Category Archives: Hospital

June 11, 2010

Two Weeks

It’s been two weeks since the twins arrived. The time has passed by in the blink of an eye and taken forever at the same time. No, you’re not experiencing déjà vu – this is just how the One Week post began. It still holds true.

Search and Destroy have now been residents of the NICU for the same length of time as my final hospital stay with them. Overall, they are doing really well. There continue to be some of the ups and downs we were warned about, but they don’t get any easier.

Search: Two weeks

Search is very ready to be a big boy. He remains our little mover – scooting around his isolette and practicing pushups. He has taken to arching his back to take a good look at us when we hold him. As Dr. Yuri pointed out, “he has a genetic disposition to make sure everyone is clear about how he feels.” Stubborn and spirited, his brother may be taking cues from him. Unfortunately, this week that meant breathing issues.

Destroy: Two weeks

Destroy has been dealing with a lot of apnea of prematurity this week. This is the medical term that means our baby has stopped breathing. Based on my vast quantities of medical knowledge – gleaned entirely from seasons of ER, Grey’s Anatomy and Private Practice – I know that after they make their grand world entrance, babies must breathe continuously to get oxygen. But in our little dudes (since they’re younger than 34 weeks) the part of the brain that controls breathing is not mature enough to remember nonstop breathing is required.

Neither the doctors nor any of the nurses seem to think this is a big deal. Every day they reassure us that he’ll grow out of it. I am beginning to believe them based on his behavior when he is not thoroughly chilling out. In order to give him a little extra oomph, he gets a bit of extra air encouragement. This week, due to an increase in episodes, Destroy got socked with the CPAP.

As noted in the NICU 101 post, the CPAP uses small tubes fitted into Destroy’s nostrils to push a continuous flow of air to help keep tiny air passages in his lungs open. It is usually secured to his head by a ridiculous looking sock hood. Destroy does not like the CPAP. At all. Even a little. In fact, I would venture to state that Destroy hates the CPAP.

Yesterday, it took two nurses to hold the little two-pounder down while the respiratory therapist fitted Destroy with the contraption. According to his nurse, with wax-on wax-off karate kid-like strength, Destroy fought with all of his being to keep the blasted thing off. Yes little man, you are indeed your mother’s son (see Missing: My Sense of Humor post).

Mom and Destroy

Today, he’s back on the nasal cannula. The doctor pointed out he just seems much happier. And by happier, I’m pretty sure she means “not ripping tubes from his nose while howling at the nurses.” When I held him this afternoon, he seemed very content. We have also begun noticing a pattern that many of the apnic episodes occur as Destroy poops. A multi-tasker he is not – of course, given the size of said poops, I suppose his forgetfulness is understandable.

Dad and Search

Since they’re now tolerating full feedings and consuming a whopping 127 calories per day, they are expected to start gaining weight soon (provided they don’t poop out all potential gain). I am more than ready for my little muppets to get bigger. As hard as it is to picture, they’ll allegedly gain more than three pounds over the next month. How funny that we’re excited to see chubby five-pound babies.

In any case, I know there will be many more frustrating phases to deal with. Both now in the NICU and throughout their lives. Gramma J – you got your wish. I have two sons just like me. And I couldn’t be more in love with the stubborn and spirited little men.

Stream Two Week Family Photo

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June 9, 2010

NICU 101

The other day I was sitting with my little muppets while I spoke with the nurses about their development. I ask them about breathing, heart rates, feeding, weight and general attitude on a daily basis.

Linguo: Not a NICU term.

But as you’ve seen, the boys were also both born with full heads of dark hair. This may be due to generally fabulous genes, but some of their hair could also be the result of their prematurity. According to my research, this hair will disappear as they get bigger. (Doesn’t it seem like everything happens “as they get bigger”? I guess that’s the whole “premature” concept…) Out of curiosity, I asked how long we could expect the linguo to last.

Jon later pointed out that Linguo was the name of Lisa Simpson’s grammar correcting robot in a Simpson’s episode. I was trying to find out how long the lanugo – a fine downy hair on developing babies – would last (33-34 weeks gestation).

Since I am still getting confused even though we visit the NICU twice a day, talk to the doctors and nurses as much as possible before coming home and researching things further, I thought I’d share some of the common NICU terms and concepts surrounding Search and Destroy’s development.

Please add your own in the comments or let me know what you’re interested in and I’ll add the definition to this post. (Definitions below pulled from preemiecare.org.)

Adjusted Age: Also known as corrected age, is a term used most appropriately to describe children up to 3 years of age who were born preterm, “corrected age” or “adjusted age” is calculated by subtracting the number of weeks born before 40 weeks of gestation from the chronological age.
(Search and Destroy were 12 weeks premature.)

Apgar Score: A scoring system that helps the physician estimate a baby’s general condition at birth. An acronym for A- activity, P-pulse, G-grimace, A- appearance, R-respiration. The test measures a baby’s heart rate, breathing, muscle tone, reflex response and color at 1 minute, 5 minutes and 10 minutes of life. Named after its creator, Virginia Apgar, in 1952.
(Search and Destroy both got a 5/8.)

Apnea: A pause in breathing that lasts longer than 15- 20 seconds. Apnea of Prematurity occurs in infants born before 34 weeks gestation. Because the brain or respiratory system may be immature or underdeveloped, the baby may not be able to regulate his or her own breathing normally.
(This may be normal/typical – but it’s scary as all get out. Destroy is struggling with this right now.)

Beta-methasone: Corticosteroid medication given to the mother before the baby is born to stimulate fetal lung maturation and to decrease the frequency and damage from intracranial hemorrhage in premature infants.
(These are the aforementioned steroids Search and Destroy received.)

Bilirubin: Bilirubin is a breakdown product of hemoglobin, the substance in blood that carries oxygen. Normally bilirubin passes through the liver and is excreted as bile through the intestines. Jaundice occurs when bilirubin builds up faster than a newborn’s liver can break it down and pass it from the body.
(Preventative treatment for Jaundice is why the boys look like they’re at a rave in some of their earlier pictures.)

Bradycardia: A heart rate less than 100, slower than normal for an infant.
(This seems to go hand-in-hand with the apnea episodes.)

Breast Pump: A machine to collect breast milk without the baby present. A hospital- grade breast pump is often more powerful than those for home use, and may be available for rental.
(I am the Dairy Queen!)

Cannula: A slender tube that can be inserted into a body cavity or duct.
(The boys have thus far been consistently on and off a cannula of the nasal variety.)

Complete Blood Count (CBC): Blood test that looks at the number and type of white blood cells, the concentration of hemoglobin, the percentage of blood volume consisting of red blood cells (hematocrit), and the number of platelets.
(Search and Destroy have both had several of these. Doctors order them to rule out infections or other issues. Typical diagnosis: “They’re tiny.”)

Continuous Positive Airway Pressure (CPAP): Through small tubes that fit into the baby’s nostrils, called nasal CPAP, this machine pushes a continuous flow of air or oxygen to the airways to help keep tiny air passages in the lungs open.
(Search and Destroy have been on and off of this machine as well. It encourages them to remember to breathe.)

Electro- cardiogram (EKG): An adhesive patch placed anywhere on the body, and connected by a wire to a monitor, used to detect heart rate, respirations, or blood oxygen levels.
(Destroy had one of these yesterday because of his bradycardia episodes. It was positively terrifying to see all the little patches on his tiny body. Diagnosis: “He’s tiny.”)

Gavage Feeding: A method of feeding a baby with breast milk or formula before he has learned how to swallow. A small flexible tube is placed into a baby’s nostril or mouth and passed down into the stomach.
(The boys are big fans of food – regardless of how they get it at this point.)

Incubator/ Isolette: A heat-controlled crib used to maintain a baby’s body temperature.
(Baby jail.)

Kangaroo Care: Holding a baby against one’s naked chest, so there is skin-to-skin contact.
(See Kangaroo Kare post.)

Lanugo: Fine, downy hair that covers the fetus until shortly before or after birth.

Monitor: A machine that records information such as heartbeat, body temperature, respiration rate, and blood pressure.
(They beep. A lot.)

Nasal Cannula: The “oxygen tubes” that give extra oxygen by blowing moisturized oxygen, possibly mixed with air, into the nose.
(See “cannula.” Both Search and Destroy receive standard room air through this “oxygen tube.”)

Neonatal Intensive Care Unit (NICU): There are three levels of NICUs: Level 3: Cares for any infant (at any age of gestation) that may have or could have severe or life threatening conditions. Level 2: Any newborn that may require monitoring after birth and requires more than routine newborn care. Level 1: Routine newborn care. Usually for full term infants, there may not be specialized equipment or physicians for problems.
(Kaiser Santa Clara is a Level 3 care center. Thank goodness.)

Neonatologist: Physician with 10 years of training specialized in dealing with the diseases and care of newborn infants.
(A big thank you to Drs. Lawrence Dong, Yuri Knauer, Preeti Patel, Anupama Shetty, Richard Vanwoerkom and Carlene Wong for taking such great care of our little ones.)

Percutaneous Line (PICC): Also called percutaneously inserted central catheter or PICC line, this is a long catheter placed into a surface vein, with the catheter tip extending farther into the body into a large central vein. Doesn’t have to be replaced as often as a regular IV line.
(Once the boys got their PICC lines, we got to start Kangaroo Kare. Now that they’re eating so well, the lines are already gone.)

Severe Prematurity: Also known as very premature, refers to babies born from 28 weeks through 31 weeks gestation.
(The twins were technically born at 27.5 weeks, but we’ve upgraded them to 28 since they were only two days short of the coveted third trimester.)

Very Low Birth Weight (VLBW): Very low birth weight infants weigh less than 1500 grams or 3lbs 5 oz.
(Search weighed in at 970 grams and Destroy was born at 1005 grams.)

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June 6, 2010

Feed Me Seymour

So I can grow up big and strong!

(Disclaimer: Despite the current surge in bloodsucker popularity, I do not have vampire children. I just thought the “Little Shop of Horrors” theme fit this post.)

The boys are tolerating increased amounts of milk very well. Fingers crossed that they continue to do so well. I just knew my children were perfect! Now that they are at the ripe old age of over one week old, their doctors are increasing the amount of milk they eat by 2ml every three hours. Tonight, they receive their last dose of IV nutrients – TPN and lipids. Yum, fat!

I know that feeding is the next hurdle our little preemies are challenged with. The nurses again noted the two steps forward, one step back concept. It all depends on the strength of their tummies and performance of their insides.

Rumor has it, once they’ve reached the top level (20ml) – and continue to tolerate it – that is when they start to get big and strong, fast! Naturally, both Search and Destroy already proved how strong and determined they are (stubborn – just like mom). But there really is no decent debate to legitimately argue they’re big. Let’s face it – two pounds is just tiny. (Even if you are reading this at 6’5” boys.)

I’m really looking forward to the getting chubby phase of development. Ideally, increase in weight and size correlates directly with outgrowing apnea and bradycardia. At that time, Search and Destroy will start co-bedding as well. They’ll get a real crib to share – instead of their current incubators. I can only imagine they miss each other. Born so early, they were rudely ripped away from both mommy and each other. I have no doubt being together again will make them thrive – right after Search gets in another kick to his brother’s head…

Until then, we visit the boys every day. We indulge in Kangaroo Kare, which both of the boys seem to truly love. We talk to them, telling them about daily events and occurrences outside the NICU bubble. Today it was a gorgeous 85 degree spring day – I described a future where I can see Jon and me playing catch with the boys in our backyard while the dogs run amuck on just such a day. (Well, maybe not with the dogs. Cooper’s likely faster than Search or Destroy will be at a young toddler age and he fancies himself the catch champion in the Stream household.)

And Jon and I talk to each other. Often we just repeat what we’ve just heard as we head home for a few brief hours. Sometimes we try and analyze the non-verbal cues from the day’s debrief (yes, just like a pair of teenage girls). And when only one of us can make it to a particular visit, obviously we pass along the updates.

The hot topic du jour is pooping. Pooping means they’re processing their food and their insides are working. A typical dinner conversation will, in fact, include the question, “Did he poop today?” For those inquiring minds, both boys are pooping well – Destroy is doing so well, he’s been upgraded to size 2 diapers. They are about the same size as Destroy, but they hold more poop.

Destroy and the Diaper

Even if they are still so so tiny, I can tell they’re growing every day. Search is already up over his birth weight and Destroy isn’t far off from his. Today, I kissed Destroy’s little nose and noticed tiny little freckles I haven’t seen before – freckles just like his daddy has.

So, for now, I am proud to be the Dairy Queen. Every three hours for the sticky licky sweets they crave. That’s right boys, you can do it! Grow up big and strong.

Search as he grows

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June 5, 2010

One Week

It’s been one week since the twins arrived. The time has passed by in the blink of an eye and taken forever at the same time.

The routine we have developed is as follows:

9 a.m.: Pump milk for the boys.
9:30 a.m.: Morning visit to the NICU. Quiz the nurses on Search and Destroy’s progress and spend some family time with our boys.
12 p.m.: Pump milk for the boys.
12:30 p.m.: Attempt to run errands and eat lunch.
3 p.m.: Pump milk for the boys.
3:30 p.m.: Afternoon visit to the NICU. Call the NICU, letting them know we’re in the lobby and would like to be let in to see our boys. Kangaroo Kare! (Depending on how the boys are doing.)
6 p.m.: Pump milk for the boys.
6:30 p.m.: Pause to see if I will have a stress breakdown about how unfair life is for my babies.
7 p.m.: Attempt to clear items of household to-do list. (Usually a futile attempt.)
9 p.m.: Pump milk for the boys.
9:30 p.m.: Dinner-ish (Cereal counts.)
10 p.m.: Crash on whichever soft furniture item happens to be closest. Think about trying to muster energy for a blog post.
11 p.m.: Get ready for bed.
12 a.m.: Pump milk for the boys.
12:30 a.m.: Nap.
3 a.m.: Pump milk for the boys. Try in vain to remain upright and awake for said process.
3:30 a.m.: Nap.
6 a.m.: Become very confused about why an alarm is going off. Fall out of bed and pump milk for the boys.
6:15 a.m.: Discover Scout has been eating apples from our tree again by way of the doggie vomit on the nursery rug.
6:20 a.m.: Clean and curse.
6:30 a.m.: Nap.
9 a.m.: Rinse and repeat.

The boys routine changes slightly depending on their daily interaction with the neonatologist. The vast majority of their day is spent sleeping, although recently they’ve taken to opening their eyes quite a bit more. Today during Kanga time, Search would try to lift his head and look up at me with his eyes wide open. I know all they can allegedly see are out-of-focus hazy shapes, but I prefer to comfort myself with the thought that my boys are already little geniuses.

They also eat (via their feeding tube) every three hours, and an hour after mealtime is the standard coffee break. (Yes, the boys get dosed with caffeine. After all those months that moms spend avoiding it, it’s the first thing a preemie gets.)

Search and Destroy are doing very well. All the doctors and nurses warned us, as par for the course in a preemie’s development, parents should expect to see two steps forward and one step back. During these first weeks, the lesson is breathing.

Due to their young age and tiny size, apnea and bradycardia are very common. Medically, this means an interruption in breathing and a slow heart rate, respectively. In reality, this means they forget to breathe on their own. Each of the twins is currently dealing with the aforementioned problems. Destroy currently has no air assistance, while Search has gone forward and back needing a little extra aid. Apparently, their lungs work fabulously but the extra help is a bit like a personal trainer helping them to strengthen the muscle tissue.

We are very focused on this lesson right now – breathing is very important. The NICU staff assures us that they fully expect Search and Destroy to pass Lung Functionality 101 by simply growing. Growing is to be expected when they start tolerating more and more milk. We expect eating to be heavily involved during the next phase – they need to convince their tiny tummies to process food. Multi-tasking won’t take place until NICU graduate levels.

Destroy: One Week

Search: One Week

It’s been one week. We’re hoping the next 7-11 weeks go smoothly. Then we can finally all be together as a family. And I can make the boys read this post when their teenagers and confident that they know everything – reminding them that at one point they didn’t even know they should keep breathing.

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June 4, 2010

One Big Happy Family

No witty repartee on the blog today. The twins are a week old and I’m exhausted.

So without further ado, may I present to you the first Stream family photo:

Mom and Search, Dad and Destroy

Additional in-depth analysis of this week shall resume some time this weekend.

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June 2, 2010

Kangaroo Kare

I didn’t plan to write a post today. I thought perhaps I’d take a day off to try and accomplish some of the items on my to-do list. But then Kangaroo Kare became a part of my new routine. This just had to be shared.

For those of you expecting an off-the-wall rant or adventure involving marsupials, you may be shocked to learn Kangaroo Kare is actually a medically proven technique. (It’s even listed in my new preemie dictionary.

Since the boys arrived last Friday, my to-do list has been steadily growing. I’ve even had to organize my lists into a list to keep everything straight. Six weeks of bedrest, four spent locked in a hospital, gave me lots of time to realize what we needed to do before the boys come home. In addition, now that I’m home (and very sadly my muppets are not), nesting fever has fully encompassed me.

I’d like to straighten out several of our rooms: clean out my medicine cabinet (since I have oodles of extra pre-term birth prevention, which worked oh so well…), organize the office and categorize my digital files (since the boys will be top paparazzi targets) and put the nursery in order.

I have lists of items to get like basic household necessities in Costco bulk, groceries, baby needs (we’ve ordered preemie pacifiers based on the boys attitude toward sucking on their food lines and impressive attempts at thumb sucking) and books I think the boys may enjoy hearing now.

I’ve got paper work to fill out for my maternity leave, insurance, new dependants and Thank You cards to write for all of you who have been so wonderfully generous during this seriously stressful period. And Gramma J keeps heavily hinting that perhaps we should be looking at new (larger) vehicles. (I have become the lone supporter for my trustworthy 12-year-old Honda.)

I’ve got pampering issues to deal with. I’d love to get my hair cut and perhaps even a massage since my back still hurts. Ideally, I’ll be out walking and enjoying beautiful weather – something I was dearly deprived of during lockdown. (This is doctor ordered to help heal a C-Section and muscle atrophy from long-term bedrest.)

Babywise, I am in process of crocheting each of my sons a unique baby blanket. Yet, since this takes time, I am also looking for a simple sewing pattern to make them small quilts. One of the practices in the NICU is to place a blanket over the isolettes.

Totally radical waves dude!

Yee-haw!!!

(This helps keep the environment darker for the boys as they’re already getting enough stimulation as it is.) Right now, Search’s blanket is blue with surfer dudes. Destroy’s is green/tan with John Deere tractors. Neither is appropriate – I just can’t seem them as “brahs” hangin’ 10 or country-boy farmers.

So what does this have to do with Kangaroo Kare? And how does that add to my current commitment and dedication to being the Dairy Queen every three hours and visiting their temporary home twice a day? Simple. All those activities in the previous five paragraphs – so what, who cares? They may or may not get done some time in the future, possibly before Search and Destroy graduate college and move out.

We got to hold Destroy today (hopefully Search will be Joey-ready tomorrow). For the first time, I held my tiny baby in my arms, cradled him and felt his heart beating against mine. He opened his little eyes before falling into what I perceived to be a tremendously content and peaceful nap.

Kangaroo Kare is the technique of skin-to-skin contact between baby and parent. Our nurses have repeatedly told us how much the babes enjoy the experience and that it makes them thrive. Studies state this marsupial method offers significant benefits for preterm infants such as increased ability to regulate their own temperature, decreased apnea occurrences and increased weight. Additional studies also suggest that Kangaroo babies have improved cognitive development, decreased stress levels, reduced pain responses, normalized growth and positive effects on motor development. Maybe this means earlier release home is a possibility?

Going back to yesterday’s post, today gave me yet another new perspective – realizing how small they are and the expansive intensity of a parent’s ability to love. I would happily spend every moment of the next several months holding my babies. It’s true. I’d voluntarily commit myself back to the hospital for this.

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June 1, 2010

Perspective

Hand in Hand

According to a  Chinese proverb, there is only one pretty child in the world, and every mother has it. Jon and I have two of the most handsome dudes ever. At least that’s my perspective.

Our little family is living a new normal. We’re creating our routine out of necessity, certainly not choice. Live it a while and it’ll become typical for us. I imagine as soon as we become used to the order we create, it will be time for the boys to come home so we can create yet another new normal. We’ll just have to keep it in perspective.

The above photo exemplifies just how much our perspective is changing daily. There, a 3-day-old Search holds his Daddy’s hand. So different in size, but I don’t think the picture gives any indication of who truly has the strength. (And regarding that leadoff photo, both Search and Destroy are surprisingly strong! It continues to amaze me when we feel their vice-like grips holding our fingers.)

Most women enter pregnancy expecting to slowly grow for about 9-10 months. They have a set idea of when the baby will arrive. He or she generally does arrive in a generally set time frame. I was terrifically excited to last six months. I was desperately hoping for a third trimester, but the NICU staff keeps congratulating me for making it over 27 weeks.

Most new parents expect to leave the hospital, dazed and confused, clueless about what to do with a newborn. I left the hospital with a charge and purpose. My multiples stayed behind. Instead of trial and error, Jon and I are arming ourselves with dictionaries of medical terms and lists of questions for multi-degreed doctors.

I saw a baby in a stroller yesterday. “Oh my God!” I practically screamed. “That is the most gigantic baby ever to walk this earth!!!” (Luckily, I don’t think any offendable stranger actually heard me.) The baby was perfectly normal – but my new normal involves babies under 3 pounds.

The boys can’t quite see yet. The nurses said they can vaguely make out shapes. They occasionally open their eyes (looking kind of drunk when they do), but mostly their world is identified by smells and touch. So really, when Search attempts to rip the wires from his body, he’s really just proving what a talented and gifted kid he’s going to be.

When they’re a bit bigger, we’ll bring them educational flashcards (Say Lady! It’s a Lady!). The black and white images will slowly start to become clearer for them – making their perspectives a bit greyer as they continue to grow up. Just like Mom and Dad.

Search - 4 days old.

Destroy - 4 days old.

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May 31, 2010

On the Way to Blue Jay

My sources say that parents should converse with their children to help them develop. Allegedly, Search and Destroy already recognize my voice from the non-stop babble they heard constantly in the womb. Now, as they need all the extra developmental abilities as we can provide, I deduced that they would benefit from story telling.

When we were young, my brother and I used to look forward to hearing a “Grandma story” every time she came to visit. Grandma (henceforth known as G.G. for Great-Grandma) would forego reading any book at bedtime. Instead, she would sit in the hallway between our two rooms and tell us stories about her past (of course including all friends and relatives affected by the detailed events). Continue reading →

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May 30, 2010

Waiting for CaLo

I came home from the hospital today – such a bittersweet release. Search and Destroy remain sequestered in the NICU. They will be there for a minimum of two months.

In Samuel Beckett’s “Waiting for Godot,” the two main characters wait out the length of the absurdist play for Godot. Instead of the literal meaning of an impending in-person meeting, one could argue that Vladimir and Estragon (the aforementioned main characters) are in the midst of an existential crisis.

This is the surreal existence I now find myself in. I am a mother, a mommy of two precious twin boys. Jon and I are parents. Search and Destroy are ours to care for. But they are not yet really ours. You meet your children and you would do anything for them – then you are faced with the guilt of not having provided enough to keep them out of harm’s way. Continue reading →

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May 29, 2010

Press Release: Birthday Boys

And Babies Make Six…
The Stream Family Welcomes Twin Boys

 

SANTA CLARA, Calif., – May 29, 2010 – Yesterday, Jonathan and Tricia Stream, parents, welcomed twin baby boys into the world at Kasier Santa Clara. Search Welker and Destroy Anthony were delivered at 27.4 weeks by a stellar medical staff of more than 15 professionals, including surgeons, perinatologists, anesthesiologists, nurses and an individual pediatric team for both boys. Continue reading →

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