Thursday, June 17, 2010
The friend who was going to watch the kids for us this morning called last night and her sweet little family just got hit with a vicious bout of the flu so James stayed home with the older kids and I ran over to see Timmy and see what information I could glean on the upcoming extubation. I left a note with Holly last night that I wanted to be there and asked if they could call me before they were going to pull the tube out. I hadn't received a call so I was hoping I hadn't been forgotten.
And I was not. In fact, I made it to the NICU around 9:15 this morning and only waited about 5 minutes before Dana and I were called out for rounds. Melissa was conducting (so going to miss her next month. I love having her be the resident on!) and got right down to business.
The surgeons cleared Timmy for full breastmilk tomorrow - hooray! I'm just going to keep my fingers crossed and not count chickens for a few days. So hope he can continue to tolerate feeds well and not need any more formula. As of this morning, he was at 39ml feeds. I asked about the sudden increased goal for feeds and Melissa said they just hadn't weight-adjusted in a few days.
Timmy received his second dose of steroids at 6:00am and extubation was planned for after rounds. I asked if I could be there and the doctors were all in favor. Dr. Bedrick is back on as attending and Andrea Saugstad is the current neonatal nurse practitioner. I really like both of them as well and was so excited to have the three of them there the day of Timmy's extubation.
Timmy's ophthalmic exam, which had been scheduled for Tuesday but didn't take place until yesterday, came back looking normal. Timmy will have another follow-up in another 10 days or so. Previously, his zones 2 and 3 (not sure where each is located precisely) were avascular and warranted following. Now zone 2 is the one to watch. Dr. Bedrick explained to me that it's all looking normal, they just want to make sure Timmy's eyes continue that way. Sometimes as the muscles and vasculature of the eye develop, they will pull or put strain on the eyes. But so far, so good. Thank heaven for small favors!
Dr. Bedrick also talked a little about the extubation. We are all pleased with the vent settings, but he has been close to being that low before so I asked what they thought was going to make the difference in Timmy wanting to work harder to take the deeper breaths that would allow him to stay off the ventilator. Definitely the steroids reducing inflammation and he's growing and getting stronger, but if he wasn't willing to inhale deeply before, why would he now? From the vent settings, and previous extubation attempts, the lungs looked perfect. Dr. Bedrick said that he may have just needed another week to grow but there was also the possibility of swelling around the vocal cords creating a stenosis or some other form of constriction that was narrowing the upper airways. He asked if we had witnessed any stridor - a high-pitched wheezing sound indicating an obstruction - on previous intubation attempts and Melissa shook her head no. Definitely a good sign.
By the time I finished pumping after that, Timmy was due for his 11:00 cares and then there wasn't time for holding, but I was planning on returning for the extubation so that was okay.
Just to tell you how giddily excited I was to have my baby finally off the ventilator, I washed my hands with lotion when I got home!
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