Sunday, March 8, 2015

"The Return of the Oscillator" (12/23/13)

The morning of Monday the 23rd, I got a phone call at 6:45 am from the NICU.  That was the first phone call that we had gotten that was not a routine daily call.  I panicked as I hit the ‘ANSWER’ button.  Why are they calling us?  What is wrong?  When I answered, they told me that Nathan was fine; they just had to tell us a few things.  They first needed our permission to give him a blood transfusion.  Ruth Ann was one of the few PICC line Nurses in the NICU and when she put Nathan’s PICC line back in yesterday, he lost a bit of blood.  She had mentioned that having a blood transfusion was a possibility because of that reason.  So I would have been fine if that is all they needed to talk to me about.  The other thing that they mentioned was that they were going to have to put Nathan on the Oscillator today and take him off the ventilator.  That scared me because Colin was on the oscillator as a last resort and it worried me that this was close to the end.  I couldn’t understand why because he was doing pretty well for the most part.  What changed over night?

I can’t remember completely, but I am pretty sure after that phone call I started to cry.  Of course that news is going to scare me.  They only have 3 oscillators in the entire NICU and they only use them on the babies who really need them.  And apparently, Nathan is now one of those babies.  My mind couldn’t help but jump back to the days with Colin and being so scared seeing his tiny belly shake so fast because of the oscillator.  I know I had just became acquainted with the NICU and was still learning everything when dealing with all the terrible news with Colin, but in my mind, oscillator = the end is near.  That scared me so much.  All I wanted to do was get up and rush over there but Kevin reiterated what the Doctor said and that Nathan was FINE!  So I forced myself to sleep an extra hour and then we headed over to see our beautiful boy.

When we got there, he had already been switched to the oscillator.  His nurse was Sarah today and she said that he did very well in the transition.  I wish I was there for it because I would have love to see what he looked like, even for a split second, without a tube coming out of his mouth.  I have no idea what he looks like without anything on his face.  Maybe someday. 

After saying ‘Good morning’ to Nathan, we started asking questions and fishing for more information on why he was put on the oscillator.  The Neonatologist came to discuss it with us and he said that Nathan’s CO2 (blood/gas) levels went up to around 83 and he was going to need more support for his lungs.  Apparently his oxygen requirements were going up as well on the ventilator so they had to make a change.  The ventilator gave slow, large breathes whereas the oscillator produces quicker breathes with less pressure.  With his CO2 levels and oxygen requirements going up, they had to put him on the oscillator so it was less traumatizing to his lungs. 

They explained that the oscillator was a double edge sword in the sense that Nathan’s lungs weren’t developed enough to handle the ventilator but the oscillator slows down the development of the lungs.  The oscillator was going to be an, ‘as needed’ basis and hopefully he wouldn’t be on it for more than a couple weeks.  Now, you know I would give up everything for my baby to come out of this healthy and happy, but I was sad that he was on the oscillator because I knew I wouldn’t be able to hold him.  Because the oscillator needs to lay flat and be parallel with his body, there isn’t much wiggle room.  But on the other hand, he was in isolation so I wasn’t sure of the ‘rules’ for holding him anyway.  If there was one way to make me smile ear to ear was to put that sweet 1 lb baby on my chest and to feel his fingers move and feel his legs move and kick my belly.  Absolutely THE BEST feeling ever. 

Since Nathan was taking to the oscillator extremely well, it was now time for his blood transfusion.  So around 1:00 pm, he got his 15 mL of blood right after he got his 12pm antibiotic.  The transfusion goes in over a period of an hour or 2.  Nathan was definitely getting a lot of fluid pumped in him.  Along with the blood transfusion they Doctor told us that Nathan got a Newborn screen.  I am not sure what all that entailed, but they do this for all babies apparently.  Luckily…Nathan’s came back normal!! YAY!!  They test for genetic disorders such as hypothyroidism and his came back normal!  We had one less thing to worry about.

After a morning full of events and spending it side by side with the cutest baby in the NICU, we left after his 3 pm care and went back to the RMH around 4.  I think this is the day that I went back and crashed.  The oscillator really got me stressed in the morning and being stressed wares me out.  So I took a little nap and rested up for an evening with my handsome man (Nathan). 

We ate some dinner that was so kindly provided for us and then we headed back to the NICU around 8ish.  You always hear that babies recognize there mom and dads voice and it is a good idea to read to them while in the womb and right after they are born.  So…since I never got the chance to read to them while in my belly, I had my mom go out one day and pick me up some children’s Christmas stories so I could read to him.  So tonight, I was bringing A Christmas Story. 

When we arrived back to the NICU around 8 pm, Nathan was wearing his Christmas hat to keep him warm.  We started his care around 8:30ish.  Tonight he was getting 9mL of my milk and he had a wet and poopy diaper of 14 grams.  His stool was beginning to look like normal and not so much of the tar like stool that newborns have.  Nothing about this situation is normal for a first time mom, but even the slightest things like changing his poopy diaper made it so special for me. 

Since Nathan was put on the oscillator, he seemed to be doing very well with his CO2 levels and his oxygen levels.  His CO2 went from 83 before the oscillator to 62 and is oxygen levels were hovering in the 30-40% range.  They weighed him at 9 pm and he was 729 grams which is around 1lb 9.7 oz.  That went down just a tad from the 732 grams that he was the night before.  They measured his belly and his girth was 18 ½.    After we were done with his care, we flipped him on his belly and he seemed to like that a lot.  
You can see in this picture the amount of milk we give him in relation to the size he is.

After he was all fed, his diaper changed and tucked in, I got out A Christmas Story and sat by him with the incubator door open, and read to him.   Just because he was in the NICU for Christmas didn’t mean that he had to miss out on Christmas stories and festivities. 

After another hour or so, we said Goodnight and headed back.  Tomorrow was Christmas Eve.  My parents, my brother Dan, and my Father-in-Law were going to be in town.  I told them that I was not going to give up time with Nathan and take a whole day off from being with him just because it was Christmas.  There was nowhere that I would rather be than with my baby and they completely understood that.  So the plan was to spend all day Christmas Eve with Nathan and then head downtown Cincinnati to the Hotel they were staying at and have dinner together.  I was fine with that plan as long as Nathan was good.  Everyday can change in an instant so it was always a play it by ear type thing. 

Once we got back to the Ronald McDonald house, I began writing up his nightly update.  Here is what it said:

Nathan’s Nightly Update (12/23/13)
Hello Everyone!

Nathan had another fairly good day today.  This morning, the Doctors called me at 6:45 am.  That always scares me just because it's usually not good news that early in the morning.  They were just calling to let us know that he was going to need a blood transfusion and they needed my permission to do so.  We knew yesterday that that would be a possibility since he got his PICC line back in and lost a little bit of blood so that ended up being ok.  He was only going to get 15ml of blood.  

They also said in that same phone call that they will switch him from his current breathing tube to an oscillator.  His breathing tube prior gives slow positive air pressure breaths to his lungs whereas this oscillator delivers fast rapid breathes.  This news really scared me because that is the same machine that Colin was on as a 'last resort' for his breathing so I assumed something went terribly wrong during the night.  Later to find out that his CO2 (blood/gas) levels were up and needs more support for his lungs. His oxygen requirements went up on the previous breathing tube and that can be a lot of pressure on his little undeveloped lungs.  So this oscillator is just a way to deliver his breaths in a less traumatizing way to his lungs. After hearing that, it made me feel better. He took to the oscillator very well.  We left around 3:40 pm and he was using around 50% oxygen and then when we returned at 7:45, he was weaned down to around mid-high 30s.  We were very excited.  His CO2 levels before the oscillator were 83 and with it, it went down to about 62. 

The oscillator is a double edge sword as the attending was telling Kevin and I.  He needs the help of the oscillator because his lungs aren't developed as well but the oscillator also slows down the growth of his lungs a bit.  So we predict he will be on this for at least a few weeks.

The oscillator and the blood transfusion are the biggest new developments with this care.  Other than that he is doing great!  All the nurses are very pleased with him and he is a very good boy for them.  His newborn screen was normal which apparently all newborns get and that tests for any genetic disorders such as hypothyroidism.  His Kidneys still look good.  His glucose level is down to 80!  

He is now getting 9ml of my milk.  In that one picture you can see the size of him compared to the size of his food.  He is a growing boy!  His belly is 18 1/2 cm and I think last nights email I mentioned that he grew 2 cm in length from Birth and an 1/8 of an inch around his head.

Other things that Mom likes to mention - His poop is starting to look like normal and not the tar color.  Tonight Kevin and I read to him "A Christmas Story" children's book.  Tomorrow night we will read " 'Twas a Night Before Christmas".   

P.S, - feel free to forward this on to anyone that I may have forgotten and would like to get these updates.

Love you all,

Kelly, Kevin and Nathan

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