Miggs on the Mend

Texts from Kate:
6/23/11
7:44pm “NG tube out tomorrow. Start feeds then. Morphine off in am.”
8:04pm “She is peeing like a dickens and has eyelids once again”
8:32pm “I see a beebo [bellybutton].”
6/24/11
6:04am “It was a great night. She is so sweet when she’s not strung out. Swelling way down.”

Ingrid looks much better today – her face is no longer swollen. She woke up this morning and played with her Dad a bit. She enjoyed reading the book that Ms. Sherri sent her. Thanks, Ms. Sherri!!

Ingrid has made great strides today: She is off the continuous morphine drip, receiving it in scheduled doses, and she’s down to 2L at 35% O2 (don’t forget that 21% O2 is normal.) Her NG tube did indeed come out this morning and while Dr. Barksdale was visiting Ingrid had a little poop! In the world of the PICU and major abdominal surgery that is great news! And, to top it off, she was able to have a bottle of Pedialyte this afternoon. (It made her a little gassy, but that just means the pipes are working!)

Anna and Grandma stopped by for a visit. Anna really misses her mother, it’s nice that we can all be in Ingrid’s together. When Ingrid started crying Anna sang Just and Beaver to her, "Baby, baby, baby, oh! Always be mine!"

Ingrid is much mellower today. She’s awake and alert for short periods, playing with books and toys. I can’t tell you how wonderful it is to have our baby back again! Once she is totally weaned off the O2 she will be ready to move out of the PICU.

Crabby Patty

Ingrid is crabby! The general consensus this morning was that she is not in pain so much as just irritated. Ingrid had a crabby night while Kate held her for several hours and then Kate was able to sleep for a bit when her night nurse let Kate in another room.

Overall it was an ok day with a few slow baby steps towards progress. Other than pain control (which is fairly well maintained) the major issue has been Ingrid’s breathing/blood oxygen. Her O2 levels stayed up as long as we were holding her, so Kate and I took turns holding Ingrid all day. Mid-afternoon she tolerated a reduction in her O2 supplement from 55% to 45% so that should continue to go down. We are also weaning her off morphine in favor of a non-narcotic as another step towards getting out of the PICU.

We are also moving forward with some nutrition. Ingrid began receiving TPN this afternoon, although that did require a great multitude of doctors and nurses to find another good vein to replace one of her IVs.

A good sign: Ingrid opened her eyes a little this afternoon and she really seemed like she recognized her parents. Her eyes are swollen (as is the rest of her body) so they didn’t open much more than slits, but she seemed to be more “there” than the last time we saw her pin-prick-pupils.

Tiger Mother

Another rough night: Ingrid’s breathing took a turn for the worse and there was talk of putting her on a ventilator. After much discussion, phone calls among doctors, and Kate putting her foot down that she would NOT spend another night holding her baby’s arms down they decided to use the nasal cannula to increase the pressure in Ingrid’s lungs. The problem is that she is taking shallow breaths and not filling her lungs. This has caused the lower lobes of her lungs to collapse a bit; all normal or at least expected say the doctors. So far this has regulated her breathing and kept her blood oxygen at or near 100%.

They took out her epidural last night, in part because it was coming out and leaking anyway. But they replaced the catheter/Foley bag because her urine output had dropped off. So now they can accurately measure her urine output (a good measure of how fluids are moving inside her) and can measure her bladder pressure to tell how much pressure is being put on the organs in her abdomen. The fear is that the pressure from organs begin forced back into her abdomen will limit or cutoff blood flow there.

And, after multiple sticks, bright lights, and ultrasounds looking for good veins she got another IV in her neck so she would have to be pricked again to draw blood for testing.

Dr. Barksdale was in early this morning to look at Ingrid’s incision and to remove the dressing in hopes that less tension on her chest would help her breathing. Her incision looks great. He left off most of the dressing so now she has only a smallish gauze pad held on by 2 long pieces of tape.

We’ve been told that day 2 or 3 after major surgery is when most patients start to turn towards recovery. At this point the pain team’s plan for pain management is working. Ingrid slept peacefully all morning.

With her pain fairly well managed, the biggest issue now is Ingrid’s breathing. She has been breathing with some forced air to keep pressure in her lungs. We’ve tried to wean her down from 5L at 60% pure O2 but it has been slow with setbacks. She didn’t tolerate going down to 40%, but was ok at 45%. She didn’t tolerate going down to 4L so they bumped her back up to 5L. De-sats continued frequently throughout the afternoon. In time she should be able to take full breaths on her own, but as of now she's having a rough time.

Tiger Mother Kate has not left the hospital since we arrived early Monday morning. She has been a forceful advocate for Ingrid and an invaluable member of her care team. And she was there when Ingrid broke everyone’s heart moaning, “Gaa gaa” (what she calls Kate.)

Did I Say Feisty?

Kate spent a sleepless night with Ingrid in the PICU. The Pain Team was called frequently to adjust and administer medications. Early this morning, after several increasing doses of morphine, they tried some anti-anxiety medication to calm down our raging redhead. During the night she managed to pull her NG tube out of her nose twice and the IV out of her hand once. The last while Kate struggled to hold her down! Kate finally made the doctors understand that the problem wasn't pain but that Ingrid was pissed off! Shortly after I arrived this morning they gave her a dose of Adavan (sp?) which did the trick and she slept for about three hours straight.

When she wakes up a little she wants to roll over and move about. She has been up on her hands and knees several times. She is obviously in some discomfort and periodically flails about. This is a problem mostly because she has a bunch of tubes and wires that get hopelessly tangled. And a nasal cannula was added this afternoon because her blood-oxygen level kept dipping. The doctor said that she's not taking deep breaths because it hurts too much. So, the main issue still is pain management.

Kate held Ingrid for a little while this afternoon while her nurses changed the sheets on the bed. And late this afternoon Anna and Grandma came by for a short visit. Here's hoping that everyone can maintain for the duration: Ingrid needs to rest and recover, Kate needs strength to make it through on hospital catnaps, Anna needs strength to deal without her mother around, and Grandma needs strength to deal with a wild 4-year-old! (Me? I'm fine. I get to go home a sleep at night.)

The Big Day

Well, Ingrid did a great job yesterday and slept soundly through the night.

We arrived at the hospital at 6am and were in the surgery prep area by 6:30. Ingrid was relatively peaceful and quiet while various doctors and nurses asked us the same questions about allergies, etc. And then, with everything ready, she was whisked away in the arms of a young anesthesiologist on her way to her very big day!

Our pager beeped around 8:30 with the message that Ingrid's surgery was beginning. And then, every hour after with encouraging news of her progress. Around 11:30 we got the call that she was done and we met with Dr. Barksdale, her surgeon. He said they we able to close her "primarily" which meant that she now has skin and muscle going across her belly with a biodegradable patch added for support (rather than to help fill in any gaps.) And he gave us a before-and-after picture so we could see the suture and her brand new bellybutton!

We were finally able to be with Ingrid in the Pediatric Intensive Care Unit (PICU) around 12:30. Her nurse said she had already woken up and had pulled off her nasal cannula (supplemental oxygen). She has plenty of other tubes to yank at: an NG tube to get rid of fluid in her stomach, a catheter, an IV, an epidural, a pulse-ox, and a blood pressure cuff. She's a feisty one - she's rolled herself over a few times already!

Right now the main issue is pain management. We've been told (and Kate has read before) that redheads process pain medication faster than other folks and, therefore, need more! There have been a few adjustments this afternoon to her pain meds so that, hopefully, she will sleep off the worst discomfort.

Kate is spending the night at her side. She's a little worried because the PICU nurse said she'd be in for a rough couple of days! My girls are strong, though!!

Thank you all for the thoughts and prayers these past few days.

The Countdown

Everyone made it to Cleveland safely; The girls flew and Daddy drove the minivan.
We are 3 hours in to the 24 hour liquid diet before Ingrid's 7am surgery tomorrow (June 20).
Hopefully today won't be as stressful as we're anticipating. Hopefully Ingrid will be happy with jello and popsicles all day.
Thank you, everyone, for prayers and good thoughts.
Check back tomorrow and in coming days for news of the surgery and recovery.

Happy Father's Day!!

Happy 1st Birthday, Ingrid!!

Ingrid celebrated her 1st birthday today! Yay!!

She is cruising and scooting all over the place and she is working on growing in her front teeth.

We are all anxiously awaiting our big trip to Cleveland for Ingrid's surgery in 2 weeks. The girls are flying on June 18 and Dad is driving.

But, for now, all is normal and happy!


Happy Birthday, Miggs!