Saturday, May 31, 2008

Saturday

Mikan the day before trach surgery, on CPAP.

Mikan the night before trach surgery, during a bath.

Mikan practicing "the look."


Mikan with his new trach attached to the vent.

Mikan is down to a rate of 10 breaths per minute on his ventilator after another set of good gases. He is being fed 10 ccs of milk every 3 hours through a feeding tube in his nose. He was more alert today. We watched some "trach care" today, which Mikan appears to dislike. We are learning how to clean around the trach tube and suction him out. So far we haven't held him yet, but we may be able to tomorrow.

Friday, May 30, 2008

Tracheotomy Day

The tracheostomy operation is done. The surgery lasted about an hour. The surgeon was an Ear, Nose, Throat specialist. He examined Mikan's airway and found some floppy airway tissue (laryngomalasia) especially near his voice box. The doctor thinks this might have something to do with Mikan's breathing problems, but not everything.
The tracheostomy (basically a synonym for tracheotomy) is bad for the following reasons...
1.) Can't really hear Mikan
2.) Every 3-4 hours suctioning will be needed.
3.) Tube Care will be necessary twice a day. (Where we switch out for a clean tube and clean the area)
4.) We constantly have to make sure no debris gets in the tube.
5.) The average babysitter just won't do.
6.) It will be in for 10-15 months, according to our Ear, Nose, Throat Doctor.
The tracheostomy is good for the following reasons...
1.) He will start to feed more naturally using a bottle and breast.
2.) We will be able to go home earlier.
3.) Mikan will not have a bulky CPAP on his face pushing air up his nose.
4.) We can see his face. (He is pretty cute, pictures to come)
5.) The average babysitter just won't do.
6.) This should prevent any long term heart issues that are sometimes caused by laryngomalasia.
7.) Stephen Hawking has one.
8.) Mikan is not in an iron lung (one reason I teach science)
Once again -6+8=+2.

Mikan is currently on a ventilator through the tracheotomy tube. He is getting 20 breaths each minute at fairly low pressures. He is getting morphine as needed for pain. He seems very calm and is starting to sporadically breathe a little on his own. Hopefully, the support through the trach will wean quickly and feedings will restart so that his IVs can be taken out.

Thursday, May 29, 2008

Mikan's Last Day of Making Noise for Awhile

Tomorrow morning at 9:15 Mikan is scheduled for a tracheotomy. At that time, the surgeon will examine his bronchial tube with a scope to look for airway failure. He most likely has one of two problems. The most likely scenario is that he has some airway collapse due to being on the ventilator for so long. He also could have a neurological problem that prevents his brain from sending his throat the proper signals for opening and breathing. If the latter is the problem, it would have been a condition he was born with. Either way, time and growth are the ways to solve the problem. We are hoping for airway collapse instead of the neurological issue. He may be circumsized while he is anesthetized tomorrow. He will be able to start sucking down and tasting food soon after surgery. We are looking forward to this.

Wednesday, May 28, 2008

Mikan's Original Due Date


Mikan is probably going to need a tracheotomy operation to allow him to breath without any head apparatus. This is after Mikan required 100% oxygen for a period of time this afternoon and showed signs of lung collapse in his x-ray. The doctors think he might have a floppy airway or a narrow airway into his upper right lung which is causing his lung collapse. The CPAP pressure of 10 has probably been keeping this airway open. However, we all want Mikan to start feeding on his own, and a tracheotomy will expedite this process.

Jenna found out that he was going to need a trach put in during rounds today. We are excited at the prospect of going home within about 30 days. However, we were hoping for him to go home on oxygen through a nasal canulade. He could go home on a ventilator, CPAP, or oxygen as long as the tracheotomy tube is in.

So, surgery will be necessary for the tracheotomy tube to be put in. We think it will be Friday or Saturday. He will once again be mute. He has already asked for a Stephen Hawking voice synthesizer. I told him to wait.

The tracheotomy tube could be in anywhere from a couple of months to a couple of years. It depends on how Mikan grows and develops. Thanks for your thoughts and prayers.
Stephen Hawking is considered to be the best mind in physics since Einstein. Mikan is considered to be the best Gensic since Jenna. NOTE: Mikan does not have Lou Gehrig's Disease. Mikan and Stephen Hawking will have understanding of the universe and tracheotomies in common, that's it, that we know of.

PSA: Please remember to have your upcoming surgeries pre-certified.

Tuesday, May 27, 2008

Still Off the Ventilator!

We got some good news today. Mikan passed all of his tests. His CBC came back normal, meaning he's not infected. His blood gases were decent, his hemoglobin was good, his electrolytes were good, and the unofficial report of the echocardiogram said that his heart did not look enlarged. His chest x-ray showed a partial lung collapse in his upper right lobe, but the rest of his lungs looked better than they did last week. The doctor said that the lung collapse was probably causing his high oxygen requirements right now. He wrote orders for Mikan to lay with his right side up 50% of the day. He thinks that once the collapse is taken care of, Mikan will be able to wean. Currently his oxygen requirement is 62%. If it drops below 60%, the doctor said he would consider weaning his pressures. He is still at a pressure of 10. But overall, the doctor is happy with Mikan's results and said he didn't have any reason right now to put him back on the ventilator; he was going to keep him on CPAP and see if he continued to make progress.

Tonight after John held Mikan, we put him back and bed and just sat talking to him because he was awake and smiling and happy. John didn't fully attach his diaper because he said Mikan wanted to "air himself out." He appeared to enjoy this for awhile. Then when we finally changed his diaper, before any of us could react, he projectile pooped approximately 1/2 meter. The sound made us jump. He pooped all over his crib sheets. His NP t-shirt that was hanging on the end of his crib caught a bunch of poop and prevented it from reaching the floor. It was pretty impressive. From what we've been told, this may not be the last time we experience this.

Even though we currently still have no cars that are in working condition, we are hoping to get them both back tomorrow. When John left for work this morning, the truck wouldn't start again. He flagged down a charge nurse to jump the battery, and then he drove it to an auto shop. Thanks Charge Nurse Kim.

Monday, May 26, 2008

Memorial Day






Mikan's on about 70% O2 still and a CPAP pressure of 10. His doctor was a little disappointed he hadn't made any progress since last week. He said it was good that he was able to make it off the ventilator for a week, but he wants to run a bunch of tests on him tomorrow to make sure his body is handling it ok. He will get an echocardiogram to measure the size of his heart and the pressures that the heart is giving the lungs. If his heart is working too hard, he will have to be put back on the ventilator for a few weeks. He is also getting blood work to test for blood gases and possible infections. If everything appears normal, he will try to keep him on CPAP until he continues to get healthier. Hopefully, that is the case, and he will turn a corner here soon. If he has to be reintubated, it is doubtful that Mikan will be home before the end of the summer. But of course, anything could happen I suppose.

Mikan's doctor is taking a 3 week trip to India soon to deliver medical supplies to some hospitals there. Beginning next week, he will have a new physician for awhile.

We'd like to thank everyone at New Prairie schools who purchased a T-shirt for Mikan. We love the shirts! Mikan's is hanging on his crib.

Thank you everyone for your support! The three of us are thriving on it.
Mikan is in about 70% oxygen and is on the same pressure support as yesterday. Mikan has been coughing when he is upset and today's nurses have heard a little bit of juiciness to his lungs. He is on a diuretic to help dispel this fluid, but we're not real sure what is causing it. Tomorrow our doctor will be back and we expect some decisions to be made about a plan from here on out.

Lisa, Todd, and Catherine visited this afternoon. Uncle Zach and Grandpa Kartje stopped by for shakes tonight.

Happy Memorial Day! Thank you to all those who serve, especially those going to Guam.

Saturday, May 24, 2008

100th Post

Mikan is on C-Pap, pressure of 10 cm of H2O and 70% of oxygen. We feel relieved that he has made it through the past couple of days on the C-Pap. Currently, he is being fed every three hours. You could almost set a watch based on his fussiness when he should be fed. He is starting to be a little more calm with the C-Pap, although it is obviously an irritating device for all parties involved except his lungs.

Nurse Sally took real good care of him tonight while we went out to dinner with Grandpa and Grandma Gensic. She shampooed his hair under the sink for the first time. Have any of you had to bag your child while shampooing his/her hair? Apparently he liked the shampoo and once he settles down on C-Pap some more, we may be able to start up with the tub baths again.

Grandpa Gensic helped us start our truck, so now we are not completely stranded at the hospital. There appears to be a steering problem though, but we are making sure to wait until the Buick is fixed before we drop off the truck to get worked on. Someday we'll have a reliable car.

Friday, May 23, 2008

Friday

Mikan is on C-Pap pressure of 10 cm of H2O and around 92% oxygen. He has orders for the diuretic lasiks for the next three days to try and keep his lungs dry. He will have steroids tomorrow morning at a dose of 0.35 mg per kg. Congratulations to my brother Pete and wife Sarah on cousin Alek.

This week the following happened...
1.) Flat tire on Buick Skylark
2.) Antifreeze pipe breaks in Skylark
3.) Repair part for Skylark won't be in until mid next week
4.) Skylark gets broken into overnight at the shop (We were kind of living out of our car so they thought there was some good stuff in there. They were mistaken. We are out about $10 cash and a rosary Nikole gave us. They probably need it more than us.)
5.) Truck battery drained after sitting for about 1 month in New Carlisle.
6.) Jenna was sick and couldn't hold Mikan.
7.) Mikan went from hi-flow to max pressure on C-Pap.
8.) Jenna wasted a day applying for social security benefits for Mikan that we don't qualify for.

Silver Lining...
1.) My ND student ID means free rides on Transpo buses.
2.) Jenna is producing antibodies to protect Mikan from disease.
3.) We don't qualify for social security benefits.
4.) Uncle Ben was a savior to get Jenna back to South Bend from New Carlisle.
5.) Two new visitors, Aunt Betty and Uncle Mark.
6.) Mikan is not on the vent.
7.) Mikan proved hi-flow abilities for a day.
8.) Did anyone see the peach trees in our backyard?
9.) We live in South Bend and don't really need a car, yet.
10.) Everyone is still praying.
-8+10=+2 (FYI: Sixth Grade Indiana State Math Standard: Addition with negative numbers)

McLaughlin Style Predictions
He will stay off the ventilator until tomorrow's steroids and start to wean more tomorrow afternoon. He will then decrease his C-Pap pressure. Upon decreasing C-Pap pressure, he will start to feed. This may be interrupted with an eye exam that will set us back a day.
Bye, Bye.

Thursday, May 22, 2008

Back on the C-Pap

Mikan is back on the C-Pap today. He had a oxygen desaturation episode this afternoon where he maxed out the hi-flow settings and needed to be put back on the C-Pap. The doctor thinks he may have had a small lung collapse.

Currently, Mikan is on C-Pap at pressure 10 cm of H2O and around 90% oxygen. He had a follow up eye doctor appointment tonight and all the eye doctor could say was, "It looks good, there does not appear to be any complications from surgery. We still don't know how his eyes have responded to surgery, but I'll check him again next week." Before his eye appointment, Mikan was given choral hydrate to calm him down.

Jenna is not feeling well, so she stayed at home tonight. Grandpa Kartje, Steve, and Sandy visited this evening. Mikan was very relaxed throughout their visit and slept the entire time.

Wednesday, May 21, 2008

39 Weeks: Mikan's Farewell to the CPAP



Great news! Mikan decided to throw a royal hissy fit just as the doctor came in to examine him for the day. Because Mikan appeared so uncomfortable on the CPAP, he decided to try him on a high flow nasal cannula. He is doing great on it! It is a lot less cumbersome, so he is much more comfortable. He also doesn't have an exorbitant amount of pressure blazing through his nostrils. So far his doctor has called twice since he left the NICU today to check on Mikan. He still thinks it's too good to be true. He had given us an early estimate that we should plan on Mikan being on the CPAP for about a month. If Mikan can stay on High Flow, then that cuts into a lot of our hospital stay. We also like High Flow because we can go pick him up and hold him whenever we want. We don't need a nurse to come help us because there are a lot less wires and devices to be messed up. You can also see a lot more of Mikan's face. We've just begun to realize how really cute he is. His doctor today said, "Wow, he looks really different. He looks like a normal baby...I mean...not like he looked weird before or anything."

The video will give you an idea of what his cry sounds like.

Tuesday, May 20, 2008

Mikan remains on the C-pap this evening. We look forward to times when this will not be news. The doctor is worried about Mikan running out of energy, therefore Mikan has not been weaned on his support. His eye examine on Thursday night will be another test. First of all, we hope his eyes are responding to surgery without complication or further intervention. Second, we hope he can withstand an eye exam while on the C-Pap. I think that once he proves himself during an eye exam, the doctor will be more likely to wean pressure support on the C-pap.

In Mikan's room we have posted humorous, important, and timely quotes our doctor has made. For example, "To be perfectly honest with you, Mikan is acting more like a 26 weeker than a 28 weeker." Another "When I left him (Mikan), he was doing fine." Or "The problem is, is that he is a white boy (lung reference)." And finally, "Do you have good insurance?"

The last one he didn't say but it would be funny if he did, but only because we have good insurance.

Monday, May 19, 2008



Mikan is still on the C-pap, good. He is on steroids every 12 hours. They are going to wean his dose from 0.3 to 0.25 tomorrow. He is very temperamental. He is either asleep or hoarsely wailing. He likes to do pushups when he gets moody. I think he doesn't like the 2 prongs up his nose giving him constant pressure in his nostrils. While all vent families want the C-pap, it is a cumbersome, difficult to manage piece of equipment. Mikan has a little more freedom and has to keep his mouth sealed to allow the machine to work the most effectively.

He is making progress and we thank you for your prayers.

NO TUBE CONTINUED!

Mikan is still hanging in there! He is doing really well today so far. His oxygen was weaned to 70% last time I left. All the doctors and nurses have been stopping by to check on him and give him words of encouragement. His primary doctor was on-call this weekend and he said he got four different calls in the middle of the night, and each time his pager went off he thought, "Oh no, it's Mikan." But for once, it wasn't. His cry is extremely hoarse as you can imagine. He doesn't make too much noise yet. He also has a problem with using his tongue to push out his feeding tube, so he has extra tape on his face. With the new apparatus, you can barely see him, but at least it's not ruining his lungs. I'll post some pictures later tonight.

Sunday, May 18, 2008

Extubation-Preliminary Success

Mikan was extubated this morning at around 9:45 am and put onto C-pap. Right away we knew that it was better than the last attempt (12 days ago). He started breathing on his own. His breathing rate has been high all day at around 60 to 90 breathes each minute. His oxygen support on C-pap started at 100% but has decreased to around 80%. His pressure support on C-Pap is 10 cm of H2O (which is nearly the highest amount of pressure the C-pap can give). So, Mikan has a prong up each nostril instead of a tube down his throat and his mouth needs to be sealed shut so the air goes down into his lungs. We are both excited about his progress. If he makes it through tonight, chances are he won't need to be re-intubated.

Jenna has been singing verses of Kool & The Gang's song "Celebration" today. But instead of "Celebration" it has been "Extubation."

There's some breathing going on right here.
We been waiting for what seems like a year.
So bring your C-pap, and your Si-Pap too.
We're going to hold your mouth shut for you.
Come on now, extubation.
Let's all extubate and have a good time. Yeah Yeah.

It's time to breathe forever,
It's up to you,
What's your pressure?

Everyone around the NICU, come on.

So we're crazy. Yesterday was exactly three months at the hospital.

Saturday, May 17, 2008

Extubation Tomorrow?

Mikan is at presurgery levels in terms of his ventilator support. Our doctor was thinking of calling us during the shower to try and extubate Mikan. However, about 30 minutes after the doctor was thinking of extubation, Mikan had an episode where his oxygen levels and heart rate dropped substantially. Therefore, the doctor decided it was best to wait for another day. Jenna and I think that Mikan's episode was because of fluid in the tube getting into his lungs. We are hoping that he is extubated tomorrow. The doctor has mentioned that if this extubation fails (Sunday), a Ear Nose and Throat doctor will need to be present for the next extubation attempt to see if Mikan needs to have a tube put directly into his trachea and by-pass the nose and throat. We'll see.

Regarding his eyes, we really did not get any new information today. We probably won't until the eye doctor sees him again later this week. However, once the morphine wore off from surgery this morning he was back to his normal support.

We would like to thank everyone who came to our house for the shower. We will be having a party back in Ft. Wayne at a later date at "Party Central" (Annette, Gil and Big T's house). It was nice to see everyone. The weather was wonderful to be able to get outside and play around a little bit. We also thank Grandma Kartje and Alexa for their staying over night to help set up for the party.

Friday, May 16, 2008

Retinopathy Surgery

The early results of the surgery are good. Basically, the surgery went as planned and Mikan behaved. However, we won't know the effectiveness of the surgery for awhile. We do not know if he will need a surgery again. We do not know if he will develop cataracts (for babies is a possible cause of blindness, which can't be treated like adult cataracts). The eye doctor will see him again in a week. We hope to have him extubated by the end of the weekend.

He looked pretty pathetic after the surgery. You would have thought there were "sharks with frickin' laser beams attached to their heads" shooting them into Mikan's eyes. When we went into the operation room Jenna asked, "Are those the lasers?" referring to the large lights (about three feet in diameter) that are used to illuminate the operating table. Jenna was reassured that the laser generator was the small black box on the table next to Mikan.

One way we know that Mikan is a Gensic. He is good at keeping his temperature up without being swaddled. He is a warm body. He'll be ready for the winter Lake Michigan swim before you know it.

We had visitors today. Grandpa Gensic, Grandma Kartje, Aunt Alexa, Aunt Katie, and Mary Ann all made their way by at various times. We thank all for their support.

Thursday, May 15, 2008

Mikan will have eye surgery tomorrow night (Friday) at 7:15 pm. It should take about 2 to 3 hours. He has stage 3 retinopathy of prematurity. The success rate of the surgery is 50%. Their is a 10% complication rate with the laser which could lead to blindness. If surgery is not successful, another laser surgery might be necessary, or a retinal detachment surgery might be necessary in Chicago. We'll probably know this within a couple weeks of tomorrow night's surgery.

We continue to thank everyone for your support. If surgery goes well, and he seems okay, then extubation would be soon to follow the surgery. (Hopefully Saturday or Sunday)

Wednesday, May 14, 2008

38 Weeks Today


We had another status quo day. Mikan's blood gases this morning weren't good or bad enough to make any vent changes. The doctor says he is much more optimistic of the prospect of extubation Round 2. We find out for sure whether or not he will have laser surgery tomorrow evening. But it is looking like he probably will. After the surgery, his doctor wants to extubate him as soon as he is stable and the eye doctor has determined he won't need a follow up operation. This could be sometime this weekend or early next week. He also said he wants to start Mikan on feedings early because he is showing some good developmental signs of wanting to eat by mouth.

Some of the nurses are fighting over who gets to be taking care of Mikan when he is extubated. Everyone wants to be there to see it. He's a real flirt with the girls already.

Tuesday, May 13, 2008

Tuesday





Mikan had his eyes checked again today. He has advanced stage 2 retinopathy. He will be checked again on Thursday evening. If the retinopathy is at all worse on Thursday, he will have surgery on Friday. In the meantime, the orders are not to extubate him so that the sedation involved with surgery will not cause him the stress of reintubation. Mikan had his regular doctor today. The doctor's language seemed more optimistic about getting him off the vent within the next week. I think the doctor is just happy that Mikan's vent settings have not needed to be changed in the past few days.

We had many visitors today. Grandpa Kartje came and gave blood, should Mikan need it again. He also became the fourth person to hold Mikan. Steve, Sandy, Angela, and Mary Ann also visited this evening. Jenna was polite enough not to ask for an ice cream shakes from our visitors tonight. She embarrasses me when she asks for shakes from our guests. I keep telling her that it is rude, and that is enough for them just to come and see us, they don't need to bring us any shakes. She usually asks for chocolate shakes from Steak and Shake. I don't why she asks for chocolate when there are so many other shakes she could get. I am glad my social etiquette skills make up for what she lacks.

Monday, May 12, 2008

Monday

Today was another steady day of growing. Mikan has remained between 40 and 45% oxygen and on a rate of 12. His primary doctor returns tomorrow and will hopefully wean pressures. It looks like we will probably be looking at extubation or laser eye surgery at the end of this week. Mikan has been attacking his pacifier lately. Hopefully this is a sign his bottle feeding will go smoothly. He was upgraded to a "big boy" pacifier and "newborn" instead of "preemie" diapers. He's getting big. He's also starting to acquire the baby rolls everywhere. The biggest thing we've noticed about his development is his desire to grab everything lately and put it towards his mouth. This includes all of his tubes and wires. I think this is a sign that he needs to lose them before he does something he shouldn't. Right now I have to restrain him with blankets in order to get him to stay connected to everything.

We left our camera in the NICU tonight. Pictures tomorrow.

Sunday, May 11, 2008

Mother's Day

Happy Mother's Day Jenna! Mikan has maintained his status from yesterday. He has not had a blood draw for the past couple of days. Therefore, Mikan's support has not changed.

My mom and dad came up today and brought some house stuff with them. My mom was the first person besides Jenna or I to hold Mikan (we'll have pictures later). He did pretty well (slept) during the hold with periods of eye openings. We decided that Mikan may have Harber ears.

I was humming the Indiana Jones theme to Mikan today. He enjoyed it.

Saturday, May 10, 2008

At home

Mikan is doing okay. He is in 45% oxygen at a rate of 12, pressure control of 41 cm of H2O and a pressure support of 28 cm H2O. Today was pretty consistent with his status the last few days. His weight continues to increase. We hope this translates to more lung tissue.

Friday, May 9, 2008

Mikan is staying pretty consistent in the 40's% in oxygen. His pressure support was weaned slightly today. He seemed to handle it pretty well. We're hoping that his eyes are okay next week so that he will not need the laser eye surgery to prevent further retinal detachment.

Retinopathy of Prematurity is actually growing in incidence because more and more premature babies are surviving to tell us how good their vision is or isn't. Apparently the weight threshold for concern of retinopathy is 1.25 kilograms. Mikan was born at 0.8 kilograms. Therefore, the doctors have seen this coming. We wonder how much is coming.

Today Jenna was able to use the NICU's supplies of scrapbooking to start a baby book for Mikan. The NICU has lots of stickers with premature specific slogans. Such as...
"Bouts of Apnea" "Desatting" "Ventilator" "Suctioning" "Jet Vent" "Shift Change" "Skin to Skin" "Another round of Antibiotics" "Blood Transfusion" "Dex Levels" "OG Tube" "Pulse Oximeter" "Bradiocardia" "Low Birth Weight" "Ruptured Membranes" "Retinopathy" "Billy Light" "Jaundice" "Incubator" "Wash your hands" "Avagard" "C-Pap" "Si-Pap" "Kangarooing" "Passing Gas" "Dexamethasone" "Premature Lungs" "Fluid Retention" "PDA ligation" "Hernia" "Vitamin D Shots"

Okay some of those weren't stickers. But it's a good vocabulary list from the last 2 months.

Thursday, May 8, 2008

Thursday

Mikan is in about 44% oxygen and at pressure support similar to about a week ago. He has remain fairly consistent in his support over the last couple of days. He has about a week and half before another steroid induced attempt to extubate. If he does remarkable well on his own over the next week, he may get an opportunity before then. However, today we found out that Mikan has stage 2 retinopothy (the beginning of retina detachment, yet another symptom of prematurity). If it progresses to stage 3, he will need to have laser surgery immediately to correct it. The eye doctor checks him again in a week. He prefers that Mikan stay on the vent if he needs surgery because sometimes the babies have to be sedated so much that they require intubation during the surgery even if they are breathing normally. If Mikan just came off the vent and then would have to be reintubated, future extubation would be difficult.

Annette, JT, and Gil came to visit and have dinner tonight. It was good to see them. We've already started to plan the first cousin party "The Next Generation."

Wednesday, May 7, 2008

Wednesday

While Mikan was being reintubated yesterday, the respiratory therapist noticed some swelling in his throat. Hopefully this will go away on its own. If not, Mikan will unfortunately need a trachea tube. The doctor just informed us that this is a possibility, something he hopes won't have to happen. Today Mikan was around 40% oxygen and the doctor was able to wean his pressure support and pressure control a little again. He is on .15 mg of steroids and will continue to receive this every 24 hours for at least 10 days until they try extubation again. This morning Mikan moved his head so he was laying in the completely opposite way his tube was facing, almost causing self-extubation. The doctor said if he self-extubates, then he wants to try him on C-pap before they reintubate him.

Mikan has also been doing normal baby things, like trying to suck on his fist, or tracking with his eyes a little more. He also has really bad gas. Last night he weighed 5 lbs: a porker. He's starting to look like the fat term babies.

P.S. There are now 28 week twins whose mom never had steroid shots and may have been on drugs while pregnant. They are both on C-pap and currently being weaned after only being in the NICU for a few days.
I know, don't tell us. "Every baby is an individual." We know.

Tuesday, May 6, 2008

Failed Extubation

We just tried to extubate (pull the ventilator tube out and put him on lower support) him at around 10 am this morning. He was not ready. They tried a C-Pap then they tried a darth vader sounding SiPap. He was visibly agitated. He kept doing this shoulder shake motion which Jenna and I had never seen before. The doctor's plan is to wean his steroids down and try extubation again in a couple of weeks after he is closer to 2.5 kilograms. He is currently weighing in at around 2.23 kilograms.

It's a good thing Mikan is so cute.

Monday, May 5, 2008

2 Months Ago Today


Mikan was born 2 months ago today. He is in about 50% oxygen and was unable to be weaned on his pressures and rates today. He is getting 12 bpm at a pressure of 43 cm of water. We were given papers for 2 month vaccinations today. Because he is on steroids (which are immunosuppressants), we are not sure if he should be getting a barrage of vaccines at this time. We plan on talking to the doctor about this tomorrow. We may try to extubate him tomorrow. However, he has not been put on caffeine in preparation for such an event.

Sunday, May 4, 2008

Sunday Night

Currently Mikan is in about 60% oxygen and awaiting an x-ray to look inside his lungs. He was in about 37% oxygen all day long so the increase to 60% is the reason for the x-ray. He had good CO2 levels this morning so his rate was dropped to 12 bpm and one of his pressures was dropped from 43 to 35. Both good things. He is getting steroids each night at 9:30 pm. Steroids are planned to continue until Wednesday evening.

Mikan probably has a hernia. He has part of his intestines protruding into his scrotum. He will probably need surgery at some point. The surgery is common and babies usually handle it pretty well. Just another side effect of being a premature boy.

My brother Pete with kids Tia, and Liam came to visit today. We went to the East Race and to a park by the hospital. Liam cried when I hit him on the head with a football. Yet another risk Mikan is protected from by staying at the NICU.

Saturday, May 3, 2008

Saturday



Mikan's been having a good streak. He loves his steroids. He was on 35% oxygen for most of the day. His steroids are now being administered only once a day and at a smaller dose. He is extremely irritable throughout all of his assessments, but once he settles down, he seems to do fine. He has had good-moderate blood gases over the last two days so his pressure support has been reduced and his vent rate is now 15 breaths per minute.

One of the nurses told us that when he is fussy we should help to calm him by softly repeating the same phrase over and over again, such as "it's ok." Every time I do that I can't help think, "Is it really ok? Surely it can't be comfortable with all those tubes down your throat." Mikan's new favorite thing to do is use his tongue to push out his feeding tube. It's painful to watch the nurses continue to shove it back down his throat. Nurse George explained that during his training the students had to practice on each other by putting feeding tubes through each others' nostrils. I'm glad I'm not a nurse.

The video posted shows how dramatic each nighttime weighing is for Mikan. He has to be unhooked from all of his gadgets. We always try to guess his weight in kilos before the final reading.

Friday, May 2, 2008

Friday

Mikan has been weaning on his ventilation support needs since his steroids started yesterday. He is in about 65% oxygen. His antibiotics will continue through tomorrow. His steroids have been 2 shots per day for today and yesterday. For the next five days, he will get steroids once each day. If his oxygen and pressure support continue to wean, we may be able to try extubation next week (getting the breathing tube out of his mouth). Mikan may still be on a smaller amount of steroids post-extubation to help from further set backs.

The nurses think that Mikan has gotten hilights in his hair. They think he is cute. So do we. However, they couldn't tell us if he were otherwise. I doubt a NICU parent has ever reported, "My nurse thinks my baby is ugly. She told me so." I know some babies are ugly, they usually grow out of it. I am not sure if Mikan is "cute" but he already has shown me his character, at least a little bit of it.

Thursday, May 1, 2008

Thursday Night

Mikan is currently requiring about 60% oxygen and his evening blood gases were good enough to wean his ventilator pressures slightly. It appears that the steroids are working pretty well right now. Or it might be the change of vents, morphine, blood transfusion, or antibiotics. For some reason, we think its the steroids more so than the other changes.

We are more relaxed tonight than last night. He is continuing his antibiotics and steroids for the next couple of days. He has blood gases and an x-ray in the morning.

May 1 12 pm

Last night and this morning were pretty rough. Mikan's oxygen requirements went from around 50% to 100% within 4 hours yesterday evening. Therefore, he had the following tests done...
1.) x-ray (check lung condition and tube placement)
2.) urine analysis
3.) CBC (measures white blood cell levels sign of infection)
4.) tracheal aspirate (check for infection)
5.) Started antibiotics vancomiocin and gentamicin (sp?)
6.) Blood gases (carbon dioxide levels)
The x-ray showed that his lungs had collapsed while the signs of infection were negative. The Doctor bagged him for awhile and this helped to reopen his lungs and get him to about 70% oxygen. The doctor thinks the lung collapse was caused by excessive secretions and the jet vent. So this got him through the night.

Then we woke up to Mikan requiring 100% oxygen again. Therefore the following things were done...
1.) Another doctor tried to bag him as last night but to no avail.
2.) X-ray (which showed a little better lung volume)
3.) 2 doses of morphine back to back to get him to breathe with the vent and not against.
4.) Emergency dose of steroids which was larger than any of the doses that he got during his steroids last week.
5.) The doctor messed with the settings (PEEP, PCP, SIMV Rate) on the ventilator for a little over an hour, trying to get him to come down on his oxygen requirement.
All of this resulted in his oxygen requirements dropping to 85% and a very lethargic looking Mikan Gensic.

I am typing from home because Jenna had a textbook adoption meeting at school, therefore this update is effective 12 pm May 1 (We know why it is called May Day now). I'll try to type after tonight is over as we hope to have more reassuring news.

I haven't had school the last two days because of sewage issues at St. Adalbert. This is the time of year we try to recruit new students to our school so I hope the sewage issue doesn't hurt enrollment.