Finished!

It's official. Karsie's doctor appointments this year are done in San Diego. We're sad to be leaving them as pretty much every doctor has been amazing, but it's exciting to leave for home. Our plan is to leave Thursday night and arrive in Bakersfield on Friday.

Today Karsie saw the G.I. doctors. Everything looked great. There wasn't much done except a look at her lab work that was done a bit ago. Her liver functions are pretty much normal, especially for her. We will be returning in a month or so to talk with nutrition and G.I. together about her feeding. But she is looking great!

Her blister popped. We thought she wet herself with a blowout from her diaper, but it was the "juice" from her blister. So now we have a new thing to look at on her belly. Hopefully it's a quick heal. Tomorrow is "goodbye day" for the grandparents. Nana and Grandpa will be spending as much time smothering Karsie as they can before she leaves.

History of Karsie (12-14-09)

WARNING:  BIRTH FOOTAGE and medical pictures

Two Down, One to Go...

Today, Karsie had two of her three appointments before we leave for Bakersfield.  She had four lined up this week, but one of the appointments (nutrition) bailed on us and we set it up in January.  So far so good.  We had neurology early today.  The doctor she saw was the first neurologist that told us about Karsie's burst suppression after the initial EEG.  He looked her over, pulled out a toy and let Karsie track it (she passed with flying colors), and checked her reflexes.  As far as he's concerned, she's perfect.  He also pulled out a preemie growth chart for Karsie's head and she's pretty much smack dab in the middle, so she's growing fine.  Her weight now is 9 lbs. 14 oz. but they weighed her with her clothes on, so a couple ounces probably should be shed from that weight.  We go back in April.  

Surgery was next.  It was interesting seeing Dr. Saenz out of the hospital.  We were a little nervous about the surgical appointment as Karsie has grown a blister on Pinky.  It showed up a couple of days ago and has filled with fluid since.  However, he did not seem too concerned about it.  He said to treat it just like we're treating the rest of her granulation tissue, which is to put wet to dry dressing on it.  He said it will pop one of these days and it will set her back a bit with the skin growth on the omphalocele, but it's not a huge concern.  But the rest of her looks amazing!  She's so close to having total skin all around it.  

Last night Karsie went to her first party.  One of the Sunday School classes here at the San Diego church we attend holds an annual Christmas party.  They have all been so faithful praying for Karsie, so we made a cameo and had dinner while showing off our miracle.  She was wearing a homemade dress made by Nana.  Isn't it cute?  We had to leave early as we miscalculated Karsie's food, so we needed to fill it up.  Also, we're now part of the infant parent club so commitment to something for a couple of hours is always up in the air.  

Tomorrow ends our doctor visits in San Diego for the year.  We visit G.I. tomorrow and get to weigh her for real (they do the whole naked weight thing).  Think fat thoughts...    

Aunt & Uncle Time

It's been a long time coming, but we finally got the aunts and uncles time with Karsie.  Uncle Todd and Aunt Christine were able to visit Karsie the first time she came home.  Aunt Mandy was sick that weekend and she never was able to see her.  This weekend, Aunt Mandy finally was able to visit Karsie.  She spent a lot of time walking around with Karsie's "bag" of food (the black bag under Aunt Mandy's arm carries Karsie's food and pump connecting to the G-Tube). Hopefully this Christmas we will all be together and Karsie will get to see everyone at once. Next up...great grandparents!!!

Pediatric Appointment

Yesterday we went to the final pediatrician appointment in San Diego (at least that we know of). We are very sad to say goodbye to our doctor as she is wonderful, but excited to take her home and meet a new one.  Hopefully he will be as good.  

Everything with Karsie looks as good as can be expected.  She weighed in at 9 lbs. 7 oz.  She's finally getting to the weight of some big babies at birth.  She's still got another pound to go to get to her mommy's birth weight.  

We haven't mentioned Pinky in a while, but it's almost completely skin now.  There is a little area, maybe the size of a half dollar, that is still granulation tissue, but even that is starting to look like it's ready to turn into skin.  It also looks smaller compared to her body.  It's still a pretty good size, but it used to be really tall and the base is now bigger which means it's probably going into her abdomen.  We're working on a little video that goes through Karsie's first few months and we'll try to get in a few good pictures of Karsie's current skin on Pinky. 

One appointment down, four to go.  Next up:  Surgery and neurology.  

More Zoo Pics

It was a fun enough day yesterday to devote two blog entries to it.  Here are a few more pictures with explanations:

There is a baby in Michelle's arms, but by this point in the day Karsie was in her little Moby wrap.  Plus since it was cold, she was bundled by blankets.  But trust us, she's there.  
We had to get this picture (all of these actually) sent to us from Kelli and Dave, but here is the proof that there were actually animals where we went.  
Our favorite place to go at this point has been the viewing area by the orangutans.  We got Subway and brought it in to eat our lunch.  This is one of our favorite things to do, sometimes just for lunch.  And this time lunch featured not only the monkey entertainment, but a little girl to entertain as well.
Karsie is actually awake, but her hat wiggled its way down her face and covered her eyes.  One day she will enjoy the monkeys when she can actually see them.

Zippity "Zoo" Da What a Wonderful Day!

In front of the orangutans.  None are in this picture, but we just missed one earlier that was peering out looking at the people.  
There was a lady that stared for a very long time at Karsie's little setup here.  We fashioned a little venting device with the syringe.  It hangs from the car seat and the food goes into the top. The venting helps Karsie get out gas that builds up.  It's definitely not something you see everyday. 
In front of the duck pond.  We learned lots of facts on ducks here.  Maybe one day you'll hear us talking about them randomly.

In case yesterday's post was a bit cryptic, Karsie is out of the hospital and home with her family. Although judging by the comments it seems it was understood.  We had a hard time keeping it from everyone including the blog as Michelle really wanted to surprise her mom and dad.  Reva would say from time to time that she was hoping that Karsie would just be there one day.  We found out late last week that Karsie would most likely come home on the 9th.  So we really had to work to make things seem pretty ho hum during that time.  Even before that we could tell it was coming as Karsie was doing so well.  Needless to say, we feel better not having to tip toe around the subject.  The blog was especially hard since it's whole purpose is that very subject we were trying to tip toe around.  It was tough but totally worth it when Michelle's parents walked in and saw us holding her.    

That being said, Karsie is home and doing great.  She slept 8 hours last night.  While we would never wish the G-tube on any baby, especially our own, it does have its advantages.  One of those being we don't have to wake up in the middle of the night to feed her.  It does that on its own.  We've noticed a little decline in her leg strength.  Babies have the reflex to use leg resistance when parents stand them up and most babies just get stronger with that until they walk.  Since Karsie has been in the hospital for so long she hasn't had to use her leg strength, so it has gone down considerably.  Therefore, one of our tasks is to get her to push back when we push on her legs every so often.  We continue to work on her neck strength as she hasn't had a whole lot of practice sitting up or being held so she has to use it (that darn Pinky keeps getting in the way).  She is doing very well considering her lack of practice.  

We have a slew of appointments coming up starting with tomorrow's pediatric appointment with Dr. Gorton (we LOVE her and we're sad we have to leave her).  Just in one week we have at least one pediatric appointment, a surgical appointment, a neurology appointment, a G.I. appointment, and a nutrition appointment.  They slow down after a bit, but for now it's a bit hectic.  

Lastly, we were finally able to take Karsie to the zoo.  That was a desire of ours for a long time. It's very relaxing to us to see animals and it's a fun place to bring a baby.  We didn't spend much time there, but there was one very amusing thing that we must share with you.  We, the three of us and Karsie's Godparents, decided to go down the bear trail.  Most of the bears were in their little caves and homes because it was freezing cold, like 50 degrees (I say that with a hint of sarcasm as there are people that read this blog from other parts of the country rolling on the floor with laughter at the wimps - animals included - that reside in California).  We stopped to put Karsie in her Moby wrap, which she absolutely loves.  Karsie falls right to sleep when she is snuggled up in her Moby.  To do so, Michelle needed some assistance, so we were all helping put Karsie away.  Karsie began to get a bit fussy and started to cry and whimper.  As she was doing this, the bear that was in his cave (a sloth bear to be precise) came barreling out and stopped right at the edge of the moat that was keeping him from the fence that we peered over. He was definitely not aggressive but very concerned for Karsie.  He paced back and forth rapidly and even stood up on his hind legs a few times to peer at our little one.  It was absolutely hilarious.  We wish we had gotten a picture or video, but we were all helping, so our hands were tied.  So, if you are ever at the zoo with a baby and want to see an animal, have the baby cry on command and you might luck out.

Until next time...    

No Words Wednesday

BEFORE AND AFTER...

WELCOME HOME BUG!

Speedy Stats...

As of this afternoon:

Up to 28mL of 24cal/oz Elecare/Duocal formula.
Breastfeeding like a champ when she is allowed to!
Gaining steadily... up over 9lbs, gaining around 25 grams each night.
Gagging every once in a while... but responding well to being vented. Prayers that she continues to respond well to venting!
Skin is growing well and healing as well as her recent surgery incision and g-tube site.
PICC line is now gone :)
Happy girl!

One Year Ago...

It was about this time a year ago that we found out we were having Karsie.  We had been trying for a few months and got pretty discouraged.  We decided to relax about it all and took a pregnancy test just for the heck of it.  Things happen when you least expect it.  The news became one of the Christmas presents we gave to our families as we visited them during the holidays.  

Karsie continues to do very well.  The gagging has pretty much stopped altogether.  We're pretty sure that she just needs to be vented with all the gas that gets built up with slow motility.  Once she gets vented she is much happier.  The doctors really want to get her to 150 mL per Kilo which would put her at about 28 mL.  She is currently at 25.  This kind of sprung up on us, but we do know that they wanted her up to that since the beginning.  3 mL to go!!!

She is currently weighing in at 4.15 kilos.  That translates to 9 lbs and 2 oz.  Also good news: her PICC line comes out tomorrow assuming she tolerates the feeding today.  We are so excited to have our little girl home for Christmas.  

Gagging

Maybe I didn't knock on wood hard enough... or maybe it was fake wood... but the Karsie has had a little bit of gagging today. We are desperately praying that it goes away. We are not sure what set it off because nothing changed until later in the day today (after it started). We are trying to vent her tonight and hopefully she will let some air out of her tummy and the gagging will be done, but if not it would be a safe bet that she'll go back down on her feeds.
She is currently getting 22mL an hour and it is now 24cal/oz. The formula is being fortified with duocal so she doesn't get overloaded with calcium and vitamins from Elecare. She started that this evening, so we are not sure how she will handle it.
Karsie is also still growing. Tonight's weight would put her at just over 9lbs, but the weight might be a little high and will likely come down slightly over the next couple days (her bed scale is a little touchy and the weight tonight was a 115 gram jump).
We are feeling down about the gagging... and we are praying that it stops and was just a little air in the tummy. Please pray with us that Karsie will be able to digest her added calories and that the gagging is over. We are ready to have her home again...

Back to the C

Karsie is continuing to do well (insert the sound of me knocking on wood).

She is up to 21mL an hour of 22cal Elecare. Tomorrow she should go up to 22mL and then over the next few days her calories would be increased. We are not sure how many calories she will need per ounce, but there are a few different options for how to get there being tossed around. We will start with increasing the caloric value of the Elecare. If that doesn't work, there are a few different ways to add MCT oil or possibly flax seed oil. We are trying not to use rice cereal this time as it can slow down motility... and Karsie already has super slow motility (hence the g-tube/fundo).

Karsie is still growing. The last two days she has slowed down her growth a little, but still growing. Over the last 7 days she has grown better than any other time in her life! That is amazing :)

This afternoon Karsie was moved back to C-pod (the step-down unit). We are not in a private room, but we do have a good amount of space. We are hoping this means they plan on sending her home soon!

The nurse practitioners from the NICU and GI talked yesterday about some flavor options for Karsie in regards to her oral feeds (since she HATES Elecare). They decided to let her breast feed!!!!! She has a 5 minute time limit so she doesn't eat too much. Last night she didn't do well. She really just wanted to look around and see what was going on, and eating was taking away from that. Also, she has been taking her paci so much lately (which we like) that it can make the transition a little tricky. Tonight however she breastfed like a little champ! She ate for all 5 minutes and then I had to give her the paci back because she wanted to keep going. She gave me a great milk drunk face and fell right to sleep. That was a great moment! She might not get back to plain breast milk for a while, but what a treat to get to nurse her again!

Karsie is now up to 20mL an hour on her feeds... but the pump is only running for 22 hours a day! That means that in the evening she has a 2 hour break from food. The goal is to get to 20 hours a day (a 2 hour break in the morning and another in the evening). The other goal is to get up to a good volume (approx 130mL/kilo/day=520mL/day=26mL/hour) and then modify the calorie content so she will continue to grow. The process is very day-to-day... and based on provider preference. Therefore, we only know the general outline and not so much the day-to-day plan. Thankfully we are at peace with this plan and are feeling ok about taking time with it.
Karsie is still a fun little bug! She is active and awake lots now and she loves to play and have books read to her. It is so fun watching her develop! She smiles all the time!

Christmas Bug

"I love me some linkys!!"
"Look at me, I am so sweet in my Christmas outfit! Thanks Aunt Darla!"

It seems the backtracking has helped. Karsie is now up to 18mL an hour of 22cal Elecare. She is doing very well on it and not really gagging at all. She had another bottle attempt yesterday and didn't gag but didn't enjoy the Elecare (yuck). We are now asking about having her take breastmilk by bottle to make the experience more pleasurable.
She is growing a lot! She has grown well for the past week... and she is now more than 8 1/2 lbs. While I still want her back on breastmilk... I have to say that the Elecare is working well to keep her growing!
Karsie's skin is continuing to heal, but it seems her body might be prioritizing general growth above skin growth. The granulation tissue growth has slowed down a bit. Her g-tube site and fundo incision both are healing nicely.
We are pretty ok with the plan being a little slower... in hopes that if we take our time, there won't have to be much backstepping again. We are ready to have Karsie home with us yesterday... but we want her to be healthy too. And for now... as much as we don't enjoy the hospital... we are enjoying every minute with our little bug! She is amazing :)

The Climb Begins Again

After 36ish hours of staying at 15mL/hour, Karsie has begun to climb back up towards a goal of at least 21mL/hour. She is going to go up once or twice a day depending on how she is doing each day. If it seems like she is getting more gaggy she will stay longer at each volume. If however she is handling well, she will be increased. The trick now is to find her tolerance level and then not go over. Then, once we have a good volume for her, we will see about increasing calories.
Karsie is still doing well in all the other areas! Her skin is still healing well... the granulation tissue is about 2in across now! Her incision from the fundo/g-tube is healing nicely and the g-tube stoma (hole) is healing well also.
Karsie is a lot of fun these days. She is so happy and interactive most of the time. She LOVES to play with her toys and look at books or pictures. All the nurses are saying how comfortable she looks and how fun she is to watch. We feel the same.

Happy Karsie But The Soap Opera Continues...

Thanksgiving was great!  We were able to have the whole family together (minus one of course) and we got to go see a happy Karsie during the day.  

Today was back to the roller coaster that is our life now.  Karsie has been gagging quite a bit lately and really starting to retch.  If this had been before she had the fundoplication she would have been throwing up quite a lot.  It really started to pick up today as she was doing it many times during the hour.  So we got a call from the hospital today while we were out shopping (if you avoided shopping today you lucked out).  They said that they have backed her down to 15 mL an hour (she was at 25) and are going to go up slower to see if they get to a point where she starts it again.  The thought is that she is just hitting a wall and is unable to handle the volume. If that is the case they will increase her calories to make up for the lost volume so she can grow and get hydrated.  She's still growing and pooping so that has been a plus, but we've taken a step back.  We're pretty beat up about this because this seems to be the story every time.  We get real close and then we have to go back and start all over.  The good news is that they still seem to be talking about how they can get her home even with all of this stuff happening.  But for now our stay has been extended a little bit longer.

When we eventually went in today Karsie was alert and happy the whole time.  Since being backed off she hasn't gagged nearly as much, so we're hopeful this is something fixable soon. As of yesterday she was about 8 lbs. 7 oz so she is still growing.  Slowly but steadily.  We want her home for Christmas, so if any of you want to get us something great for Christmas call up Children's and tell them what to do to fix Karsie to get her home.  Blessings...  

Thankful... Part 2

Because who doesn't like a little more thankfulness (especially if it comes with some pics)!!

Over the last year... 

We started here:

Then we became three:
Now we are here:

What AMAZING things we have to be thankful for!

Happy Thanksgiving!

"Ooh, shiny...I'll take those!"

Technically it's Thanksgiving now, but we still get to go to sleep for a bit before the feast. Speaking of feasts, Karsie gets to feed by mouth tomorrow for the first time in a few weeks. We are excited to see her get some food. However, we're not on breast milk (yet); we're on Elecare, so she will probably hate the taste, but hopefully not eating for weeks can persuade the pickiest of eaters.

She is currently getting 19 mL of formula every hour which translates to 58 mL every 3 hours (she was at 70mL when we took her back to the hospital). She is continuing to increase 1 mL of volume every 6 hours. Unless you're an amazing mathematician (hi Todd) we'll just tell you that it means she will be at her admission volume tomorrow night and at her approximate target volume (78 mLish) Friday (they increased her target volume because of her weight gain and age). She has been tolerating her feedings well so far. She did gag pretty hard tonight only a couple of times, but they said she could do that due to the fundoplication (and she has lots of saliva too). However, she's pooping like a champ so things are moving through.

We think if everything goes perfectly that we could be out as soon as early this next week. That's our hope at least. She is weighing about 8 lbs. 5 oz. That changes day to day, but we think we've hit her actual weight (she was much heavier after surgery as she retained fluids).

Finally, Karsie has been very content and downright happy lately. She just sits and stares for long periods of time trying to get everything in. In fact, we can tell that she is about to just crash but tries to stay awake because she wants to look around. She has started to talk a bit (cooing) and smiles very easily. She still has a pretty weak neck as she has been on her back for weeks and weeks, so we've decided to try and get her to practice holding her head up when we get a chance. She was doing fairly well tonight, but we can't do any of the natural things to help her with that like tummy time or holding her over our shoulder (as babies practice holding their heads up then). So we are trying to encourage the skill.

In the spirit of Thanksgiving... we wanted to acknowledge some things we are thankful for!

First of all we are thankful for our new family of three! We are so happy to have our incredible little Karsie Gene. She is such a fighter and she continues to amaze us. We are so glad to be on this journey together. We are able to pull strength from each other daily and neither of us could do it without the other.
We are thankful for supportive families. We are so grateful for the love and support they have offered. We are thankful for a place to stay in San Diego to be close to Karsie. We have enjoyed being able to spend time with our families.
We are thankful for incredible friends. We have friends all over offering to help us in any way they can. We haven't had to worry about things like a bum refrigerator or mail or the sprinklers. Having friends to come along and help lift some of the load has made a huge difference.
And we are thankful for prayers. We are overwhelmed (all the time) by the comments, emails, letters, calls we get from people letting us know they are praying for the three of us. We know that is just the tip of the iceberg. We will never be able to count all the prayers that have been sent up on our behalf... and for that we are incredible thankful.
We are blessed!
Wishing you a VERY Happy Thanksgiving!
Kevin, Michelle and Karsie

Happy Girl!

Sorry for the lapse in blogging... I have been a blog-slacker for the past few days.

Karsie is a trooper! She is up to 11mL an hour of feeds (Elecare 22cal) and will increase to 12mL at 1am. She is handling her feeds very well and moving it through! She did go about 48 hours without pooping, but then this evening she had a nice big poop! Someday Karsie will give us a hard time for broadcasting her bowel movements... but we are happy for the poops! She is also urinating a lot and getting rid of all her excess fluids from surgery.
Today she got her 4 month immunizations. She was given Tylenol in advance and was also given emla cream (numbing cream) so she didn't feel the 4 injections. She took it like a champ and didn't cry! She was a little more fussy this evening and you could tell she was sore.
She has been really alert and happy lately though! This is so fun! She likes to play with her linky toys ("Thank You Aunty Carolynn") and watch everything that is going on around her. We have to cover her eyes to get her to take a nap because there is so much to watch (she is on the monitor... don't cover a sleeping baby's face at home). She smiles all the time and really is just a fun happy girl!

A Very Special Thank You Part II

The three of us want to put out a special thank you to two incredible prayer warriors who have prayed every day since we can remember for our little girl. We know there are many more little ones that pray for Karsie and we thank all of you.

Thank you Garrett and Payton for your continued faithfulness to our family. You are helping Karsie every day with your prayers.

4.07 ??????

This afternoon we walked into the NICU to see Karsie's weight posted on her growth chart.  It read 4.07 kg which is basically 9 lbs.  This was an enormous increase from the day before and we were sure that it was a mistake, but it was exciting to think that she beefed up that much.  Sure enough we came back today and it was 3.775 kg which is 8 lbs. 5 oz roughly.  Even that might be slightly inflated as she has the G-tube now part of her weight and she has a few extra wires and such, but we're pretty sure that she is at least 8 lbs. now officially.  

Karsie has been increased to 2 mL per hour.  We thought that the order was going to be to increase by 1 mL per hour every 6 hours or so, but that didn't happen.  However, she has been changed to Elecare which is a formula, so that was a change.  They will go very slow at first and the hope is that if she tolerates it they will increase her feeding much more quickly.  

Thanksgiving is a good day not just for us eating but for Karsie as well.  They are giving her throat and esophagus a rest for a while as it has been hit hard by acid, surgery, and her being intubated.  However, we have decided that Karsie will get a Thanksgiving treat by getting to eat by mouth.  By then she should have ample time to heal her throat and from her surgery, so we want to try to give her a pleasurable experience with eating. 

Bit of News... and a couple pics!

Today Karsie was started back on feeds! Yay! She started VERY slow at 1mL an hour continuous. She has been tolerating it well; and if she continues to tolerate it, then she will be increased tomorrow (by an unknown amount). She is on pedialyte today and sometime within the next 24-48 hours she will be moved to Elecare. She will need to get up to full feeds of Elecare and tolerate that before we transition back to breast milk (but that is still the goal).

As promised, here are a couple pictures of our baby's tape-free, tube-free, beautiful face!!

Post-Op Day 3

Not much new today. Karsie is post-op day 3 and resting lots. She is still on Tylenol and Ativan for pain and to help her relax. She is breathing on room air and doing very well. She is a little "junky" sounding in her breathing, but nothing to be worried about... just a reaction to being intubated. She is still having a little bit of drainage through her g-tube which is also normal.
This afternoon she got rid of the NG tube that was being used to suction her esophagus. So, she is now tube/tape free on her face! Pictures will follow!

The other GREAT news in her post-op status is POOP! She has had two little poop smears today as well as a decent sized poop! Yay for working bowels! That is really great news. It means that her insides aren't too angry after surgery. It also means that if all continues to go well, she will get to eat tomorrow. We are not sure of the exact plan for feeds, but we do know she will start with pedialyte and things will go slow.

4 Months!

Well, not quite 3 months gestational age, but 4 months from her birthday. It doesn't seem like that long and at the same time it seems like forever.

Karsie has been doing very well today. She was extubated at about 2:00 p.m. and has done fairly well ever since. She has a nasal cannula for now until she can keep up her saturation level for a consistent amount of time, which we hope will be early tomorrow.

She was quite upset tonight when we went in, but not too terribly bad. This could just be that she was fussy or that she was too tired to really scream it out, but she went to sleep after a while and looked pretty comfortable. We hope that they manage her pain better than last time after she had surgery, but we're not counting on it. Part of the problem is that it's hard to tell if she's having pain or if she's just fussy, so that's not the doctors' fault, but when it's obvious she's uncomfortable we're expecting something to be done. So far it hasn't gotten to that level. She is on Tylenol only now and she seems to settle down after she gets it.

This is her G-Tube. It's a little blurry but you can see it comes right out of her skin. Her stomach is on the left side of her omphalocele so it sticks right out of there and it's only about a centimeter deep. That little tube that's dark (which is old blood from the surgery) comes out and you can plug the tube like a beach ball. Dr. Saenz said it's very fragile right now, so we're not sure what that means and when we can hold her, but for now we're staying away from that. We have had to put little mittens (or socks in this picture) over Karsie's hands so she cannot grab onto the tube.

We may start feeding tomorrow with pedialyte or we may just be waiting another day to give her body a chance to recover. We suspect the latter, but who knows. We're just praying for a quick recovery and that it works for her growing.

Continuing...

Not really much news other than what we posted earlier.  Dr. Saenz was able to do everything he planned to do without any trouble even with everything in her belly "cattywompus" (that was his quote).  He's planning on going real slow on the feeds, but he will be working with the NICU on how slow.  

We were able to see her briefly before we get kicked out at 6:30 and she looks good.  She has elevated blood pressure and heart rate and a couple other things that happen normally after surgery, but it's something to keep an eye on.  As soon as she wakes up the plan is to extubate her as long as she breaths fine.