Category Archives: Hospital

Search “The Chubster” and Destroy “Chunky Monkey” are both doing well as they hit their seventh week of life.

When we first joined the NICU family we knew there would be ups and downs in their progress. At the time, I didn’t realize they meant that literally. In Pod B, the Stream boys are known as “The Swing Boys” and “The Dueling Desatters.”

Their oxygen saturation levels continue to bounce up and down. Sometimes we think it may just be to keep their nurses on their toes. The monitors track their heart rate, breathing rate and the aforementioned saturation levels – when levels fall below a set number, an alarm starts beeping. (We may have to find a recording of obnoxious beeping to soothe the boys once they come home.)

Time seems to stretch out as their corrected gestational age closes in on the point where they would no longer need an extended NICU stay. And since Search and Destroy are doing well, we are breathlessly awaiting the time when they come home. (Medical opinion is still placing bets on Search to precede his brother.)

Today, we saw what the light at the end of the tunnel looks like. M, the little girl across the pod, went home today. Born in March at a tiny two pounds, she proved beyond a shadow of a doubt that she was a fighter. On several occasions her mother reminded us to never lose hope – if her little girl could make it, so would ours. And no matter how far away the time seems, someday soon they’d all be home.

M would often sit near the boys crib, charting with the nurses. Sometimes she’d eat her bottle while our boys attempted the new technique of sucking and swallowing. Being the great flirts that they are, the nurses referred to her as the boys’ girlfriend. In that sense, we were sad to see her go. But in the grander scheme – we’re thrilled she’s gone. There will be plenty of older women in their lives…

Seeing our friend depart reminds me that our family is not too far off from being together. Search and Destroy have grown so much already. They’ve doubled their birth weight and are now a giant four pounds each.

This evening the doctor decided they were growing so well, that their calories have been decreased. (We want chubby babies, but the doctor is concerned about the potential for not-as-cute fat toddlers.) Although the boys are on a steady diet of mom’s milk, it’s mixed with human milk fortifier to fatten up babies. It also makes them constipated. So they spend a majority of their days trying to poop.

We’re hoping that the slow decrease of sludge will help relieve their tummies and as a consequence release pressure from their diaphragm, allowing them to maintain a steady oxygen saturation level. This will make for a very much less paranoid mommy.

As a start, Search was relieved of his nasal cannula today. He is no longer receiving any oxygen assistance; breathing is all up to him. So far, so good – here’s hoping he keeps it up! It’s amazing how much cuter he is without giant tubes in his nose.

Keep your eyes peeled – sometime, not too long from now – there should be a post that someone’s coming home.

I have completely lost track of the days. I could not tell you what day of the week it is today nor whether it’s been three days or 30 since the last update. Six and a half weeks into this adventure, the boys are 34 weeks corrected gestational age.

The routine remains exactly the same day in and day out. The routine remains exactly the same day in and day out. The routine remains exactly the same day in and day out.

We park the car in the second or third row of the parking lot. I take off my sunglasses to put on my eyeglasses when we hit the crosswalk leading past the complementary valet and into the Lawrence Hospital Entrance. We walk through the first set of automatic doors and head straight for the second set to our right – you don’t need to slow down, they’ll open right as you think you’re about to smash into them. I immediately prep for the blast of cold air conditioning that cools the hallway. We enter in front of Ambulatory Surgery, pass a set of restrooms and cross one of the hospital’s lobbies. Next to the gift shop are three elevators; we take whichever one arrives first up to the third floor. We then head toward the NICU’s lavender awning located to the right of the elevator bank.

We greet the receptionist with a smile and “hello.” She unlocks the door and we enter, stopping to wash our hands at the sink right on the left. After scrubbing with soap to the length of Twinkle Twinkle Little Star we wind our way past the first door with it’s sign reminding us to be quiet because there are “Babies Developing. Shhhh.” In front of a kiddie table, we pick up the phone and dial Pod B. When one of the nurses answers, we say, “Hi, it’s Jon and Tricia Stream. We’re here to see our boys. Can we come in?”

The door opens and we squirt a shot of antimicrobial gel onto our hands. We greet the nurses as we rub in the gel while heading to the second and third beds (now one pedi-crib) on the left of the pod. I put my purse under their crib and ask, “How are my little guys today?” The nurse tells us they’re doing well. Jon and I set about taking the boys temperature. Destroy screams bloody murder; Search makes grumpy faces. Then it’s time to change diapers. Wipes are located above the pod sink, where we dampen them with lukewarm water. Diapers are stored in each kids respective corner. As we pick up the muppets to feed them their bottle, I ask the nurse what their weight is.

Harumph

We’re all ready to come home. The nurses warned us when Search and Destroy first arrived that time would likely mess with our emotions in this precise manner – although time passed by so quickly at first, it will start slowing down interminably as we approach our homecoming date. We are currently looking at 2-3 weeks more – but at this point, it’s all up to the boys.

Search and Destroy seem equally ready to come home. In fact, they have overheard us speaking about the three big criteria and decided to let the nurses know they’re ready. Destroy has made it his personal mission to permanently remove his nasal cannula. My poor little guy currently has a large red welt on his cheek because of his vigorous removal methods. I assumed that ripping the tape off his face would make him cry. It did not – he just gave us all a sly grin. Every time we swaddle him, we’ll see his little hands sneak out of his wrap and covertly grip at his wires.

“Well you said we couldn’t come home until we were off our oxygen tubes.” Destroy was just speeding that process along.

Search knows he needs to be taking all his meals from a bottle. So when I told him how proud of him I was because he was such a good eater, he took it upon himself to take out his feeding tube. “Look Mom, all done!”

They’re just trying to help out the doctors. And slowly, but surely, they are making great strides. It just seems like forever right now. Today, Nurse Jennifer let us know that we’ll likely see a huge difference between week 34 and 35. And Nurse June think they’ll likely graduate in about two weeks. (And Nurse June doesn’t take any backtalk from the boys. They WILL progress under her care. Period.)

Each day our routine remains the same. I just need to remember to take a step back and remind myself that we weren’t even supposed to have met the munchkins yet. They’re still tiny babies – even if they are rapidly approaching merely “small” as opposed to tiny.

Search

Destroy

What are little boys made of?
What are little boys made of?
Snips and snails
And puppy-dogs’ tails,
That’s what little boys are made of.

What are little girls made of?
What are little girls made of?
Sugar and spice
And all that’s nice,
That’s what little girls are made of.

Brothers - Destroy and Search

Since becoming a mommy to two handsome little dudes, I have chosen to interpret this poem as the simple stereotype that boys will be out and about getting down and dirty as they get older.

What our boys are really made of includes blood. According to our doctors and nurses, it is extremely common for babies to have dropping hematocrit levels. (And, we’re back to the “he’s tiny” diagnosis.) After the color and energy burst from their transfusion, we’re back to lowering levels.

So in order to test for anemia, more blood was taken from Search (oh, the irony…). No need for another blood doping just yet, but docs wanted to verify his “retic” count. Reticulocytes (retic for short) are immature red blood cells made by the bone marrow. Once they spring forth into the bloodstream they will develop into grownup blood cells after a couple days; only about one percent of red blood cells are retic. Search’s blood test measured the rate that the retics are being made – creating more oxygen bearing transports through his body. Results were lower than the standard range, but the doctor believes this is due to the recent transfusion. Transfusions often confuse their little bodies into thinking “no need to produce more reticulocytes – we’re good!”

In the meantime, the NICU continues to fatten up our boys in true fairytale style by upping their caloric content. Although mommy’s milk is about 20 calories per serving, the hospital adds human milk fortifier – a supplement intended for low-birth-weight infants – to each beverage. Both boys are up to 28 calories! At first glance 224 calories per day may not seem like much. But compare those 75 calories per pound/day with only 10 calories per pound/day with a 200 pound person eating a recommended 2,000 calories a day. Our boys are going to end up as the next Michael Phelps! (He allegedly needs 12,000 calories per day.)

But here’s the catch. While the fortifier works like a charm in developing chipmunk cheeks, it’s a lot harder on their digestive systems. So they spend a significant portion of their days trying to poop. I’ve noticed they’re quite a bit more fussy but I get pretty cranky when my tummy hurts too.

Search

Search is still doing well with his bottle. Although I’ve noticed he’s much more amenable to the idea of putting effort into his meal during the evening. Yesterday morning I tried to give him breakfast via bottle. He peered up at me with half-open eyes and steadfastly refused to open his mouth. “I’m all about food Mom, but seriously – it’s naptime.” This afternoon was just the opposite. He was wide awake and as the nurse moved around his isolette preparing dinner he followed the movement with his eyes, opening his mouth and sticking his tongue out at us, “I’m ready people! Feed me!”

Destroy

Destroy thinks he’s ready – and he’s really really interested – but still hasn’t quite caught on. Responding to his cues (big wide eyes, sucking motions and his general obsession with his pacifier), Nurse Anne decided to give him another chance. Destroy took one or two normal sucks on the bottle and realized that this nipple had more than just a taste of milk on it; it just kept coming out. With extreme over-exuberance, he gripped the bottle with both hands and started sucking fast and greedily. Suddenly, mouth full, my little muppet realized he had no idea what to do with the milk now that it was his – all his. It dribbled out the sides of his mouth as his stats dropped since he hadn’t remembered to breathe during the excitement. So we’re going to wait a bit more with him.

My theory (using the expertise garnered from multiple viewings of ER, Gray’s Anatomy and Private Practice) is that lowered levels of oxygen in their blood combined with the added stress of gas plays a large role in the swings of their saturation levels.

Throughout all this medical drama the boys continue to get cuter every day. This is a bit dangerous as they’re also started to get a lot more flirtatious. So what are my big holiday weekend plans? I’ve got a hot date in the NICU with two little chubby guys who have already stolen my heart – even if they are made from snips and snails and puppy dog tails.

During those last few days in the hospital before the babes arrived, all I could think about was having healthy babies. One of the key factors was birth weight.

“Think chubby babies!” I kept telling everyone. We were pretty successful given how young they were – both muppets weighing in over two pounds. (I’ve already discussed how one’s perspective changes to the point were two pounds can be “chubby.”)

And I’m sure you’ve noticed, many of the recent posts talk an awful lot about food – both going in and come out. Well, weight is still a big deal. Before the boys can come home, they must meet three criteria:

1)    Regulate their own temperature. Both Search and Destroy are off the temperature probe and may even start rooming together next week.

2)    Remember to breathe all by themselves. We’re still experiencing some A’s and B’s (apnea and bradycardia) but vastly improved.

3)    Eating via bottle or breast. We’re going to start seeing how they feel about bottles next week.

All three significantly involve size. And so far, this seems to be their biggest strength. We have finally reached the point where both boys are soaring upward. After four weeks as residents of the Hotel NICU we are rapidly approaching three pounds.

Each morning, Jon and I get an update. The medical staff use grams. I’ve had several people ask me to translate to pounds. But telling you how much they’ve gained in grams is so much more impressive! So I propose a compromise. I will continue to update everyone in grams since I like being able to say, “Search gain 50 grams today!” (Also, that’s what I’m told their weight in each morning.) And you can use the nifty preemie grams to pounds conversion chart I have conveniently posted below. (Click chart to enlarge.)

What I find amazing is that even though I see them twice a day, even I can see that they’re really growing. They’re starting to fill out and develop those classic chubby cheeks. They seem less fragile. (Although I’m not sure if that’s just because we’re getting used to them.) Can you even imagine how big they’ll seem when we bring them home at five humungo pounds?

Each week the NICU developmental therapist observes the kids and provides a report on their strengths and “sensitivities.” It appears that even at their tender age no one can escape performance reviews… Destroy’s report notes that he makes sucking gestures when he’s hungry and startles at loud or sudden noises. (I’m going to disregard the latter in this post since I’m almost 30 and startle at loud or sudden noises – so smart kid.)

This morning Destroy began making his mouthing and sucking motions about 20 minutes before breakfast. His nurse dipped his pacifier in milk and decided to see how he’d react. Destroy went bonkers over it; he sucked on it for 2-3 minutes! (In the world of a preemie, 2-3 minutes is a big deal.) Here’s hoping this means he’ll do well when we trying to move from a feeding tube to a bottle. I know he’ll prefer the bottle in the long run; he hates the feeding tube but loves the feedings. So we’ll just take baby steps toward sucking, swallowing and breathing – all at the SAME TIME.

Destroy’s nurse reiterated that the muppets were doing really well. “Fingers crossed – you’ll have them home in three and a half weeks. That’s the goal.”

Suddenly that doesn’t seem so far off. Of course a lot can happen in three weeks. But at the very least it means they’re star preemies right now.

So we’ll keep getting excited about weight gain and resulting developments. Before we know it, Search and Destroy will be home and we’ll be introducing all our friends and family to our giant babies.

Chubby 4-week-old Search

Chubby 4-week-old Destroy

It was bound to happen. Search and Destroy are currently healthy, rosy, little cherubs. So guess who got sick. You guessed it – Mom.

I was at lunch yesterday, after my morning visit with the muppets, when the restaurant suddenly became as warm as the arctic circle during a cold spell. By the time I shivered my way home I had a fever of 101. Teeth chattering, I called the NICU to let them know I wouldn’t be in for the boys evening bath. (Destroy – this does not mean you’re off the hook for your soggy bottom photo.)

The nurses told me the boys were doing great and that I should get some rest and take care of myself to get all better. So I crawled/fell into bed – highly amused at the latest speed bump on this motherhood ride (which may have been slightly influenced by the fever).

But like the nurses told me, the boys were both doing great. The boys have been competitive with one another since birth. With both developments and setbacks, they tend to follow each other closely. During our care conference (meeting with the NICU doctor, nurses and social worker), the doctor began by reminding us that twins mature at different rates and not to expect them to follow the same timeline. With that, our nurses shared that Search and Destroy both weighed exactly 1,200 grams today. (Yay for chubby cheeked kids!)

Search - 25 Days

During my pregnancy, Destroy was labeled Baby A because he was expected to arrive first. At the last minute (literally), Search debuted before his brother. The two were even born during the same minute; they’re 30 seconds apart in age. Both received the same Apgar score of 5/8. (The Apgar test occurs right after a baby’s birth at 1 and 5 minutes. It’s meant to evaluate their initial condition.)

As their first few days passed, the two traded off between who needed oxygen or assistance breathing. At first, Search got extra aid because he was working to hard to breathe. Three days later, Destroy started having recurring apnea episodes. Not to be outdone, Search followed suit that weekend with both apnea and bradycardia episodes.

Destroy - 25 Days

Search figured out how to rip his nasal cannula out several weeks ago. And when he’s not doing that, he’s got a death grip on his feeding tube. Destroy apparently watched his brother; he has now learned the same skill. As Search practiced his army crawl tactics in his effort to inchworm out of the NICU, Destroy discovered how to turn his head. Yesterday, when I went to visit with Destroy, I discovered his nasal cannula firmly ensconced in his mouth. Nice try dude. Today, Jon asked the nurse why Search no longer had his feeding tube in. “Ask him. He’s the one who took it out,” replied the nurse. Both of them now smile when a nurse has to get up to turn off a false monitor alarm.

As I shared in the Momma Bear post, Search needed a blood transfusion because his hematocrit levels tanked. Quick reminder – a drop in such levels isn’t abnormal for premature babes. In fact, we were expecting the possibility of a transfusion since both boys were slowly dropping. Search just wanted to be a showoff. Search got his blood last Wednesday. Demanding the same VIP treatment as his brother, Destroy received his transfusion on Sunday. Although his levels didn’t drop as quickly, Destroy planned ahead and received Dad’s blood. (You know, with all this talk about blood, perhaps I was subconsciously foreshadowing their needs with my Little Shop of Horrors reference.)

Both love their food. Search reached his full-feed levels before Destroy. But Destroy started taking an extra mL than his brother shortly thereafter. (Full-feed for their current size is 20mL and 24 calories per serving.) For added measure, Destroy also upped his caloric intake to 26 calories. Search matched his brother at 26 calories, but he hasn’t needed that extra mL yet.

All the eating is key to growing big and strong. One of the first questions we ask every morning is “How is their weight today?” Both have reached the upward trend we’ve been waiting for. Yet, there have still been a couple drops – usually of around 10-15 grams. Interestingly enough, the gains and losses seem to continuously equal each other out. Current score: 1,200 g all.

I bought them “The Hungry Caterpillar” today. Besides the fact that is precisely what Search looks like when he’s on the move, I feel it’s an appropriate theme for our muppets. The caterpillar eats and eats and eats and sleeps and emerges as a beautiful butterfly. Our boys will eat and eat and eat and sleep and emerge from the NICU. From their start as our little men to their lives as our big boys. Thank goodness Costco (and corresponding diapers, snack food, etc.) is on my way home from work.

And let’s play a new game. Who can be the healthiest? Winner gets to not be sick.