Monday, October 17th, 2005

Time	Event
1:03a	Patri and I wanted to post about how great KC is, and having been doing it, its obvious how much it means to the baby. Tonight for example, I came in and he was obviously rather agitated, but upon getting him tucked on my chest, he calmed down, and within about ten minutes went into a very deep sleep which lasted for over an hour. I was originally thinking I'd do this with him about three times/day, but one seems to be all we can handle for now :( Despite that KC makes him and me so happy, its very very stressful to get into and out of. As stated, he's got several lines coming off of him: IVs, monitors, the pic line that goes straight to his heart, and since the surgery, he's now on a respirator. The respirator is a tube that goes down his throat, supported by a contraption that is taped to his cheeks, and pulls them forward, very close to his eyes. I actually ended up putting him back a little early today, because his head kept slipping and the thing taped to his cheeks was smooshing his nose. Its also harder to read his signs with the respirator in his mouth. Usually he grimaces when he's uncomfortable, but he can't with the thing in his mouth, so its not until his knuckles go white or his pulse monitor shoots up that I can tell if there is a problem. Today, in addition to all the usual pain he has to go through, the nurse accidentally put him in an arm bar. I think he's okay, because his pulse went back down fairly quickly after I realized what was happening and told her to stop. She was showing me something on his arm, and he was resting on his stomach on my chest. She pulled his arm back to show me, and it unfortunately took me a second and a look from his arm to his face to realize he was in serious pain. He couldn't even make a sound to tell us he was hurting because of the tube down his throat. While not usually from arm bars, I see my baby in pain of some nature on most days. Instead of being nice and safe in the womb where he can sleep 20hrs/day he's in a room with constant loud beeping sounds, his arm is splinted, his hand is bruised, and he's got a femoral arterial line, his foot is bandaged, he's constantly having blood drawn, being disturbed, etc. And every time we do KC, he has to be moved, along with all his cords. It took three nurses to move one 2lb baby today: one to hold the cords, one to move the respirator tubes, and another to move the baby. This is of course, after they spend about ten or fifteen minutes untangling and positioning equipment. And of course, things get jossled in the process, and its always scary to watch, just hoping that they don't drop the big heavy thing that's attached to one of his cords, or yank any of the others. He does have it much better than most premies though, at least he is getting held, and despite how awful the process of getting there is, I don't doubt that its worth it. There was one day early on where he had an echocardiogram, and was obviously unhappy afterward. I went with the nurse's recommendation of not holding him that day because he'd already been through so much with the echo. The following day was the worst I'd ever seen him, I think that 20% of his body weight disappeared mostly that night. He looked a lot like ET when he was in captivity: pale yellow color, eyes not tracking very well. Of course, I don't know how much was from the echo related trauma or other factors, but I got the sense that a big contributing factor was that he thought he'd been deserted. He's had two echos since then, and while he's always a big of a wreck afterward (getting bradycardia pulse drops), he hasn't looked that bad since, and his weight has been crawling back up, although last I checked he was still down 15% from birth. Anyway, regardless of whether my coming back and holding him every day after that was influential in his handling echos better afterward, the stats Patri posted show that kangaroo care is very effective in helping out premies in many different significant ways. And I think I would become depressed and lose weight as well as Tovar if we weren't doing it. Its hard to think of him there by himself most of the time, so helpless and alone, and so often in pain. He should hopefully get the breathing tube out by day after tomorrow. Patri suspects that its taking so long because they're giving him morphine for pain reduction after his surgery, and that's depressing his system and making it too difficult for him to breath on his own. Anyway, just wanted to give a little more rounded picture... Tovar is doing well, for a preterm baby, but to say that its a tough way to start life is a major understatement. (5 Comments | Comment on this)
9:13p	an up day :) Tovar and I both seem to be doing better today than last night. And he's finally getting food from more than an IV!!! :) As is the case about many things in the still heavily evolving field, I got different advice from different nurses about breast feeding and about how to bring in milk. A nurse had told me a few days ago that I should only put about 15cc in a bottle, because they wouldn't be using more than that for a while and the rest would all go to waste. But the last several days I've been producing 300-500cc/day, so I talked to a nurse about it a few days ago and this one told me to make some medium sized bottles and thought my idea of making more full bottles to be frozen and a few medium ones. Today the nurses told me to stop bringing in milk entirely, because they already had five bins for me! I think I'm probably going to hit the goal the lactation specialist recommended I be at by two weeks today, 600 to 720cc/day. I was glad to be there when they started feeding him today, because I immediately noticed that the food syringe was filled with milk rather than colostrum (colostrum is thick and yellow compared to milk). The nurse explained that she'd only seen two out of the five bins of my milk at first, and that they did not contain the syringes, but that she'd found them since, and that they'd start him on the colostrum once this bottle was done since she didn't want to waste this bottle of milk. I assured her that no really, I would much rather she waste one of the gazillion bottles of milk they have from me than not start the baby on colostrum ;) So, while his first taste of food was milk, he should be getting the good immune system stuff now for the next few days. He was still on the respirator when I came in around 2pm, but by the time I was able to hold him, 5:30pm (I waited until after the 3-3:30 break and then the nurse wanted another hour or so because he'd been having some bradycardia which she thought was related to starting food), they'd taken it off and switched him over to breathing tubes that went up his nose. (It looked like cpap but the nurse said that it doesn't go as far up the nose and isn't as strong or irritating for them). The nurses and I were much relieved about the switch, although Tovar was not quite as enthusiastic ;) Although it was much less stressful for all involved to move him without the tube down his throat, he really doesn't like having tubes up his nose, who can blame him. So instead of going into a nice deep sleep like he normally does when I hold him, he spent the entire hour trying to pull the thing off his face. But even so, it was clear that it was just annoying for him, not something to cry or even grimace very much about. I was a little annoyed, because it was clear that the oxygen levels were too high for him, which was likely part of why it was bothering him so much. The monitor kept flashing and beeping that he was at 100 saturation, and the nurse did turn it down a few times, but she was concerned about turning it down too fast despite the monitor's beeping and the baby's irritation. I was impressed with Tovar's dexterity in trying to get the thing off, he actually managed to pull it down a couple of times, but inevitably would get tired and go to rest his head and accidently push it back in. I was very tempted to help him but figured that it wasn't a good idea, especially because while I do think the oxygen was too high, I don't know if he was really ready to go completely without. I did draw the nurse's attention to it and got her to turn it down a little more than I think she would have on her own, but I didn't dare push much more, as I'm fairly certain she was getting irritated with me, and I figure its better to try to stay in her good graces than to push her to get the tubes out a tiny bit earlier. There's a good chance that they came out not long after I left, because it was time for the doctors to do their rounds and his stats were looking excellent. If all goes well Patri and I will be making our midnight baby run again tonight, and Daddy will get to try KC himself for his first time :) (4 Comments | Comment on this)

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