8-31-10

Oliver has had a very productive day. The morphine was weaned down to 25mcg/kg and he seems to be doing better today with the weaning. He still gets a little jittery and his blood pressure elevates but nothing like yesterday. His blood pressure seems to be running higher so they did an ultrasound of his kidneys since they're thinking that tiny clots may be forming at the tip of the umbilical arterial catheter (UAC) and migrating to his kidneys causing the blood pressure to go up. So, today they took out the UAC and he was such a good boy during it and slept through the whole thing. This means that they will have to prick his heels now for blood draws but at least they made the lab draws to only twice a day instead of every 6 hours. With the UAC out now we also won't be able to see what his blood pressure is constantly.

They discontinued his antibiotics today. They also discontinued the NO (nitric oxide) that he got through the ventilator to help dilate the capillary branches. He seems to be doing really well with his breathing. His oxygen concentration is at 29% and his saturation is 95%. They turned his respiratory rate down to 10 breaths a minute but he takes a lot more than that on his own. He is initiating most of his breaths on his own at this time taking over 100 breaths by himself.

Slowly they are starting to wean him off of everything. His nurse today said that with the UAC out that they can put him on his tummy now and see if he likes that AND that also means that I may be able to hold him finally today or tomorrow!!!!!! His feedings were increased to 20ml every 4 hours now so that is 2/3 of an ounce he's getting along with the IV nutrition, fats, and lipids. His labs were all good today as well.

One of his fellows (doctor in training to be a neonatologist) told me today that in the next few days he might be able to be extubated (take the breathing tube out). I can't believe how fast this is all going now. I'm so excited and proud of Oliver. He's doing so well. He really is a fighter. If I get to hold him I'll get pictures and will post. That is all for now I guess.

8-30-10

Today Oliver was more awake than ever before. It is the small things in life that make life worth living. I got to see my son's eyes wide open looking back at me!! They decreased the morphine drip this morning from 30mcg/kg to 20mcg/kg. He woke up more than ever and he tolerated it well at first except for this afternoon when he started to go into withdrawals from the morphine. He started shaking terribly and his blood pressure shot up too high. They gave him ativan and fentanyl which helped for a while, and we ruled out all other things such as dirty diaper, being hungry, and needing to be suctioned. So they increased the morphine drip up to 25mcg/kg. He was calm only when I was at his side talking to him and comforting him as best I could. The nurse kept saying I had the magic calming touch. I said he knows who his mommy is. They ended up turning it back up to 30mcg/kg by the end of the day when I left. I got some pictures of him with his eyes open (sorry it is so dark, I still cannot use flash).

Also today they increased his feedings to 10ml every 4 hours and while I was there he had no residuals of previous feedings not being digested completly. I got to change 2 poopy diapers, take his temperature, and swab out his mouth with oral swabs. I think he will be a pacifier baby because he really sucks on the swab and also his ET tube. No real ventilator changes today except they changed to respiratory rate down from 25 to now 20 breaths per minute but he usually breathes more than that on his own. He is initiating most breaths now as well. His oxygen saturations (SPO2) level was great today in the 90's but they did not wean the oxygen concentration down today.

This is a picture of his room today. Since the stress precautions were lifted they were actually able to change his bedding and they got his weight. He now weighs 6 pounds 3 ounces. Although most of the weight gain is from fluid that is still pooling in his body. Also because they hadn't gotten a weight since his birth weight when he was so dry and had hardly any blood with his hemaglobin of 5 at birth. Normal hemaglobin for a newborn is 13 and that is why he needed so much blood and platelets transfused for the first few days. Since then he has been maintaining normal limits of hemaglobin and platelets so he is now making them on his own. He still hasn't had a bath but I'm sure it will come. The pink thing holding his legs in is called a "Zaky" named after a child that the mom made this for that helped sooth him. It looks like a forarm and hand that is full of beans like a bean bag. It adds weight and support like a mothers arm holding their child. The only one they had left was a pink one, I said I didn't care what color it was as long as it soothes him and it does. It keeps his legs pulled in close like he is being swaddled.

8-29-10

I have to say that I am so proud of my little boy he has come along so far this weekend that this afternoon they lifted the stress precautions!!! It was great that Shawn got to see him without his eye shield before he left. We're not pushing anything with Oliver, it was a milestone enough that we can see his face without the eye shield and ear muffs. Still no touching without gloves on but hopefully they can give him a bath in the next few days and they will get a weight on him tomorrow morning - his first since he was born. I still haven't held him but I can see that coming in the towards the end of the week if things continue to progress as they have been.

Oliver is still on the ventilator but he is not requiring as much support. His oxygen concentration he is requiring is now 31% and his N.O. (nitrous oxide) has come down from 20 on Friday to now 6 today so his capillaries are staying open and not constricting. His oxygen saturation (SPO2) is staying in the low 90's on the 31%. I just can't get over how well he has come since Thursday. He even had 2 episodes of the hiccups today and he tolerated them well with his SPO2 staying above 85%. Now the only thing we have to control is his blood pressure. It has been high yesterday afternoon and part of today. They are trying to keep him sedated with the pain meds and ativan for restlessness when the BP goes up. It's good to know that he is like other babies in that he doesn't like to have dirty pants. He started having bowel movements yesterday so we know that his GI system is working now. It scared him the first time he pooped he didn't know what to do. He doesn't cry so it's hard for us to know what is wrong with him and why he's worked up with his BP elevated. You just have to rule out things like dirty pants, too much secretions in his lungs so you have to suction, or he wants to be swaddled. They stopped the dobutamine drip today since they only started that to help with his cardiac output and getting blood to his extremities.

Oliver had both sets of grandparents visit this weekend and also our neighbor Thea. We appreciate all the well wishes from everyone out there and appreciate everyone's concern. It will just be Oliver and me the next few days so I hope to spend quality time with my little man and hope that things keep progressing.

8-27-10

Today has been a great day so far. We came into his room this AM and his oxygen saturation was 92% on 61% of oxygen. He is a bit puffy today because they had given him 2 saline boluses overnight to bring up his blood pressure and he also received another blood transfusion. They are thinking that with all the blood draws through his arterial line and umbilical venous line that that is contributing to the low hemaglobin (red blood cells). Last night before we left, they started him on dobutamin to help with his blood pressure and perfusion to his extremities. They had to since the viagra does have the side effect of dropping your blood pressure even in babies just like the commercials say. During rounds today, Dr. Segar said that we're just going to continue doing what we're doing because he must be responding to something. The plan is to try and wean his oxygen concentration through the vent today based on the arterial blood gases (ABG's) results they take every 6 hours. Today I can actually say I saw him on 46% oxygen with his oxygen saturation (SPO2) at 92%. To put in in perspective for you, the normal air we breathe is 21% oxygen so he is doing very well. They ended up turning it up soon after since they removed his eye shields briefly so we could see his face and take more pictures. We got to see him squint his eyes open and I saw his left eye. It is dark colored but cannot tell what color it is. He is the cutest baby in the world even though he hasn't had a bath since he was born!!! I may be a little partial though. He is still under the stress precautions so no unnecessary things like bathing, weighing him, or anything extra that would stimulate him and cause him extra work. They are working on decreasing the oxygen concentration slowly throughout today. His right upper lung as also stayed inflated and today you can actually see 9 ribs on the right and we could only see 8 yesterday on the chest x-ray so there is more air perfusing the lung.

Oliver had many visitors today including his Great Grandma Mary, Great Uncle Jim and Great Aunt Lisa. As well as my coworker Michelle Keppler. When we left tonight to go for supper he was still at 46% oxygen concentrations with his SPO2 90-93%. I'm so proud of my little man! If he stays still with no stimulation his SPO2 stays good but with any stimulation it tends to fall. That will be the next battle to overcome for Oliver. We're pretty excited that Shawn comes back tonight even though he was only gone for a little over 24 hours.

8-26-10

Today Oliver's doctor - Dr. Segar spoke to us about Oliver's lungs. Oliver is in a stand still with his lungs and we just have to wait until he tells us he is ready to be weaned. They gave him more surfactant today through the ET tube and then bagged him through an ambu-bag to have high pressure in his lungs to try and "fluff" up that right side of his lung. It was the scarriest thing I have ever seen in my life. They put it down, turn him on his side for 30 seconds while bagging him with 100% oxygen then turn to the other side and repeat. I don't think I will be in the room if they have to do that again. No mother and father should have to watch their son turn blue and struggle to breathe even though they were there breathing for him, he was trying to cough the fluid up and out of there. After they suctioned the tube out it did help him and his saturations came up. Dr. Segar explained his lung condition in that they are thinking it is either the smooth muscles around his vessels of his lungs that are enlarged from working too hard or the vessels in his lungs are constricted too much. If is the vessels themselves they have started him on viagra. Yes I said viagra - before it became popular for the use that we all know it for it was used in babies to help dilate (open up) the blood vessels. He will get that every 6 hours but it can cause his blood pressure to drop so they watch it closely. He tolerated the first dose well at noon today. If it is a muscle problem, it just takes time so the muscles shrink back to normal size with no use. It's like other muscles - if you don't use them they shrink and that is what they are hoping happens to Oliver's lung muscles. After the surfactant was given today, they repeated his chest x-ray and we had great news - his upper right lobe expanded!!! It's not fully expanded but it is open and there is air through the whole thing just not the amount that is normal. He is also having an ECHO done right now because his heart looked hazy today in this morning's chest x-ray but at noon the heart was more defined which is a good thing.

They also increased his feedings to 10ml of breastmilk every 6 hours and he seems to tolerate them well with minimal residuals. His labs looked good this AM. He's still pretty sedated today and they are starting him on fentanyl as a short acting pain/sedation agent to use as well as the morphine and ativan. They want him to rest as much as he can so that he doesn't have to work so hard. They turned his nitrous oxide that he gets through the ventilator up to 20 today in the hopes that it dilates the capillary branches in the lungs and makes it easier for him to breathe. They still have no answer about what happened to cause this but the nurses tell me he's not the sickest baby in the NICU anymore and that he's made good progress but just have to wait for him to tell us that he is ready to wean more. Shawn went home after lunch and he will go back to work tomorrow and then come back tomorrow night and stay the weekend. Shirley is here with me now.

Oliver got to meet his Great grandma Billie and Aunt Marti yesterday when they came to visit. He still has his eye shields and ear muffs on but I like to think he can still hear us when when whisper to him. Thanks for the continued thoughts and prayers.

Oliver's hiccups

This is Oliver's hiccup episode this AM when he was tolerating them and breathing at the same time. It was pretty cute to see him so active when he has been so sedated lately.

Happy Birthday Shawn

Today is Shawn's birthday and Oliver turns 6 days old. It's hard to believe that my little boy will be a week old tomorrow. My biggest wish is to hold him. Everytime we go in his room and I see his cute little face (well with eye shields and ear muffs on) my heart melts and I just want to lean in and kiss him. We have to wear gloves when touching him again and he had a rough morning. He had a great day yesterday he tolerated the lower dose of his morphine drip well and his oxygen level stayed good. Today he still has that upper right lobe of his lung that is collapsed and they are still hoping that with the position changes that it will just "fluff" up on its own.

Today when we arrived at the hospital he was moving around but he was maintaining his oxygen level well. Then he developed the hiccups which was cute but he was not happy with them. He's going to be like his mamma and have hiccups that last for more than 20 mintues that is for sure. It was taking too much oxygen/energy for him to breathe and to hiccup that they had to sedate him with ativan and morphine and we had to hold his arms and legs close to his body to help calm him. They had to turn his ventilator oxygen concentration up so he would get more oxygen because his oxygen saturation level was not where it had been. When they suctioned him today they got back just some thick fluid not pink-tinged as yesterday so that is good. I guess that this is what they call the NICU rollercoaster as other parents we've met say happens. This is what it means to take it hour by hour and not day by day because things can change so fast. He is comfortable now and his oxygen need has decreased some from before when he had the hiccups. Click on the next blog to view the video of him hiccuping while he was still tolerating the workload of doing both (I can't figure out how to incorporate them together.)

Oliver's Grandma Shirley is coming back today to bring us more items from our house and stay with me until Shawn returns again on Friday night. Shawn and I are going out for supper tonight for his birthday while Oliver spends some time with Grandma Shirley and then Shawn will go home tomorrow and back to work on Friday. Here's also another picture of me with Oliver.

Replaying the last few days

I don't even know how to start this blog other than to say that I have a new baby boy! Oliver Forrest Peterman was born on Thursday 8-19-10 at 4:12 pm weighing 4lbs 6 oz and is 18 inches long. It all started with me going in for my regular 36 week appointment to the clinic in Dubuque. This is a picture of me the day before Oliver was born.

At my appointment the Dr. asked me if I was having contractions and I stated yes but that I didn't know if they were braxton hicks or if they weren't. She stated that she'd hook me up to the fetal heart monitor for 20 minutes to see if they were real contractions. After 20 minutes she came to talk to me and stated that I needed to get over to Mercy Hospital to labor and delivery as soon as possible. No contractions were seen but the baby's heart rate would go from 150 bpm and drop down to 90bpm and last for almost a minute before coming back up. After having an ultrasound they found that I had no amniotic fluid left around the baby and therefore he was compressing on the umbilical cord and that yes he was still breech. So Dr. Berger decided that I needed to have an emergency C-section as soon as my husband arrived. And, as soon as Shawn got there and got changed into his scrubs, I was wheeled in and Oliver was born. He was wisked away quickly to the NICU at Mercy and Shawn followed him. After I was taken to my postpartum room I was waiting around to hear how my son was when my husband came in and stated that there was a possibility that they would have to transfer him to the University of Iowa. He was given a quick baptism at the Mercy hospital which Shawn and my parents were able to participate in but I was still recovering and still hadn't seen even what he looked like. The flight nurses did bring Oliver down to my room before they flew him to Iowa City so that I could touch him and blow him a kiss goodbye. Shawn and his parents drove down to Iowa City then Thursday night and spent the night with him at the hospital and my mom stayed with me in Dubuque since I was still recovering.

This is Oliver in his NICU room at UIHC

The doctors first thought that Oliver had and enlarged heart and was anemic and required blood and platelet transfusions. After doing an ultrasound of his heart they found that it was functioning normally just was enlarged. They kept asking Shawn if I was sick throughout the pregnancy or more tired than normal which I wasn't either of those. They started him on a few antibiotics and kept him on a morphine drip to sedate him so the ventilator would do all the work for him and he could conserve his energy. He then had to be put on a dopamine drip because his blood pressure dropped due to the morphine. He had to be on a special ventilator called an oscilator that shakes him and acts like a diaphragm and breathes for him even if he initiates a breath for himself.

Friday they still did not know what was causing Oliver's condition and had run a lot of labs and done many ultrasounds on many parts of him body still giving us no diagnosis other than that he had pulmonary hypertension requiring him to be on the ventilator and that the top right part of his lung is collapsed. Friday I was still in Dubuque as they would not discharge me yet although they were really trying to get me down to Iowa City as much as they could. I can't say enough about the wonderful care at Mercy and the great nurses.

Saturday I finally arrived at UIHC to see my baby Oliver and have our family all together.

It has been a whirlwind since I came. Both my parents and Shawn's parents stayed all weekend here with us and my sister surprised us with a visit as well on Saturday.

Today, Monday, Shawn and I are here with Oliver as we wouldn't want to be anywhere else than here. He's making a lot of progress and they're taking him off the dopamine today because he is able to keep his BP up on his own. They're going to try him on a different type of ventilator today that will not shake him therefore he will not require as much sedation and can hopefully wake up a bit. He is still on stress precautions which means we can touch him but only slightly and no stroking him or holding him yet. We have to speak in a whisper and he has to wear ear muffs and eye shield so that he has as little stimulation as possible. I can't wait to be able to hold him as I haven't been able to yet but the nurses have let me change his diaper today and yesterday when he is more sedated and today I got to take his temperature. It's the small things that melt your heart. We're staying at Shawn's parents camper they pulled down here for us since we have heard we may be here for around a month. We're praying nonstop that we can soon bring our beautiful baby home and that he keeps making progress although we know to take it hour by hour. He has had set backs but he has also fought his way back very well and we're already very proud of him. Thank you for all of your thoughts and prayers. Here are some more pictures of Oliver.

35 weeks

I had my 35 week OB appointment today and everything is going well. The babe's heart rate is 155 and my platelet count was actually in the normal range. It's getting more exciting now since the last time I went to the Dr. they told me that I need to "talk to my belly button and tell him to come out" after this visit. So don't think I'm crazy but I did that today on the way home because wow it is hot and humid again today! Looks like next week will be better heat wise hopefully. I still think that the day after I deliver we will have our first frost because it is only this hot because I'm pregnant, I'm sure of that. Thank goodness for air conditioning!

Speaking of heat, I had posted on facebook over the weekend that I had done some major cleaning of my house except for washing the windows because frankly there are too many windows in this house and it is HOT outside and I didn't want to open the windows to the heat. So, to my surprise last night when I came home from work, I found my windows spotless and shining bright, my dishes done, my bed made and my stove scrubbed thanks to 2 great nurses that I work with. Thanks Debby and Sandy!

Busy Saturday

My sister Colleen and Shawn's aunt Lisa threw me a baby shower on Saturday. I have been so worried lately that I'm not prepared to have a baby and let me tell you, I don't have to worry about that now. Between all the clothes my sister had brought me that were my nephew and niece's and all the new very cute clothes, I feel like we'll have the best dressed little boy. I had a great turn out of people including my Grandma's, aunt's and cousins on both sides of my family, Shawn's mom and Grandma, and many friends. We ate a little luncheon and had ice cream cake to celebrate before playing some shower games. Thank you to all who came and for those who couldn't make it for the gifts and your thoughts. The corsage I'm wearing below is made up of 2 little baby booties.

After the baby shower I went across the street to a co-workers wedding. It was a beautiful ceremony except for the fire whistle going off for a good share of it in town.

Later I met up with Shawn and my family for an outing at Kam Ham park with my Godparents and their kids/grandkids. We had a great time catching up with them and I think Shawn had a good time looking at some old tractors including an Oliver.

After we left the park, Shawn and I went to the wedding reception for my co-worker and let me tell you, it is a lot harder to dance and jump around when you are 34 weeks pregnant. People kept telling me to take a break from dancing or I might go into early labor. Well no early labor but I sure felt it the next day in my back and thighs.

After the full day of fun events, I topped it off with one of the best nights of sleep I have had in a long time.