October 8-17, 1996
Annagram Days 26 and 27 (October 8-9, 1996)
Sorry to deprive everyone of an update yesterday. Anna's doing fine. We had an unexpected systems glitch that caused us to stop the presses for a day. And incidentally, if you're ever looking through the windows directory and see a file marked "cleanup.bat", my strong advice is to leave it be. Some event always seems to happen with Anna at mid-week. Today's crisis involved her and all of her co-preemies. Due to a mechanical problem with heating and air conditioning machinery in the neonatal intensive care unit, the room started to fill with a strong odor of burning wires this morning around 10:00 a.m. and they had to move all 16 babies to the pediatrics intensive care unit on the other side of the building. This was the first time in the last 20 years the room had to be evacuated. They'll probably move the babies back tomorrow. We visited Anna this evening in her new home, and she was doing fine. Kelsey held her for about 20 minutes while she mostly slept, but she woke up for a while before we left. Anna's breathing tube also came out unexpectedly at one point today, but they put it back in without incident. They're going to give her a couple of more days of steriods to help get her off the respirator. Also, they're fortifying Kelsey's milk with some type of additive to further increase its already potent caloric content and thereby encourage the little peanut to start growing. Let's dispense with the technical stuff. Anna's respiratory settings fluctuated within the same range they've been at over the past week or so.
We're going to be using a new e-mail service through an AOL offshoot called GNN which allows us to better serve our subscribers, including sending out pictures periodically. To illustrate, we've included a recent family portrait. You can read it out of Netscape or one of many good viewing programs on the market. Please note as well that with this switch our e-mail address has changed. Thanks for keeping us in your prayers.
Love, Anna, Kelsey, and Craig.
Annagram Day 28 (October 10, 1996)
Anna is four weeks old today! She'll officially be one month old on Saturday the 12th at 6:55 p.m. All the babies returned to the neonatal intensive care unit today in the wake of yesterday's emergency. Anna had a very good day, making some improvements on her ventilator settings. She was at a rate of 15 to 16, with pressure of 16/5 and an oxygen percentage of 21-23%. The latter is significant because 21 percent oxygen is the same as room air. Anna is still tolerating her feeds well at 3.5 cc's per hour. She also gained a little weight yesterday, and broke the 700 gram mark for the first time (remember she started out at 585 grams). Those of you who successfully viewed yesterday's picture please let us know how you did it and we'll pass the news along.
Love, Anna, Kelsey, and Craig.
Annagram Day 29 (October 11, 1996)
Thought you all would want to know that Anna came off the respirator today and is breathing on her own for the first time! Her blood pressure is up a bit due to the steroids she is taking for her lungs, but it's not a concern to the doctors and she appeared to be handling the transition to real air quite well. She has two small tubes in her nose known as CPAAP which keep air pressure in her lungs to help keep them from collapsing, but she's doing the breathing without a ventilator pushing air in and out.
Love, Anna, Kelsey and Craig.
Annagram Weekend Update Days 30 and 31 (October 12-13, 1996)
Anna had a great one month birthday on Saturday. On Sunday afternoon, she reminded us what a roller coaster we're still riding. She did very well after coming off the ventilator Friday, but Sunday morning started having some short periods where her breathing and heart rate fell off (Apnea and Brachycardia, respectively). Then around 2:00 p.m. she had an apnea episode where she didn't snap right out of it and stopped breathing for about 15 seconds. At that point they put her back on the ventilator (known as reintubation at the hospital) and ran a bunch of tests like they normally do when she has some type of episode. They're testing for another infection, but the leading theory is that she just got tired out after a couple of days breathing on her own and needed a rest. She was also low on blood which may have further run her down. They gave Anna a transfusion this afternoon, and she has been resting comfortably. When we visited her a couple of hours after the incident she was awake at times but overall appeared fatigued. She's letting the ventilator do the work for her at the moment, and all of her vital signs and blood gasses appear fine. Given that she doesn't quite appear ready to do all of her own breathing, the doctors may decide to give her some more time on the ventilator and focus instead on getting her weight up. She's still very tiny for a baby one month old. Even when Anna is doing well, you can see that we need to be constantly on guard and ready for anything. Please keep all of us in your thoughts and prayers.
Love, Anna, Kelsey, and Craig.
Annagram Day 32 (October 14, 1996)
Anna had a much better day today. The doctors think Sunday's episode resulted because she was low on blood, and she looked much better after her transfusion. The culture they did for infection did turn out positive, but they think it may be the result of a skin contaminant when they did the needle stick rather than an actual infection in Anna's blood. She isn't showing any listlessness or other signs of being sick. They put her on antibiotics as a precaution, but they did another culture today and if that comes back negative they'll stop the drugs tomorrow. Anna was alert when we visited her this afternoon, and Kelsey and I got to hold her for about a half hour. She felt a little bit heavier to me, but not much. Her weight is stable at around 700 grams. Anna has resumed full feedings on Kelsey's milk, and they may take her back off the ventilator sometime this week if she continues to do well. Overall, however, she remains in stable condition.
Love, Anna, Kelsey, and Craig.
Annagram Day 33 (October 15, 1996)
Anna had another good day today. She did more sleeping and appeared a bit less feisty than yesterday when she was all charged up from sleeping 11 hours. We visited her after work and Kelsey got to hold her "skin to skin" for the first time. That's when you hold her to your chest (no, it's not the same as nursing). I've never seen seen Anna look so comfortable! She rested her hand and head against Kelsey's neck and zonked out. Kelsey said she could feel Anna's heartbeat. For my part, I gave her a Tweety Bird stuffed animal. The primitive emergence of a division of labor thus becomes apparent. The neonatal intensive care unit is an anthropologist's dream. They're still doing some tests to see if Anna has an infection. She isn't acting like it, however, and the culture they took yesterday came back negative. Still, they're checking her heart, kidneys, etc. to see if anything looks out of whack. They even did a spinal tap for good measure. She continues to receive medication for her elevated blood pressure, which is most likely due to the steroids she's been getting for her lungs. Anna had her eyes checked today but we haven't yet heard the results. The nurse this evening said they decided to let Anna stay on the ventilator the rest of the week to try to put on some weight. One of the doctors who hadn't seen her for a couple of weeks told me she's gotten bigger.
Love, Anna, Kelsey, and Craig.
Annagram Day 34 (October 16, 1996)
Anna slept the whole time we visited today, but she's doing well. Dr. Hoy told us they are likely to take her back off the ventilator tomorrow because Anna's at very low settings and they don't want to keep her on unnecessarily. She has some lung congestion that could cause them to delay this move. Dr. Hoy acknowledged there can be a tradeoff between being off the ventilator and weight gain since breathing unassisted uses more calories. They're giving Anna increased liquids to promote growth, including some type of fat cocktail that would be a big no-no for us adults (like eating a whole cheesecake unassisted, for example). A number of issues are "lurking" out there that the doctors are following up on:
* Infection--Anna's echocardiagram of her heart showed what could be a little clot or an "infection ball". The latter could have caused her positive test for bacteria Sunday, but since she tested negative for infection yesterday they suspect a clot. Clots are fairly common in preemies and this is not the kind that can break off and go to her brain (although it could go to her lungs, which is less dangerous). They're consulting with an infectious desease specialist tomorrow to decide whether to treat the issue as an infection or a clot. An infection would require a month of antibiotics, but that's the less likely prospect.
* Eyes--Anna and a bunch of other preemies had their eyes checked today. The test for almost all of them was inconclusive, meaning as expected the eyes are very immature and additional follow-up will be needed to determine if any problems exist.
* Kidneys--They did an ultrasound of Anna's kidneys yesterday to check blood flow and structure (constricted blood flow can contribute to high blood pressure, which she has had but as noted previously is more likely the result of her steroids). Although her blood vessels looked o.k., the tubes from Anna's kidneys to her urinary tract appeared thicker than normal. This can increase the likelihood of urinary tract infections, so they plan to do some follow-up tests next week to further evaluate the matter. Each time they do a test it seems something pops up that requires additional monitoring or testing. Often nothing materializes but once in while it develops into more of a concern later.
Love, Anna, Kelsey, and Craig.
Annagram Day 35 (October 17, 1996)
Anna is five weeks old today! I visited her this afternoon right after they took her off her ventilator and put her on the CPAAP (like last week before her setback). Her blood gas tests have improved since they made the change. She was wide awake during my visit, and made a couple of little crying noises for me. Then she did some sneezing, which was pretty comical since it made both her little arms jump up in the air. Then she pulled the tubes out of her nose while I watched. So while the respiratory therapist was working on getting them reinserted, I could see her whole face with no obstructions for the first time. I had the nurse grab a Polaroid they keep nearby for such occasions, and captured the moment for posterity. In the second picture, she appears wide awake in her feisty fighter mode with both fists clenched. If you'd like a digitized version of this historic momento, please send $12.95 to AnnaPics, Chicago, 60609. Just kidding. I'll get you all a complimentary copy as part of your regular subscription rate. Other than that, not much new to report. They did decide to keep her on the Annabiotics for 10 days as a precaution, even though they don't think she has an infection. Also, would everyone who interacts with Kelsey make sure she eats lots of fat.
Love, Anna, Kelsey, and Craig.
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