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the eric update – day 77: a baby shower. rop, apparent but not real? a metric milestone. 11 weeks!

day 77: baby shower. I.

today, 77 days or 11 weeks after little odin was born, we had our baby shower. thanks to the hard work of kris’ sister, gina, and her partner, diane, many people came and had lots of good food to eat. we had a great time and received many, many great gifts, but of course, given the circumstances we had a tough time not dwelling in his eric’s impending transfer to the new nicu for eye surgery.

day 77: baby shower. II.

many people came to the baby shower – this is one shot of a few of the friends and family that came to the event hanging out in our living room.

day 77: baby shower. III.

i’m intently reading a card while ruby, our niece, hands us gifts.

day 77: baby shower. IV.

kris unfolds a blanket for odin, while i look on. dig those crazy dark circles under my eyes. i don’t always look like that. honest.

day 77: baby shower. V.

on the left you can see diane, who – despite being very, very pregnant, organized our baby shower and for that we are very, very thankful.

day 77: baby shower. VI.

a shot of kris’ brother, his wife and one of their children – jagger.

day 77: baby shower. VII.

i didn’t take this very cute picture of our nieces, ruby and ella. they like playing together.

day 77: baby shower. VIII.

another shot, not taken by myself, of ruby – looking very cute.

day 77: baby shower. IX.

kris’ brother with his son, our nephew.

day 77: the explanation.

i might have some of the details incorrect because i haven’t had a chance to talk at length with eric’s opthamologist, but my understanding is that eric is “pre-threshold” and “8 hours” into ROP which is technically stage 3+ and primarily developing in zone 2. if you think of the eye as a dartboard, the optic nerve is the bullseye and is zone 1 and there’s a ring around the the optic nerve which is known as zone 2. there are 4 stages of the disease and stages 3+ and 4 can lead to the formation of scar tissue on the retina, vitreous hemorrhage, and retinal detachment. by saying that eric is “8 hours” into stage 3+ disease, his opthamologist is not telling us that he’s been at that stage for a third of a day, but rather if he’s giving us an indication of hos quickly the disease had progressed. if you were divide the retina into 12 hours, he’s telling us that 8 “continuous” hours show signs of being in stage 3+ of the disease. he only needs to show signs of disease in “3 hours” to be considered “prethreshold” in zone 2 ( as the disease progresses, you move from being “prethreshold” to “threshold” which means you need surgery within 72 hours ), so it doesn’t appear that they are making a marginal call and transferring him unecessarily.

day 77: more hair than yesterday.

or does it.

after spending much of the day trying to come to grips with how his disease could have progressed so quickly, eric’s neonatologist paid us a special visit late in the evening ( on his time off, no less ). we’ve come to expect the going to get weird whenever we see him at odd hours ( he’s a great guy, but as you can imagine he’s A Very Busy Man ) and this visit was no expection.

after stating the appropriate amount of caveats , we found ourself listening to him explain that they could never not do what they were doing because they can’t ignore the results of his latest eye exam – but that fact didn’t stop him from holding out hope that eric’s ROP was not nearly as bad as the evidence would lead his opthamologist to believe. sounding much like a zen master he stated plainly, “you see, it’s apparent, but it might not be real.” in medicine in general and neonatology specifically, sometimes a test will show something to be very apparent, but all one’s instincts tell one that it’s really not real, and in this case, his instincts are telling him that eric’s ROP might not be real.

normally, ROP progresses relatively slowly and it’s fairly unusual to have severe disease appear so quickly when they were monitoring it so closely. in fact, it’s so uncommon that he’s only seen it a handful of times in his many years of practicing neonatology. and every single time it’s happened, the diagnosis was preceeded by a recent blood transfusion, which is exactly what eric received just six days ago. but in his experience, micropreemies that present the disease as eric is presenting who have also received a recent blood transfusion often have the disease disappear or at least significantly regress. his theory is that for whatever reason the blood tranfusion engorges the eye’s blood vessels in a way that makes the ROP apparent, but not real. he stated quite frankly that eric’s opthamologist would not agree with his theory and that it didn’t change the fact that they needed to treat eric as if he were going to need surgery soon, so the discussion has an academic flavor to it. but it’s a bit of hope and i guess in a week we’ll have the benefit of hindsight to know whether or not his theory is true or if it’s just a kooky prognostication by a neonatologist who likes to second guess the opthamologists ( i mean that in the best possible way, if he’s reading this 🙂 ).

day 78: saying goodbye to nurse cathy b.

we said teary goodbyes to some of the night nurses, as they won’t see his again after the transfer tommorrow early in the day. unlike some nicus, eric has had many of the same nurses for his 77 day stay at “saints” and they gave up not getting attached to him a long time ago.

when we came back from lunch today we found eric’s nurse, cathy b, cuddling with eric because she knew it was one of the chances she’d get before he got transferred to the nicu. it was a sweet, touching moment. cathy b’s own son is named eric and she never tried very hard to disguise how much she truly enjoyed caring for our eric.

she sat with us for a long time today and shared stories about her life. we’ll miss her very much and she’s a great example of why saint mary’s nicu is unique.

she doesn’t have to cuddle with our son while we’re away for lunch, but she does because she’s a great nurse and a fantastic person.

day 77: saying goodbye to theresa

theresa was his nurse tonight and, ironically, she was also his nurse on his first night.

she’s sad to see him go the the new nicu for surgery and holds him for one of the last times before he gets transferred in the morning. we’re sad too, because we like theresa a lot.

she asks us if we’d like to give him a bath so he’s fresh and clean before the big move and we decide that we’d like her to have the honor. we can tell from the look in her eye that it means a lot to her and, really, it’s the least we can do to repay her for all her hard work at helping to keep him alive.

we won’t soon forget his nurses and i suspect they won’t forget him either.

day 77: a metric milestone

amidst everything else, eric continued to do what he’s been doing so well on his 11 week birthday – eating and gaining weight. he’s still guzzling bottles at breakneck speed and he tipped the scales tonight at exactly 2 kilos or about 4 pounds 6.5 ounces.

the eric update – day 71: another transfusion. reduced reflux. reglan questions.

day 71: living strong with a new transfusion

pooh decided to put one of the yellow “live strong” wristbands to good use after eric finished getting his latest transfusion. as regular readers are quite aware, we’ve known for awhile that he’s needed a transfusion, so it was nothing surprising and it will go a long ways towards giving eric the energy he needs to bust out of the nicu.

interestingly, they did a special blood test to see specifically how many new red bloods cells he was making and it seemed like he wsa doing a great job creating new ones, but just not making them quite fast enough to keep his hemoglobin levels from slowly dropping.

day 71: burping in a big, blue hat

otherwise, eric had a quiet day. he gained a little weight, but most of that was due to the transfusion and fluid retension. his reflux problems were greatly reduced, presumably due to his new meds, but i’ve been given some reasonable information that reglan can often some with some nasty side effects. i specifically asked about it today and the nurse, who is very normally very responsive, sort-of dismissed the question and said that it’s just part of the normal nicu course of treatment for reflux and they never see any problems. we’ll definately be following up a bit more rigorously tommorrow to see what the thinking is, considering that his reflux is fairly mild ( although, it must be stressed that reflux in a micropreemie is nothing to play around with as it can quickly spiral into a host of other issues ).

the eric update – day 68: getting taken to bottle feeding school.

day 68: it's the long lost fingergrab

well, it’s more of the same today – feeding and sleeping, sleeping and feeding, sleeping, sleeping and feeding. i think we’re going to find him off tube feeding entirely quite soon, as he’s now able to take four or more bottle feeds a day, depending on the nurses discretion as to how tired he’s getting. i think he’s also getting strong enough that soon kris will move from non-nutritive suckling to honest-to-goodness breastfeeding.

day 68: getting taken to bottle feeding school. I.

for his past couple of feedings, eric had started to increasingly behave in a way that i interpreted to mean that he was getting tired of having a bottle – closing his mouth, pursing his lips, blocking the bottle with his toungue etc. usually when this happens, the nurses are quick to “gavage” him ( feed him via a tube ), with the explanation that it’s best to get his feeding done quick so he has enough time to digest his food.

tonight, when i was feeding him and he hadn’t taken a sip in ten minutes, i started to signal to his nurse that maybe it was time gavage him. i had noticed that nurse marlene had been watching me closely while i was feeding; she walked over and gingerly picked up eric but to my surprise, instead of putting in a tube, she started to whisper to him that she had a lot of faith that he knew exactly what he needed to do to eat. and much to my astonishment, in about five seconds, eric was guzzling away.

nurse marlene is the archetypal nurse caregiver. if you close your eyes and imagine the most grandmotherly of grandmotherly nurses and you’ll likely being envisioning nurse marlene. her white, couffed hair, bifocals and ageing hands betray the fact that she’s been nursing for quite some time and all that experience translates into the thousand little things that she’s doing which result in an easy bottlefeeding.

she very sensitively explained to me all the things i was doing wrong. most obviously, she sits him up, while tilting his head back. i often lay him along my forearm, while holding his head with my hand, which tends to tilt his head foreward making it more difficult for the milk to go down.

she also showed me a great technique for getting the bottle nipple past his tongue. he likes to put his tongue on the roof of his mouth and pretend that he’s sucking, but in reality he’s just playing with the bottle. nurse marlene showed me how put the bottle in his mouth so that the nipple touches the inside of his cheek and then she swoops it past his tongue.

as if that weren’t enough, i’m also being far too timid about putting the nipple all the way in his mouth. apparently, my fears of gagging him are vastly overblown.

day 68: getting taken to bottle feeding school. II.

nurse marlene continued here tutelage with a lesson on the proper way to burp. his head must be tilted up, not down as i had been doing. and she carefully but very firmly grasps him while keeping his airway open. she swings his head and torso in a full 360 degree circle to show me just how firmly she’s holding him, as his head doesn’t change it’s upward tilt during the arc.

i’m admonished to not rap on his back either, and she rolls her eyes when i tell her that’s what the other nurses do. she’s gently massaging his back and right on cue, eric lets out a little burp.

she clarifies that a properly burbed child never needs their back rapped and i suspect that she might be making a comment about the burping skills of some of the other nurses.

the eric update – day 66: more big feeds. more weight gain. a few alarms. getting ready for the baby shower.

day 66: sucking thumb

for the most part, today was a pleasantly quiet day. eric continued to guzzle his bottle feedings in near record setting time – he cleared away his 40 cc ( 4 more than his feed required ) evening bottle in 15 minutes! the nurses are continually amazed at how well he does with his feedings. currently, he only gets two bottle feedings a day, with the rest being done via a tube. if he keeps up the great work they will gradually increase the number of bottle feeds.

eric put on another ounce and weighed in at 3 pounds 13.2 ounces or 1735 grams. if he keeps gaining an ounce or so a day, he has a pretty good chance of hitting the four pound mark by his ten week birthday!

day 66: yet another bottle feed

they also decreased his nasal cannula again to 1.25 liters per minute. he’s started “desatting” ( decreased blood oxygen levels ) a bit more and had a few more “a’s” and “b’s” ( apneas and bradycardias ) around feeding time. this is probably due to the fact that his hemoglobin levels are getting low and has a diminished oxygen carrying capacity; after he gets another another transfusion, which we expect to happen in the coming days, everything should clear up quickly.

day 66: getting ready for the baby shower

i guess there’s no small amount irony in the fact that we haven’t finished getting our registry in order for our baby shower for a baby who is already two months old. our shower was originally going to be on july 31st, but we moved the date to september 19th to give us time to adjust to being in the nicu.

some might remember that there are good reasons why kris trots me out to babies ‘r us in the evening. we had a fun time picking out a bunch of cloths for eric; “grandma pam” accompanied us to the store and spent entirely too much money, but i suspect that grandmas like to do that sort of thing. thanks! grandma pam

the eric update – day 64: first bottle feeding from pops! progress, the micropreemie way.

day 64: first bottle feeding from pops.  I.

in my continuing efforts to provide evidence that i am not one to shirk my fatherly duties, i’m happy to present photographic evidence that i am capable of feeding my son without drowning him or otherwise causing any grievous bodily harm. woohoo! perhaps due to my superior bottle feeding skills, he managed to make small work of the whopping 29 ounce cc ( d’oh! there’s a big difference between ounces and cc’s! ) feeding in about 12 minutes, with nary a burp or sign of reflux!

he’s looking right at the camera and it’s fun to imagine that he might be waving to his fans all over the world.

day 64: first bottle feeding from pops.  II.

we’re in much more cramped quarters these days since the move to the isolette and it’s rude to turn the overhead lights on when a baby might be sleeping just a few feet away. so kris, relents and decides to use the evil flash.

i like this picture because it shows that even though he’s getting big, he’s still quite small and it’s easy to hold him in one hand while i feed him with the other.

day 64:  moving to three hour feeds

eric has been getting fed every two hours, but today they decided that it was time to move to three hour feeds, as he’s been doing so well eating over the past few days.

when micropreemies are very small their stomachs can’t handle very much milk during feedings, so they feed them less milk more often. but as they get bigger, they can feed them larger volumes less frequently; so it’s a great sign that he’s transitioning into three hour feeds, and it’s yet another little, tiny step towards getting out of the nicu.

day 64:  sleepy time after feeding

in another bit of progress, micropreemie style, eric’s had his isolette temperature turned down from 30 degrees C to 29.3 degrees C which means he’s rapidly getting even better at holding keeping his body temrerature stable all by himself. when the isolette tempterature reaches room temperature ( about 26 degrees C ) and he approaches 1800 grams, then he’ll probably be ready to move to an open bed. tonight, eric gained an ounce and weighed in at 3 pounds 11.1 ounces or about 1675 grams, so it’s possible that he could hit the 1800 gram mark before the end of the week.

the eric update – day 59: even more weight gain. too big for bedding. impending transfusion and guessing games.

day 59: outgrown his bedding!

sniff. they grow up so fast. it’s hard to believe that it was on day 26 that eric received his custom bedding and he looks like he was swimming in it on day 28. but now, he’s so big, at 3 pounds 8.3 ounces or 1595 grams ( yes, he gained over two ounces in 24 hours ) that he can’t fit in his bedding anymore! we decided to give his bedding to some new neighbors who just arrived with a 24 weeker. we remembered how nice it was to have his own bedding from a thoughtful stranger, so hopefully in some small way, it’ll help the new parents transition into the nicu and their own long road ahead.

one of the nurses told us that during “rounds” today the neonatologist commented how very happy he was with eric’s progress and that he thought he had “turned a corner” and was looking very, very good lately. it’s going to be quite difficult to manage our expectations in the coming weeks now that we know that he, himself is being so optimistic – all the more so because the nurse said that he never makes predictions.

as i mentioned earlier in the week, he is looking increasingly pallid as the days goes by due to his decreasing amount of hemoglobin in his blood, which means he is getting closer and closer to needing a transfusion. for a variety of reasons our neonatologist lets hemoglobin run down farther than perhaps is done in other nicus, in an attempt to see if babies can increase their production on their own. often he’ll even go so far as to let the alarms start to increase before he’ll begin another transfusion, so i guess i’d expect to see the rate of alarms pick up over the next few days, due to the decreasing number of “boxcars” ( nurses term for red blood cells ). while he doesn’t seem to be alarming more than usual, his supplemental oxygen is gradually being increased, as a consequence of his decreased oxygen carrying capacity.

day 59: the return of kangaroo care!

i like to play games with the nurses by “forcing” them to guess when they think certain events will occur, such as when eric will get his transfusion. normally the nurses hate answering the “when do you think such and such will happen game” but i make it so much fun to play that most of them eventually play along ( in fact, i believe i may have developed quite a reputation for being able to cajole normally retrained nurses into playing ). being the veterans that we are, they know that i don’t really believe a word that comes out of their mouths and that it’s just a way to pass time. today, eric’s day nurse was quite sure that eric would get the transfusion tommorrow. or, i think it might be more correct to say that she was advocating that eric get the transfusion so that he could get it done before he goes to “full feeds” and is therefore be able to get rid of his intravenous line that much sooner ( i.e. if he went to full feeds before he got his transfusion, they’d keep his IV line in for the impending transfusion, which she was presumably trying to avoid ). however, eric’s night nurse laughed at the speculation and said that maybe the day nurse didn’t work in the same nicu as she did. the day nurse was still talking with us at the time, so it was all in good fun and i got they impression that they were gently expressing their impressions of the neonatologist’s transfusion policy.

day 59: pops gets some light reading time.

in addition to playing games with the nurses, we stuck to our increasingly normal routine of holding and kangaroo care, with and afternoon bath from kris and reading from both of us. tired of all the other reading, i decided to read to him about “mr. craigslist, master of the nerdiverse”.

the eric update – day 56: eric’s second lunar birthday!

day 56: a lunar birthday party

thankfully, eric’s alarms stopped alarming and everyone feels quite confident that the whole hullaballoo was just eric’s way of saying that he needed a little more help breathing that we thought. without the constant alarms, we were able to enjoy a relatively quiet 8 week birthday. eric’s friends all gathered around to wish him a very happy birthday. after eric was finished socializing, i had the chance to give him his very first “spit bath”! it took me a little longer than kris takes when she gives him a bath, but we eventually made it through the process relatively unscathed.

kris will claim that she doesn’t know how to take nice photos, but i think this series proves that she’s fibbing.

day 56: a lunar birthday spit bath. I.

there’s a diaper under his head to help prevent water from soaking his bed. the nurses never put a diaper under his head when kris gave him a bath, so i believe they’re really thinking that i don’t know what i’m doing 🙂

day 56: a lunar birthday spit bath. II.

he’s trying to subtly let me know that i should hurry it up so he can get back to sleeping.

day 56: a lunar birthday spit bath. III.

one simply must have a sqeaky clean forehead on one’s second lunar birthday.

day 56: a lunar birthday spit bath. IV.

as i’m trying to give him a bath, he grabs my finger very tightly and won’t let me pull it away as he looks right at me as if to say, “enough, already!”

day 56: a lunar birthday spit bath. V.

he keeps looking right at me as i clean the folds in his neck, as i think about how amazing that he actually has folds of skin on his neck, given how skinny he was just a few weeks ago.

day 56: a lunar birthday spit bath. VII.

you don’t want to leave any soap on a micropreemie’s head, so it’s mighty important to give him a good rinse.

day 56: a lunar birthday spit bath. VIII.

it’s that easy to scrub his back with the intravenous lines and nasal cannula, but we make the best of the situation.

day 56: a lunar birthday spit bath. IX.

his head is drying under the towel as i’m scrubbing his legs and feet.

day 56: a lunar birthday spit bath. X.

i’m picking him up as kris is changing his bedding and simultanously trying to take a picture. he’s a little bigger than the last time i held him like this on day 8 ( she took that picture too ).

day 56: a lunar birthday spit bath. XI.

kris and i have switched roles and now i’ve got the camera. he’s looking up at her as she’s telling him what a super job he did enduring my bath, which was twice as long as the those that she gives him.

she’s getting ready to put a “big boy” top on him to help keep him warm after the bath.

day 56: a lunar birthday spit bath. XII.

all done! baths are quite tiring, he almost immediately falls asleep and enjoys a lunar birthday nap.

day 56: serenity

clinically speaking, eric is doing very, very well, which is amusing to say considering all the alarms just yesterday. he’s tolerating his feeds as well as anyone could expect and the amount of undigested material that they are pulling out of his stomach between feeds is gradually diminishing. i think that it might be possible for him to be back on full feeds by the end of the week. he’s looking a little pallid due to a gradually decreasing number of red blood cells. so, despite the hope that he might have recently had his last transfusion, it looks like he might get one ot two more.

i haven’t been giving any updates on his weight because he hasn’t been adding on any weight. i discovered that being on the vent is a great way to add weight to a micropreemie, since it’s doing all the work and they can convert the extra energy towards gaining weight. since eric’s not on the vent, it’s not unusual for him to stop adding weight as quickly as he had been; however, i think they’ll look at adjusting his diet a bit in the coming days, since it’s not a good thing to not put on any weight for five whole days.

day 56: full moon lunar birthdays

we always know that odin’s lunar birthday is approaching because it coincides with the full moon. well, technically, it’s a day after the full moon, but it looks full enough to me. i realized tonight that i hadn’t bothered to capture a photograph of the moon 4 weeks ago, and i couldn’t let it happen again.

it’s seemed like a big, bright birthday candle in sky as we took the dogs for their nightly walk.