Home sweet home.

Grandma and Bumpa April are up in Lebanon with Tyler this weekend while mom and dad spend the weekend at home with Rachel away from DHMC. Rachel is loving every second of it, and it is so nice to be home!

I checked in this morning and Tyler was doing great. His incoming O2 was down to 21% the same level in room air! The ventilator is letting him rest his tired lungs, but that's all it's doing. The general consensus from his follow-up head ultrasound yesterday is that there is no significant change (A VERY good thing). We are still waiting for the radiologist report that will indicate if there was any change at all.

We came home to a nice set of new blue bracelets. They say "Tyler Paul April" on one side and "2lbs. 13.8 oz. & GROWING" on the other. Go Grandma!



Time to make a dump run. Life doesn't get any more normal than that! :-)

Round and round we go.

Tyler is back on the ventilator. This is not a surprise nor a disappointment to us. He was looking tired last night when we went to sleep. With his gestational age and PIE (Pulmonary Interstitial Emphysema) he needed a break from breathing on his own. He is thumping along again and looks much more comfortable, and sats look great. Depending on how fast they dial-in his settings we may be on CPAP again in a few days.

Today is also a big day as he'll be getting another head ultrasound. This is to confirm that the bleeding has stopped and the pressure is reducing on it's own.

Pre-Poop

This morning I got to change a diaper that had a little trace of that new baby tar. We've been waiting to see some output with all the input he's had and today we started. I showed the nurse and she decided he needed a little help. She inserted a very mild suppository and Tyler instantly pushed that out and a small jelly bean of tar. YEAH! another system coming online. Right now it's hard for him to concentrate on pooping while breathing. They have a hard time holding their breath in order to push. We are waiting for another good bowel movement, he still looks a little full. Overall right now he look comfortable despite all the pin pricks and holes in his little body. He had 4 attempts for a regular IV. (Tyler 4, nurse 1). Still his spunky self.

PDA, No not your Blackberry.

We've known from day 1 (now seems like oh so long ago) that Tyler had a heart-murmur. No one is surprised and the way it has been explained it would be more surprising if he didn't have it. It is not a huge threat at the moment and the plan is to treat it now while a drug called Indomethican will work vs wait until surgery is the only option. Tyler has been diagnosed with a small to medium (We were expecting medium to large) Patent Ductus Arteriosus (PDA) with Patent Foramen Ovale (PFO). The PDA is a path between the oxygenated and de-oxygenated outputs of the heart. The PFO is a hole between the two atriums. It allows mixing of blood between the two right and left atrium. These were required when the umbilical cord was doing most of the heavy lifting.


We have been assured that these are 100% expected in pre-term babies. In the vast majority of cases it would heal if left alone. The main reasons for treating it are that the drug will only be valid for a short time. It is a vasoconstrictor that will likely take his kidneys and digestive tract off-line for about 2 days so feeds have stopped. Second his cardiopulmonary system is working harder than it will need to when these are fixed to maintain the same oxygen saturation.

I've also just got the call that Tyler now has a PICC Peripherally inserted central catheter. It is as serious as Ellie's Central Line, but inserted in an arm (or leg), just not as long-term. It is only good for about 2 months. This is intended to be a longer-term placement for medications and TPN. The UAC and UVC that were being used have reached the end of their expected life, in addition they want to move as many skin punctures are possible as far from his core as possible. This should increase our ability to catch another infection before it really gets going.

So I don't get yelled at here are some new pics:

Much less hardware in out new home:


Resting comfortably:


Doing 3 things at once. (At his age breathing requires some thought)

Sorry it took so long to post today, Wireless here is NOT playing along.

Spoke to soon.

Add UAC (Umbilical Artery Catheter) and Fentanyl Bolus(Stand-by Pain-med) to the list of items removed! Good Busy day!

Movin' on up!

Lots of exciting changes today. Lots of tubes and gizmos were removed since last night:

-iNO (Inspired NitricOxide)
-One Pulse-ox sensor (Still has one).
-Chest Tube.
-1 IV line (will likely be replaced tomorrow)
-CO2 sensor.

and drumroll please.....

-High Frequency ventilator!!!!

He is now on something called CPAP (Constant Positive Air Pressure). Similar to the nose thingies you often see on people who require Oxygen. It's a bigger nose fitting that actually seals pushes airfolw into his lungs to keep them open. At this point he is responsible for the breathing action, CPAP makes sure he doesn't have to work as hard and keeps his lungs from collapsing (all the way).

With Tyler responsible for his own breathing we now face a heart-stopping wonder called Apena. Babies this young (29 weeks gestation today) often forget to breathe. It often only takes a touch of his hand to start him up again. Tyler still has more telemetry than the Space Shuttle so it's just a matter of knowing the alarm sound and snapping him out of it. One of the requirements for release is at least 7 days with no Apena. Overall it's not that bad, just scary the first time.

We also moved today. (It's just a bed-shuffle, no status-change associated with it. Still in critical care).

Our old bay:
Note: we left the ventilator and iNO behind (on the right)


And now for some pics of Tyler. Sorry you can't see his face verry well. He's under Billy lights so his eyes are covered and the CPAP tube covers everything else.

Getting to know Tyler part 1

Since Friday, we've answered "How is Tyler today" with a lot of medical readings and stats. We have neglected another important part of "How is Tyler", the "Who is Tyler".

As I've mentioned in earlier posts, Tyler always gave the nurses a hard time anytime we needed to monitor him. Well he is the same way on the outside. I'll focus this installment around the events of his birth.

Friday morning was the first day I felt lousy and could tell Tyler also felt lousy. Friday was the first time he just sat through a monitoring session without kicking and trying to move away from it. His readings were stable but lacked the usual ups and downs. It was the day to meet Tyler. I had a very short intense labor. He wanted out badly. Labor was a total of 7 hours. After the Epidural and an hour rest, the SNHMC neonatal Dr came in the meet us. We talked for a while and Ben went to tour the unit. Meanwhile I asked the nurse for help using the restroom. With an Epidural, one uses a bed pan. Ben just came back as the nurse finished setting me up, when I realized I didn't have to pee. As I told the nurse this, her eyes became very large and rushed to get me off the pan. Tyler decided at this time to surprise everyone with his presences. Super Nurse caught him just before he actually landed in a bed pan. No one but Ben and Super Nurse were in the room, the Dr's were not even aware he was coming, none of the carts were near the room. He once again, despite feeling lousy put everyone on their toes.

I had a precious 2 minutes with him on my tummy while Super Nurse calmly explained to the charge nurse up front she was holding my baby and needed a cart and support staff STAT. As soon as the Dr. came in and took him off me, he started a fierce round of grunting. Grunting is a preemie's version of crying. I could see his anger from across the small room above all the working voices of the Dr's and nurses. He is a fighter. We wants to live, He has inherited the stubborn attitude of his parents.

From here I don't have a lot of direct interactions with Tyler until Sunday afternoon. From what Daddy and Grandpa have said, he has kept fighting and has bonded with Ben in that special first bond. Tyler hears Ben or sees Ben and you can see recognition. He does his best to try tracking Ben with his eyes or turn his head to the sound of Ben's voice. Out of all this, Ben has been given the greatest gift that usually mother's receive first. It is very special to watch. These two will be very close.

More on Who is Tyler another time, our rounds are about to start.

What goes up...

It was made very clear to us from day uno that we are on a roller-coaster. There WILL be ups and there WILL be downs. Yesterday we had one such down. A pretty big compared to our recent progress. I'm sorry it took so long to post but we needed some time to absorb the magnitude of it all, and collect our thoughts.

Yesterday, if you had asked Tyler's docs if they thought he had an IntraVentricular Hemorrage (IVH a type of bleeding in his brain) you would have heard a firm "No". His activity level and responsiveness tend to indicate otherwise, and he is making good progress on his breathing.
His activity and responsiveness are still great and his ventilator settings are even lower than yesterday. However today we saw an ultrasound that clearly indicated that all is not right in Denmark. There are 4 levels of IVH 1-4, 1 and 2 being considered minor and 3 and 4 getting progressively worse. 4 is also called a Periventricular Hemorragic Infarction, That means blood is getting into the brain tissue not just filling the ventricals.

This is scary stuff, I will take a second to caution that cases worse than Tyler have grown up "Normal" and cases better than Tyler have ended up with severe disability. By itself the diagnosis means very little. It can't tell us what problems he is likely to have, or how normal his life would be. Meeting with one of Tyler's doctors today he showed us the ultrasounds and explained Tyler has a small grade 4 on one side and a Grade 3 on the other. He also gave us a measured dose of optimism when he said that based on the fight he sees in Tyler he would suggest that we give Tyler a fighting chance. As one of his nurses said the other day "These kids haven't read the books or research papers, they don't know how they are supposed to react. Anything can happen".

This news pretty much put me over the edge. I let loose 5 weeks of pent up emotion right there in the ICN. It had been building for a long time. I sat there bawling as Tyler held my finger and looked at me as if to say "What the hell is your problem?". Again we don't really know anything firm other than Tyler now has some elevated risks for brain related disabilities. There is nothing on or off the table that wasn't there before just the risks have changed. His still under-developed brain could possibly re-route around any damage and work just fine. There are still many concerns to consider, this ultrasound is only one point in time, this could have happened anytime between birth and moments before the scan. It could also be ongoing. They will scan again on Friday to see if his condition improves or worsens.

When you get right down to it, not only are we on a roller-coaster but at the moment we are also in the dark. Space Mountain?
I never did like roller-coasters....

Ah.. the power of Motrin(tm)

As Sharron and I sat in the ICN last night trying to reach a nice balance of Tyler being stable and our being tired. My farther who had just left to go home ran back in. He told us that Rachel had a fever! That is a pretty big emotional blow. Our little girl not feeling well, we're 2 hours away, and even if we were right there we would have to choose to see her and wait a few days to see Tyler or wait until she is feeling better. It's a very hard call, The child who knows they would like to see mommy and daddy vs the child who needs every bit of time we can give him, but won't remember that we were there. In the end Rachel is in good hands with Grama and Bumpa. We may try and have a web conference with her tonight.

Today we have the exciting addition. Tyler now has an OG(Oral Gastric) Tube. We have just started Tyler on expressed milk from mommy (also called "liquid gold" around here). So far he has had 1ml, and seems to be tolerating it well. We will see how he does and slowly increase from there.

For those who like to send flowers, Please don't. We have nowhere to put them. Tyler and his hardware(mostly his hardware) is taking up about 110% of his alloted bed-space. Most of the time we sit in an empty bay next to him. If either one fills up (the last two open slots in the unit) it's going to get cozy. If you feel like you need to send something please consider donating to David's House. They have a great facility that allows parents and family of children at DHMC a cheap, family oriented place to stay within sight of the hospital. The offer us dinner each night, and common food to eat for breakfast and lunch. The staff also takes care of the cleaning and suppling everyday items like dish soap, free laundry machines, paper towels, you get the picture. They are always looking for simple household items to help the gusts focus on their children. A local school boy today asked his mom if he could bake brownies for David's House. His mom says of course, I'll bake anything that I don't have to eat myself. So today, Sharron was able to indulge her love of brownies.

One last programming note: My cell-hone folded. It happened last Friday night. Thanks to Tim I've got a cheapo go-phone and swapped my SIM-card so my old number works. I have some of my address book, but most of it died with the phone. If I don't call you and you suspect I should consider calling me. Though be aware we are asked to have our phones off in the NICU. It is a room full of tension and beeping the last thing they need is a cell phone.

And... A picture:

Mommy has landed!

Sharron was released from DHMC at noon today. Thanks to the Fly-By-Night Ambulance and Catering service (Gugg and Tim) she was here by 2:30. I think mommy was rather happy to be out of the hospital for herself and there to support Tyler. We are still concerned about the infection, but being 50' from the ward where she would be treated makes everyone feel a little better.

Today was full of baby steps. Some forward and some backward. When Dad and I got in this morning they had weaned his Oxygen to the target range of 30% (FiO2) By the time Sharron and I left this evening we were back up to about 65%. His lungs are doing much better, but still rather immature. The main goal today was to reduce the pressure that the ventilator provides to the airway, as this likely caused the pneumothorax. The trick is to do this and keep him stable overall, this we accomplished though at the expense of some other gains that we have made. We also gained ground on blood-pressure. Tyler is now off the drug (Dopamine) that they have been using to boost his BP in order to help him fight the infection.

We had also started to reduce the dosage of the Nitrous Oxide gas he is breathing to help his longs work, but that was reset later while trying to dial-in his ventilator settings.

Tyler was also started on TPN (IV Nutrition) today. Hopefully this will give him the energy he needs to fight off the infection. At the moment Sharron and I are going to sleep, safe in the knowledge that he has a great team watching out for him. And glad to be in the same place again.

More tomorrow, now I need to sleep.

Can you say pneumothorax?

Rule #1 You are not in the way!! If one of the docs/nurses asks you to move you should have an escape plan, but know they will ask you to move when they need to. The best thing we can do for Tyler is spend time with him.

I found out last night how important it is to spend time observing your child up close. When my farther and I got back from eating there was alot of activity and Tyler just didn't look right and his numbers sucked. I got right in there and let him hold my finger. If I hadn't done that I would never have started the conversation with the respiratory therapist about his chest looking inflated and not jiggling right.

The high-frequency ventilator gives his chest a pretty constant bounce. With the incredible team here they would have reached the same conclusion anyway, but having a parent who has watched him for 2 days be able to point out things that don't look right with their child is a prized commodity around these parts.

The first x-ray shows the collapsed left lung. The image on the bottom is after the chest tube went in, the lung is re-expanded and working well.



Rule #2 One number means nothing by itself. I'm looking at an isolet with at least 36 values displayed around him updated every second or so. Any one or two of the numbers can freak out at any time. Yesterday Tyler's UAC (A catheter in is umbilical artery) started reporting a bogus blood-pressure. When I say bogus we're talking freaky stuff like 6/-2. None of the other numbers skipped a beat. They replaced the line and we're getting good numbers. Thankfully that was fixed before he started having problems later last night with his lungs. The numbers are only useful in context. If there is a problem more than one element will change.

Rules #3 ICN Staff Rocks! No two was about it. We have 2 amazing nurses that have chosen to take Tyler on as their primary patient. They know their stuff, and I can leave for some food or sleep knowing Tyler is in the best hands possible. I know I need sleep, If it weren't for people like these I suspect I'd be sleeping in a chair in the ICN.

General Updates:
-Sharron is en-route now. She was discharged from Nashua at Noon. Uncle Guggy and Tim are bringing her up.
-Tyler appears back on track after last night's events. We are again working on weaning his respirator settings.
-I've been told there are too many pics of hardware and not enough of baby. So here's a baby pic. It's harder than it looks to get a pic of mostly Tyler. There is alot of gear in here.

He is Stable Right Now

I called the NICU about 6:30 this morning to see how Tyler was. He is responding very well to the chest tube. His blood pressure is in the normal range again. They were able to lower the ventilator pressure while keeping the oxygen saturation level down. This means the ventilator isn't pushing his lungs as hard. The oxygen saturation level is the amount of oxygen in his blood. At this age, they typically have to use high concentrations of oxygen with high ventilator pressure to stabilize the oxygen level into the normal range. The significance of having the pressure of the ventilator decreased and not having to crank up the oxygen saturation for Tyler is his lungs are working more efficiently at grabbing the oxygen without it be hammered into his lungs. All good things to hear. The chest tube is still showing signs that his lung is leaking air into his chest but it's doing its job at releasing this air. One of the first indications that the lung is healed over is the chest tube no long shows air bubbles releasing. I will hear more about this when I get up there today.

And on that subject, the doctors here are waiting to see what my white blood count has done since Friday before they decide how I'm leaving today. I'm not sure if I'm being straight transferred back to Dartmouth or if I'll be discharge here and use Dartmouth as an out patient for a couple of days. Either way I have to make the tough journey back up to Dartmouth and leave my beautiful daughter in loving hands of her grandparents a little longer. I have no idea how we do this without all the support from both of our families.

One of us will try to post something later if events allow.

Here We Go

Today was probably a first in the long line of roller coaster days. Tyler was great during the morning and early afternoon. And just like that we are on a downward hill speeding. Somewhere around 8pm Tyler's blood pressure dropped and his breathing became very difficult. His lung developed a small hole in it and was filling his chest cavity with air. His team responded quickly by putting a chest tube in to release the pressure. As of 1am (it's hard to sleep being 2 hours away and not truly having a clue what is going on), when I called the NICU, Tyler was stabilizing very well. Ben and David felt comfortable enough to get sleep themselves. As too causes there are many for this age. It is a common complication that happens to these small under develop preemie lungs. As always they will monitor him very closely.

My conversation didn't stop after I heard that Tyler was good for the moment.

My conversations with Ben today have had a lot of questions of when I'll be released from SNHMC. My infection is rather serious, there is little doubt I'll be on IV antibiotics for another 20 or so hours with a follow up with oral meds. My tummy is still very tender to touch. The nurses and Doctors here have been very careful not to bring up the "you are going home" topic to me at all. I've asked and I keep getting we shall see what tomorrow brings. My night nurse has been the most frank with me by saying they are waiting to see if the fever comes back tomorrow or if the tenderness finally goes down. Either way, it sounds like I'm going to be transferred yet again back to Dartmouth tomorrow morning. Tyler's nurse told me to do everything I could to get out or transferred back up because Tyler and Ben need me up there.

So for now, everyone is stable and resting as comfortably as we can. Tomorrow promises to be a new day of this ride called a roller coaster.

Settling in at DHMC and stable.

Last night Dad and I got up to DHMC at about 11:30. Tyler had already been in his room for an hour, and was well in the process of being hooked up to their fancy High-frequency ventilator.

We were told in no uncertain terms that the long road we were on is now a long roller-coaster. There will be lots of ups and downs. We had one such down-event last night. Not long after we arrived his Oxygen saturation took at turn a nose-dive. The team worked for a good 2 hours tweaking and adjusting. We watched for a while as his levels came back into the normal ranges. We finally hit the sack at 2:30 am. I called back at 8:30 AM for a status report and he was doing fine.

After a quick bite to eat we're back in the hospital When I got to his bed I almost went back to the desk to make sure I had the right kid. His color was great, he looked much more relaxed and comfortable. The baby the greeted me this morning. Nice and pink, all the cables and wires neat and dressed. Last night he looked like something you would find in my office :-)

The next few pictures may come as a shock. He currently has ALOT of supporting hardware.
At last count 7 IV pumps, A tricked-out super-bubble-bed, High frequency ventilator, 2 PulseOx monitors, Co2 monitor, nitric oxide supply system, an arterial Blood-pressure monitor, and an ECG. The kid is drawing more power than my rack of servers at home...

Last night.















This morning
Here's some of the hardware:
Tyler has 3 IVs right now.
UVC (Umbilical Veins Catheter)
UAC (Umbilical Artery Catheter)
perherial artery
7 IV pumps:

Left side top to bottom:
1)UVC Starter TPN Protein
2)UVC D10 (Sugar water)
3)Meds and flushes.

Right side top to bottom:
1)UAC D10 (Just to keep the line open)
2)Fentanyl Bulbus. standby sedative.
3)Fentanyl drip. sedative.
4)Dopamine (blood-pressure control).



The Machine to the left is the High frequency ventilator. It pulses air(about 150 times/second)
On top of that is the C02 monitor To the right of the ventilator is the nitric oxide infusion system. The nitric oxide dilates the capillaries in his lungs so that he can absorb more oxygen into his blood.

The Fentanyl in the IV to keep him sedated and pain free. If he is too alert he will try to breathe on his own and work against the ventilator.



The last pic I had turned out pretty bad so I'll spare you. It is the monitor screen with all the vitals tracing on it.

Westward Ho! (And some North too)

I'm writing this in the car riding with my farther (He's driving) back up to DHMC in Lebanon. I just got word that the chopper carrying Tyler is on the ground at DHMC. I'm about an hour out. Sharron is still in Nashua and will likely be there a few days until they get the infection knocked out.

The DART (Dartmouth Area Regional Transport) brought him into Sharron's room in his transport system so that she could see him before they took off. The lead Nurse Practitioner on the team is one of the NP on the ICN team at DHMC. I was impressed with the pre-flight briefing she gave us before Tyler came in, I was even at more at ease when she mentioned that she was an ICN nurse and just happened to be on the transport team this week. One of the first things she said to us was how huge he was by her standards. :-D


Tyler in his 300Lb Road-case. saying goodbye to mommy.
This is the back side of the ICN transport system. Weighs about 300 Lbs. has just about everything you could possibly need to support a preemie for the ride. They told us we didn't need most of it but better to have it and not need it. The nurse joked that the pilot has been known to ask for the weight of the patient before takeoff. Somehow I don't thin 2 lb 13.8 Oz (1275 Grams) will have much impact on fuel consumption :-)

My brother Tim spoke to the flght-crew while they were waiting for Tyler to get to the heliport. Apparently this number costs $4 million and averages 150 MPH. Pretty cool ride for your first day..

Thanks to Uncle Timmy for the pics!

Please Welcome Tyler Paul April

Long way to go. Lungs are under-developed.
He's about to take a chopper-ride to Dartmouth back in Lebanon.

Make that May 23 [blush]

Baby is born. Early but doing well for it's age. (Still a boy ;-)

NICU docs are doing their things now.

Vital Stats:
- 3:58 PM EST.
- 2lb 13.8 Oz
-14.5"

He's breathing with the help of a ventilator now.
It sounds like I'll be riding with him back to Dartmouth.

More to come...

May 25th sounds like a good birthday to me!

Dilation has on track, contractions are doing their thing. Epidural is in. Sharron is relaxing as comfortably as possible. Baby vitals are great! The docs think an infection triggered labor.

Stay tuned, more to come.

Game on!

Sharron is having contractions, and feeling pretty sucky. It looks like the contractions are getting more organized. This could be it.

Stay tuned, updates to follow.

Hello Nashua

Well I've settled into Nashua at SNHMC. They have given me the penthouse suite here. It's the largest room in the ward reserved for long term patients. So I will continue my bed rest routine until this child is born. I've made it to 28 weeks and now the short term goal is for 30 weeks. Everyday I stay pregnant is approximately three days less in ICU.

I had another routine ultra sound today to check to growth progress of the baby as well as the fluid levels. He is about 2 pounds and 13 ounces. A couple ounces short of 3 pounds. He's grown about an 1/2 pound in 13 days. He is still big for this age development which is great. All the organs and the measurements look good. The doctors here are very pleased with his development. My fluid measurement today was 7.8 AFI which was slightly lower than 2 weeks ago. The transport and the evaluations jostled the baby enough to cause me to leak a little faster yesterday and today. I expect that to slow down again now that things have quieted down. Today's number is low, but isn't critically low. Even though the baby doesn't need fluid right now to grow, having as much fluid as i do will help strengthen his lungs. He will use the fluid to practice breathing and swallowing. This is why babies get the hiccups. Most of the fluid is produced by the baby. Since it looks like I keep an amount around 8 AFI when the baby's head isn't subjected to a lot of movement, we are assuming his kidneys are doing what they are suppose to be doing. Yeah! Keep making that baby pee.

(Note from Ben: AFI is Amniotic Fluid Index. It is calculated by dividing the uterus into 4 quadrants. With ultrasound measure the largest side of each pocket of fluid. Add up all the quadrants and you have the AFI.)

Rachel has come to visit me the last two afternoons and it's been great. She is happy to see me and doesn't seem too nervous about being in the room anymore. We've been taking turns tracing hands and feet onto paper with colored pencils. She gets quite a kick out of "tracing" my feet; her tracings rivals the foot size of Big Foot. I can tell Ben's stress level has been relieved now that he see me everyday and get here in under 30 minutes if I need him too. Oh, the food is better here too, I just wish I could have taken the bed from Dartmouth.

28 Weeks and Back in Nashua

I've made it and in my new room. I've got the penthouse suite here. I believe it's the biggest room in the ward and they reserve it for cases that are here long term. It's just as busy here in SNHMC as at Dartmouth. I've been here 6 hours and I know at least 2 babies have been born. Over the weekend Dartmouth was releasing routine mothers after 24 hours of giving birth to free up beds. Most stay 2 days before going home. It's been a busy month for new babies.

I feel pretty good. I'm very tired, which I expected after the excitement of today. So far my vitals and the baby's are stable. Hopefully I can stay pregnant for another 5 to 6 weeks and then I can be free to move about life.

Cleared for departure on runway 89S

Nashua has a bed and is willing to take the case. DHMC has signed off on the transport, Insurance company says okay. Sharron is expecting to be en route by 10:00am today, she should be settled in by 1:00. I took most of Sharron's stuff down to Amherst yesterday so she is all set to roll with one bag. I don't have to drive all the way up and back just for stuff. We'll post more when we have it.

Waiting for a Bed

We just heard that Nashua will be happy to take me back on Tuesday if there is a bed available. The insurance company also is cooperating in this move. DHMC will call in the morning to see if a bed is available. If not tomorrow then we try again each day until I can go.

The baby and I are still doing great. Despite the stress and lack of sleep yesterday, both of us are still very stable. He is moving around and with the lack of fluid in my tummy, I can tell easier if a hand, foot, or bum is pushing against my skin. I've seemed to have gotten over the stomach upset from last week. My energy level and wanting to eat has improved quite a bit. Now if only I had something other than hospital food to eat.

Of course we will keep everyone informed about the move and get the new info out as we get it.

A long night.

Sharron had a roommate for most of the three weeks she has been here. They both had very similar situations (She was a few weeks farther along). After about a week in they each got their own room, but that only lasted a day and they were back together. Dartmouth has been extremely busy with many nights having a couple of rooms double occupancy.

Late last night the roommate went into labor. We only have dribs and drabs of information but from what we can tell mother and baby are doing well. It took the team a couple of hours to shuffle everyone around before they could move her to a birthing room. Needless to say Sharron had a very long and emotional night. A happy visit from Rachel and nap later Sharron is feeling better. Sharron has moved to the bed near the window (Hurray sunlight :-). Note to those who have the phone number it has changed.

Tomorrow promises to be an interesting day. The doctors are threatening to start talking to Nashua about a transfer again. Tuesday is the earliest she would move, but it will be a nice conversation to have. I have already spoken with the NICU folks in Nashua. The main thing we loose by transferring is the instant access to a pediatric surgery team that we have now. We will have to weigh the risk of complications requiring surgery/transfer with the benefit of being 90 minutes closer to home. Between gas prices, travel time and the possibility that Sharron could go on like this for another 6 weeks it is starting to sounds like a no-brainier to me.

3 Weeks!!! Who Hooooo!

Wednesday I passed the 3 week mark in our journey. There really isn't anything new with my condition or the baby's. I'm still suffering from some form of GI track upset which irritates my uterus. I have not had anymore contractions which is a small comfort. The baby still looks good on the monitoring system and continues to have major parties when I feel my worst. We are taking this one day at a time.

Administrivia

A few people have mentioned trouble posting comments. I have tweaked some of the settings so that should now be working better now. Let me know if you have any problems.

Ben

And before anyone posts a comment asking if Administrivia is a word... Princeton thinks so here

Wake up Call

Well, I'm still pregnant. I started contractions yesterday afternoon which continued until about 8:30 last night. Nothing very severe, but contractions all the same. The baby is fine, he took a page out of Rocco's "How to annoy Mommy while she is pregnant" book and kicked at every contraction. I had a very sore tummy. The nurses gave me some ambient to help me sleep through the night. It worked great, I finally woke up around 4:30 this afternoon. Blood work doesn't show any problems with infection. If I still feel under the weather again tomorrow they may check it again.

The doctors here will not stop active labor once it starts. If I don't feel well again tomorrow and my white blood cell count is higher, they will induce me. They will not give me anymore antibiotic while I'm still pregnant. So everyone is hoping that I feel better. They also said I could have false labor contractions (the type I had yesterday) for weeks before I go into active labor. So it is still anyone's guess as to when I have this baby.

Hiccups!

Today Sharron heard hiccups during her morning fetal monitoring session. Some claim this to be an indication of good progress in lung development. Along with the hiccups there was something on the strip-chart that we aren't so thrilled about... Contractions. At the moment they are small and not attributed to active labor. They are doing blood-work now to rule out an infection. If they find one the Doctors will likely induce labor. I'm sitting at home playing with Rachel standing by to run back to Lebanon.

More news as it happens.

The Start of Another Week

This Tuesday I will be 27 weeks. My condition hasn't changed much at all in the last week. I am very stable and (knock on wood) I still haven't had a contraction. The baby is doing just as well. Last week his heart rate changed slightly to show that his brain activity is maturing. Up until then the heart rate was very steady with very little slowing or speed ups. Now the heart rate still has a steady base rate, but you can see dips and bumps that I can almost correlate with his movements and waking up. Today the high risk doctor called his heart rate gorgeous.

The only other exciting news is, he was about 2 lbs and 4 Oz's on Thursday when we had our routine 2 week ultrasound. Most 26 week old are just under 2 lbs. So he is growing very nicely despite having little fluid around him. The fluid levels looked low but that is expected. Everything else on the ultrasound looked good.

I had a wonderful day yesterday with a long visit from Rachel, Ben, and most of the April family. Yesterday was the first visit from Rachel where she really relaxed and was herself here.

2 Weeks and Still Good

Today was my second full week in the hospital. All the doctors are very pleased that I'm still stable and the baby is doing well. Already I've beaten a lot of odds with a ruptured membrane. From here there is no way to guess when or if I'll go into labor. Right now the plan is for me to get as far as I can and if I get to 34 weeks, they will induce me. If I make it to 28 weeks, Dartmouth will talk to Southern NH to decide if I can continue this closer to home. A lot can happen between now and then.
I've also reach 26 weeks which is also a small milestone for the baby. A big development is the baby is now starting to practice breathing. The practicing will help strengthen the lungs which will mature around 28 to 30 weeks. Another development is the ability to open eyes and distinguish light from dark.
I've been incredibly lucky to have visitors almost everyday. And everyone is supplying me with little projects and books to keep my occupied. Thanks Everyone!

Oh what a difference a week makes...

We are now working on the 26th week. Things are looking even better now, but we are by no means free and clear. Again: your mileage may vary, One size fits most, past performance is not an indication of future results.

Based on the following characteristics:

Gestational Age (Completed Weeks):	25 weeks
Birth Weight:	907 grams ~2lbs
Sex:	Male
Singleton Birth:	Yes
Antenatal Corticosteroids:	Yes

Estimated outcomes* for infants in the NRN sample are as follows:

Outcomes	Outcomes for All Infants	Last Week
Survival	90%	77%
Survival Without Profound Neurodevelopmental Impairment	79%	60%
Survival Without Moderate to Severe Neurodevelopmental Impairment	62%	42%
Death	10%	23%
Death or Profound Neurodevelopmental Impairment	21%	40%
Death or Moderate to Severe Neurodevelopmental Impairment	38%	58%

A Couple of Steps Back

Today was a disappointing, yet unexpected day. Friday, the Doctors decided since I haven't had any leaking since Sunday and all our vitals have been beautiful, to start exploring the possibility of my membrane resealing. I was encouraged to take a few short walks around the ward and they did a simple test yesterday. I woke up early this morning to the familiar cramping and soon discovered I had started to leak again. I've most decidedly haven't healed.

There is no way to know if the test, the walking, both combined, or just that I've gained enough fluids again to make the membrane leak. So far this episode has not produce any contractions and I'm not showing any signs of infections. Fishface is still strong and giving the nurses a hard time when we have to monitor him. All of which are great achievements to have each day. Even though Ben and I did not share the Doctor's optimism on me healing, we are both rather disappointed.

There be Dragons...

Well it looks like we've run clean off the edge of the map. According to the doctors and nurses few cases go this long with a confirmed rupture and no labor (This is when you knock on the closest wooden object). They are starting to consider the possibility of a healed membrane. We are still exploring what this will means for the coming weeks/months. Sharron has been cleared for the occasional walk to the patio near her room. This is a step above her 2 hours a day in the wheelchair.