The Incredible Shrinking Patch

This morning, Michelle received a call from Dr. Saenz. This took her off guard (especially because she thought he was on vacation). He was calling to inform her that he had taken a look at patch and decided, because it was getting kind of loose, to take off 2/3 of the gore-tex. WOW! He explained that there was granulation tissue all the way up the sides, and across part of the top. The remaining part of Patch is stuck to the granulation tissue that is still forming, but he anticipates it will be removed within a few days. The mound of organs is now mostly covered with granulation tissue and some skin. The dressing changes will happen every 12 hours now instead of 6, and the dressing is the wet-to-dry dressing. This will help facilitate skin growth and healthy healing. This is all amazing news, and we are hoping that now that Patch is shrinking down, that will mean faster healing (like when you take the band-aid off the wound and it heals faster).
Another great report, is that Karsie is now off CPAP! She of course, can be put back on for a little help if she needs it, but as of today, she is on nasal cannula 24 hours a day!!! Hooray! She was breathing about 27% O2 today when we were in and doing well with it.
Her feeds are still climbing back up; she is at 6.5mL today.
Michelle was also able to meet with the Occupational Therapist who talked to her about how to meet some of Karsie's developmental needs while she is stuck in the isolet. She recommended a mirror toy, some small teethers, and books and music. The really great news is that we have been doing most of that already. We have been reading books with her for quite some time. We have the little mp3 player for stories and music as well (though we are having some technical difficulties loading the music). And today Michelle took in some little linking teether toys for Karsie to play with and suck on. Now we are on a quest for a mirror toy. The OT said that mirrors are especially calming for babies because they don't like to see other babies cry. Therefore if they are looking in the mirror, and the other baby (their own reflection) is crying, they will stop crying because it makes the other baby stop crying! How great is that! It also helps them with moving their neck because they like to see babies! Our little miracle! Patch (on a diet)... you can see where patch ends now if you look at the bottom left of the patch. Most of the sides are gone! Only the top circle and a small area towards her head remain.
Grandpa spends some time with Karsie.
Karsie is holding one of her linking toys (thanks Auntie Carolynn)! These are especially great because they have different colors and textures and they are thin enough for her tiny hands to hold onto!

And We Have Skin!

Tonight was an especially nice visit.
After the spit-ups from last night, we expected to see Karsie on 5.5mL of milk, but the nurse practitioner went ahead and bumped her up to 6mL. She will continue at her regular rate of increase (0.5mL a day) as tolerated. So if all goes well tonight, she will go to 6.5mL tomorrow. And though you might be getting tired of hearing it... she is still pooping which is fantastic news to us!
She was also increased to 8 hours on the nasal cannula tonight. So as long as she tolerates it, she will have 8 hours on and 4 hours on CPAP each shift. This is also great news!
The best news came during her dressing change. Our fantastic nurse, Amy, let Michelle help with the dressing change. While everything was exposed, Amy pointed out that the area where the patch was originally stitched was now skin!!!!! There are some places where it looks like as much as 1/2 an inch of skin has grown up!!! The patch is kind of moving up off the mound of organs. We are not entirely sure of the mechanics of all this, as the patch is/was sewn to her skin. But none-the-less, the skin is growing. There is still granulation skin at the very edge of the patch, but there is clearly new skin growing too! This is super great news because we anticipated this process taking much longer to progress. Granted, she still has a very large mound of organs for the skin to grow over, we are still pleased to see that the process is underway! We will try to get a picture of this soon.
Karsie is continuing to do very well considering all she has been through, and goes through each day. She gets messed with quite a bit... but she is a little trooper!
We are continually amazed by the power of prayer and the amazing support we are recieving. We still have a very long road ahead of us, but God is good and we are thankful for your faithfulness.

Pre-Delivery Pic

This is the scary hall that Kevin had to wait in while Michelle was getting anesthesia just before Karsie was born.  Note to any father waiting in the room:  Don't believe the doctor or nurse when they give you an estimated time to wait.  What was supposed to take 15 min. actually took 45-50.  It was not a fun wait.  

More Spit-Up

Well, after Michelle and her mom left last night, there was apparently more spit-up. Probably another 7mL. This put Karsie back to 5mL an hour on her milk feeds and back up to 9mL an hour on her TPN. She is still pooping, so the nurse practitioner said she would still go up today (by 0.5mL) to 5.5mL. This allows a little break for Karsie's stomach. She tolerated 5.5 well, so they went down and will slowly try to work their way back up again. There has been no spit-up today so hopefully this will just be a little set back and Karsie will do better this time around.
Otherwise, she is continuing to improve in the other areas. She is on nasal cannula 6 hours each shift and today she was holding steady with 27% O2. The nurse was going to check and see if that would be increased to maybe 8 hours. Her labs came back today and the TPN is still causing her biliruben level to be elevated, but the level is not increasing.
She is starting to turn nocturnal... so she was asleep most of the visit today. Hopefully she will get her schedule straightened out soon! This will not work when she gets to come home ;)
She also has her primary nurses back for the next few days! This is great because they know her and know how to handle her best! This makes both Michelle and Kevin feel much better.
Karsie looking at a picture of daddy! This way she doesn't miss him as much while he is gone!

Karsie got to wear her first sock today. Her foot was getting cold... so Michelle put a little sock on to keep her warm. The other food stays warm from the dressing on the picc line and the O2 lead.

Update (8-23)

Karsie still looks good, but we've hit our first bump in a long time.  She had been moved to 7mL an hour on her feeding, which means that she is at 7mL on her TPN (the stuff that we need her off of...they both have to equal 14 since that is what her weight level needs).  However, this evening she threw up.  Kind of a lot.  It was enough that the doctors wanted her to decrease her feeding to 6.5 mL an hour.  We're not sure if this is going to last until 2 p.m. (when they normally increase the feeding) and then go back to 7mL or if they are going to go the entire day and a half on 6.5. Either way it's a little break for her stomach.  The good news is that she's pooping quite a lot. This means that while her stomach rejected her feeding, everything is being digested and passed through...so no blockage.    

She's also getting a tad more fussy lately.  We're pretty sure most of it is just her being a normal baby, but we're also pretty sure that part of being a normal baby is being held when they are sad and since we cannot do that it can make a fussy baby.  Michelle tried to calm her a bit by getting real close and get as close to holding as possible, and it helped some the closer she got.  We are praying that the doctors will let us hold her soon.    

Karsie's Stages Through Five Weeks

Just a little reminder of how far she has come and how much support your prayers have given. It's pretty amazing to see the journey that Karsie has taken and will continue to take.  Thank you all!!!

Pre-Delivery Pic

All dressed up and ready for Karsie.  Michelle was wheeled off right after this picture and taken to the O.R.  

Update and Pictures 8/22

Great boring update today! Karsie went up on her feeds to 6.5mL an hour and her TPN went down to 7.5mL an hour. She has had no more spit-ups (even though we are fairly sure she has a mild case of reflux). She is getting prilosec for the reflux and to help everything (food-wise) continue to move throuh her. Her breathing still looks good and her lungs are getting stronger. She is on CPAP for 6 hours each shift and nasal cannula 6 hours. Her patch looks good with minimal drainage and no new ripped stitches. We are praying for many more days of boring reports... and of course super fast skin growth so we can hold her and bring her home soon!
Karsie taking a little rest... so sweet!
Karsie got to listen to Kevin via a voice recording! She was a little fussy and when this was played, she relaxed and stayed calm for quite a while. She sure does love her daddy!
Nana got to have two visits today. She is Michelle's support person while Kevin is at home. This is nice because it means Michelle doesn't have to do the night visits alone.
Our little sleeping beauty!

Due Date!!!

This was supposed to be Karsie's due date.  We were never going to go this long even if she didn't come early, but what it means is that developmentally, Karsie is term.  We don't think she will ever lose the term "preemie" since she was born premature, but as far as her development goes, she is at 40 weeks even though she's over a month old.  This makes a difference now on weight and expectations and such but after a while she will lose the idea she's a month behind.  The last time she was weighed and measured she was about 6 1/2 pounds and around 19 inches long. We'll try and get an exact weight and length today as it would be interesting to see, but she still growing strong.

Update (8-21)

We are absolutely in love with this string of boring days we have been having.  

First of all, Karsie is up to 6mL an hour and handling it.  Again, it's important for her to handle it as it shows her bowels and other digestive organs are working under the patch, plus it lessens the amount of TPN she will need to supplement what she is not getting but supposed to be getting. The TPN will start to hurt her liver if she gets it for a longer period of time.  

Secondly, Karsie has been doing so well on her breathing that they increased the amount of time she is on nasal cannula to 6 hours each shift.  In other words, she is now on it half of the day. At some point we believe they will just decide to lift the CPAP completely, but for now we are happy she is getting half of the day off of it as it shows she is breathing well.

The patch still looks good.  There wasn't as much leakage from the right side that we reported yesterday, so that is good.  Leakage isn't bad as long as it's moderate.  

Kevin made it safely to Bakersfield and is now starting the long Fall journey of back and forth from work to family.  Please pray for Karsie's skin to grow so this journey will be much shorter than we all anticipate at this time.  

Daddy says "Goodbye"

Today is a hard day for us. We haven't really said a lot about our plans for work yet. We made the decision a few weeks ago for Kevin to go back to work for the beginning of the school year. He is driving back to Bakersfield today in order to grab a few things from his classroom before school closes this afternoon. He will then be taking Fridays off as often as possible to make the trip back down to San Diego. This will allow him to save some of his days off until Karsie is bigger and more aware. This will also allow him to take some time off when we eventually get to bring Karsie back to Bakersfield with us.
We had a good visit this morning. Everything is still going in the right direction: no more spit-up, feeds are increasing to 6mL at 2pm, breathing looks good, Karsie might get more time on nasal cannula (up to 5-6 hours) if she does well for the first four, still pooping. All of this is very good news, and we are praying that this is a trend that continues for a long time to come.
A family picture... Karsie is 5 weeks old!
Daddy and Karsie snuggle before he leaves.
One more kiss... She is so in love with her daddy!

To my amazing husband... I love you so very much, and I am so thankful for your commitment to Karsie and me. We will be waiting here for you to come back every weekend... and in the mean time we will be loving you together. You are an incredible father already, and Karsie and I are so blessed to have you in our lives. I cannot wait for the day we get to be a family together in the same house. Safe travels... we love you!

Michelle and Karsie

Update (8-20)

Mostly boring news to report.  We'll target the big areas one by one.

Breathing:  She is continuing to do well on the nasal cannula that they are probably going to move her up to using that 10 hours a day.  At some point, as a doctor told us today, they will probably just call it when Karsie continues to do well and switch her to nasal cannula completely.  She was pretty much on room air and sating high.  

Feeding:  Today was a little interesting as we witnessed her first real vomiting.  It was not enough to do anything about it, but enough to be cautious.  They still went up on her feeds to 5.5 mL an hour and will continue if she doesn't spit up again.  

Patch:  Still looking good.  On her right side today we noticed a significant amount of leaking when we did her diaper change.  However, the surgeon had seen it before and so had the nurses, and are not too concerned with it as long as it doesn't get much bigger.  But overall the skin is continuing to do well.  

We met our occupational therapist today who will be working with us to help with Karsie's development.  She's a USC fan, so things are looking real good!  We are looking forward to meeting with her to see how we can help with Karsie's development while not in our own home. 

Lots of Karsie

Pre-Delivery Pic

Waiting for the doctor got tiring.  

The "of the day" part had to be taken out as we have not kept up with that part.  But nevertheless, we have more pictures.

Update (8-19)

Good News:  Not much to report

Karsie was wide awake when we went in today.  She has been sleeping a lot and real well, so that's great, but there is a lot of time spent awake too.  Today Nana came in and read to her and Karsie really seemed to enjoy that.  Her respiratory rate has been keeping in the zone a lot (40-60) more lately, which is good, and she has also been breathing much more easily when she is in that zone.  Earlier when they started the sprinting on nasal cannula Karsie was either breathing faster (80's, 90's) or she was showing slight signs of higher effort in her breathing (chest up, nose flaring slightly), but she's getting better, which means she should do real well after she is switched to cannula completely.

Karsie is now at 5mL an hour.  For her weight the goal is around 15 an hour.  They go so slow for a few reasons.  One is to make sure that she tolerates the amount and not throwing up. Another is to make sure she doesn't get bloated.  You and I eat a real big meal and can loosen our belts and our stomach expands.  If she gets bloated, she has no room to expand because of the patch, which could pop more stitches.  She is still going up .5 mL a day, but the higher she goes they may increase it to a full mL an hour.

One thing we are keeping an eye on has been her chest tube stitch.  It's still on.  We think Kylee will take it out today, but it's been on much longer than it probably needs to be, but it's probably not a big deal.  Just might be a tad uncomfortable if she grazes it.  

CPAP and Nasal Cannula

Every once in a while we go back and reread the blog just for a little history lesson (it takes everything in us not to correct errors...we may eventually as we are both teachers and cannot stand it).  However, we have noticed that for the past few days of pictures Karsie is on the nasal cannula, which may give the impression that she is on that continuously.  She is only on it about 8 hours a day, but the NICU staff are wonderful and trying to time it so she gets on the cannula when we are there so we can see her face.  However, we do have a couple pictures that show her on the CPAP machine that is a bit new.  She kinda looks like Hannibal Lecter.  

Disclaimer:  Nana said "she doesn't look like Hannibal Lecter."  Which is true.  The mask does. So for now we'll say it also looks like an old school football helmet.

Karsie Gets a Bath

No Holding

With as much good news that is happening, it gets harder and harder for us to not think that Karsie is ready to go home today (even though we know that she is not even close).  

We met with our surgeon, Dr. Saenz, and one of the neonatologists, Dr. Knight, one of our primary nurses, Lindsay (who we're still not sure if we're spelling correctly), and a social worker to talk about Karsie.  

First and foremost, the decision was made that we would not be able to hold Karsie for a while. They plan to evaluate that decision regularly, but it sounds like it could be as long as a month before she is able to be held again.  We went into the meeting with two expectations.  Either they tell us yes.  Or, if they tell us no then we needed a good explanation.  Dr. Saenz was good at giving us a good explanation even though the answer was not at all what we wanted to hear.  He is concerned that because Karsie's patch is basically shaped like a mushroom (very top heavy) any movement is cause for concern.  The problem is not the holding; the problem is the transfer, which is where many accidents take place.  He seems like he just really wants to be ultra conservative with it so nothing else goes wrong since it is going so well.  We were able to live with that response (there was much more, but that was the basic idea).

The good news out of all of this is that Dr. Knight said we could do all her cares (providing nurse comfort).  Also, we were able to arrange Karsie's little condo (with Dr. Knight's help) so that we can get closer to her so there's a quasi-hold happening.  We really felt like she was wanting to help us with not only Karsie's emotional development, but our emotional needs too. 

A bummer meeting, but we are somewhat at peace with it.  We just need Karsie to be a skin-growing-machine so we can get out of there and take her home.  

Karsie Discovers Her Tongue

Karsie Prayer Bracelet

Todd and Becky:  Thank you so much for these wonderful prayer bracelets.  We both are wearing ours and it is a constant reminder to pray for our little one.  Also, thank you for all our friends at Olive Knolls that took one as well.  We were given many more, so if you didn't happen to get one, we have more.  We love them!  

One Month Old!!!

It hardly seems possible that Karsie has made it this far, but here we are.  Our little girl has beat all odds and has lived to be a month old.  If that's not a miracle we don't know what is.  We are so proud of you Karsie, and whenever you are old enough to understand all of this, please know that you have been spoiled with such an outpouring of prayer and support from people all over the world.  You have been such an inspiration to us all.  You're only 6 pounds, but it's amazing how such a small creature has made such an enormous impact on both of your parents' spiritual lives watching your story unfold.  Keep fighting Karsie!  We want to take you home!

Very Quick Update and a Funny Story

First of all, Karsie is still doing well.  She was a little napper today as she slept for almost all of the day, but was awake and a tad fussy when we were there tonight.  Not too bad though.  We love that the respiratory therapists and nurses try to put her on nasal cannula when we are there so we get to see her face during our visits and also so she's happier.  She's been having a slightly elevated heart rate (180-190) even when she's resting or not upset, but we're not sure that that's accurate because some of her wires had been going kookoo.  But she looked comfortable.  Maybe she was hot.

Anyhow, earlier today we had quite the fun time with a diaper...actually three.  Don't all good stories start with that sentence?  We wanted to see if she had pooped and we took a peek.  She had, in fact pooped, but she was so peaceful looking that we thought we would wait until she woke up to change her in case she had more (we were pretty sure she had just done it and didn't want to change her prematurely).  After a while, she just kept sleeping and sleeping and we thought "eventually we're just going to have to do this."  So we did.  Kevin started to try to do it on his own and he was doing a decent job.  He was lifting Karsie's lower half above the poop so he could start to wipe up her unmentionables.  He finally finished, set her on a new diaper, and she decided to pee....EVERYWHERE!  By this point Kevin, with a dirty diaper in one hand and Karsie's legs in the other, was defenseless, so Lindsay, one of Karsie's primaries, came to the rescue by covering Karsie with the new diaper and trying to save her bedding (a valiant effort, but an exercise in futility as her bed was drenched).  While Lindsay was doing this, Kevin was cleaning up the prior mess with the original poop off of Karsie (yes, we said "original") and throwing away the wipees that he used on Karsie.  Kevin and Lindsay then switched back (Kevin on Karsie-duty and Lindsay on diaper duty) so Lindsay worked on the cleanup, because nurses have to measure the diaper, and Kevin started the cleaning of pee off of Karsie.

Then came the volcano!  Kevin's exact words were "Oh crap....literally!" Michelle joined us at this point as she was coming in from outside the NICU.  Lindsay, a brave warrior, dove to the aid and stuck her gloved hand (thank goodness) under the "spewing lava" that was coming out of Karsie's rear to keep it from getting everywhere as there was not yet a new diaper under her. So here's our picture: Michelle is holding a pee-covered diaper with wipees and trying to catch everything that Kevin is throwing at her in a panic since he is holding Karsie's legs up with one hand and trying to help Lindsay hold the diaper that SHE was holding in her hand that was now under Karsie quickly filling up with poop while trying to use her other hand to create a barrier between that and the bedding.  

No such luck.  It might have been easier to just throw that bed away and get a new one. But, we actually managed to get out of that situation with minimal linen damage.  Just lots of cleanup. 

Pre-Delivery Pic of the Day

I couldn't ever get this mask right.  The air kept fogging up my glasses.  Yes, I pinched the metal ring.

Vent Session

It's amazing how fast we are starting to move from understanding to downright bitter that we are not able to hold our daughter. It has almost been a month and she has only been held twice. Rest assured that starting tomorrow we will start to push really hard for us to start to hold her. We find it offensive that we are not allowed to hold her or even pick her up to do her cares when they have to find an extra nurse to do that anyway. Messing with medicine, giving her shots, fixing monitors, yes the nurses can do and should do that as we are not qualified. But who is more qualified to hold their own baby and care for her than her parents? Our nurses seem to understand this and want to let us, but they are nervous to let us do that as they think the doctors will be upset if they see us hold her.

As far as her status goes, things are moving, but moving slowly. She is still being sprinted on the nasal cannula, now going on three days. They were giving her 2 hours a shift on the cannula now moved to 3 hours a shift. They want to evaluate every 3 days, so unless they increase the evaluation time or increase the rate of time spent on the cannula, she will be on the CPAP for another month. Hopefully, that will not be the case since she really seems to like the nasal cannula. When we were in today (stayed for 3 hours) she was sleeping like an angel for almost all of that and her breathing looked at ease.

She is up to 3.5 mL an hour on her feeding. We are noticing her rooting reflex now when she is awake, so we want to start dry feeding so Michelle and Karsie can bond as they have not been able to do. For any of you keeping score, Karsie is about 6 lbs. now. We also want her to do one of her feeds by bottle so she keeps her sucking and swallowing reflex, but we're sure that will depend what her respiratory rate is (and of course if the doctors okay it).

Stitches still look good.

Wish us luck tomorrow as we are planning on setting up a family conference with the doctors and plan on bringing up all of our concerns. We want to hold her and we think we have been patient enough as the doctors don't seem too concerned anymore about the stitches (at least they are more confident in the foam support).