Pre-Delivery Pic of the Day

This was our nemesis during the month or so before Karsie was born.  Michelle was hooked up to this monitor (as many women are familiar with we're sure) that read Karsie's heart rate on the left and Michelle's contractions on the right.  This was taken the day before we delivered.  The scroll on the right reads the same thing only it draws it out for the doctors and nurses.  On the left side of the scroll reads the heart rate which they like to see fluctuate and keep up especially during a contraction.  The right side of the scroll are the contractions.  You can see one big one as it looks like a big hump and according to the numbers Michelle was having one while we took the picture.

Ding Dong...Lucifer's Dead!

Today was the day Karsie would have been delivered had she not decided to come early.  Maybe it was good it was on her terms.  

She is still continuing to be calmer.  When we are there there have been things done to her that usually make her mad, but she is able to be comforted.  She has lately been wrapped up tight with straps holding her limbs snug which we think makes her happy.  Also, her patch has been secured amazingly.  We watched the nurse change her dressing and she unwrapped foam, tons of gauze, wet pads, shields, ties, and cover it with a foam pad and a blanket.  That thing's not going anywhere (hopefully).  The surgeon also came by today and said it still looks good.  We were able to see it today and it doesn't look as high as it did earlier and the part that is exposed is really granulated, so things are looking good at this point.

She has been giving lots of spitup lately, so instead of feeding her 3 mL every 3 hours of milk, she is getting a continuous feed of 1 mL every hour.  

Her breathing has looked good except one thing that happened when we were there.  The first 5 minutes or so that we were there she had an episode of apnea where she just forgot to breath or stopped breathing for just a bit.  It was slightly concerning to us as we were seeing her turn a tad bluer, but it apparently isn't too abnormal for preemies.  They grow out of it after a while and she was able to turn it around quickly, but seeing your daughter turn blue isn't too fun.   This was apparently the only time she had done it and it was a little suspicious since she was given a bit of morphine last night, so we're hoping that was just a reaction.  

Finally, her infection is gone.  Lucifer is dead.

Pre-Delivery Pic of the Day

We realize that there was a dead space before delivery that there weren't any visuals given. We do have quite a library of pre-delivery pictures that we thought would be fun.  We'll try to post one each day if we can.  This is Michelle's crazy uterus contracting right before a sonogram. You can probably tell the heart shape as there are two bumps on the sides and a soft-looking middle.  Dr. Dowling encouraged us to take a picture of this as it is a textbook shot.  

Karsie's First Lunch

We ran out of memory before it was done, but this is our daughter's first lunch.  She has been doing fairly well on feedings after this.  She has spit some of it back up, but she is digesting it. It'll be a slow process, but this is the first step to getting to bottle feed followed by the ultimate goal of breast feeding.  We still have the obstacle of swallowing to overcome, but one step at a time.

When we went in tonight she was still very consolable.  We took her temperature and changed her diaper, which she hates, and she only fussed for a bit.  She seems to be trending toward being able to be calm.  Stitches are still holding and no change on her breathing.  A good day today.

Happy Days

After three weeks and two days....Karsie was fed breast milk!!!  She has been doing very well on her eating and today was her first meal.   We will hopefully have a video of that first feed up later today.

She has been so calm today!  Both Jamie and Ruth (our night and day primaries) told us that she slept most of the time and when she did get up it was much easier to console her.  We hope this is the trend from now on.

Karsie's patch rips are up to seven, but there is some good news.  First of all, the doctors and nurses have fashioned a support for Karsie's patch so she doesn't hit it directly and so that there isn't so much pull when she is on her side.  Add to that fact Dr. Saenz said that she can be on her back, it will hopefully slow down this deterioration.  Secondly, we have a specific prayer request now.  Dr. Saenz said that if we can get through a week or two without something big happening like the liver or bowels poking out, or lots more stitches ripping, we might be out of the woods because the granulation will be much more scabbed and able to withstand the patch not being there.  

Karsie's breathing was a bit quick earlier today, so they upped the pressure a tad, but her gases still looked great and she is still doing very well.  

Overall, today was a really good day for her.  

Find a Happy Place

We seem to be racing the clock.  Karsie busted another stitch.  We are really hoping that this might just be the bowels expanding as they move a bit and are now getting fed because that will eventually go down and maybe not be so detrimental to her patch.  However, it could just be that she is continually uncomfortable with the tubes in which case she needs to hurry and get those out so she doesn't get so upset that she continues to bust stitches.  It's not like those will heal and grow back together.  However, the surgeon is still saying he doesn't want to take her to the OR for that, so as long as her vitals don't plummet or a piece of her liver doesn't just start hanging out, she's staying put.  But there's only so much more that can happen before they just bite the bullet and take her in again which would mean a whole new patch or part of the patch along with another round of weaning off ventilators.

Good news:  Everything else!  She is now not getting any supplemental breaths.  She is getting something called a CPAP (continual positive airway pressure) which is just pressure given to her constantly.  Our lungs are like a balloon that we have to blow up.  You and I have a stretchy balloon because we are used to expanding our lungs.  When babies start to breath, especially preemies like Karsie, every breath is like that initial blow up of an empty balloon until they get enough strength that it gets stretchy like ours.  This new ventilator is like keeping the balloon blown up just a tiny bit so she doesn't have to use such force to blow up her lungs.  When she gets off of that, she is moved to the conventional nasal cannula.  She is having good gases still which means only a couple more of those and she's off the CPAP.  Also, she is still feeding well. Only a night to go and she will start getting breast milk fed to her.  We are really praying hard for her patch since she is doing everything else so well.  We really don't want to go through this all again.  But until then, praise God for everything else.

Update (8-8)

When we came in today Jaime, one of our primary nurses that are fabulous, told us that she just conked out 5 min. before we got there but had been very angry since 7 o'clock.  However, the entire time we were there, which was about 2 hours, she was asleep and her vitals were great. We are thinking that we will need to be spending a lot more time there, even though it gets exhausting, because she responds well to someone other than the nurses soothing her.  She just needs to be held.

Concerning news:  She broke another stitch.  The surgeon came by and still though it didn't warrant a trip to the OR, but if this continues it will.  We hope that the stitch that broke was one of her stitches that was close to breaking already.  

Happy news:  She is on 10 on her ventilator.  She will be put on another setting on her current Ewok-looking thing that just gives her constant pressure (light).  If she does well on that she will be put on the nasal cannula, which is what she had for a day before she had to go back on. This time she should be able to stay on it because she has been much more slowly weaned. Also, she's continuing to eat!  We are a day away from giving her actual breast milk as long as she keeps doing well on the pedialyte.  

As long as she doesn't have to go to the OR (which means we start this whole ventilation process over again) things are going well - minus the angry girl sometimes.

She Likes Her Mommy

Karsie was happy when Michelle came in and sat with her.  She was apparently pretty fussy for the day shift nurse, but when we got there and Michelle touched her, she calmed down and was that way until we left.  She has been weaned every gas she has done, which makes her down to 14.  

Karsie has also been taking her food fairly well.  She has been fed two times and done well on both. We'll see how it goes from there, but even if we have to stop for a bit, she is improving.  Her bowels need to wake up, so it's a slow process.  

Feeding Part II

Karsie still is having her tantrums, but she seems to be consolable after some work.  However, her stats and gases seem to be going well.  She is still on the new ventilator and her blood gases so far have been great.  She is being weaned off of that starting at 20 yesterday.  This new machine gives Karsie air pressure every minute so it is an easier transition, but it's still very bulky.  She has been since weaned to 16 and 10 is again our goal.  If she continues to produce such good gases she may not be on this one long.

Just before we left there was discussion about starting to try and feed her again with pedialyte. The only stats that have been not so good are her blood pressure and heart rate.  However, with the boosts of steroids just given, those are expected to be high.  Hopefully Karsie will just get some rest.  

Our Little Ewok

This picture was taken last night.  We are getting ready to see her and find out if this stays.  The "beard" or chin strap is to keep her mouth closed while resting so that the oxygen goes to her lungs and not out her mouth.  In addition, she has the oxygen tube and a hat and a blanket.  This is just after one of her tantrums, so her eyes are puffy from the wailing.  Bad news for the nurses:  she's audible now. She hasn't quite learned her cry and her vocal cords are still swollen, but look out.  It won't be long now!

Her Own Worst Enemy

Kevin here:

Ok...these darling pictures that we are putting up of Karsie are in the minority lately.  She is starting to fight against herself.  I just came back from the hospital (yes...it was crazy early/late but I wanted to see how she was doing off of her ventilator) and am slightly concerned over her anger.  The poor thing has been through a lot, but the doctors say that her fury lately is not as much about pain, but about being mad (and some uncomfortableness).  While this seems to be an issue her parents are going to have to deal with, Karsie herself is becoming her own worst enemy.  She was just extabated and put on another breathing tube.  This one goes in her nose and is given oxygen.  With her anger, she is not only bearing down and wiggling a ton (which we believe is causing her stitches to loosen) but she holds her breath, which depletes her oxygen thus making her CO2 gases higher.  If she doesn't calm down, she may have to go back on the ventilator.  

Hopefully this is just a transition phase and she will break out of it soon, but tonight's a hard night as we are not sure which way she is going to go.  When I left she was calm and her stats looked good.  However, everyone is a little on edge not to disturb her because any little thing does.  She will be messed with in a few hours to change her diaper and do assessments, so another storm is coming.  We'll see tomorrow morning (or later this morning).  Anger management Karsie!  Out with the bad air, in with the good.  Namaste.    

Tube is Coming Out

So...we have a fighter.  In the good way and the bad way.  She has fought her way through three weeks of such intensity that most of us will never know, but she is fighting everything that's good too...including us.  Tonight we went in and she started to fuss.  She was given some pain medication and she fought that.  We calmed her down, but then she would wake up and throw a tantrum.  Bearing down, wailing her fists, holding her breath, etc.  We know that part of this is probably due to the steroids, which increases heart rate, blood pressure, and alertness (which makes it harder to sleep), and we're also sure this is due to her tube that she wants out.  At 10:00 she will have her second dose of steroids, after which they will extubate her.  So, hopefully by midnight tonight she will not have a tube down her throat.  

Awake and Not Cranky

Karsie looked good today.  She has been weaned to 10 bpm, which means she will be off very soon.  They are looking to give her a boost of steroids just before she goes off to help her with her breathing.  They also weaned her pain medicine to once every 12 hours instead of 8.  We'll see how that goes.  We're much happier with this plan set in place as it seems they are taking their time with taking her off the ventilator.  Last time it seemed like they were trying to power through, which is fine, but it didn't work.  We are happy that this time they are really taking their time.  

Karsie is also getting close to getting some food again.  She hadn't produced much bile and so that probably means it's close.  Patch still looks good.  When we went in we just missed the surgeon, but he said it looked good so far.  The nurse also told us that the granulation looked tougher and had a coating on it that was more than yesterday.  Signs are looking good today.

Evening Update (8-5)

Karsie is doing well.  She is so calm lately.  Her feeding came with good news and bad news.  She took her 5:00 feeding well.  However, her 8:00 feeding produced a lot of liquid and so they are stopping the feed until that goes down.  The nurse practitioner told us it would be like this, so as long as we continue to try to feed, she should hopefully improve.  For you nurses, they gave her 2 mL of pedialyte and she produced 8mL of liquid, which is much more than you want after a feeding.  We'll try again later.

Karsie's blood gases came back as being good while we were there and she was one point away from being weaned.  We're actually happy about this because we would like a little more time on the pain medication, but she's so close to being off.  

There was a little redness in one of her stitches, but it isn't too terribly concerning because if there was an infection it's being covered by the antibiotics that are already killing Lucifer. Speaking of Lucifer, he's almost dead.  The nurse this morning told us that her CRP (Reactive Protein) was close to normal.  

Random (Graphic Picture)

A couple of errors to fix:  First of all, we apparently spell it "Pedialyte."  Thank you Cory and Google.  Secondly, one of our nurses that read this blog (apparently a lot do as we have had multiple say that read it) corrected something about an earlier post that said her PIC line goes up an artery when it actually goes up a vein.  Arteries are way too fickle to deal with as we have found out.  We also wanted to make an addition to a post a long time ago about our neurologist. We wanted to put that we were really impressed with his explanation and how nice he was.  We really liked him even though we had to wait, which he apologized for even though it didn't seem like it was his fault.  He also saw us in the hall another day and said hi and asked us how Karsie was doing, even though he didn't need to and he was obviously busy on his way to do something else.  It's the small things that win us over.  

A thousand thoughts:  Yesterday we decided to install a traffic counter at the bottom of the blog just for curiosity's sake.  We became curious when we had been told by numerous people that people that they know and other people that THEY know read the blog.  We're very humbled at what our little girl means to so many people, we just didn't know how much.  While we may take it off, we just wanted to share that in less than two days' time, we had over a thousand people visiting the site.  We know that this could be our family obsessively pressing refresh every day, but it still means that Karsie is being thought of a thousand times in two days, which we are so very thankful for.  This means during the course of all of this we have had tens of thousands of times you have all thought of her to go on the blog let alone just thinking about her throughout the day.  We don't even know what to say to that other than thank you and we are so blessed!  This is truly a captivating story that is unfolding, and she is our daughter!  We are very proud of her and very thankful for her support.  

Karsie's Patch:  As you can see it looks like four stitches ripped and maybe one or two more are getting ready to.  We realize you may not have ever seen this side of her, so you're probably shocked at how much skin she actually does have here.  None of it is new; it was like that right after surgery.  However, the gross "new" skin is new.  That was explained to us as the liver with a coat of granulation protecting it.  That is the stuff that her skin that grows under the patch will eventually become.  The green guacamole looking stuff is just secretion coming from the incision for the past week and a half.  It's normal, it's just gross.  We're praying the stitches hold for a while, but Dr. Saenz did say right after he put it on that some stitches would rip, but I'm not sure he meant this early.  Stay still Karsie. 

Update (8-5)

Lots happening today.  First of all, the good news.  She has weaned down on her bpm to 12.  She's real close to being able to get off of the ventilator.  She had a string of good gases last night, so a few more and we might get to hold her.  Also, they will quite possibly start to feed her today.  She has stopped producing such dark green bile and is only producing very small, light green liquid. This means that she is dealing with her situation well.  They will start with very small doses of pedialite (we have no idea how to spell it, so it's phonetic) which is a nutrition that is easily run through the body.  If she handles that well, with no vomiting (which we're afraid would also cause trauma to her patch) then they would slowly introduce breast milk to her.  They took out her nose tube and put in a new one for feeding when we were there.  They are planning on waiting for four hours to see if she vomits.  If not, around five o'clock they will give her a little Pedialite. Finally the pain medicine has seemed to keep her very calm throughout the day.  While this didn't stop her from throwing an all out temper fest when her nose tube was put in, it has been much easier to calm her and the rest of the time when she is not being messed with, she is quite comfortable.

The concerning news:  Her rip is still a cause for concern.  We were able to briefly meet with Dr. Saenz today and he said basically the same thing as Dr. Losasso said yesterday night, which is that it seems to be looking okay for now as long as NOTHING else goes wrong.  If so, it is a trip to the O.R. and a new sewing of the patch.  The granulation that we are seeing is basically a scab over the liver, so the liver is kind of exposed with the skin matrix over it.  This is obviously much better than the actual liver being exposed and it is extremely reassuring that she is stooling because that means that while things are exposed, the bowels are still working properly.  If we can get through a few more days of not having to restitch anything, we hope that the scab will become hard and tough enough for it to be less of a worry.  But for now, it is. Also, the doctors are going to start to wean her off of the pain medication.  While we understand this is necessary and a good thing, we definitely don't want to be back where we were before she was prescribed where we felt like there was a "wait and see" policy for three days.  We hope she still takes to the smaller doses of medicine so we don't have to worry about it.  

We plan to put up a picture soon of her exposed patch just for our records.  If gross-looking goopy wounds bother you, you might want to pay attention to the post title before scrolling down too fast.  Hopefully tonight's post will have some feeding information on it as well as some pictures of us holding her again.  

Evening Update (8-4)

We only stayed a short time tonight as Karsie seemed to be comfortably sleeping so we didn't want to disturb her too much since she has had a rough couple of days.  She seems to be doing much better on the pain medicine and we hope she stays comfortable.  The balancing act here is that they don't like to keep babies on pain medicine after they take out the breathing tube, so that may make her hurt a bit more.  However, with the tube in, she is most likely uncomfortable which makes the pain medicine necessary.  The balance that needs to happen is for her to be on long enough for her to be comfortable when they take her off.  She just needs to learn telepathy so she can tell us when she hurts.

A note about Karsie's patch.  Our nurse tonight, Amy, told us that Dr. Saenz came by and wasn't real thrilled about the ripped stitches.  He wanted to be notified immediately if there were any more rips, or if any organs were exposed.  The good news here is that the part that the patch uncovered is the skin matrix which is where the new skin will grow shortly.  And, it's quite a healthy bit of growth given the time (that's our take...the surgeon hasn't exactly told us that). When we were there Dr. Losasso, our other surgeon, came over and looked at it.  He didn't seem too concerned about it because it is doing what it is supposed to be doing, but he definitely thought it should be watched carefully.  We plan on talking to Dr. Saenz about it too as he was the one that put on the patch.  From what it sounds like, if more stitches were to rip, there would be another minor surgery to repair just those stitches.  We obviously don't want that to happen.  It sounds like Karsie ripped it from excessive moving, which we are sure was from her pain, and her bearing down so hard.  If this is the case, we are a little upset that there wasn't more effort to minimize her pain.  All of our nurses have said that they have been after the doctors for well over three days to do something about it.  Good news is that she is now on it, so hopefully she will be much more comfortable so more extensive damage won't be caused.  

She is still continuing to be on the same ventilator settings, so no movement yet.  We're a little glad that she is taking her time on this now so that later she won't have to be reintubated. 

Mmmmm....pain medicine....
FAT ROLLS!!!  Yay Fatty!

   

Morning Update (8-4)

Karsie was still ticked when we went to see her this morning.  The day nurse also thought that she was in pain.  After a while, the nurse practitioner came by and ok'd the use of continual pain medication other than Tylenol.  She almost immediately seemed to calm down and her heart rate/blood pressure went down as well.  We also noticed that she is starting to get a little chunky...not puffy, but getting fat rolls.  

She was also weaned when we were there.  She is now down to 14 breaths per minute.  We hope that with a good day she may be off of the ventilator by tomorrow.  Hopefully for good.  She is still producing green bile, albeit a lighter color of green.  Therefore, her feeding will be pushed back a bit.  We'll update again some time tonight.  Sweet dreams Karsie.  

Evening Visit

Karsie is still doing well.  We think she's in a little bit of pain, so the nurses are pushing for a little more pain medicine given to her because she's getting fussy.  Plus, we think two of her stitches ripped from her Patch which may be a result of her being fussy.  However, the good news with that is even though it ripped, her skin has scabbed and started to heal under the rip, so nothing is exposed or leaking.  

Many of you have asked about the birth weight and length.  We will probably never know how much she weighed at birth, but we do now have stats.  She currently weighs approximately 5.5 pounds.  About a week ago they started to calculate her weight (in kilos) and each day she has gone up a tad.  She also is 46 cm long, which translates to about 18 inches.  Since her gestational age is just about 37 weeks, she's pretty long...and if you could see her feet, she might rival Shaquille O'Neal.

Sassy for Her Parents Already

A quick update on Karsie's PIC line.  Thankfully they didn't need to put an entirely new line in. They just needed to adjust it and it worked.  Maybe some of you parents of kids older than infants can sympathize with us, but why is it that they are perfect angels for complete strangers (or in our case NICU nurses) but like to fuss when you are around?  She was apparently a complete doll for the nurses who were moving a tube inside her body that goes into her heart for pete's sake, but when we change her diaper the world is ending!  

For medical news, she has been weaned even more off of her ventilator.  She is down to 18 bpm and if you remember, 10 is the magic number that they start to consider taking her off.  She is still peeing and pooping like a good little girl, so that means as soon as she stops producing such dark green bile, she will get to eat!  The doctors and nurses want to see clear to no liquid coming out of her stomach as that means liquids are passing easily through her system instead of coming back out (which essentially means she is throwing it up).  So as far as the praying goes we want her to be off the ventilator, her to produce less green liquid from her stomach, her infection to go away (which it is), and when she starts eating (possibly tomorrow) for her to take to it well.  The good news is that she is going to town on the pacifier even with the tube in her mouth, so transitioning to the breast might be easier than we though it might be.  Looking back after 2 1/2 weeks you know it's been an improvement when we are praying for these things instead of praying for her to make it through the night.  We feel very happy about that.  Thank you all!!

Poor Little Thing...

Karsie's PIC line had to be messed with today.  A day or so after Karsie was born she was given something called a PIC line which is a line that goes from her foot through an artery (we think) directly into her heart so that medications can be more easily given and she only has to get stuck that one time instead of giving her multiple shots into her veins every day.  While it is supposed to last for a long time, her line got tangled or "kinked" and they are having to adjust it.  It's just something that we can't imagine feels good, and given the last few days, Karsie has been messed with a lot.  It's time for her to rest.  

Other than that she is doing well.  Her ventilator was weaned again today, so hopefully that means she is getting closer to trying again off of it.  We actually haven't seen her in close to 24 hours as yesterday we were exhausted and didn't go in for the night shift, and today we went in and since they were doing the sterile procedure with her PIC, we couldn't go in.  We are getting very anxious.  

One Angry Girl

Karsie has done fairly well today.  Her infection seems to be dwindling a bit based on her white cell production and she looks better than she did yesterday.  She was absolutely furious when we left her today.  Her tape that holds the vent tube in place came off, so they had to mess with that as well as give her more blood.  She got pretty cranky then, but we tried to hold her after that. When all of that happened and if she had an audible cry, her cry could have been heard around the world.  After Michelle was able to hold her for a bit we called it quits as her heart rate and blood pressure spiked a bit and she was flailing about and screaming (without the noise...it's like the mute button that at some point we might wish we could resurrect).  She was given some meds to help with her stress.  Hopefully she can get off the ventilator soon so we can hold her to calm her down and so it doesn't agitate her breathing tubes.   

Small Step Back

We just got a call from the hospital that said that Karsie had to be put back on the ventilator. Her CO2 levels were reading high.  Even though she's mad about the tube being back in, she needs to be breathing out more CO2.  We're all pretty sure this is due to the infection that we will now name Lucifer.  While this is not a major setback (it was always a possibility), it might mean that holding Karsie again will be delayed until Lucifer is dead.  

We Have No Words...

Good News, Bad News

Let's start with the bad news.  Karsie most likely has developed an infection.  This is common with NICU babies because of all the tubes and everything being inside for long periods of time, plus she has Patch to worry about with that being sewn to her skin.  They have all but ruled out pneumonia because they did a chest x-ray and everything came back normal.  However, other than that they don't really know where it's coming from.  They sent some labs down this morning and they will be ready in a couple days or so, but in the mean time they are pumping her with antibiotics, so it should clear up (hopefully) in a week or so.  The other thing they are concerned about is that it could be meningitis so they are doing a spinal tap to check that, but she is not showing many signs toward it being a real bad infection anyway, so keep that in your prayers.

Good news:  As you can see, Karsie is off the ventilators completely.  She has had an oxygen tube put in her nose (like athletes) and she seems to be doing fine.  She was given a pacifier and it took her a while, but she has started the sucking reflex on that.  They might start giving her food soon, but the infection possibility has slowed that down a bit.  Maybe tomorrow.  Best news yet is that we will most likely get to hold her tonight.  She is needing to take a long rest/nap this afternoon as there was a lot of stuff done to her, so she has had a busy, tiring morning, but after shift change tonight we will probably get to hold our baby for the first time.