Thursday, July 22, 2010

Hitting Milestones

September 8:
Unfortunately, due to the way they calculate the boys “corrected age,” they lost 6 days. (Crystal was 31 6/7 when she delivered, so the boys were considered 31 and 0/7 weeks old when they were born). The neonatologists have specific corrected ages when they will let the babies attempt various things, including attempting to eat on their own. The boys have been very awake during their care times. This is one requirement for beginning to have them eat, rather than have them be fed through their feeding tube. They won’t let the boys even attempt to take a bottle until next week which really stinks, but Crystal was allowed to do non-nutritive nursing with the boys today. Crystal worked all day with the boys on this, but they are definitely still developing their sucking reflex.

September 9:
Today was Daddy’s birthday. The boys’ night nurse, Nurse Jillian, made a footprint card for daddy from the boys. It is great. We have been pushing to try to get Dane off the nasal cannula and today the nurse got the okay to attempt it. He was off it for about 30 minutes, but started to have oxygen saturation issues again and had to go back on it. We really can’t wait for him to get off of it.

Our nurse taught Crystal how to do kangaroo care today. Kangaroo care is something that has been proven to help babies grow and also helps with a mom’s milk supply. Basically, it is skin to skin contact with the boys in their diaper lying on mom. It was great for Crystal to get some good snuggle time with the boys and a nice nap in during the day.

September 10:
The lactation consultants came up today to see how Crystal was doing with the boys and all the fun that comes with breastfeeding preemies. She was amazed at how well they were doing for their age. She also gave Crystal some pointers on how to get more consecutive hours of sleep at night.

September 11:
Today was a long day because Kenny had to close. On these days, we still head up to the hospital at 8 a.m. so that Kenny can get some time with the boys. This allows him to be a part of each of their care times twice. Unfortunately, he doesn’t get back to the hospital to pick Crystal up until around 9:30 and we usually don’t leave until 10 by the time we pack up and get going.
Today was a monumental day for progress for the boys, though. Nyle’s cord fell off and Dane came off the nasal cannula and stayed off of it.
Here’s a picture of him without the nasal cannula.

With the nasal cannula off, Dane’s feeding tube can now be put into his nose to help him with learning to eat with his mouth.
The boys are slowly losing everything that is attached to them (temperature monitors, breathing assistance, oxygen saturation monitor, etc.). The more they can get rid of, the more quickly we should be able to head home!!!

September 12:
Today was another long day because Kenny closed. Crystal has been really tired for the past few days and not eating enough. Since she’s supposed to be eating more calories now than when she was pregnant, she is going to focus on herself a little more today. She’s going to try to get some sleep and make sure she is eating enough. To do this, she is going to attempt the non-nutritive nursing a little less frequently.

The boys are hitting some big milestones and getting us closer and closer to going home. We came into the boys room this morning to see Dane in an open air crib!!!!! How exciting.
Here’s a shot of what we saw first thing this morning.

We had other milestones too. Dane’s cord fell off during the night. Nyle finishes his feeding protocol today, so we will see how his feedings will change. Dane should finish his protocol tomorrow. Yeah!! Nyle’s IV is also coming out today. They will leave it in his foot still, in case his blood sugar goes out of whack, but will disconnect all the tubing, etc. Dane’s should do the same tomorrow. Nyle will begin getting his caffiene through his feeding tube instead of through his IV. If Dane continues to do well with his oxygen levels, his feeding tube will move to his nose tonight to make nursing much easier. Nyle’s feeding tube was moved today and he had a rough time of it. You’d fight having something, even that small, shoved down your nose into your belly. We are getting closer to home every day.

September 13th:
We came to the hospital today to discover that Nyle’s IV was completely removed overnight.
With the IV out, Nyle can finally wear some of the adorable sleepers that Grandpa Hardesty got for him.

Dane’s IV came out today. They took it out immediately because he had never had any issues with his blood sugar. Nyle hadn’t either, but many times, the boys get treated differently depending on which doctor is doing rounds that day.

September 14:
Today was quite eventful for the boys. Nurse Jan took the time today to teach Crystal how to give the boys a bath. Getting them in and out of their beds and doing their care times is much easier since they no longer have their IVs, but they still have their heart and breathing leads on. It is quite an event to do their baths because the tub has to be brought into the room as well as a heat lamp to keep them warm. This is especially important now that Dane is in an open air crib. Nyle is still in the isolette, so he gets some help with staying warm. Crystal and Jan gave Dane a bath first. Crystal made the mistake of getting Dane naked, then testing the water temperature and touching Dane’s naked bottom with her warm hand. He peed all over her. His bath went well and he enjoyed it. He didn’t like coming out and being cold, but warmed up pretty quickly after getting dressed again and covered up with a blanket. Crystal gave Nyle his first bath at his next care time. That went really well too and Nyle really liked the warm water. He handled the cold air pretty well, but definitely liked being wrapped up afterwards. Baths have to be done before they eat or they will get sick, and it really wears them out, so the nurses discouraged any nursing attempts. We just pushed the boys’ food through their tubes and Crystal held them while they ate. Because we had to work so quickly for these baths, we weren’t able to get any pictures, but we’ll have our memories.

September 15:
Nyle got moved to crib today, finally!!

Now the boys only have to be eating on their own to go home!!! We attempted nutritive nursing today, but didn’t have any luck. Any amount of milk the boys might get through nursing has to be taken into consideration, so before nursing them, Crystal has to weigh them, feed them, then weigh them again. The difference in weight in grams is then subtracted from the rest of their feeding. Neither boy was getting any milk today, but they are still getting the hang of things.

More Phototherapy

Saturday Sep 4th – Dane’s biliruben levels are high again, so they have decided to put him on a biliblanket. It gave off a nice “pool light” illumination to the room.

We also came into the NICU today to find out that they had moved the boys to smaller room because 27 week twins would be coming in soon and they need that bigger room for their equipment. We totally understand that because we’d want someone to do the same for us. Although they pulled the boys out of the big room, they did keep them together in the smaller room. That makes it much easier to spend time with both of them and not feel like we are neglecting one or the other.

Sunday Sep 5th – Who knew that one day we’d be praying for the boys to have a poopy diaper. Since their biliruben levels are up and they are slightly jaundice, the nurses have said that all they need to do is just poop, and the color will go away. Thankfully, today was the day! After days with no dirty diapers, we got two poopy diapers from Nyle and one from Dane! Who would have thought that something like this could make us so happy?
We are starting to see the boys’ personalities a little more each day. Neither like having their temperature taken (it’s only in the armpit). The night nurses say Dane has such personality, but he is so quite during the day. Nyle is the one with personality when we are there.

Sep. 6th – Grandma and Grandpa McMasters came up to visit with Uncle Tanner and his girlfriend, Sydney today.

Here’s a shot of Grandma with Dane

Nyle's biliruben levels were high today so they decided to put him on the BiliBlanket.
Doctors say everything is going great. We need to get through the feeding protocol, then we will work on non-nutritive nursing. Non-nutritive nursing is when Crystal will pump before the boys’ care times, but while they are getting fed through their tubes, we will get them to latch on like they are feeding. This is supposed to help them put together nursing with their bellies getting full.
The boys are working on keeping their temperatures up as the isolette temperatures go down. They are both doing great with this, and we hope they’ll be in an open air crib by the end of the week.

One Week Old

Friday, Sep 4th
The boys are 1 week old today.
Here's Dane

Here's Nyle

Nyle’s feeding tube moved from his mouth to his nose today to get him working more on his sucking reflexes without the tube in the way. The nurses have been teaching both of us more and more everyday. They are allowing us to get the boys in and out of the isolette on our own, swaddle them ourselves, and change their clothes, bedding, etc. Feedings continue to increase for each day for both of the babies.

Today was a great day for Crystal. She got to hold both babies at the same time. The boy’s nurse took some pictures for us. Crystal loved this time, but found that holding the boys together sucks the life out of her no differently than holding them individually. She finally had to put both of them back into their isolettes because she couldn’t stay awake.
Here are a few shots of her holding both of them.

Going Home and Finding a Rhythm

September 1st
Crystal was released from hospital today. Here are a few shots of her kicking back in the hospital, dealing with the swelling that happened after the delivery. Her feet were really aching.

Kenny had gone to work and had to close, so the nurses let Crystal wait to be discharged until late afternoon. That way, she could still have a place to rest and could order food rather than pay for it. Kenny had taken all of their things to the car before he left for work. He came back to pick Crystal up once he got off work. It was very difficult to leave tonight. It’s hard to know that you are going home and your babies can’t come with you.

September 2nd
Kenny is back to work full time for now and will bring Crystal up every morning but today he had the day off. We decided that since today is Dad’s day’s off, we wouldn’t accept any visitors, to allow Kenny as much time as possible with the boys. For us, the best time for visitors has been during the boys care times. That off hour is just too difficult to get everything done that needs to get done and entertain people. We are getting into a rhythm with the boys schedule. Right now, we start at 8 a.m. with our day looking like this: Nyle’s care (diaper change, temperature, blood pressure, etc), snuggle with Nyle, Dane’s care, snuggle with Dane, 1 hour break. Unfortunately, in that hour, Crystal has to pump, potty, eat, drink, return phone calls, etc. Once that hour is over, we start all over again. With such a busy schedule, it makes the days fly by.
Here's a shot of Crystal snuggling with Dane after one of his care times.

Today, the nurses tried Dane off of the nasal cannula but he was breathing too fast again, so they put it back on him. He should be done with it soon.

Sep. 3rd – Today, we came in to see that they had moved the boys into the same room. They are in a huge room now. It is big enough for 2 recliners and is great for resting.
Here are a few shots of Kenny doing some care with the boys.

Suntans and Feeding Tubes

August 30th
Kenny’s mom and step dad came up for a visit today. They got to see the boys looking cool with their phototherapy glasses on. Their biliruben levels (jaundice indicator) were a little high, so they had to be put under a really bright light. Because the light is so bright and the boys eyes are also very premature, they have to wear some foam sunglasses that strap around their head. They are unswaddled and stripped down to just their diaper, which most babies don’t like, but Dane and Nyle didn’t seem to mind. They looked like they enojoyed their time in the sun.

Here’s a shot of Nyle and Dane. Their futures’ so bright… (I know it’s lame, but the kids are cute.)

Nyle also began getting breastmilk through a feeding tube today (that’s what is coming out of their mouths in the pictures. They tape the tube to the boys chin to keep it in the correct place. At 6 hour intervals, the nurse will check for aspirate to see what is left in his stomach and not digested yet. If the amount left is okay per a feeding protocol, they will then give them more milk. If there is too much they will skip that feeding. Before this, all of their nutrition came only from their IVs. They boys will remain on their IVs, though, until they are taking more food each day.

August 31st
Dane started getting fed through the feeding tube today. Since he is a little bit bigger than Nyle, he gets more food at each feeding. Dane was a little later getting mik because they were trying to let the blood that he swallowed during delivery work its way through his system. They are both only getting very small amounts (2 or 3 ccs per feeding). Each day, though, the feedings will increase by 2 ccs until they get to 6. Then the feeding schedule changes to every 3 hours. This also changes their care times from every 4 hours to every 3 hours.

The nurses have begun to change the temperature of the boys isolettes based on their temperature at care times, rather than based on a constant monitoring of their body temperature. The little silver leads on their bellies in some of the pictures is what monitored their body temperature and that fed their temperatures to the isolette and it automatically adjusted the temperature inside. The temperature of the isolettes have begun to come down slowly as the boys are showing that they can hold their own temperature.

Dad's First Diaper

August 29th
We headed down to see the boys in the morning. When we got down there, we discovered that Nyle was already off the CPAP machine and that Dane would come off in a few hours. That put both boys on room air in a little over 24 hours. That is spectacular.

Here’s Dane with no breathing assistance, waving to the camera. The things on his cheeks are the velcro that is used to hold the CPAP to his face. The "mustache" came off shortly after this picture was taken.

Here’s Nyle with no breathing assistance.

There were plenty of visitors today. Besides Crystal’s mom and sister, Tennille, Crystal’s Dad, Grandma Hardesty, sister, Jill, and niece, Maddie, all came up to visit and see the boys.
Here’s Crystal and Grandpa checking in on Nyle.

Kenny got taught how to change a diaper today. He did well, considering it was his first diaper ever, Crystal’s entire family was watching, it was through an isolette, and it was meconium. Kenny had also just been told to be very gentle with the boys because they’re nervous system is still developing, so rubbing and caressing can be painful. However, to clean up meconium with just a wet towel, you have to rub a little. Dane made it through the ordeal unscathed. Here’s the progression:

Dad – ready to go

Getting the diaper off

Trying to wipe

Help from Nurse Quinna with Dane’s legs

Trying to wipe again

“You teach me – I promise I’ll do the next one”

All done, phew!

Kenny went back to work for a half day today, since he hadn’t really been into work for almost a week. He really didn’t want to leave and Crystal didn’t really want him to go either, but we decided we’d rather have him take time off of work once the boys are released and at home.

Monday, January 11, 2010

The Boys' Birthday

It has been a crazy few months. Crystal hasn’t been able to update the blog because we have a desktop at home and it wasn’t worth setting upwireless to update while she was on bed rest and since the boys have been home, who’s had time to sit at the computer? She has been good about journaling through all of this, so she is going to update the blog in pieces and hopefully be able to fill everyone in with the information about what has happened for the past 4 months. We’ll start with late August and go from there.

Bed rest at home went really well. We had a doctor’s appointment once a week that included and ultrasound and then had non-stress tests (NSTs) twice a week. These monitor for contractions as well as the babies heartrates. On Tuesday, August 24th, we went in for our final cervical length ultrasound and our final doctor’s appointment with the perinatologist. Crystal had begun having contractions the week before, but they weren’t painful and would only happen occassionally. At the appointment, she was released to go back to the regular OB’s office and forget about their place. This was because we were halfway through our 32nd week of the pregnancy and everything was looking great. We had an NST that day as well and Crystal had a few contractions, so they gave her a shot of Turbutaline to help stop them. She’d had this before and it worked, so we weren’t concerned at all. The worst part about the turbutaline is that it gives Crystal the shakes and it stings pretty bad going in. Since things looked so good, we headed home, excited that we’d made it to the point where we could go to our regular doctor.

Unfortunately, things started to change later that afternoon and evening. Previously, the turbutaline had stopped contractions for about 5 hours and spaced them out to only a few, if any in an hour. This day, though, the contractions came back within an hour. They were still spaced apart, but around 7 p.m. things started to pick up and we started timing them. After an hour, Crystal had about 15 contractions, so we called labor and delivery to see what they wanted us to do. They said to come on up, so we headed to the hospital. We got there around 9 p.m. and they immediately put Crystal on the monitor. The contractions were very regular, so the doctor ordered more turb. The first dose didn’t really work, so they ordered a second dose. That didn’t appear to help either, so the doctor decided to give Crystal an oral medication called ProCardia. That didn’t help immediately either, so he went back to the turb and followed it with another dose of ProCardia 15 minutes later. This combination did the trick and the contractions spaced out to 20 minutes. We finally got the okay to go home at 3 a.m. Wednesday morning if we wanted to. We decided that we would, with the oral prescription to help keep the contractions spaced out. Crystal had to schedule a follow-up appointment in the office for Thursday and closely monitor contractions to make sure they didn’t start up again. If they did, we were to call the office or Labor and Delivery.

Wednesday morning was a restful morning because we both desperately needed it after the night we had. Crystal got her appointment scheduled, but around 3 p.m. that afternoon, the contractions started coming back. She called the doctor’s office, but since it was so late, they said if they got worse, to head to the hospital. Kenny was preparing to go to work, so Crystal was going to ride into Kalamazoo with him and stay with friends in case things got worse. We were questioning whether or not we should just go to the hospital, so Kenny decided that since we didn’t know what to do, it would be best just to head up to triage again.

We got there around 4:30 p.m. on Wednesday night. After monitoring again for a while, they decided that they were readmitting Crystal with failed home tocolitis (bedrest at home). Crystal was crushed after all we’ve been through and knew as we drove to the hospital that she probably wouldn’t be coming home until the boys were born, but that didn’t make it any easier to hear. After another shot of turb with no luck, they started an IV on Crystal and began giving her a medicine called magnesium sulfate. They called this medicine the “Big Guns.” Needless to say it wasn’t a pleasant experience for Crystal. When you are on this medication your fluids in and out have to be measured, and it makes you have to go to the bathroom more frequently. Wednesday night/Thursday morning were really rough. At times, the monitor showed that the contraction had stopped, but Crystal was still feeling incredible pressure and tightening on her sides. They also had to increase the amount given to the maximum just to get the contractions under control to start with. There were stretches of time where there was just no relief. Thankfully, this slowed and we were both able to get some rest that night. Thursday during the day went much better, they were able to decrease the dosage. One side effect of this medicine is also that it makes you very warm and lethargic. Kenny had the thermostat in the room set a 55 degrees and Crystal still felt like she was on fire. Crystal’s sister, Tennille decided to come up Thursday night to be available in case something happened. Thursday night was a very rough night. Contractions continued at about every 10 minutes and Crystal was up and down every 30 minutes to go to the bathroom, so her sleep was in small segments. That also meant Kenny’s sleep was in 30 minute segments because Crystal needed help getting up to walk to the bathroom.

Even though it was a fairly rough night, we anticipated just more of the same for Friday. The nurses would be available to help Crystal with her bathroom breaks and things, so we decided to have Kenny go to work. He had to be there at 7 a.m. so he left for work around 6:45. Around 7:25, Crystal had 3 really rough contractions, so she called her nurse at 7:35 and asked to be put on the monitors. The nurse put everyone on the monitor, then got Dr. Hendricks from the desk outside. Immediately, the decision was made to take Crystal down to triage. On the way downstairs, we met up with the ultrasound folks who pushed ahead of us to get the machine plugged in and warmed up to look at the babies. At this point, Crystal really didn’t know what was going on, so emotions were running wild. She just knew that something was wrong. Later on, her nurse said that she was giving off some strong signals that things weren’t right and the nurse went by those to figure out what to do. We don’t know if she would have been able to determine those signals if Crystal hadn’t already spent so much time up in antepartum.

Dr. Hendricks did a quick ultrasound looking at Baby B because Crystal told her that he’d been moving less than Baby A. After the ultrasound, Dr. Hendricks immediately told the nurses to prep Crystal for surgery. She was so calm and just told Crystal that everything was fine right now, but we had to go get het boys now. While the nurses were prepping Crystal, she asked one to call both Kenny and Tennille to get both of them here. They were on top of it right away. Crystal was quickly taken to the OR, got to move herself to the table and was finished getting prepped for an emergency Cesearean section. She remembers telling Dr. Hendricks that the boys names were Dane and Nyle and whoever was born first would be Dane. After that, the anesthisiologist told Crystal to close her eyes and think of sweet dreams and when she woke up she’d be a mother.

Crystal’s nurse was able to reach Kenny and Tennille. Of course Kenny “flew” to the hospital from Gander Mountain, but thankfully, arrived safely. He got changed into scrubs and was able to get into the OR just in time to see Nyle being born. He was told if he wanted to go see them he could. Dane was already on the warming table when Kenny got in the room.

While the doctor and nurses finished up with Crystal, Kenny went with the boys to the NICU. Doctors and nurses were running back and forth between the boys two rooms getting them stabilized and all set up on the respirators and making sure there were no major complications with them that needed addressed.

So, we were blessed with two beautiful baby boys:
Dane Richard Sattler – 4 lb. 14 oz, 17.25 in. long, born 8:17, August 28, 2009

Nyle Andrew Sattler – 3 lb. 8 oz., 16.5 in. long, born 8:18, August 28, 2009

Crystal was moved to recovery while Kenny spent some time with the boys. Dr. Hendricks came in to tell her that although she probably wouldn’t remember too much of the conversation, but that everything went really well during the delivery. The reason for the emergency was that Nyle’s placenta abrupted, causing his heartrate to drop. During delivery, Dane then swallowed a bunch of blood from the abruption, so he had a few issues at the start, but was doing well. She said the boys looked great and told Crystal their weights.

Once the boys were stable and Crystal was stable enough in recovery, Kenny came into recovery to be with Crystal. The nurse got her morphine set up for pain and Kenny got to feed Crystal ice chips since they wouldn’t let her have any water. They allowed Crystal to sit up in stages, but she began to feel light-headed and her blood pressure plummetted. The nurse called the doctor and they determined that Crystal’s hemoglobin levels should be checked. Of course, they were extremely low, so she was going to have to have some blood. They decided, however, that they would wait to do that until they got Crystal up to her room in the Mother/Baby unit. On the way up to the room, they took us through the NICU so that Crystal could see the boys. At the time, the boys were still on the respirators and were in separate rooms that were next to each other. The visit was only brief with the promise that as soon as Crystal’s hemoglobin levels were acceptable, she could come back down to see them.

Once in Mother/Baby, the nurses started with 2 units of blood. Unfortunately, after the blood was all in and flushed, we had to wait 2 hours before doing the blood draw for testing and the results took about 1-1/2 hours to get back. During this time, Crystal’s mom had made it up from Indiana and Kenny was able to take both her mom and Tennille down to see the babies. During one of these visits, the boys had been removed from the respirators and started on CPAP machines for apnea. Doctors had told us to expect them to be on the CPAP machines for 2-3 days.

Crystal’s blood work came back and her hemoglobin levels were still pretty low, so she was told that she would have to take 2 more units of blood. At this point, it was already into night shift (after 7:30). It took about 1.5 hours per unit of blood, so that meant it would be a long time still before we could go back down together to the NICU. Thankfully, my nurse said we could go down once the blood was in and we didn’t have to wait until after the blood draw and results were back (they weren’t going to draw blood until 6 a.m. the next morning) Finally at about 2 a.m. Saturday morning, we were done with the blood and could get set to go downstairs. At this point, Crystal now had 2 IVs, each with a pump. One had morphine in it for her pain from the surgery and the other was still flushing for the blood. It took some dancing and work, but Crystal’s very patient nurse finally got everything set-up and connected to the wheelchair poles so that Kenny could push Crystal downstairs to see the boys.

The NICU was very intimidating with lots of machines, monitors, wires, and teeny tiny IVs. Even with all the wires on the boys and all the wires on Crystal, the nurse pulled Dane out and let Crystal hold him for a while.

Here’s Mom and Dad with Dane

Here’s Mom with Dane

The boys’ nurse taught us about care times. Basically, every 4 hours, the nurses would tend to the boys. This is when they would change diapers, take temperatures, poke the boys for blood sugar, measure blood pressure, and check the boys’ IVs. Obviously if they need something else prior to their hour, the nurse would tend to that, but the idea is that once their care is complete, they should be able to rest for as long as possible so they can grow and get healthy. She taught us about their isolettes (basically an incubator). These were set up to automatically adjust the temperature surrounding the boys based on their body temperature. If they are cold, it will warm up and if they are hot, it will cool down. The boys are also not on the same schedule. Dane is one hour and Nyle is another. This allows us to spend time with each of them. The parents are encouraged to participate in the baby’s care time. We are allowed to change diapers and take temperatures as well as help with calming the boys during any other poking and prodding, and we can always snuggle with them for a bit as long as their temperature stays up.

This pretty much sums up the boys birth. It was very eventful and stressful, but they arrived safe and sound with minimal issues. We are just so blessed to have these two tiny boys in our lives.