Curry in a hurry [DOH]

I picked up Dylan and took him to lunch at Curry House in Cupertino. We both ordered exactly what we shouldn't be eating these days - Me: masala curry chicken with a huge plate of Japanese rice sprinkled with some seaweed flakes; Dylan: plate of plain spaghetti noodles w/ tons of Parmesan and french fries. Anyhow, we were just about to chow down like gluttons when Jen called. "Good news! Jared went from oscillator to ventillator to CPAP in the last 24 hours. Blake is off the CPAP and doesn't need the canula. Come to the hospital and you can hold Blake while I hold Jared." Wow - these twins are kicking serious butt in week 2 (technically week 33). Dylan and I toasted each other and inhaled our carbs and lard.

I dropped Dylan at Tammie's then went to the NICU. The nurse wanted me to take Blake's temperature (fail!) and change his diaper (I'm a pro) before I got to hold him. Then she placed him in my arms and what can I say, it was pretty special. Blake on the other hand wasn't having me at first - turned all red and dare I say alien-like. After a couple seconds though he calmed down and slept on my chest for an hour - pure loveliness. I gotta say though that these guys are small and even though I've got experience holding newborns I still have that first-time parent trepidation because of their size.


Jared looks exactly like Blake did yesterday because he's wearing the same hat and mask for the CPAP. He's foaming at the mouth from the CPAP just like Blake did too. The nurse said, "they're doing really well now!" I told her that we are grateful for everyones efforts at the NICU.

Yesterday I read that 40,000 preemies with Respiratory Distress Syndrome (RDS) used to die every year (?) in the United States. But because of advancements in medical science in the last few years / decades over 85% of them survive now.

The description of RDS was chilling too - basically the baby comes out of the womb, breathes in and exhales. But since the lungs are immature there is no residual air left in the lungs - it's a complete exhale. The repetition of completely exhaling can exhaust the baby within minutes. In addition, the little sacks that would normally hold residual air collapse and stick together making it progressively harder to breathe. This is when the blood oxygen / CO2 levels start to get all crazy. The blood becomes acidic which constricts the blood vessels in the lungs... etc. etc.. - it's really a crazy downward spiral and the only reason I recount it is so I can better understand the last week. We really had (still do) a piecemeal understanding of what was going on...

Diaper Day

Today's visit was low-key. Both guys were sleeping very contently when we arrived at the hospital so we didn't want to bother them too much.  Blake is doing well on his CPAP and they think he will move up to the nasal canula breathing machine very soon.  Jared moved to the regular ventilator. They are going to remove his umbilical arterial since we are pushing 2 weeks and insert a peripheral arterial so they can continue blood gas measurements.

As I was about to leave, the nurse asked if I wanted to change Blake's diaper.  Another milestone!  Although I was successful at removing the dirty diaper, I wasn't so smooth in getting the new one on.  I'm still very cautious and not confident in handling these little guys.  It's going to take some practice.

Dave thinks they have his nose.  I disagree, but you know these things change all the time the first few years.

Alright nighty nite.

Hold Em

David and I took his mom for her first time to visit the twins at the NICU. To my surprise, the nurses asked if I would like to hold Blake?? "I'm scared," I said. "I think he would really like it," they replied. They disconnected all his wires and wheeled his CPAP oxygen machine closer to me and I held my baby for about 45 minutes. He slept peacefully and stirred just a bit. I was able to give him a pacifier which he absolutely loved. So tiny, so precious, so fragile but at the same time strong! It takes strength to endure everything they've gone through in the past 10 days.

It was a wonderful, unexpected milestone. Of course this is the only day we didn't bring our camera so here are pics from David's iPhone.





As far as updates, both are doing as good as can be, finally starting to kick the wicked nasty virus.

Jared will go from 2 lasic? doses to 1 lasic dose a day to decrease the fluid his body retained. He's currently being fed my milk by a dropper in the cheek but will start taking a 2ml every 6 hrs through the feeding tube directly to the stomache like his brother.

Blake had a xray and his collapsed lobe in his right lung is looking much better but he will continue his mist treatment for another day or so. His feedings are going well.

Steps Forward

Blake ripped off his ventilator tube today. That was a sign for the doctors that he's ready to come off of it. Now he's using a CPAP which gives oxygen and makes it easier for him to breathe but does not breathe for him. Doc said that's a big step for him, but doesn't mean that he won't go back on the vent. Sometimes premies don't have the rib / chest cavity muscles to breathe on their own for a long time. They can get tired the nurses told me and have to work up to it. Everything else with him is the same. He got another transfusion today.



Jared is still on the oscillator but off his blood pressure medicine completely for now. That's progress too though it'd be great if he could get off the oscillator. He's looking a bit bloated and jaundiced. Lasic (?), the diuretic should help that. They gave him some tummy time today. I can tell he hates that big rigid tube sticking into his mouth and into his trachea...

I can tell we'll be spending lots more time at the NICU once J & B get a little more solid. I got to touch Jared's head yesterday and hold Blake's pacifier in today. So fun.

Update Monday 2/23

We went to the NICU around 10:30am when Dylan was at preschool. This was Jen's first time back since being discharged. I'm sure the boys were happy to hear Jen's voice. We met with the social worker that gave us a good overview of what to expect in general with premies - lots of two steps forward one step back. She also gave us a load of good reading. Then we met with the doctor and he gave us our semi-daily update...

• Jared is still on the oscillator - they had to turn the settings up a bit. They lowered his dopamine level from 10 to 8. This means his blood pressure is doing a bit better. Chest x-rays still cloudy. He's still being given the diuretic to get some of the fluid out of his body. They don't know when he'll be off the oscillator... could be days could be weeks. His infection was more severe than Blake's. They put some ear muffs over his ears so he's not so bothered by the sound of the oscillator... pretty cute - I should take a picture.
  
• Blake is doing a bit better. However, a chest x-ray revealed that the upper lobe of his right lung is collapsed. They started some drug that's the more dilute cousin of the drug they give people with asthma to get the crud out (technical term). By the end of the night the drug seemed to be somewhat effective.. they'll continue this till the condition resolves. The ventilator settings are coming down so he's doing more breathing on his own. He's also on the diuretic and so looks less bloated today. The nurse says that "he's doing pretty well... and should tell his brother Jared how its done." The nurses are cool.
  
• Both will need to get a peripheral arterial (???) put in... which is a quick way to draw blood for the numerous blood tests they both receive when monitoring there blood gases - they've been using an umbilical arterial but it gets all gross as the umbilical cord dries up... both are anemic and are getting blood transfusions... both need to start some feeding when they're 10 to 14 days old. Blake's getting some drops of Jen's milk in his mouth to stimulate enzymes and prime the gut (technical term). Jared needs to get off his oscillator before this can happen. Go Jared Go!
  
• There's a couple of other things but I need to start bringing a notepad to write down everything the doctors say - its a lot to take in. We're starting to get to know the different personalities of the doctors and nurses. Some love to talk... some can't tone down the jargon... some are more serious.
  

That's it for today.

Roller Coaster Ride

Looking back I feel so naïve. When Jared and Blake were first born everything seemed normal and fine. They were typical 31 and a half week old preemies that would just live and be cared for at the NICU until they reached their full term until we could bring them home. Little did I know that we were just boarding the wild NICU roller coaster ride.

The first 48 hours seemed pretty normal for the twins. Dave had to sign some consent forms to have an umbilical catheter type of device put in. They would administer a steroid to help the twins with lung development.

48 hrs after the birth more complications began. Here’s a list summarizing the issues the twins have or are dealing with this first week:

• Respiratory issues started first. Both of the twins had to go on ventilators. Their lungs were not only premature, but they were dealing with a bacterial or viral infection (most likely my flu).  The x-rays a week into it are still cloudy.
• Received antibiotics in case infection was bacterial
  
• Blood pressure issues. Both guys were given dopamine to regulate their blood pressure. Additionally they were give a blood transfusion to boost blood pressure and replenish blood levels. Additionally after that they were given fresh frozen plasma to stabilize their blood pressure. Jared is still dealing with blood pressure issues
  
• High Levels of CO2 – related respiratory issue, both guys are switched to oscillators that helps them take 100 quick short breaths per minute instead of normal breaths 
  
• Jaundice. Both have jaundice and are being treated with phototherapy. 
  
• Echocardiogram confirmed PDA (Patent Ductus Arteriosus) – a duct in the heart that doesn’t close which is the most common heart disease for premies. Medicine was administered that helps the duct close. Jared’s opening closed after 1 round of medicine. Blake had 2 rounds of medicine and his has closed considerably but not fully. However, the doctor doesn’t feel surgery is needed at this time.
  
• Fluid problems - Blake is retaining his fluids causing him to appear a bit bloated. They are giving him a diuretic.  It's hard to find the balance w/ everything else going on.

At this point in time Blake is off the oscillator and the dopamine.  His blood pressure is fine and he is on the ventilator until his lungs improve.

Jared went off the oscillator to the ventilator but had to go back on it. His blood pressure is still problematic. 

So at this point our expectations for the 5-7 weeks Jared and Blake will stay in the NICU are more sobered. We anticipate hiccups and more challenges but hope for them to progress overall.  We just have to wait and give them more time to recover.  It pains us to see them in this condition at the start of their lives and accordingly will be spoiling them rotten when they come home!

Jared and Blake Have Landed

The twins were born one week ago today! I can’t really say if the first week has gone by slow or fast cause I feel somewhat frozen in time. It’s definitely been a busy week, so much has happened and our lives are forever changed…

First things first – our birth story. I contracted some nasty upper respiratory flu/sore throat bug Tuesday, Feb. 10th and was pretty much bedridden with a fever and chills for 3 days. I can’t tell you how many times I coughed and blew my nose. I must have used at least 1 roll of toilet paper a day. This is the worst flu I’d ever experienced and of course, I happened to be carrying twins. My poor body! My poor babies! By Friday, Feb 13th the flu wasn’t letting up and my body just said ‘no more’. Jared wasn’t having it either – he wanted out! I went to bed at 10pm and then 15 minutes later my water broke. Houston, we got a big problem!! Jared had ruptured his sack in protest of the flu.

I went to the bathroom and of course Dave was geeking out online. I said “I think my water broke.” His face turned pale – his laptop couldn’t help us now. I called my doctor, he said to go to the hospital to have it checked out. Dylan was sleeping – sick with the flu from hell too. We called our neighbor to baby sit – thank god she was home. She hurried over and soon we were on our way to El Camino Hospital – no birth plan, no suitcase, no camera, no nothing. The drive over felt like the “calm before the storm” though it was storming heavily outside.

We got to El Camino Labor and Delivery around 10:30pm. They set us up in the private room and made us wait. We watched some crappy TV. They said that it was a busy night – tons of deliveries, seems to happen with the stormy weather and Friday the 13ths.

11pm or so the nurse comes in and does a check. “Yep. You’re water broke.” She then goes on to tell us that the sack is only ruptured and that they have drugs that can forestall labor. She thinks I’ll just have to stay in the hospital for 2 weeks or so till I deliver. We start to feel relieved – 2 more weeks would mean 34 weeks. The twins would be pretty close to full term by then. Big sigh of relief. We call Dave’s brother to come down to relieve the baby sitter.

Next, I get an IV line and my doctor shows up. He says that the plan is to administer steroids to develop the babies lungs and give me drugs to stop the contractions. He hopes we can get 48 hours until delivery. Whoa, that’s a lot less than 2 weeks but still 48 hours would give us some time. At first the medicine seemed to work, the contractions were slowing down and weakening. Dave went home to take care of Dylan because he’d been waking up in the middle of the night from being sick.

For about 3-4 hours (after midnight), I thought we’d be okay. My doctor had just left my bedside and said he’d check back in a few hours. Then all of a sudden, the contractions started to creep back and became stronger and then more frequent. Within a matter of hour or so, I was in excruciating pain asking for pain relief. The nurse checked me out and I was 6cm dilated. They paged my doctor back to the hospital. The twins were coming out and there was nothing anyone could do about it. Epidural!!! I call Dave at 5:45am… he’s groggy but wakes up in an instant when I tell him its show time.

Dave gets to the hospital and within the hour I’m fully dilated. They wheel me into cesarean room just in case. It’s a madhouse… there are 10 people in the room – 6 NICU people (3 per baby), 2 nurses, an anesthesiologist and my doctor. It’s the complete opposite of when we delivered Dylan, where it was mainly one nurse and Dave.

The delivery goes smoothly. I push Jared out. They show him to me and then wheel him off to the NICU. 15 minutes later I push Blake out and they wheel him to the NICU too. The only speed bumps during the delivery were when my doctors cell phone rang and he wanted the nurse to try to help him answer it (Ladies and Gentlemen please power down your cell phones!) and dealing with the placenta afterwards.  Without going into too much detail, it was something out of an Aliens movie.  I’d rather forget.

An hour later, I’m eating bacon and eggs in the recovery room. Whoohoo! I’m also still fluish – boohoo! Dave goes to the NICU to check on Jared and Blake. My legs finally stop shaking from the adrenaline and the epidural. Quite an 11 hours we just had.