Wow, three weeks...it has sort of flown by, but in some ways still has been like an eternity for us. His September due date (hopefully around the time he will come home)...seems like a year away at this point. I was joking with the attending physician today that Evan will be walking by the time he decides to come off the respirator!
I had a good talk with the new attending physician (Dr. Cahan)...she told me the steroid treatment hasn't been normalizing his CO2 levels as she had hoped. He's had really good results on his blood gas lab results, then they'll adjust (turn down) his respirator settings, but then his next lab results will show that they need to turn the respirator settings back up. She is planning on finishing this course of steroids on Sunday, and maybe starting another course of small doses if he still doesn't show the results they are looking for. She is thinking of maybe testing him and putting him on the regular respirator in a few days. She doesn't want to be too hasty in doing that since she doesn't want to risk his lungs deflating. They are attributing his slow weaning to that darn pulmonary hemorrhage he had during that first week he was admitted.
The doctor said no change to the IVH conditions I posted about earlier. That's good news...no change is good. His chest x-ray was also looking fine. His primary nurse Marianne was working today and she has figured out why he seems to be so fussy at times. Normally, the nurses will only suction his lungs about every 4-6 hours. Marianne found that when he starts getting fussy, he needs suctioned...about every hour. He calms right back down after she does it. They are feeding him 1 ml every three hours now, so he is tolerating the breast milk.
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UMC Charges: $6,591.05
Running Total: $207,160.84
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Showing posts with label steroid treatment. Show all posts
Showing posts with label steroid treatment. Show all posts
Friday, August 04, 2006
Wednesday, August 02, 2006
8/1/06: Day 18 (Tues.) PIC Line Adjustment
If only there was a way to put the car on auto-pilot for that drive to Tucson! I have co-workers who do the drive every day and I don't know how they stay sane!
So, the visit was good, no major improvements from his condition yesterday. He was much more calm than yesterday when I got there, so I didn't do much but watch him through the incubator. I didn't want to take the chance of getting him fussy.
The one odd thing the nurse told me was earlier in the day his heart rate kept dipping lower thasn usual (below 100 and then it would jump into the 140s). They thought maybe it had to do with that PIC line; that maybe it slipped in too far and was tickling a part of his heart. They x-rayed him and I think they did adjust the line a bit.
He is still on the course of steroids for the next few days, so I don't think we'll know if they helped until the weekend. They only check his blood gases every 12 hours, so that is a good thing, showing his levels are getting normal. He is still getting minute doses of breast milk every 8 hours, so he was due for a "feeding" at 9pm last night.
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UMC Charges: $7,302.60
Running Total: $186,829.49
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So, the visit was good, no major improvements from his condition yesterday. He was much more calm than yesterday when I got there, so I didn't do much but watch him through the incubator. I didn't want to take the chance of getting him fussy.
The one odd thing the nurse told me was earlier in the day his heart rate kept dipping lower thasn usual (below 100 and then it would jump into the 140s). They thought maybe it had to do with that PIC line; that maybe it slipped in too far and was tickling a part of his heart. They x-rayed him and I think they did adjust the line a bit.
He is still on the course of steroids for the next few days, so I don't think we'll know if they helped until the weekend. They only check his blood gases every 12 hours, so that is a good thing, showing his levels are getting normal. He is still getting minute doses of breast milk every 8 hours, so he was due for a "feeding" at 9pm last night.
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UMC Charges: $7,302.60
Running Total: $186,829.49
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Monday, July 31, 2006
7/31/06: Day 17 (Mon.) PDA is Healed!
Some good news today...they did Evan's chest ultrasound and it showed that his PDA is all healed. No PDA ligation surgery, yea! We had the opportunity to talk to Dr. Edde while we were there and she was pleased to give us the good news. She is considering starting a mild steroid treatment in hopes of giving him a little push to wean off the respirator. I think she had said this was her last day as the attending physician, so I think she was going to confer with the oncoming attending physician to be sure of the treatment plan.
Evan was so nice and calm when we first got there, but then, turned into mister fussy again. T and I watched him like a hawk since he was flailing his arms around (we were worried he would dislodge the respirator tube). It seems like every time they give him his dosage of Ativan, he gets really agitated. It was sad watching his little face grimace like he was trying to cry. It was like he was really trying to get that tube out. One of the nurses put a little bit of this sugar-water mix on his lips...she says that the mixture causes the brain to release endorphins (sort of like when you eat chocolate). He did start calming down a bit afterwards.
<12:05am>
O.k....the steroid treatment is a go! He'll be on a course of steroids for the next week (3 times a day, with the next three days being the highest dosages). His night nurse said he's been very calm (he hasn't pulled out his respirator tube thank goodness). Fingers crossed this will get him off the respirator! The nurse also said they started feeding him breast milk again (very small doses for now).
I'm driving up solo tomorrow so I can spend a bit more time with him.
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UMC Charges: $8,276.25
Running Total: $179,526.89
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Evan was so nice and calm when we first got there, but then, turned into mister fussy again. T and I watched him like a hawk since he was flailing his arms around (we were worried he would dislodge the respirator tube). It seems like every time they give him his dosage of Ativan, he gets really agitated. It was sad watching his little face grimace like he was trying to cry. It was like he was really trying to get that tube out. One of the nurses put a little bit of this sugar-water mix on his lips...she says that the mixture causes the brain to release endorphins (sort of like when you eat chocolate). He did start calming down a bit afterwards.
<12:05am>
O.k....the steroid treatment is a go! He'll be on a course of steroids for the next week (3 times a day, with the next three days being the highest dosages). His night nurse said he's been very calm (he hasn't pulled out his respirator tube thank goodness). Fingers crossed this will get him off the respirator! The nurse also said they started feeding him breast milk again (very small doses for now).
I'm driving up solo tomorrow so I can spend a bit more time with him.
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UMC Charges: $8,276.25
Running Total: $179,526.89
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Friday, July 28, 2006
7/28/06: Day 14 (Fri.) Two Weeks Old! PDA Diagnosed
Today we took a break and didn't drive up to Tucson. When I called the NICU to get an update on Evan, the nurse told me she was going to have the resident doctor (Andrea) call to discuss the results of an EKG they did. Andrea called me back about 30 minutes after I had called and told me the results of the EKG weren't in the computer yet. She did say that Dr. Eddy (who is the main doctor) would speak with us on Saturday about starting steroid treatment on Evan to help wean him off the respirator. There are good and bad points of using steroids, but the benefits far outweigh the risks. The one big risk is that steroids supress the immune system which can make him prone to infection. The benefit would be that steroids cut down on the lung inflammation, which would help him breathe easier.
The rest of the call went well...nothing else major to report about. About thirty minutes later, the phone rings again and it's the NICU. Andrea was calling again to tell me she saw the results of the EKG. She said that the EKG shows that Evan has a PDA, which stands for Patent Ductus Arteriosus (it sounds like a Harry Potter spell to me). :-) It is a very common condition that the majority of preemies get. Not to get too medical technical on you, it basically means, a blood vessel near his heart and lungs did not close as it is supposed to do after birth. When a baby is still in the womb, that blood vessel sends blood directly into the aorta (bypassing the lungs which aren't being used yet). When a term baby is born and starts breathing, the PDA starts to close automatically. Since Evan wasn't born at term and didn't start breathing normally, his PDA didn't get that signal to close. Andrea says that almost 80% of the babies in the NICU have PDA, so he's not alone.
So, treatment is for him to get doses of indomethacin over the next few days (the only drawback is that this medication works best if the baby is within 2 weeks of birth and Evan is right on that time limit). If that medication doesn't close the PDA, then he will have to have surgery to close it. The PDA ligation surgery (if he has to have it), is a very safe operation and is always successful. They would go through his back (so it's not open-heart) and the result would be a very small scar that would fade over time. So, fingers crossed the medication works, but if he has to have surgery, it's not anything to worry about.
So now, with that second phone call, the steroid treatment is on hold since the PDA treatment takes priority. The PDA could also be contributing to Evan not coming off the respirator more quickly, so we'll be glad to get that cleared up. After the PDA heals, he may not need the steroid treatment anyway.
We'll get more details tomorrow after our visit.
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UMC Charges: $9,825.95
Running Total: $155,329.44
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The rest of the call went well...nothing else major to report about. About thirty minutes later, the phone rings again and it's the NICU. Andrea was calling again to tell me she saw the results of the EKG. She said that the EKG shows that Evan has a PDA, which stands for Patent Ductus Arteriosus (it sounds like a Harry Potter spell to me). :-) It is a very common condition that the majority of preemies get. Not to get too medical technical on you, it basically means, a blood vessel near his heart and lungs did not close as it is supposed to do after birth. When a baby is still in the womb, that blood vessel sends blood directly into the aorta (bypassing the lungs which aren't being used yet). When a term baby is born and starts breathing, the PDA starts to close automatically. Since Evan wasn't born at term and didn't start breathing normally, his PDA didn't get that signal to close. Andrea says that almost 80% of the babies in the NICU have PDA, so he's not alone.
So, treatment is for him to get doses of indomethacin over the next few days (the only drawback is that this medication works best if the baby is within 2 weeks of birth and Evan is right on that time limit). If that medication doesn't close the PDA, then he will have to have surgery to close it. The PDA ligation surgery (if he has to have it), is a very safe operation and is always successful. They would go through his back (so it's not open-heart) and the result would be a very small scar that would fade over time. So, fingers crossed the medication works, but if he has to have surgery, it's not anything to worry about.
So now, with that second phone call, the steroid treatment is on hold since the PDA treatment takes priority. The PDA could also be contributing to Evan not coming off the respirator more quickly, so we'll be glad to get that cleared up. After the PDA heals, he may not need the steroid treatment anyway.
We'll get more details tomorrow after our visit.
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UMC Charges: $9,825.95
Running Total: $155,329.44
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