Today was my first time going to church in seven weeks. It was so fun to get out of the house and see some of my friends again! Once again, it was very humbling to hear of all of the people who have been praying for us. Wow! We appreciate you all so much!
Let me tell you a story I heard today that gave me chills. My friend Kimberly was leading a team of people from our church on a mission trip to Ethiopia. Before they left, she told me she was going to pray that I'd still be pregnant when then return, which would put me a few days past the 30 week point. Well, I knew they got back this week, but I wasn't sure of the exact day. Today, she told me she has been praying every day for me to stay pregnant until they got home. Amazingly, their flight landed at 7:30 Thursday night, and Joshua held on until 29 minutes later, when he was born at 7:59. Just as she prayed, I was still pregnant when they got home. I think that's pretty cool.
When Jeremiah was born, I had a couple of episodes of being really teary, you know all that hormonal stuff with having a baby. I don't really understand it, but I haven't been tearful with Joshua since the day or two after we found out about all of the issues back at 24 weeks. I have just been so thankful for each day, and miracle after miracle occurred, so I had nothing to be sad about. Even after the delivery, I was so excited he was healthy and didn't need to be intubated, so I have had a pretty positive outlook this whole time. Then it hit me today. I saw a woman at church holding an adorable baby who looked like a newborn, and all I could think of was how huge that baby was. I was so envious of her for having her baby in her arms, and I just broke down because I missed Joshua so much, and I just wanted to be able to bring him places with us, or even hold him, something I had only been able to do twice. The episode eventually passed, and the self pity didn't last more than a few minutes, but it made me realize I guess I'm not as strong as I thought I was. Then the service was over, and I was enveloped in the love of the ladies from Moms and Beyond, and everything became ok again. I really needed that pick me up, so I'm glad I ran into them when I did.
NICU Updates:
1. Joshua's bilirubin level went down from 8 yesterday to 4 this morning, so they took him off the lights. No more shades covering those handsome eyes! He is sleeping so much better and seems so much more content now that he can be all bundled up again.
2. His GI system still hasn't gotten moving, and things now seem to be reversing in the wrong direction (bilious output from the stomach through the orogastric tube). The xray showed normal bowel gas pattern, so that's a good sign. None of this is surprising because his blood was shifted to his brain in utero since that's the most important organ, so his abdomen and GI system were neglected and may take awhile to get started up again. This is common in IUGR preemies. He is now NPO (no more breast milk in his OG tube, just nutrition through his venous catheter), and he's getting frequent suppositories to try to get things moving. He is on "nec watch," meaning they are looking closely for necrotizing entercolitis, a rare but very serious problem in preemies where the intestinal tissue dies from lack of blood flow. He does not have this disease, but he is at risk for it. Please pray for this GI issue to be nipped in the bud before it becomes something serious.
3. His umbilical venous catheter has become dislodged a little, so the doctor is going to put in a PICC (peripherally inserted central catheter) line tonight for Joshua to receive his nutrition. The UVC cath is only good for up to about 10 days, so he may have needed a PICC line anyway, so this isn't a huge deal. Both the doctor and the nurse said the cath probably shifted out because he is so active for a preemie his age, and they were impressed with how active he is. You can imagine how proud this mama and papa were to hear that compliment!
4. I tried to hold Joshua today, but he didn't handle it so well. We couldn't get him to stop crying, and his heart rate and respiratory rate kept going up. After about 10 minutes, we put him back in the incubator, and he immediately settled back down. Hopefully tomorrow we'll get another chance. Logically, I know babies this little don't like excessive stimulation, so I shouldn't put too much pressure on myself. Emotionally, though, it's a little discouraging thinking I'm his mother, so I should be able to calm him down.
We are quickly learning that a NICU course can be tenuous, and sometimes it's two steps forward and one step back. We're definitely learning as we go, just continuing to pray for the strength we need each day. Thank you for praying for Joshua's health, and especially for his little bowels to get moving so we can avoid necrotizing enterocolitis.
Sunday, March 4, 2012
3/4 of the Bales' are Home!
Yesterday was a big day. Joshua's big event was getting weaned off his CPAP in the morning. For about an hour, he was doing well on nothing for supplemental oxygen. Then he started to show that he was needing to work a little harder to breathe, so they put him on a nasal cannula (just a little clear tube under his nose to give him a little extra oxygen). He did well on that throughout the day. It's so nice to be able to see his face now, without that big mask and tube in the way! When they first took the CPAP mask off, he furrowed his eyebrows exactly like James does when he's annoyed. I thought it was funny.
I think Joshua is going to look like Jeremiah. He has the same big eyes that are so alert, and he reminds me of how Jeremiah looked as a newborn. He also has James' and Jeremiah's feet. They are so tiny, but they are still long like flippers with a big space between the big toe and second toe. Other than the eyes and feet, it's hard to tell what he's going to look like because he still has a lot of filling out to do.
Joshua's follow up bilirubin level was the same, so they want to keep him on phototherapy for another day. It's good that it's not still trending up. They put him on a new bed, so the lights shine from underneath him instead of above him, and he seems to like that a lot better. His face does look a little jaundiced, but I think the rest of his color is improving.
For me, the main event was getting discharged from the hospital. It was really hard to leave Joshua, and I already miss walking over to see him in the NICU whenever I want to at any time during the night. Driving away, it was bittersweet. I have to admit it was nice to walk to the car and then ride fully upright without having the seat pushed back and reclined with my feet on the dashboard. We were excited to head home, but we were leaving a quarter of our family in the hospital, so we were sad. It's hard to leave your child in the hands of others, especially when he is so helpless, but we know he's getting the best care. Hopefully the next 8-10 weeks will go quickly.
Arriving home was a big moment. My mom and dad made our house immaculate, which was so nice. The best part was having Jeremiah so excited to have us home. The last time I came home from the hospital, he ignored me at first and only wanted to be with my mom, but he wanted me right away this time. He had so much fun with his cousins the past two days, and he was trying to tell me all about it in his limited language. "Slide! Up up up, doooowwwwwwnnnnnn!" "Outside!" "Grandpa Bob!" "Luke! Jack!" So precious. When we realized the baby was coming on Thursday night, James' brother John immediately hit the road to come pick Jeremiah up, and that started the adventure of going to "Jack's house!" and then Grandpa Bob and Karen's house for a few days. They were so wonderful for taking such great care of him while allowing us to focus all of our energy on Joshua for a few days. Jeremiah had a blast! He's still talking about going "ni-night at Grandpa's house."
I think Joshua is going to look like Jeremiah. He has the same big eyes that are so alert, and he reminds me of how Jeremiah looked as a newborn. He also has James' and Jeremiah's feet. They are so tiny, but they are still long like flippers with a big space between the big toe and second toe. Other than the eyes and feet, it's hard to tell what he's going to look like because he still has a lot of filling out to do.
Joshua's follow up bilirubin level was the same, so they want to keep him on phototherapy for another day. It's good that it's not still trending up. They put him on a new bed, so the lights shine from underneath him instead of above him, and he seems to like that a lot better. His face does look a little jaundiced, but I think the rest of his color is improving.
For me, the main event was getting discharged from the hospital. It was really hard to leave Joshua, and I already miss walking over to see him in the NICU whenever I want to at any time during the night. Driving away, it was bittersweet. I have to admit it was nice to walk to the car and then ride fully upright without having the seat pushed back and reclined with my feet on the dashboard. We were excited to head home, but we were leaving a quarter of our family in the hospital, so we were sad. It's hard to leave your child in the hands of others, especially when he is so helpless, but we know he's getting the best care. Hopefully the next 8-10 weeks will go quickly.
Arriving home was a big moment. My mom and dad made our house immaculate, which was so nice. The best part was having Jeremiah so excited to have us home. The last time I came home from the hospital, he ignored me at first and only wanted to be with my mom, but he wanted me right away this time. He had so much fun with his cousins the past two days, and he was trying to tell me all about it in his limited language. "Slide! Up up up, doooowwwwwwnnnnnn!" "Outside!" "Grandpa Bob!" "Luke! Jack!" So precious. When we realized the baby was coming on Thursday night, James' brother John immediately hit the road to come pick Jeremiah up, and that started the adventure of going to "Jack's house!" and then Grandpa Bob and Karen's house for a few days. They were so wonderful for taking such great care of him while allowing us to focus all of our energy on Joshua for a few days. Jeremiah had a blast! He's still talking about going "ni-night at Grandpa's house."
Here's a short video Jeremiah's Uncle John and Aunt Holly
took of Jeremiah opening up his birthday present from Jack the night Joshua was
born.
Jeremiah playing in the fort he built with Grandpa Gus last week.
Saturday, March 3, 2012
Kangaroo Care
As I write this, I'm pumping milk (colostrum, actually) for Joshua. It's a little discouraging being hooked up for 15-20 min only to see a return of about 1.5 ml (although I had a whopping 2.5 ml, or 1/2 tsp, return in my last pumping session). Hopefully, once my milk comes in that will increase substantially. At least I'm producing what he needs since he can only take 1 ml every 4 hours through his OG tube for the time being. They have to start slow to gradually get his GI system up to speed. He gets most of his nutrition through his umbilical venous catheter. I have been told he won't be able to take milk directly from my breast until around his due date, May 7th. His due date seems to be this magical time in the far off future when life may get back to normal (what is normal?) because that's the projected time when he'll get to leave the NICU.
Yesterday, I got to hold Joshua for the first time! We did "kangaroo care" with skin on skin contact. At first, he was all worked up when the nurse moved him from his little nest, and his heart rate went up to the 170's while he was crying. Then after a minute or two, he got all snuggled in, and his heart rate settled into the 130's. I think he likes me. :) I wonder if he was thinking, "oh ya, I remember her now..." We sat like that for an hour. It sure meant a lot to me to have that time with him.
It's hard to not be able to do much with your baby other than look at him or gently touch him. I'm trying to get as involved as possible. Four times a day the nurse does care sessions, where she unwraps him from his swaddling, changes his diaper, takes his vitals, massages his face where the CPAP mask sits, etc. I have done a few diaper changes now, and it's a whole different world from changing a squirmy toddler. At first, I was so scared I'd hurt him since he's so tiny, but I caught on pretty quickly. I still marvel at how small he is! Check out how tiny his diaper is (and it seems big on him).
There were a few minor events that occurred overnight with Joshua. First of all, he had his first weight taken since birth. As expected, his birth weight dropped down to 940 g, or 2 lbs 1 oz. They typically lose about 10% in the first 24 hours and then take about 7 days to regain it. The other thing was he had to go "under the lights." His bilirubin level came back high, so the phototherapy helps bring it down. Again, not surprising since it's pretty typical in this age group. It's not alarming since they catch it and treat it so early. I feel so bad for him, though, because he loves being swaddled in his blankets, and now his body has to be fully exposed to the lights. Watching him, his moro reflex keeps kicking in, and his arms flail about like he's falling, and I just want to go wrap him back up like a burrito again. If things look good on the follow up labs, he may not be under the lights for long. We'll see...
Yesterday, I got to hold Joshua for the first time! We did "kangaroo care" with skin on skin contact. At first, he was all worked up when the nurse moved him from his little nest, and his heart rate went up to the 170's while he was crying. Then after a minute or two, he got all snuggled in, and his heart rate settled into the 130's. I think he likes me. :) I wonder if he was thinking, "oh ya, I remember her now..." We sat like that for an hour. It sure meant a lot to me to have that time with him.
In our "previous life," this is how we defined kangaroo care. Brisbane Australia, 2007.
There were a few minor events that occurred overnight with Joshua. First of all, he had his first weight taken since birth. As expected, his birth weight dropped down to 940 g, or 2 lbs 1 oz. They typically lose about 10% in the first 24 hours and then take about 7 days to regain it. The other thing was he had to go "under the lights." His bilirubin level came back high, so the phototherapy helps bring it down. Again, not surprising since it's pretty typical in this age group. It's not alarming since they catch it and treat it so early. I feel so bad for him, though, because he loves being swaddled in his blankets, and now his body has to be fully exposed to the lights. Watching him, his moro reflex keeps kicking in, and his arms flail about like he's falling, and I just want to go wrap him back up like a burrito again. If things look good on the follow up labs, he may not be under the lights for long. We'll see...
Friday, March 2, 2012
More Pictures
Wow, it has been fun to hear from so many of you today through comments, emails, Facebook, texts and voice mails! Thank you for reaching out to us! We can't bring our cell phones to the NICU, and I had my ringer off when I was trying to sleep (in between pumping sessions), so if you tried to call, sorry I didn't get back to you.
Due to popular demand, I went back to my last post (Introducing Joshua Gus Bales) and added a picture of a normal, healthy placenta for comparison to ours, so if you are intrigued, check it out. If you are one of my friends who wasn't so impressed I chose to put such a graphic picture on a blog that is supposed to be about cute babies, don't go back to it. :)
Here are some more pictures from last night after Joshua was born. I'll add more tomorrow.
Due to popular demand, I went back to my last post (Introducing Joshua Gus Bales) and added a picture of a normal, healthy placenta for comparison to ours, so if you are intrigued, check it out. If you are one of my friends who wasn't so impressed I chose to put such a graphic picture on a blog that is supposed to be about cute babies, don't go back to it. :)
Here are some more pictures from last night after Joshua was born. I'll add more tomorrow.
James went with Joshua to the NICU, and this was taken before I joined them.
This is the first time I got to touch him.
Here's Joshua with Grandma and Grandpa Gustafson. I love this picture! You're looking at a huge reason for why I was able to be on bed rest for 6+ weeks!
Introducing Joshua Gus Bales!
-Introducing JOSHUA GUS BALES!
-Born on March 1st, 2012 at 7:59 PM.-Weight: 2 lbs, 5 oz, 1050 grams (yes, he made it out of the "extremely low birth weight category" and into the "very low birth weight category), bigger than the ultrasound estimate of 2.0 lbs. :) That's in the 7th percentile for age.
-Length: 14.6 inches (37 cm) 17th percentile for age.
-Head Circumference: 25th perecentile for age.
-Gestational age: 30 weeks and 3 days (nearly 10 weeks premature).
What happens when you have the best technology (31 ultrasounds) and the best doctors scratching their heads, deliberating over when will be the best time to deliver a baby via c-section?
"A CHILD SHALL LEAD THEM!" (Isaiah 11:6, ok, taken out of context a little) Joshua had a mind of his own. He knew when he wanted to come out and see the world, and he wasn't going to let anyone make that decision for him.
Skipping to the end result, he looks great. He is healthy, fully formed with all his parts (even a normal nose), and he is able to breathe on his own. Labor and delivery went so smoothly, and I am so amazed that I did not need a c-section! Of course we'd prefer a full term, full size baby, but given the whole scenario, and the fact that we were able to hold on for more than six weeks longer than expected, we are ecstatic. Praise the Lord! Thank you all sooooo much for your continued prayers. We couldn't have done this without you! Even people we don't know have been praying for us, and you all mean so much to us!
In case you are wondering where the name came from...we decided on it months ago, not realizing the meaning of the word Joshua: GOD RESCUES. I can't think of a more perfect name for this little fighter. Just think how many times, and how many ways, God has rescued him over the past months. We have always liked the Biblical story of Joshua, a man of faith and a strong leader, and I love this verse. I even hinted at it the other night in my blog, not sure if anyone caught that.
Joshua 1:9 "Be strong and courageous. Do not be afraid; do not be discouraged, for the LORD your God will be with you wherever you go."
My maiden name is Gustafson, and when I was in sports growing up, some people called me Gus and cheered, "Go Gus!" But the real reason for Gus is my dad, which is the name he usually goes by. We have always been so close, and he is such a huge inspiration to us. This little guy is already Grandpa's Boy!
They wrapped him up in saran wrap under his blankets to transfer him from L&D to the NICU
(to preserve body heat). Check out those feet!
Not too sure if he's enjoying life in the outside world yet...
This is my first up close view of Joshua, before they took him to the NICU.
This is how he looked when I got a chance to see him in the NICU.
The night prior to delivery, I was having contractions about 3-5 minutes apart. Nothing painful, but I could feel them. No big deal since they were so small, but they gave me terbutaline to stop them, and it worked. The next morning, we had our dopplers which showed normal blood flow, and we thought we can make it to 32 weeks. I was feeling contractions, more than usual, but they weren't painful. When I was on the monitor, we saw they were about every 3-5 minutes. Dr. Middle decided to check me just to make sure I wasn't dilating (I hadn't been checked since I was 1.5 cm early on in the action three nights before). Surprise, I was dilated to 5 cm! Basic review: when the cervix dilates to 4 cm, you're officially "in labor," on the way to 10 cm, or complete, when it's time to push the baby out.
Once again, I was transferred to L&D and started on Magnesium to protect the baby's brain just in case he was going to be born sometime in the next 12 hours. We arrived around 11:30 AM. I got a medication called Procardia to help stop the contractions. The mag wasn't as bad this time around, except for the headache. Everything seemed to slow down as the contractions spaced out to greater than 10 minutes apart, and I was comfortable. After several hours of just hanging out, Dr. Middle said, "well, looks like we've stopped things. We'll plan on discontinuing the mag at 11:30 tonight and monitoring you continuously, and we'll see what happens overnight and tomorrow." The baby was happy and not having any decels (drops in heart rate) with contractions, so we just waited.
At about 6:45, the contractions were still spaced out, about every 8 minutes, but they were a little stronger than before (about 3-4 out of 10 on the pain scale), so Dr. Middle wanted to check me. I was dilated to 7 cm with a bulging bag! This baby was definitely on his way. Since I was so far along, we'd continue watching and see how the baby was doing. The doctor warned me that I still may very likely need a c-section. Ideally I'd have a spinal for anesthesia, but it would have to be given lying down because sitting up would cause the baby to go off the monitor, and she wasn't willing to risk not seeing exactly how he was doing. If his heartbeat would drop and stay down, a very likely possibility given the state of my placenta and the unlikelihood of it handling strong contractions very well, there would be a "crash" c-section, and I'd get general anesthesia (put to sleep and intubated).
By a little after 7:00, the contractions were much stronger with each one increasing in intensity. Over the next 45 minutes or so, there were about six contractions that were nearly unbearable, and by the last one I wondered how it could possibly get any worse. {Aside: I know women have been having babies for thousands of years, so this is no big deal, but I had an epidural with my first one. With Jeremiah, I didn't fully appreciate the pain until the end of 2 hours of pushing after the epidural wore off}. Feeling lots of pressure, I had James get the doctor to check me. Dr. Middle walked in during a contraction and said, "NOW you're finally acting like a woman in labor!" I'll take that as a compliment. I think. Sure enough, I was completely dilated. The baby was right there just waiting to come out. It was about 7:55, and the NICU team rushed in; the doctor gowned up; the tech got the delivery table all ready; everyone was all set. I got the go ahead, and one little push later (barely even a push), we got to meet our tiny, crying baby. Let me tell you, it's A LOT easier pushing out a 2 pounder than it is an 8 pounder! Several hours later, I can also say the recovery is much nicer, too.
He was very "vigorous" with Apgar scores of 8 and 9. Apgar measures the baby's activity, pulse, appearance, grimace and respirations at one minute and five minutes after birth to assess his overall well being. 8 and 9 is awesome! He didn't even need to be intubated. Once he got to the NICU, he ended up needing CPAP, a mask on his face that forces air into his lungs, not a big deal. It's set at room air, so he hasn't required any extra oxygen.
If you are at all interested in the deal with my placenta, keep reading. Otherwise, stop here; we're done.
It turns out, during early development, a fluke thing happened and the umbilical cord attached into the edge of the placenta, right where all the hemorrhaging later occurred, instead of in the middle of the placenta, where it is usually found. That means the blood flow to the baby had to go through a lot of membranes to reach him rather than getting a straight shot from me to him. His umbilical cord was a super tiny string of a thing, so (as James says) it was almost like he was trying to suck air through a tiny little straw this whole time. The placenta was huge, and about 1/3 of it was a discolored, useless solid rock, where the hemorrhage was located. Poor little Joshua wasn't exactly living it up at the comfy Hilton as Jeremiah was when labor had to be induced at 41 weeks just to entice him to come out of his cush pad.
The first picture is our placenta. The second picture is a picture of a typical healthy placenta that I just pulled off the internet for comparison.
Thursday, March 1, 2012
Baby Today?
Hi everyone. James here. Karrn was rushed to labor and delivery. She is experiencing contractions every 3 minutes and her cervix is 5 cm dilated. Magnesium has been started as a neuro protectant for the baby. The next few hours will likely determine if she will continue to deliver vaginally vs. have a c-section vs. continue to wait as see......
We really appreciate all of your prayers and support. Stay tuned.
We really appreciate all of your prayers and support. Stay tuned.
Wednesday, February 29, 2012
Our Sassy Little (Very Little!) Guy
After such an eventful day on Monday, I'm happy to post a boring blog now. We had an ultrasound this morning that showed normal blood flow! There is no sign of absent flow today like there was the last two days. Basically, if our ultrasound looked like this two days ago, we wouldn't have been admitted (but I'm so thankful we were admitted for when the preterm labor scare happened). Since we found out things can take a turn for the worse very quickly, we plan to remain in the hospital until the baby is born.
It has been three weeks since the last growth scan, so we had another measurement today. We were hoping he'd be at least 2.5 lbs by now since we've had almost three weeks of good blood flow, but he's smaller than we thought. According to the ultrasound measurements, he's the size of an average 27 wk, 4 day baby: 2.0 lbs or 931 grams. If only we can get him greater than 1000 g...then he'd be out of the "extremely low birth weight" zone and into the "very low birth weight" range. Not that the title of the range matters, but it's a psychological thing for us, I guess. I'm just thankful he wasn't born two nights ago. Let's give him more time to grow. He is still on the growth chart (<3%), so that's reassuring. Just to give perspective, an average baby at 30 weeks should be about 3 lbs.
We had a long talk with Dr. "Buff" today. Through talking with the doctors, nurses, and techs, we have learned that his outlook is the most optimistic, but he's the quickest to cut (meaning it doesn't take as much to decide on a c-section). Dr. Pessimist is the most pessimistic overall, but she is more comfortable waiting a little before jumping to c-section (as is evident by how she let me relax the other night to see if that helped before rushing me to the OR). All three of the doctors feel a c-section will be days, and not weeks, away, but they'll keep watching and hold off as long as the baby looks good. He looks good now, but if there is any indication he gets stressed, or the blood flow reverses, or any other concerning signs pop up, they are going to have a low threshold for operating sooner rather than later. We have been so pleased with the care we've gotten. It has been nice getting opinions from all three of them. They are in agreement in the overall plan of care, but each one has a varying level of "sphincter tone," shall we say, over waiting vs operating. I don't envy them for the decisions they have to make! Since we trust them all fully, when any one of them is on duty and says it's time for a c-section, we won't argue one bit. All that being said, we are still shooting for 32 weeks. I have been told to stay NPO (not eating) every morning until after the ultrasound, so I'll be ready for a c-section each morning if anything looks concerning. I'm praying when the time comes, it'll be a relaxed, well thought out decision to head to the OR "sometime today" rather than a frantic stat c-section.
Here's a picture from 2 weeks ago of our little guy playing peek-a-boo. Actually, I think we missed the shot, but perhaps a few seconds before this, he had both thumbs in his ears, wiggling his fingers above his head, sticking his tongue out and saying, "nah nah nah nah, boo boo" to the medical world that thought he was going to be born 6 weeks ago. :) It looks like he has a big, fat arm, but I think some of that is overlapping placenta (it's also the white stuff in front of his hand).
It has been three weeks since the last growth scan, so we had another measurement today. We were hoping he'd be at least 2.5 lbs by now since we've had almost three weeks of good blood flow, but he's smaller than we thought. According to the ultrasound measurements, he's the size of an average 27 wk, 4 day baby: 2.0 lbs or 931 grams. If only we can get him greater than 1000 g...then he'd be out of the "extremely low birth weight" zone and into the "very low birth weight" range. Not that the title of the range matters, but it's a psychological thing for us, I guess. I'm just thankful he wasn't born two nights ago. Let's give him more time to grow. He is still on the growth chart (<3%), so that's reassuring. Just to give perspective, an average baby at 30 weeks should be about 3 lbs.
Here's a picture from 2 weeks ago of our little guy playing peek-a-boo. Actually, I think we missed the shot, but perhaps a few seconds before this, he had both thumbs in his ears, wiggling his fingers above his head, sticking his tongue out and saying, "nah nah nah nah, boo boo" to the medical world that thought he was going to be born 6 weeks ago. :) It looks like he has a big, fat arm, but I think some of that is overlapping placenta (it's also the white stuff in front of his hand).
Tuesday, February 28, 2012
ALMOST a Baby Announcement Today
Whew! Rough day yesterday. It wasn't pretty, but we made it another day, and I'm still pregnant (30 weeks + 1 day now). I started blogging twice yesterday, but each time things started to get worse, and I had to stop. Now that I'm feeling much better, I'll give a rundown, and I apologize up front for all of the medical jargon and the length.
We went in for the routine doppler ultrasound yesterday and found out the blood flow is worse. The absent end diastolic flow (stasis or momentary stoppage of flow with each heartbeat) has reared it's ugly head again. One umbilical artery had "persistent absent" where every beat is affected, and the other one had "intermittent absent" where some but not all beats are affected. This problem is the same as what was found on our initial ultrasound six weeks ago, but two rounds of steroids kept it at bay. The good thing is there is no reversal of flow, and the ductus venosus (in the baby's liver) has elevated pressure but no reversal. Those would be the next things to go bad as the disease progresses.
Dr. "Middle" (named because she is the middle of my three doctors on the optimist/pessimist scale) predicted I will probably deliver within 10 days, but it's hard to say. Given how our little guy has exceeded everyone's expectations so many times, I took that to mean we've got at least another 2-3 weeks pregnant. I got admitted back to the Women's Pavilion, where ladies on bed rest sit and wait to have their babies. The plan would be the same as my last admission: twice a day non stress tests (monitoring the baby's heartbeat) for an hour each time, and daily doppler ultrasounds (to check out blood flow) and daily biophysical profiles (to check out baby's tone, breathing, amniotic fluid level, etc). I sat back and relaxed and tried to enjoy my new view of the athletes training at the neighboring Olympic Training Center, imagining James working out there.
As I was nearing an hour on the monitor, the baby had several decels, or decelerations, where the heart rate drops. This was concerning enough to rush me over to Labor and Delivery to be close to the OR for a stat C-section if needed. They hooked me up to continuous monitoring, and then I started having contractions. They weren't bad, but they were regular, every three minutes.
Over the next four hours, the contractions continued every three minutes, and they got a lot stronger. The baby gradually started to tolerate them less and less, and he developed late decels, where the heart rate drops during and after each contraction, a sign of stress, and an indicator that he probably wouldn't tolerate contractions too much longer. I also started bleeding, and my cervix started dilating, which along with the regular, worsening contractions, indicated I appeared to be in labor. Most likely my placenta was abrupting more, causing the contractions. Great. Add one more issue to our laundry list of problems. Preterm labor.
Dr. Pessimist was on, and she said it was looking like the baby would be born within the next few hours, so she wanted to start me on magnesium. Mag is used for many things, but in my case it was to protect the baby's brain since he's still 10 weeks premature. It needs to be in my system for two hours before delivery to be effective. Given the issues with the blood flow, she didn't want to aggressively stop the labor because my body and the baby were trying to tell me the environment in there wasn't good. The plan was to keep watching closely and head to the OR if the baby became more stressed, or if I fully dilated, try to just "quick push that baby right out."
I was still outwardly calm, but I realized I was not at all mentally ready to have a baby. I started to worry about stupid things. For some reason, I was really concerned because I had left my camera at home. Then, totally uncharacteristic of me, I worried how bad I would look in that "new mom with a new baby" picture because I hadn't showered that day, and I realized 18 years from now that picture will probably be on display at his graduation open house. I know, silly, especially when I have gone a lot longer without bathing on hiking trips, and it has never bothered me, and I didn't have a camera anyway. In a stressful situation, you can't always control what nonsense runs through your head, and I tend to have a defense mechanism where I take my mind off the big issue at hand and think about something minor. It's easier to think of how my hair looks than to succumb to the overwhelming fear of how small our baby is right now, how he is still at risk of having a bleed on his brain as a preemie, etc.
Joshua 1:9 "Be strong and courageous. Do not be afraid; do not be discouraged, for the LORD your God will be with you wherever you go.”
Right about this time, James walked in the room, and I suddenly relaxed. He has that effect on me. He had been home with Jeremiah waiting for my mom and dad to get back to town after a well deserved weekend off in MN. He was on the phone with me all afternoon, and when Dr. P said "it looks like we're having a baby tonight," he called our friend Rachel from across the street, and she rushed over to relieve him until my parents arrived.
Dr. P asked if I wanted a narcotic for pain, but I said no, I was fine. When she said it might relax me more and slow the contractions down for the baby to get a little break, I jumped on it. So, loaded up with fentanyl and magnesium, I started down the road of drug induced stupor. Remind me never to become a drug addict! Ew, I sure didn't like that feeling. Fortunately, the baby liked it. Magnesium is a muscle relaxer, and one of the side effects can be to stop contractions. The contractions slowed down and then stopped during the night, and the baby's heart rate normalized with no decels. I stayed on the magnesium until mid morning today, feeling the continued side effects of being heavy headed with double vision, headache, sensitivity to light, and feeling like a train hit me with each limb feeling like it weighed a couple hundred pounds. Poor James must have been freezing all night since my room temperature was about 50 degrees because I was so flushed from the effects of the mag.
Several hours after stopping the magnisium, the side effects are finally feeling pretty much worn off, and I have only had a few irregular contractions today. The baby looked great all day on the monitor, so they recently transferred me back to the Women's Pavilion (WP). Back to where this all started. For some reason, when they first transferred me to L & D, I was concerned because it meant I'd have to put on a hospital gown (at the WP we can wear our own clothes and feel more like we're in a hotel than a hospital). Again, that defense mechanism thing. I quickly realized that was just the beginning, followed by an IV, foley catheter, medications, continuous monitoring for contractions and the baby's heartbeat, SCD's (pumps attached to my legs that periodically inflate to help prevent blood clots)...it was a far cry from sitting in my own clothes feeling like I was in a hotel! Now that the crisis has passed, I realize how UNimportant all of that is in the grand scheme of things.
God has, once again, proven to me that He is right here with his hands around this little guy in a huge embrace, and He isn't going to let him be born one day before He wants him to be. It's looking like that day will be sooner rather than later, but after yesterday's scare, I'm ready for it now, whenever it may be, so very appreciative of each day I feel this baby moving inside me.
Joshua 1:5 "...I will never leave you or forsake you."
We went in for the routine doppler ultrasound yesterday and found out the blood flow is worse. The absent end diastolic flow (stasis or momentary stoppage of flow with each heartbeat) has reared it's ugly head again. One umbilical artery had "persistent absent" where every beat is affected, and the other one had "intermittent absent" where some but not all beats are affected. This problem is the same as what was found on our initial ultrasound six weeks ago, but two rounds of steroids kept it at bay. The good thing is there is no reversal of flow, and the ductus venosus (in the baby's liver) has elevated pressure but no reversal. Those would be the next things to go bad as the disease progresses.
Dr. "Middle" (named because she is the middle of my three doctors on the optimist/pessimist scale) predicted I will probably deliver within 10 days, but it's hard to say. Given how our little guy has exceeded everyone's expectations so many times, I took that to mean we've got at least another 2-3 weeks pregnant. I got admitted back to the Women's Pavilion, where ladies on bed rest sit and wait to have their babies. The plan would be the same as my last admission: twice a day non stress tests (monitoring the baby's heartbeat) for an hour each time, and daily doppler ultrasounds (to check out blood flow) and daily biophysical profiles (to check out baby's tone, breathing, amniotic fluid level, etc). I sat back and relaxed and tried to enjoy my new view of the athletes training at the neighboring Olympic Training Center, imagining James working out there.
As I was nearing an hour on the monitor, the baby had several decels, or decelerations, where the heart rate drops. This was concerning enough to rush me over to Labor and Delivery to be close to the OR for a stat C-section if needed. They hooked me up to continuous monitoring, and then I started having contractions. They weren't bad, but they were regular, every three minutes.
Over the next four hours, the contractions continued every three minutes, and they got a lot stronger. The baby gradually started to tolerate them less and less, and he developed late decels, where the heart rate drops during and after each contraction, a sign of stress, and an indicator that he probably wouldn't tolerate contractions too much longer. I also started bleeding, and my cervix started dilating, which along with the regular, worsening contractions, indicated I appeared to be in labor. Most likely my placenta was abrupting more, causing the contractions. Great. Add one more issue to our laundry list of problems. Preterm labor.
Dr. Pessimist was on, and she said it was looking like the baby would be born within the next few hours, so she wanted to start me on magnesium. Mag is used for many things, but in my case it was to protect the baby's brain since he's still 10 weeks premature. It needs to be in my system for two hours before delivery to be effective. Given the issues with the blood flow, she didn't want to aggressively stop the labor because my body and the baby were trying to tell me the environment in there wasn't good. The plan was to keep watching closely and head to the OR if the baby became more stressed, or if I fully dilated, try to just "quick push that baby right out."
I was still outwardly calm, but I realized I was not at all mentally ready to have a baby. I started to worry about stupid things. For some reason, I was really concerned because I had left my camera at home. Then, totally uncharacteristic of me, I worried how bad I would look in that "new mom with a new baby" picture because I hadn't showered that day, and I realized 18 years from now that picture will probably be on display at his graduation open house. I know, silly, especially when I have gone a lot longer without bathing on hiking trips, and it has never bothered me, and I didn't have a camera anyway. In a stressful situation, you can't always control what nonsense runs through your head, and I tend to have a defense mechanism where I take my mind off the big issue at hand and think about something minor. It's easier to think of how my hair looks than to succumb to the overwhelming fear of how small our baby is right now, how he is still at risk of having a bleed on his brain as a preemie, etc.
Joshua 1:9 "Be strong and courageous. Do not be afraid; do not be discouraged, for the LORD your God will be with you wherever you go.”
Right about this time, James walked in the room, and I suddenly relaxed. He has that effect on me. He had been home with Jeremiah waiting for my mom and dad to get back to town after a well deserved weekend off in MN. He was on the phone with me all afternoon, and when Dr. P said "it looks like we're having a baby tonight," he called our friend Rachel from across the street, and she rushed over to relieve him until my parents arrived.
Dr. P asked if I wanted a narcotic for pain, but I said no, I was fine. When she said it might relax me more and slow the contractions down for the baby to get a little break, I jumped on it. So, loaded up with fentanyl and magnesium, I started down the road of drug induced stupor. Remind me never to become a drug addict! Ew, I sure didn't like that feeling. Fortunately, the baby liked it. Magnesium is a muscle relaxer, and one of the side effects can be to stop contractions. The contractions slowed down and then stopped during the night, and the baby's heart rate normalized with no decels. I stayed on the magnesium until mid morning today, feeling the continued side effects of being heavy headed with double vision, headache, sensitivity to light, and feeling like a train hit me with each limb feeling like it weighed a couple hundred pounds. Poor James must have been freezing all night since my room temperature was about 50 degrees because I was so flushed from the effects of the mag.
Several hours after stopping the magnisium, the side effects are finally feeling pretty much worn off, and I have only had a few irregular contractions today. The baby looked great all day on the monitor, so they recently transferred me back to the Women's Pavilion (WP). Back to where this all started. For some reason, when they first transferred me to L & D, I was concerned because it meant I'd have to put on a hospital gown (at the WP we can wear our own clothes and feel more like we're in a hotel than a hospital). Again, that defense mechanism thing. I quickly realized that was just the beginning, followed by an IV, foley catheter, medications, continuous monitoring for contractions and the baby's heartbeat, SCD's (pumps attached to my legs that periodically inflate to help prevent blood clots)...it was a far cry from sitting in my own clothes feeling like I was in a hotel! Now that the crisis has passed, I realize how UNimportant all of that is in the grand scheme of things.
God has, once again, proven to me that He is right here with his hands around this little guy in a huge embrace, and He isn't going to let him be born one day before He wants him to be. It's looking like that day will be sooner rather than later, but after yesterday's scare, I'm ready for it now, whenever it may be, so very appreciative of each day I feel this baby moving inside me.
Joshua 1:5 "...I will never leave you or forsake you."
Sunday, February 26, 2012
In His Time
Have you ever had one of those moments where God puts some unsuspecting person in your path to teach you a major life lesson when you least suspect it but most need it? I happened to me during my senior year of college. It was so many years ago, but I can picture it like it was yesterday. MY plan for my life was to go to college, then straight to medical school, then residency, then get married, have kids, and live happily ever after. God had a slightly different plan for me.
I was pretty confident in my medical school application, so I didn't make any back-up plan beside starting medical school the fall after I graduated from college. Well, it was spring, and I had received several rejection letters from admission committees. One by one, I was faced with a letdown. Finally, I got my last letter in the mail, and it was a disappointingly small envelope. Sure enough, it started with, "We regret to inform you..." I was at a total loss. Now what? God, how could you do this to me when I thought you made it so clear you wanted me to be a doctor? I felt so confused, not knowing what to do with my life, or at least the next year while I reapplied. It was a rough day as I tried to figure out my new plan, and I prayed for God to show me what to do, but I didn't hear Him. Where was He when I needed Him most? I was so frustrated.
That night, the phone rang. In my semi-depressed state, I almost let it go to voicemail, but I picked up at the last minute. It was Alma, the mother of my pastor's wife, someone who I barely knew but always respected. She had never called me before. She said, "I was just thinking of you, and I thought I'd call to see how you are doing." She had no idea about my rejection letter.
I told her about my rough day, and in tears, I said, "I feel like I'm driving down the freeway of life in my little Dodge Omni, and I'm stuck behind a semi." When I drive, I always like to be in front of cars if possible, so I can see the whole road. I went on to say, "I'm stuck behind this semi, and I can't see the road of life in front of me, and it's so frustrating not knowing where I'm going." That was the extent of my little word picture.
Well, Alma had a different perspective. She immediately said, "Karrn, have you considered what that semi represents? You think it's in your way and blocking your view, but that semi could be Jesus leading you down the road. Think about it. The semi knows where it's going. It's not going to go off the road. Even if it has to stop suddenly, your brakes will stop quicker than the semi's will, so you won't rear end it. It'll block the wind for you. Just sit back and draft off it. Rather than trying to move around it to pave your own path, let Jesus lead you where He wants you to go. This is all in His plan for your life." This is paraphrased, but I remember she said it so eloquently and heartfelt.
That was exactly what I needed to hear, and I know it wasn't just chance that Alma called when she did. God had a message He wanted to tell me, and that was how He did it. I ended up spending the next year having a blast and traveling the world as a flight attendant for Northwest Airlines. It quenched my thirst for adventure so that I was content to settle down and spend every night studying in the library the following year when I started back up in school and focus on the next several years of training without feeling like I was missing out on life.
A couple weeks after talking with Alma, I went on a spontaneous road trip to Colorado to see a friend graduate from the Air Force Academy. The pomp and circumstance of that ceremony made me realize I wanted to join the Air Force. I was able to successfully apply for the Air Force Health Professions Scholarship Program since I got accepted into school early the next fall, something that wouldn't have been possible the previous year with the spots filling up before spring time. I later met James during my residency at Eglin Air Force Base, and it makes me wonder how we would have met if I hadn't joined the military. It's amazing how, looking back, things seemed to have all fallen into place so perfectly, even though I thought it was the end of the world at that dark time when I thought God had left me. He was right there the whole time, perfectly orchestrating my future, just waiting for me to hand over the reins to Him.
A praise song from years ago comes to mind...
In His time. In His Time.
He makes all things beautiful in His time.
Lord, please show me everyday,
As you're teaching me your way,
That you do just what you say,
In your time.
In your time. In your time.
You make all things beautiful in your time.
Lord, my life to you I bring.
May each song I have to sing,
Be to you a lovely thing,
In your time.
I was pretty confident in my medical school application, so I didn't make any back-up plan beside starting medical school the fall after I graduated from college. Well, it was spring, and I had received several rejection letters from admission committees. One by one, I was faced with a letdown. Finally, I got my last letter in the mail, and it was a disappointingly small envelope. Sure enough, it started with, "We regret to inform you..." I was at a total loss. Now what? God, how could you do this to me when I thought you made it so clear you wanted me to be a doctor? I felt so confused, not knowing what to do with my life, or at least the next year while I reapplied. It was a rough day as I tried to figure out my new plan, and I prayed for God to show me what to do, but I didn't hear Him. Where was He when I needed Him most? I was so frustrated.
That night, the phone rang. In my semi-depressed state, I almost let it go to voicemail, but I picked up at the last minute. It was Alma, the mother of my pastor's wife, someone who I barely knew but always respected. She had never called me before. She said, "I was just thinking of you, and I thought I'd call to see how you are doing." She had no idea about my rejection letter.
I told her about my rough day, and in tears, I said, "I feel like I'm driving down the freeway of life in my little Dodge Omni, and I'm stuck behind a semi." When I drive, I always like to be in front of cars if possible, so I can see the whole road. I went on to say, "I'm stuck behind this semi, and I can't see the road of life in front of me, and it's so frustrating not knowing where I'm going." That was the extent of my little word picture.
Well, Alma had a different perspective. She immediately said, "Karrn, have you considered what that semi represents? You think it's in your way and blocking your view, but that semi could be Jesus leading you down the road. Think about it. The semi knows where it's going. It's not going to go off the road. Even if it has to stop suddenly, your brakes will stop quicker than the semi's will, so you won't rear end it. It'll block the wind for you. Just sit back and draft off it. Rather than trying to move around it to pave your own path, let Jesus lead you where He wants you to go. This is all in His plan for your life." This is paraphrased, but I remember she said it so eloquently and heartfelt.
That was exactly what I needed to hear, and I know it wasn't just chance that Alma called when she did. God had a message He wanted to tell me, and that was how He did it. I ended up spending the next year having a blast and traveling the world as a flight attendant for Northwest Airlines. It quenched my thirst for adventure so that I was content to settle down and spend every night studying in the library the following year when I started back up in school and focus on the next several years of training without feeling like I was missing out on life.
A couple weeks after talking with Alma, I went on a spontaneous road trip to Colorado to see a friend graduate from the Air Force Academy. The pomp and circumstance of that ceremony made me realize I wanted to join the Air Force. I was able to successfully apply for the Air Force Health Professions Scholarship Program since I got accepted into school early the next fall, something that wouldn't have been possible the previous year with the spots filling up before spring time. I later met James during my residency at Eglin Air Force Base, and it makes me wonder how we would have met if I hadn't joined the military. It's amazing how, looking back, things seemed to have all fallen into place so perfectly, even though I thought it was the end of the world at that dark time when I thought God had left me. He was right there the whole time, perfectly orchestrating my future, just waiting for me to hand over the reins to Him.
A praise song from years ago comes to mind...
In His time. In His Time.
He makes all things beautiful in His time.
Lord, please show me everyday,
As you're teaching me your way,
That you do just what you say,
In your time.
In your time. In your time.
You make all things beautiful in your time.
Lord, my life to you I bring.
May each song I have to sing,
Be to you a lovely thing,
In your time.
Friday, February 24, 2012
A Regular Good Day
I'm home again, settled in on the couch after another good report today. Writing this blog, I'm running out of creative ways to say "the blood flow looks good." Not that I'm complaining! The baby was moving like crazy, so the tech had a hard time even getting a good reading on the dopplers. That's a great problem to have. Today she was telling us about her other cases, that when the blood flow is really bad, the baby is just still and listless. This has definitely not been the case for our little Pele. Or should I say Richard Simmons? No, definitely someone more macho than Richard Simmons, but I sometimes wonder if he is doing Sweating to the Oldies in there, especially when he keeps both James and me up at night with all his kicking. I love that!
On another note...years ago, I wrote a story with a play by play of my first Ironman, including a little ditty about certain bodily functions. I think other triathletes appreciated it, but my mom was so embarrassed because it was TOO MUCH INFORMATION. Now, out of love and respect for my mom, I'm going to avoid any unnecessary details. But I can't resist sharing this story. Let's just say when you're lying down all day every day, certain things stop moving like they used to. That's where Miralax comes to the rescue. FYI, it's completely tasteless, so you can put it in any drink without realizing it's in there. Good stuff! Well, the other night, I noticed James kept making several trips to the bathroom, but I didn't think much of it. He wasn't looking too comfortable. Finally, it hit me that I never finished my water bottle full of Miralax, and I didn't know what happened to it. I asked James if he knew where it went, and the mystery was solved when he admitted he chugged it down after his workout, not knowing what was in it. I'm sorry to make yet another reference to the movie Dumb and Dumber, but if you're a fan, you know the scene I'm thinking of right now. Don't I have such a nice, selfless husband, willing to give me comic relief at any moment! Ha ha! Ya gotta love 'em!
On another note...years ago, I wrote a story with a play by play of my first Ironman, including a little ditty about certain bodily functions. I think other triathletes appreciated it, but my mom was so embarrassed because it was TOO MUCH INFORMATION. Now, out of love and respect for my mom, I'm going to avoid any unnecessary details. But I can't resist sharing this story. Let's just say when you're lying down all day every day, certain things stop moving like they used to. That's where Miralax comes to the rescue. FYI, it's completely tasteless, so you can put it in any drink without realizing it's in there. Good stuff! Well, the other night, I noticed James kept making several trips to the bathroom, but I didn't think much of it. He wasn't looking too comfortable. Finally, it hit me that I never finished my water bottle full of Miralax, and I didn't know what happened to it. I asked James if he knew where it went, and the mystery was solved when he admitted he chugged it down after his workout, not knowing what was in it. I'm sorry to make yet another reference to the movie Dumb and Dumber, but if you're a fan, you know the scene I'm thinking of right now. Don't I have such a nice, selfless husband, willing to give me comic relief at any moment! Ha ha! Ya gotta love 'em!
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