Sunday, December 17, 2017

Our Little Christmas Miracle

Our true gift
"All I want for Christmas is you."
Mariah Carey

Saturday, December 16th - Total Days in the NICU: 43  Days at Home: 3

Apologies for the tardy update (again), but we were very busy bringing our son home!  The last week has been a whirlwind in a very good way.  Last week was all focused on feeding; he was tolerating his feeds via bottle every three hours well.  As of last Friday, the plan was to feed him as he demanded, either via bottle or me nursing him, through the weekend and the team would reevaluate on Monday.  If he had gained weight and his labs came back positive, we could realistically discuss going home in a couple of weeks (what?!).   However, when the surgical team stopped by they made mention that this was the most difficult part of the waiting game because it sometimes takes kids weeks, if not months, to get feeding down.  They assured us that we wouldn't be stuck in the hospital for entirety of that time, but it was possible that we would need to go home with an NG tube to ensure Kieran was getting the proper nutrition.  We think Kieran was listening because he decided to pull out his NG tube himself (little stinker).  Because he was doing so well, the doctors didn't think it was necessary to put it back in unless his habits changed.  

While we didn't want to get our hopes up, we also knew that if Kieran would be coming home sooner rather than later, we needed to make adjustments to our house.  When we found out about Kieran's CDH at 36 weeks into my pregnancy, all preparations to our home stopped so we could focus on arranging the correct care for him after birth.  So, while it would have been great to have a perfectly pristine home and nursery waiting, that wasn't the case.  We called in the forces (aka our parents) to help us tackle some big projects.  As of Sunday, we had scheduled the ducts to be cleaned, the rug and furniture to be cleaned and sanitized and the dogs to be groomed.  My dad also set up a moving company to come haul out some of the stuff in our second bedroom to storage so we didn't feel so cramped.  We felt like we could have the house ready by Thursday, if needed, for him to come home.  

When I showed up to the hospital on Monday morning (Brian stayed back to meet with the movers), the nurse practitioner reviewed that Kieran had done exceptionally well and they were ready to release him the following day!  I was flooded with emotions.  I was elated at the thought of bringing my child home, but we just weren't ready.  We needed a few more days to get the house clean and ready for an infant.  After several conversations with the team, everyone agreed that Thursday would work well to send Kieran home - surgery needed to follow up on a couple of things and we would continue to work with speech to ensure feeding was going well.  During the following days, Brian and I spent the most time away from the hospital than we had during his entire stay, but we knew we needed to take advantage of the excellent care to prepare for his arrival.  Our parents were kind enough to come down and help us clean our place from top to bottom (literally).  We are so grateful for their unending willingness to help us. 

Snuggles with Laurel
Thursday morning arrived and as we wheeled in his stroller, I felt like I wanted to start sprinting before someone changed their mind and decided it was too soon.  But I will admit, it was a very bittersweet day for us.  Over the previous six weeks, Brian and I had spent roughly 860 hours combined with these people.  The NICU staff had become family; we were sad to say goodbye and they were sad to see us leave... Kieran had acquired quite the following.  We spent the morning reflecting on the journey, giving hugs, and taking pictures.  Various members of the staff came into room 1410 to get one more snuggle with Kieran before we loaded him in his car seat and hit the road.  Dr. Porta stopped by to discuss some of Kieran's follow up appointments related to monitoring pulmonary hypertension (which Kieran showed signs of at birth, but seems to have resolved itself); Dr. Porta was the first attending neonatologist to care for Kieran.  On one of the first days in the NICU when I was especially emotional, Dr. Porta told me, in a matter of words, "I'm going to care for him like he is my baby until he is healthy enough to go home to be your baby again".  He confirmed, with a big hug, that it was time for him to be my baby again.  Once again, I did my best to control my tears.  But this time, they were tears of joy... it finally was settling in that we were taking our baby home.
One more cuddle with Mary Kate
We asked Mary Kate (one of Kieran's primary nurses) to page Dr. Shaaban in the off chance he was in the hospital and had the capacity to stop by - we were thrilled that he did!  He reiterated what a miracle Kieran was and how quick his recovery turn around really was; he acknowledged that the road was bumpy but our patience and presence had definitely contributed to his success thus far.  His kind words were very humbling because we've just been trying our hardest to be good parents every day.
Kieran and his BFF, Dr. Shaaban

And then, it was time to go.  Mary Kate helped us get Kieran situated in his car seat and he fell asleep immediately.  He has been such a trooper and we couldn't wait to experience our son outside the confines of this fishbowl.  We all shed some tears (except Kieran).  Leaving Laurel and Mary Kate, who had cared for Kieran consistently over the course of his stay, was truly difficult.  Brian and I were tempted to just pack them up, too!  Laurel, Mary Kate, Sandra, Jen and Kerri especially got us through this time.  In their own way, each one of them lifted us up when we needed it, comforted us, taught us and cared for all of us.  Each one of them will hold such a special place in our hearts and, for sure, Kieran will grow up knowing their names and faces.  We owe them so much more than we can ever give them.   
Mwah!

NPs, Kasey and Chris

Respiratory Therapy, Brian and Kyle, and Robin

Our team the day Kieran left
The first step out of his room, I looked at Brian and said "I feel like we are doing something illegal.", but that soon faded.  As we made our way into the main hospital and out of our protective cocoon of the NICU, we both agreed that we felt so exposed; there were so many strange people surrounding our little boy who had been so sheltered for the first month and a half of his life.  Again, I felt like sprinting to get to the car.  The trip home was smooth and the dogs were anxious to meet their little brother.  Ali soon after was fine ignoring him, but Marley took some time to not get distressed every time Kieran cried.  Now, he just keeps a watchful eye like every good big brother should. Our first trip to the pediatrician went well.  Kieran has some weight to gain, but that is to be expected considering he only just started eating by mouth less than two weeks ago.  Don't worry - he is up for the challenge and eating every two hours in quantities that astound me and Brian.  

And now, it is like we are just normal, frazzled, tired new parents and it is blissful.  It is almost as if it all never happened, like a dream.  While we wish we were going to Wisconsin for the holidays, it makes more sense to stay in Chicago and continue settling in after the last 6 weeks of insanity. Not to mention, the cold and flu season is especially bad this year, so you won't really see us leaving our house until Spring (direct orders from all of our doctors).  We will also be keeping visitors to a minimum for now.  While we would love for everyone to meet and cuddle our little guy, he still only has 1-1/2 lungs and we need to protect him as much as possible from getting sick.  We love FaceTime dates :)  Thank you to the Vaccaro family and Tia Mathew for feeding us this past week!  We appreciate every meal - it lifted such a burden while we went back and forth to the hospital. And thank you to everyone who has donated to Brian's marathon efforts - you've helped us raise $715.00 of our $1000.00 goal!  

I have to thank my employer, McMaster-Carr Supply, for having such an amazing maternity leave policy.  Not only was it so incredible to be able to be at Kieran's side every day for the past 6 weeks, but the fact that I get to spend the next 4-1/2 months at home with him is amazing.  As of now, Brian is going to continue to take FMLA to be home with us until mid January.  These are precious days together that we will definitely cherish. 

We will continue to use this blog to post pictures and milestones.  To all of you who have been keeping us in your thoughts and prayers from afar via this blog... thank you.  Thank you from the bottom of our hearts.  We really believe that this was a group effort and all of you gave us and Kieran strength to move forward and beat the odds.  We are so grateful for our little fighter.  I wouldn't say that we love our son anymore than other new parents, but we do have an earned appreciation for his strong cry that wakes us up at night, small coos as we change his diaper and just watching him breath as he naps.  We just feel so lucky.  Merry Christmas!
 
First Packer game

"You're off to great places! Today is your day!  Your mountain is waiting... so get on your way!"
Dr. Seuss Oh, The Places You'll Go!

http://foundation.luriechildrens.org/site/TR/Events/TeamRaiser?fr_id=1771&pg=personal&px=1936812

Tuesday, December 5, 2017

One Month Old and Eating Like a Champ

Thank you NICU nurse, Gus, for Kieran's milestone signage!
"There is no one giant step that does it.  It's a lot of little steps."
Peter A. Cohen

Tuesday, December 5th - Days in the NICU: 34

What a week! Our little guy continues to be a total rockstar and we are all so pleased with his progress!  As of last week, Kieran had started continuous feeds of breast milk via his NG tube (nasogastric intubation - a tube up his nose that feeds into his stomach) and was on a CPAP for respiratory support.  The goals were to 1) maintain feedings of 22 mL per hour in order to take the next steps towards oral feeds so he could 2) stop receiving nutrition using TPN via an IV and they could 3) remove the PICC line and, if his breathing was steady through it all, to 4) move off the CPAP to high-flow therapy.  Our little nugget... DID.  IT.  ALL.

As of Wednesday, Kieran's breathing was still very comfortable, so Dr. Matoba decided it was time to downgrade his support and move from CPAP to high-flow therapy.  While CPAP helped keep pressure in Kieran's lungs during the exhale, the high-flow pressurized the air going into his lungs.  This was a very smooth transition and he did great.  The best part about moving off of CPAP was that the bulky ventilator moved out of room 1410!  One goal down.

Because Kieran gained some weight, his magic number went from 22 mL to 25 mL, but regardless, he was successfully able to tolerate this level of feed, so his TPN was stopped and two days later, they took out the PICC line!! Three more goals - done.

The PICC line was stitched into Kieran's thigh and I didn't realize until after they removed it that the tubing that was actually inside his vein was quite long... like 6" long.  After my stomach stopped flipping, I exhaled a major sigh of relief and quietly celebrated what this meant- significantly reduced chance of infection, increased breast milk, one less cord/tube/machine and... PANTS!  Up until then, Kieran hadn't been able to wear pants because of the IV.
PANTS!
We were so excited to get his cute chicken legs into some pantaloons, but then realized that they are kind of a pain when you are changing yucky diapers every couple of hours.  We've moved back to onesies and swaddles (#lazy).  NICU fashion isn't really following current baby trends, so we will save the pants for when we get home.

The other bonus of no PICC line is that we could finally give Kieran a bath with soap and water! We had been giving daily wipe downs with warmed, premoistened cloths, but nothing beats a good suds and scrub... especially when you have never had one in your whole life!  Kieran had a pretty bad case of cradle cap, so our awesome nurse (and teacher), Sandra, suggested we give him a spa treatment with a warm, wet cloth to soften it all up.  I couldn't blame him that he fell asleep while we were slowly scrubbing his head with a little brush to get all that gunk up.  He tolerated the rest of the hospital bath very well and after all his neck folds were clean and he got a good lotion, he was ready for a long sleep.

Operation Cradle Cap

Tag team hospital bath
Post bath - fuzzy hair and pooped out
By Sunday, we were in a holding pattern with the continuous feeds.  One thing I've noticed during my time in the NICU is that not much happens on weekends as far as aggressive steps in patient care.  This makes sense because the attending physician in the unit on the weekends is not the same doctor as the one on rotation during the week; the attending physicians during the work week rotate every few weeks so you get some consistency - the weekend doctors want to maintain status quo for the weekday doctors.  That being said, we could tell that Kieran was hungry through normal queues (fists in the mouth, rooting... etc) and we didn't want to wait another day to push our agenda for increased feedings.  So, we asked Dr. Henner, who we were familiar with, if we could start bolus feeds.  A bolus is a larger volume/dosage that is delivered more quickly, whether it is food or medicine.  The ultimate goal was to acclimate Kieran's tummy to receive more food and faster so he could start feeding orally.  Dr Henner agreed that Kieran was tolerating the continuous 25 mL feeds, so we could try 50 mL over 45 minutes every 2 hours.  Kieran did really well and even showed signs that he wanted more, so the nursing staff shortened the duration of the feed from 45 to 30 minutes so he would feel fuller faster.   During these transitions, Brian and I were letting Kieran experiment with "oral care", meaning we would dip his pacifier in breast milk or give him a drop in his mouth to get used to the taste.  The kid was like a baby bird - mouth open ready for his next fix.  We so desperately wanted to feed him as much as he wanted, but kids with CDH need to transition very slowly during this process to normal feedings, so we tried to be patient. 

On Monday morning we met our new attending, Dr. Robinson.  He felt comfortable trying out some PO feedings; PO stands for "per os" which is Latin for "by mouth".  Brian gave him his first bottle with only a tiny 10 mL and Kieran sucked it down like it was going out of style!  We continued the 50 mL feeds via NG tube and integrated the 10 mL bottles every two hours.  We even stretched our legs with breastfeeding by working on latching.  Thank you thank you thank you to my lactation guru, Jen, for helping with this process.  You are my hero.  On the breathing front, we also dropped the high-flow pressure from 3 to 2!  Wins all all around!

Kieran 💗 eating
As they would say in the Showcase Showdown - and that's not all!  Today, Kieran was able to take as much from a bottle as he wanted and the remaining ounces were given via NG - he did great, taking about 40 mL at his first two feeds.  The total quantity and frequency also changed to 75 mL every three hours - this equates to a normal feeding pattern for a one month old baby of his size.  We are hopeful to move from bottle to breastfeeding tomorrow - fingers crossed!  The team also moved his high-flow down to 1!

Our new set of goals are to 1) breath on room air without assistance and 2) get up to full feeds via mouth.  It is possible that we could be sent home with an NG tube, but I'm confident in Kieran's gumption to keep eating like a champ.

One month ago, Kieran was undergoing major surgery at 5 days old and the month before that we had just learned that our baby was going to be faced with incredible challenges upon birth.  Looking back, it is incredible to reflect on how much we have accomplished as a family and the immense burdens this little infant has overcome while making it all look easy.  I will admit that I still have a twang of jealousy as I see the new dads carrying their empty car seats into Prentice ready to take their brand new baby home, but I'm also starting to see the light at the end of the tunnel; someday very soon, we will be carrying that car seat into Lurie and joyfully taking our little leprechaun home.

In other news, Brian is now out of the walking boot and doing physical therapy at home (and in Kieran's room); he hopes to be running again soon!  Unfortunately, because of this stress fracture in his foot, Brian needed to defer his 2017 Chicago marathon entry.  However, I'm so very proud to write that Brian plans to run the 2018 marathon as a part of the Lurie Children's Marathon Team to honor Kieran!  His goal is to raise $1,000 specifically for the NICU to help families like ours during their journeys.  Check out Brian's fundraising page here:

http://foundation.luriechildrens.org/site/TR/Events/TeamRaiser?fr_id=1771&pg=personal&px=1936812 

A special thanks to our wonderful Lurie staff!  Dr. Matoba, Dr. Collins, Dr. Henner, Dr. Porta, Dr. Shaaban, Dr. Robinson, Dr. Wu, Jen, Sandra, Mary Kate, Laurel, Kerri, Cyndi, Gus, Julie and Cailyn.  And thank you to Juliana and Julien Lamblin and the Varble Family for feeding us this week!  You all are too generous and we are so appreciative!  

Monkey on monkey on monkey
"Be humble.  Be hungry.  And always be the hardest worker in the room."
Dwayne Johnson