ex machina
the eric update - day 81: puzzling puzzle pieces
it's over 24 hours after ROP surgery and he's looking better as his eye swelling has gone down. but whether or not he's actually feeling better is something else entirely. he's not eating well and he's not keeping down what he does eat. he could just be feeling crappy after his surgery or something worse could be going on. we'll hopefully know more over the next 48 hours.
he, himself once told us that practicing neonatology is like putting together a puzzle that has pieces that can be put together in several different ways - all of which might look right, but only one of which feels right. right now, we're having a tough time finding the way to put the pieces together in a way that looks and feels right, while simultaneously dealing with his new staff who don't have the benefit of having seen him every single day for the past 11 weeks.
he's continued his weight gains, after putting on 2 ounces a few days ago. he's gained over 100 grams since his surgery alone and is now tipping the scales at a whopping 2180 grams or 4 pounds 13 ounces. as i've said before rapid weight gain is something you don't often want to see in micropreemies. his white blood count differentials are different than we're used to seeing at saint mary's ( slightly higher white blood count, and a slight increase in his bands ), but not enought to raise any immediate red flags. after a few days of having his plummeting platelets start to rise back to safe levels, they're dropping again for no apparent reason. he's starting to throw a few apneas after weeks of nary an alarm.
and perhaps most disturbingly, after weeks of being a great feeder, he's having problems taking a bottle. everyone expected eric to be back on full bottle feeds at this point, but he's still being fed via an intravenous line and having a difficult time drinking even 20 cc's of milk. and even if he does drink from the bottle, he'll eventually puke it back up. mind you, it's not the "normal" micropreemie refluxing that we've seen from time to time, but actual somewhat forceful puking.
every single one of the puzzle pieces can be used to put together a picture that looks benign and his new caregivers aren't particularly concerned about his overall health. his weight gain can simply be seen as a few days of gains on the high end of what they'd like to see. all of the changes in his lab results could simply be due to the fact that they're being done in a different lab. he could still be tired from the surgery, and forgetting to breath a few times is not too unusual. and maybe, just maybe, he really does just have an upset stomach for no reason other than the fact that he feels like crap after surgery.
but we've learned to not take one single thing for granted and we'll be watching him quite closely over the next few days.
9/23/2004 11:44:00 PM
11 comments
11 Comments:
It seems as soon as you get over on hurdle, you come to another huh? You and yours are in our thoughts daily. Good luck, we're keeping our fingers crossed that it is just the surgery.
I am going to assume that the surgery and ketamine are making him feel lethergic with an upset tummy. I'm willing to bet that the difference in lab results is also subtle differences in lab techniques. But, it sure doesn't make you feel much better until you know that he is feeling like himself again. Keep a close on the boy - and I know you are - and we are all praying that he will feeling fine and hungry soon. I'm sure that any of us would feel under the weather too. So, I will have faith that this is the normal course of recovery - and there should be a big difference in the next few days. Know that we are thinking of all 3 of you constantly. Love, Mom
By 
, at
3:14 PM
Oh, I forgot to tell you that Nana got a huge headache and was very sick to her stomach the day after laser surgery on her retina. But, it didn't last more than a day or so. So, again, I'm thinking this is normal post surgery upset. 24 hours should make a big difference in getting the anesthesia out of his system. Hang in there. Love, Mom
By , at
3:20 PM
I was sick as a dog following some surgeries that I underwent back in high school. Couldn't even keep water down for a while. It was, apparently, just a bad reaction to the anesthesia. I hope his trouble is nothing more than that.
Now that the procedure is done, is there no way to get him transferred back to his previous Nicu?
I hope it's nothing but typical nausea, lack of appetite and wooziness that sometimes happens after surgery, but you're right to keep a watchful eye. Any parent would be overly cautious in a situation like this. We are keeping you in our thoughts.
C
By , at
5:40 PM
in theory they could transfer him back to his old nicu ( and it's what we'd really, really, really like to have happen ), but in practice it never happens for liability reasons. we certainly asked about the possibility. things are quite a bit different around here, not least of which being that he keeps getting "fresh outs" from the local community college taking care of him who refer to him as looking "punk'd" or sick. i'm not making that up.
it's sort of like watching sausage getting made - the end result might be the same in the two nicus ( most of the time kids go home, sooner or later ), but around here it's not really pleasant to watch the process.
after i left at 4 a.m. ( yes, a.m. ) they stopped his feedings because of the puking. but he's back to taking the bottles and not puking per se.
but he his spitting up what appears to be yellowish, greenish fluid which could be just boogery breastmilk or might be an early sign of necrotizing entercolitis ( gut infection ).
after forcing his nurse to actually come over and look at the spit up before it dried, she agreed it was a bit greeny, yellow and without missing a beat she casually said, "but he has to do that twice before we get concerned."
so i guess we'll sit around and see if that second time actually happens.
Oh how frustrating! It must be such a tough adjustment to move from a place where Eric's been known and loed since his birth to this larger NICU where you don't know anybody and it's all so new.
*Sigh* I can't even begin to understand how frustrating it must be to suspect something's going on and just being told to sit around and wait it out.
Hopefully, it's nothing more than a nasty case of nausea due to the narcotics.
This prob isn't comforting, but my husband is a wildlife ecologist and has used Ketamine in the past to immobilize big game (Moose, Deer, etc). He says that even animals that large tend to have residual effects from the stuff for a few days after (they're monitored for 3 days post sedation). I can't even imagine what it must be doing to your little guy's system. It's pretty powerful stuff.
Poor little man. Many prayers coming your way.
By , at
7:56 PM
phew. finally eric gets night nurse with more than 6 months of experience. i'm exaggerating for effect b.t.w., there are over a hundred nurses in this nicu ( one of the nurses commented that you could work for years and not meet all of the nurses. comforting )and many of them have more than 6 months experience. we just haven't had many of them yet.
How sad am I? We are on vacation, and I had to log in to get my E4 fix... Pins and needles, I tell you - pins and needles!
I would have to agree that this is the affect of surgery, the meds, anesthsia - everything! Just think back to when/if you were ever put under for surgery and how you felt in the days that followed. Now, try being a preemie ;)
Of course he is always in my thoughts, but I'm sure he'll be back to wooing us all in no time :) In the meantime, he's just saying - "I'm tired, and I have a booboo" :)
I've been thinking of you and little Eric.. I hope he's back to feeding soon, and that the throwing up is nothing but a side effect from the medication.
I know that my experience is nothing like a micropreemies, but I had ketamine once for a complicated oral surgery, and I felt horrible for 4 days afterwards. I've had surgeries with just versed and a painkiller and I've been back in action the next day. Whatever that is worth, I'm not sure if I can even compare a grown adult to a micropreemie.
In any case, I had my heart set on sending you guys the Glow Worm on your registry for the baby shower, but I slacked off and someone snagged it. There isn't a chance you'll be needing another one, is there? ;)
stacy
goodwillstacy.com
Oh and just wanted to let you know, that picture of Eric and the neonatologist is just beautiful! :)
By , at
1:33 AM
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