ventilator has reinforced the fact that he may not have been fully ready for extubation. While the two days were definitely good for his muscle development and breathing practice, he's much more comfortable now that he's got some extra support. He fussed for about an hour after they put the tube back in, mostly getting used to the feeling again. After that, he was far more relaxed.
In the last day, he's moved almost all the way back to his pre-extubation ventilator settings. He's down to 12 breaths per minute, which is the lowest they'll go for right now...yesterday, he was at 20. They've turned his oxygen down from the 50's (when he was extubated) to the 40's (yesterday after re-intubation) to the 20's...right now he's at about 26, which is only five percent above room air.
The doctors/nurses/respiratory therapists think that two or three days should be enough for him to take a breather and try again. There's no set date, but the doctors will make a decision whenever they think he's ready. I will certainly let you know and take more pictures when it happens.
On the feeding front, things are starting to look better in his stomach, but he's not quite ready. He still has some bile coming out of his stomach tube, though it's gotten lighter and less plentiful. They've taken the suction off his NG tube and are letting it drain using gravity...nothing has come out today.
Tired...going to bed...more late tomorrow night.
In the last day, he's moved almost all the way back to his pre-extubation ventilator settings. He's down to 12 breaths per minute, which is the lowest they'll go for right now...yesterday, he was at 20. They've turned his oxygen down from the 50's (when he was extubated) to the 40's (yesterday after re-intubation) to the 20's...right now he's at about 26, which is only five percent above room air.
The doctors/nurses/respiratory therapists think that two or three days should be enough for him to take a breather and try again. There's no set date, but the doctors will make a decision whenever they think he's ready. I will certainly let you know and take more pictures when it happens.
On the feeding front, things are starting to look better in his stomach, but he's not quite ready. He still has some bile coming out of his stomach tube, though it's gotten lighter and less plentiful. They've taken the suction off his NG tube and are letting it drain using gravity...nothing has come out today.
Tired...going to bed...more late tomorrow night.
Jul 28, 2007
Best.....Andrew Pictures....Ever!
The off-the-shoulder look is back in style.
Look right!
Look left!
Now purse your lips like you're kissing mommy!
The full view...crib, mobile, outfit, blanket, etc.
Sleeping peacefully.
Enlarge this one and check out his eyelashes.
Extreme close-up for maximum upper lippage.
It almost looks like he's wearing lipstick in this one...but that's his natural color.
Jul 27, 2007
Nice While It Lasted
I guess I should get the bad news out of the way before I upload Andrew's cutest pictures ever. He went back on the ventilator this afternoon, after spending 50 glorious hours extubated. Actually, his time wasn't that glorious, thus the necessity for additional ventilation. After two days, several increases in flow and oxygen, and a bit too much required effort for breathing, they decided to give him a break. The final straw was a minor fit that raised his CO2 level and lowered his pH to almost-unhealthy levels. Instead of waiting for things to get worse and cause damage, they re-inserted the tube. It's not a huge setback; they'll probably try again in a few days. Two days is a lot longer than some babies make it on their first try, and it was definitely good practice for his lungs.
I can't help being a bit upbeat about it, for two reasons:
I can't help being a bit upbeat about it, for two reasons:
- After re-intubation, he looked much more peaceful. After a brief fuss because of the tube in his mouth, which mostly involved sticking his tongue out at us, he felt much better. He was visibly more relaxed, his breathing was less labored, and he was able to stay awake for a long time without getting upset.
- This morning, before he went back on the vent, I got some great pictures. They moved him to a crib because he doesn't need the bed warmer any more, they put a little shirt on him, and they finally had him on his back. The combination made him much more photogenic, and I took quite a few pics. I'll post them shortly.
Thirty-Three Hours and Counting
At last check-in, Andrew was still off the ventilator and responding somewhat more reassuringly to being awake and alert. He still gets fussy very easily, but has also had a few periods of waking calm, which is better than I could say yesterday at this time. He's currently on his back, though they've flipped him several times to vary his position and keep him comfortable. I didn't get any exciting pictures, as he was on his tummy and covered up by a blanket most of the time we were visiting. I'll post some blanket-covered shots tomorrow, if I get around to downloading them.
We're hoping for continued boredom, as far as his condition goes. The more relaxed he is and the more he sleeps, the better he'll be able to heal without getting so upset that he causes himself problems. His oxygen saturation goes up and down with his moods, the bile from his stomach seems to be slowing a bit, and his gases have generally been good. If he can continue to breathe without having to work too hard, then he might be able to stay off the ventilator for a while. This could be made more difficult as they start to wean his steroids and as he gets more tired from breathing on his own...cross your fingers that he's enough of a bruiser to handle it gracefully.
We also had a "family conference" with the doctor and social worker today. It's a routine meeting that takes place every few weeks (this is our second) and allows us to ask the doctor questions in a somewhat more relaxed environment. Sitting by Andrew's bedside isn't really conducive to remembering detailed questions (or their answers). I might include some of the information we gathered in various posts over the next few days, but here's the gist: They are cautiously optimistic, as his lungs are progressing well, but there are a lot more hurdles to overcome before we can even think about bringing him home. At the moment, there are still two or three reasons why we can't even hold him. Immediate next steps involve stabilizing him completely off the ventilator, working on withdrawal symptoms from the morphine, and waiting for his intestines to calm down before we can resume feedings.
We're hoping for continued boredom, as far as his condition goes. The more relaxed he is and the more he sleeps, the better he'll be able to heal without getting so upset that he causes himself problems. His oxygen saturation goes up and down with his moods, the bile from his stomach seems to be slowing a bit, and his gases have generally been good. If he can continue to breathe without having to work too hard, then he might be able to stay off the ventilator for a while. This could be made more difficult as they start to wean his steroids and as he gets more tired from breathing on his own...cross your fingers that he's enough of a bruiser to handle it gracefully.
We also had a "family conference" with the doctor and social worker today. It's a routine meeting that takes place every few weeks (this is our second) and allows us to ask the doctor questions in a somewhat more relaxed environment. Sitting by Andrew's bedside isn't really conducive to remembering detailed questions (or their answers). I might include some of the information we gathered in various posts over the next few days, but here's the gist: They are cautiously optimistic, as his lungs are progressing well, but there are a lot more hurdles to overcome before we can even think about bringing him home. At the moment, there are still two or three reasons why we can't even hold him. Immediate next steps involve stabilizing him completely off the ventilator, working on withdrawal symptoms from the morphine, and waiting for his intestines to calm down before we can resume feedings.
Jul 26, 2007
Before And After
Some of you may want to know what Andrew looks like when he's upset. Here's a shot of him from a couple of days ago, having a relatively mild tantrum. I say that it's mild because his mouth isn't open (crying), and he didn't desaturate too much:
Here's one to make you feel better after seeing him squirm. This was Wednesday, sleeping peacefully:
Here's one to make you feel better after seeing him squirm. This was Wednesday, sleeping peacefully:
Good News For Now
If you take a look at the pictures below, you may notice something looks a bit different. That's right, Andrew had his endotracheal tube taken out today...his mouth has been freed. They took it out at 2pm today, and it was still out as of 10pm. We expect that it might have to go back in, but it's great to finally see his upper lip for the first time in forty days. The vent has been replaced by nasal cannulae, which are small prongs inserted into his nose and connected to an oxygen source. These provides oxygenated air, which helps keep his oxygen saturations high.
As it turns out, the respiratory therapist was worried about the wrong thing. Andrew's "shallow breathing" while he is asleep hasn't turned out to be a problem at all...in fact, his numbers are great whenever he's asleep. Instead, we have the opposite problem...Andrew is getting really fussy every time that he is awake. Literally every time he has fully woken up since 2pm today, he has gotten upset, started to cry, and lowered his oxygen saturation. The nurses have been able to compensate by temporarily turning up his O2 percentage, but at some point he needs to calm down. If he continues like this, he's going to tire himself out, and then he won't be able to work as hard as he needs to stay off the vent. The nurse said that it's relatively common for babies to do fine for the first 24 hours or so, then get tired and require additional ventilation. If, on the other hand, they can last more than two or three days, their odds of staying off the vent are much better. I'm prepared to hear that he's back on the vent every time I call, but I am also quite happy that he's off for now, even with the additional tantrums.
It looks like Andrew might have my upper lip, which is something we've pondered many times since he was born. It's very cute, even when he's crying. Speaking of crying, the ET tube sat right next to the vocal cords, leaving them a bit bruised. So when he cries, he's hoarse...I'd say he sounds a bit like a duck, quacking with every sob. He's also shown off his muscles, since he tends to do push-ups when he gets really upset, and he's been on his tummy for most of the day.
The pictures I got aren't great because of his position, but you should be able to catch a glimpse of his upper lip. Everything is a little red from the tape, and covered in spit in the last picture...I'll get better pictures tomorrow.
UPDATE: As of 4am, he's still off the vent. He's behaving only slightly better when awake, but he's been sleeping most of the night. They turned up his "flow" of oxygen through the cannulae, which should help him relax and not have to work as hard to breathe. We'll see if that makes a difference in his moods.
As it turns out, the respiratory therapist was worried about the wrong thing. Andrew's "shallow breathing" while he is asleep hasn't turned out to be a problem at all...in fact, his numbers are great whenever he's asleep. Instead, we have the opposite problem...Andrew is getting really fussy every time that he is awake. Literally every time he has fully woken up since 2pm today, he has gotten upset, started to cry, and lowered his oxygen saturation. The nurses have been able to compensate by temporarily turning up his O2 percentage, but at some point he needs to calm down. If he continues like this, he's going to tire himself out, and then he won't be able to work as hard as he needs to stay off the vent. The nurse said that it's relatively common for babies to do fine for the first 24 hours or so, then get tired and require additional ventilation. If, on the other hand, they can last more than two or three days, their odds of staying off the vent are much better. I'm prepared to hear that he's back on the vent every time I call, but I am also quite happy that he's off for now, even with the additional tantrums.
It looks like Andrew might have my upper lip, which is something we've pondered many times since he was born. It's very cute, even when he's crying. Speaking of crying, the ET tube sat right next to the vocal cords, leaving them a bit bruised. So when he cries, he's hoarse...I'd say he sounds a bit like a duck, quacking with every sob. He's also shown off his muscles, since he tends to do push-ups when he gets really upset, and he's been on his tummy for most of the day.
The pictures I got aren't great because of his position, but you should be able to catch a glimpse of his upper lip. Everything is a little red from the tape, and covered in spit in the last picture...I'll get better pictures tomorrow.
UPDATE: As of 4am, he's still off the vent. He's behaving only slightly better when awake, but he's been sleeping most of the night. They turned up his "flow" of oxygen through the cannulae, which should help him relax and not have to work as hard to breathe. We'll see if that makes a difference in his moods.
Jul 24, 2007
Combination Post
I figured I can get away with less information if I include a picture, so here's a shot from a couple of days ago. The ventilator was in my way, so I had to take the picture from above...he followed the camera with his eyes, everywhere it went.
As for actual information, Andrew's mostly the same. He's now down to ten breaths per minute on the ventilator, which is as low as they'll go with it. His last CO2 level was low enough to wean more, but they consider ten to be "minimal" settings. That doesn't necessarily mean he's ready to be extubated, but it's certainly one of the many requirements. The respiratory therapist says he takes pretty shallow breaths while he's asleep, which is something we all do, but it's a bit more of an issue with his smaller lung capacity. To help him out, they'll probably leave him on a different form of ventilation, which will provide oxygen through his nose at a low pressure. That's something to look forward to...perhaps next week.
As for actual information, Andrew's mostly the same. He's now down to ten breaths per minute on the ventilator, which is as low as they'll go with it. His last CO2 level was low enough to wean more, but they consider ten to be "minimal" settings. That doesn't necessarily mean he's ready to be extubated, but it's certainly one of the many requirements. The respiratory therapist says he takes pretty shallow breaths while he's asleep, which is something we all do, but it's a bit more of an issue with his smaller lung capacity. To help him out, they'll probably leave him on a different form of ventilation, which will provide oxygen through his nose at a low pressure. That's something to look forward to...perhaps next week.
Extra Boring
There was almost zero change today in anything. All Andrew's numbers are exactly the same as yesterday, and he his still comfortable and resting well. He seems particularly comfortable around us, and as such feels free to fall asleep in our presence. He was sleeping much of the time, except when being moved, changed, etc. We changed his diaper today and the nurse commented on how well he was tolerating it...I think he behaves better for us than he does for the nurses.
Andrew's morphine and Versed have been completely discontinued, meaning that he would have to be re-evaluated by a doctor before getting any morphine whatsoever. They are counting on the Ativan to calm him and the methadone to relieve any withdrawal symptoms, and so far they have been successful. All his gases have been "within parameters," even one taken today after having a dirty diaper. More importantly, he doesn't appear to be in any pain.
The suction on his NG tube is starting to look a little less green, so we're hoping that his bowels are calming down after the surgery. It feels strange playing the waiting game, as he's not really changing at all, either for the better or the worse. I'm certainly not complaining, because the last time I complained about the status quo he had a very bad week. That being said, it's frustrating being so close to both extubation and resuming feeding attempts, without taking those last few steps toward either.
I haven't taken as many pictures recently, because he's mostly covered by a blanket. They turned off the heater on his bed about a week ago and he's regulating his body temperature on his own. His head is peeking out and he frees his arms to wave them around every chance he gets, but it's hard to get a full-body shot without uncovering (and potentially disturbing) him.
Andrew's morphine and Versed have been completely discontinued, meaning that he would have to be re-evaluated by a doctor before getting any morphine whatsoever. They are counting on the Ativan to calm him and the methadone to relieve any withdrawal symptoms, and so far they have been successful. All his gases have been "within parameters," even one taken today after having a dirty diaper. More importantly, he doesn't appear to be in any pain.
The suction on his NG tube is starting to look a little less green, so we're hoping that his bowels are calming down after the surgery. It feels strange playing the waiting game, as he's not really changing at all, either for the better or the worse. I'm certainly not complaining, because the last time I complained about the status quo he had a very bad week. That being said, it's frustrating being so close to both extubation and resuming feeding attempts, without taking those last few steps toward either.
I haven't taken as many pictures recently, because he's mostly covered by a blanket. They turned off the heater on his bed about a week ago and he's regulating his body temperature on his own. His head is peeking out and he frees his arms to wave them around every chance he gets, but it's hard to get a full-body shot without uncovering (and potentially disturbing) him.
Jul 23, 2007
Slow Moves
All the changes today were relatively minor, but they were mostly in the right direction. His vent rate is down from 14 to 12, his nitric oxide was dropped from 5 to 2.5, and his oxygen is still down at 25/26. They've stopped his Versed entirely and took him off a morphine schedule. They've replaced the Versed with methadone to deal with any withdrawal symptoms, and they're still allowed to give him extra morphine if he appears to be uncomfortable or in pain. He took one morphine dose earlier today, but hasn't required any this evening. No major desaturations, no noticeable pain, and no inconsolable tantrums.
He's continued to have some bile coming up from his stomach, so they re-inserted his NG tube for suction. This is normal, and his intestines may take a few days to fully recover from the surgery. They'll wait until this clears up before they start to feed him again. Sorry that there's not a lot to report, but being off the medication and continuing to come down on vent settings is definitely progress. With the ventilator running this low and his nitric oxide creeping down to nothing, changes may be few and far between....they're only measuring his blood gases every six hours, which will move to eight hours when he gets further past his surgery. Once his stomach clears up they'll have even less to worry about, and I may start posting a bit less frequently. I'll definitely get all the milestones in there, but he's been (thankfully) a little boring during the past couple of days.
He's continued to have some bile coming up from his stomach, so they re-inserted his NG tube for suction. This is normal, and his intestines may take a few days to fully recover from the surgery. They'll wait until this clears up before they start to feed him again. Sorry that there's not a lot to report, but being off the medication and continuing to come down on vent settings is definitely progress. With the ventilator running this low and his nitric oxide creeping down to nothing, changes may be few and far between....they're only measuring his blood gases every six hours, which will move to eight hours when he gets further past his surgery. Once his stomach clears up they'll have even less to worry about, and I may start posting a bit less frequently. I'll definitely get all the milestones in there, but he's been (thankfully) a little boring during the past couple of days.
Jul 22, 2007
All Quiet on the NICU Front
Andrew had another day with the same sort of progress. They're only testing his blood every six hours, but he's been consistently weaned off his ventilator. He's down to 14 breaths per minute, from 20, and steady on his oxygen. They've started to come down on his Versed drip, cutting the dosage in half. They'll replace the other half with methadone, which should help alleviate any dependency Andrew has formed on his painkillers. As they wean him further, they'll raise the methadone dosage, then slowly wean that down as well.
In the last 24 hours, he's only had one or two agitated moments, and turning up his oxygen temporarily has seemed to stabilize him reasonably well. He's still very much awake most of the time, and the nurses have used everything from personal attention to mobiles to music to television as methods for distraction. We brought in a small music player and tiny speakers to put near his head and play to keep him entertained. Hopefully we won't have to use TV as a long-term babysitter quite yet.
When they started Andrew on antibiotics two days ago (a half-day pre-op), they took blood samples for cultures. One of those samples, from his arterial line, grew some colonies, suggesting a possible infection. They've pulled that line and put in a new one on his other arm, they've taken cultures every day since (all negative), and they've been monitoring his other vital signs for any other signs of infection. All reports from surgeons, doctors, and nurses have been great. There's no fever, no belly tenderness, and no positive cultures. It's possible that the antibiotics have already started working, or that the test may have been contaminated from the plastic itself. Either way, he's shown no adverse effects and has continued progressing in the right direction, so no one seems to be worried.
For now, I believe their strategy moving forward will be more of the same...weaning on ventilator and narcotics, watching his G-tube for any output, and keeping him happy and stable at all times. Once feedings start, we'll talk to the doctor about their new plan.
In the last 24 hours, he's only had one or two agitated moments, and turning up his oxygen temporarily has seemed to stabilize him reasonably well. He's still very much awake most of the time, and the nurses have used everything from personal attention to mobiles to music to television as methods for distraction. We brought in a small music player and tiny speakers to put near his head and play to keep him entertained. Hopefully we won't have to use TV as a long-term babysitter quite yet.
When they started Andrew on antibiotics two days ago (a half-day pre-op), they took blood samples for cultures. One of those samples, from his arterial line, grew some colonies, suggesting a possible infection. They've pulled that line and put in a new one on his other arm, they've taken cultures every day since (all negative), and they've been monitoring his other vital signs for any other signs of infection. All reports from surgeons, doctors, and nurses have been great. There's no fever, no belly tenderness, and no positive cultures. It's possible that the antibiotics have already started working, or that the test may have been contaminated from the plastic itself. Either way, he's shown no adverse effects and has continued progressing in the right direction, so no one seems to be worried.
For now, I believe their strategy moving forward will be more of the same...weaning on ventilator and narcotics, watching his G-tube for any output, and keeping him happy and stable at all times. Once feedings start, we'll talk to the doctor about their new plan.
Jul 20, 2007
He Is Strong Like Bull
Andrew's recovery is continuing well, and he's reacting in a really funny way. They gave him an extra dose of steroids just before the surgery this morning, in order to reduce inflammation, etc. The nurse said that was why he was awake so soon after his surgery, though she was expecting him to go to sleep after they started the extra medication, which is called Versed. Versed, medically known as Midazolam, has the following drug description:
"Midazolam is used to produce sleepiness or drowsiness and to relieve anxiety before surgery or certain procedures. It is also used to produce loss of consciousness before and during surgery. Midazolam is used sometimes in patients in intensive care units in hospitals to cause unconsciousness. This may allow the patients to withstand the stress of being in the intensive care unit and help the patients cooperate when a machine must be used to assist them with breathing."
The description mentions drowsiness, sleepiness, or unconsciousness four times in four sentences. He's also on regular doses of morphine and Ativan, and had major anesthesia this morning. One would think he would sleep for the next three days...but not our baby. When I called before shift change at 6:30pm, the nurse said, "Your baby is hilarious." Apparently he was wide awake the entire time, watching her every move, staring at his mobile, and even trying to turn his head to follow her movements. Just like his daddy, he doesn't want to go to sleep when anything interesting is going on. She finally had to put a blanket over his eyes to make him go to sleep.
The night nurse had the same report. He's been awake a lot, though entirely comfortable and not irritated. When he does get a little upset, he's been a lot more consolable than he was before the operation. His blood pressure is a little high from the steroid dosage, but he's still behaving very well and all his gases have been good. All his vent settings had gone up in the last few days when he was getting so upset, and they've been able to wean them back down today. His oxygen percentage is at 25%, which is the lowest ever. His vent is at 20 breaths per minute, down from 26 this morning. He's breathing above the ventilator while he's awake and sometimes when he's asleep, except for the few times the drugs have really kicked in and put him into a deep sleep. Suppressing respiration is one of the expected effects of the drugs, but he's been able to keep great blood gas levels even on low settings.
We're very proud of how he's handling his recovery so far. It appears that his discomfort in the last few days didn't involve a relapse with his lung issues, which have continued to improve. They'll continue with the same strategy, but probably won't try extubating him until he's on much lower doses of medication. He's on a few extra meds (the painkillers, antibiotics, etc) for now.
They've been getting some light green fluid from his NG (nose to stomach) tube, which is to be expected for a few days. In the morning they'll remove that tube and start doing everything through the G-tube (direct to stomach). In a few days, they'll be able to replace the huge plastic disk on his chest with a much more unobtrusive connector. As his stomach excretions become more clear, that will be a sign that his bowel has recovered from the surgery and is ready for feedings again. We'll be starting over with very small amounts of milk, but hopefully he'll respond better now that there aren't any obstructions.
It'll be several days before they remove the bandage over his incision, and probably ten days before the Steri-Strips and remaining tape are gone. We're not sure exactly what it looks like, but it's straight enough that it ruins our cover story. With his long, curving scar, we thought he could tell people it was a shark bite...the new scar will require a new explanation. Any ideas?
"Midazolam is used to produce sleepiness or drowsiness and to relieve anxiety before surgery or certain procedures. It is also used to produce loss of consciousness before and during surgery. Midazolam is used sometimes in patients in intensive care units in hospitals to cause unconsciousness. This may allow the patients to withstand the stress of being in the intensive care unit and help the patients cooperate when a machine must be used to assist them with breathing."
The description mentions drowsiness, sleepiness, or unconsciousness four times in four sentences. He's also on regular doses of morphine and Ativan, and had major anesthesia this morning. One would think he would sleep for the next three days...but not our baby. When I called before shift change at 6:30pm, the nurse said, "Your baby is hilarious." Apparently he was wide awake the entire time, watching her every move, staring at his mobile, and even trying to turn his head to follow her movements. Just like his daddy, he doesn't want to go to sleep when anything interesting is going on. She finally had to put a blanket over his eyes to make him go to sleep.
The night nurse had the same report. He's been awake a lot, though entirely comfortable and not irritated. When he does get a little upset, he's been a lot more consolable than he was before the operation. His blood pressure is a little high from the steroid dosage, but he's still behaving very well and all his gases have been good. All his vent settings had gone up in the last few days when he was getting so upset, and they've been able to wean them back down today. His oxygen percentage is at 25%, which is the lowest ever. His vent is at 20 breaths per minute, down from 26 this morning. He's breathing above the ventilator while he's awake and sometimes when he's asleep, except for the few times the drugs have really kicked in and put him into a deep sleep. Suppressing respiration is one of the expected effects of the drugs, but he's been able to keep great blood gas levels even on low settings.
We're very proud of how he's handling his recovery so far. It appears that his discomfort in the last few days didn't involve a relapse with his lung issues, which have continued to improve. They'll continue with the same strategy, but probably won't try extubating him until he's on much lower doses of medication. He's on a few extra meds (the painkillers, antibiotics, etc) for now.
They've been getting some light green fluid from his NG (nose to stomach) tube, which is to be expected for a few days. In the morning they'll remove that tube and start doing everything through the G-tube (direct to stomach). In a few days, they'll be able to replace the huge plastic disk on his chest with a much more unobtrusive connector. As his stomach excretions become more clear, that will be a sign that his bowel has recovered from the surgery and is ready for feedings again. We'll be starting over with very small amounts of milk, but hopefully he'll respond better now that there aren't any obstructions.
It'll be several days before they remove the bandage over his incision, and probably ten days before the Steri-Strips and remaining tape are gone. We're not sure exactly what it looks like, but it's straight enough that it ruins our cover story. With his long, curving scar, we thought he could tell people it was a shark bite...the new scar will require a new explanation. Any ideas?
Post-Op Video
Here's a video of Andrew an hour and a half after finishing his surgery. Sorry it got squished somehow...it makes him look shorter and wider than he actually is.
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