Day 12 Update

Hi All!  Visiting the babies yesterday was nice.  I really missed seeing them on Sunday, but it was definitely a needed reprieve.  Golda slept most of the time we were there, but held my finger while she did.  She was doing well and still is today.  She is still on her CPAP, breathing room air, and her vital signs are all stable.  The blood culture is listed as "preliminary negative" and we are hoping when they round today she will come off the antibiotics.  While Golda isn't eating anything, she is still getting plenty of fluids and the nurse says she is "peeing up a storm" which is very good - and tells us her kidneys are indeed fine!  She weighs 1081 g (2 lbs. 6.13 oz.) today.

I got to kangaroo Leah yesterday.  She snuggled right in and went fast asleep.  It was such a nice feeling to just hold her for that half hour and feel her resting on me.  When we got there, she had yanked her oxygen cannula out and it was blowing nicely on her chin!  I put it back in and she reached right over and tried to yank it back out!  The nurses say she has been doing that often.  This morning she took her 20 ml of fortified breast milk from a bottle!  Her nurse decided to see what she would do with it and she apparently has figured out exactly what to do with it - drink it all down!  Her oxygen was decreased from 0.04 L to 0.03 L.  She weighs 1420 g (3 lbs. 2.08 oz.).

Micah is still trucking along.  Daddy fed him yesterday and he ate all of his bottle.  When I finished my half hour with Leah I took him from Daddy and snuggled my little guy for a bit.  He was fast asleep with a look on his face that reminded us both of his big brother when he was a baby.  Micah is now up to 29 ml of fortified breast milk, still alternating between NG and bottle feeds.  He is weighing 1885 g (4 lbs. 2.49 oz.).

Okay.  I need to go spend some time with Harry now!  More details on the triplets tomorrow.

Day 11 Update

Good Morning.  Jon and I are feeling a litte more human today after taking some time out yesterday.  Mema and Pepa paid visits to all three for us and reported that they were doing well.

Just the brief morning update from the nurses today:  Golda is holding steady.  Her blood cultures are thankfully still negative, but they have to wait a full 48 hours (tonight at 11:30 ish) for them to be sure it's negative.  That means she is still getting her antibiotics just in case.  She is still on CPAP, breathing mostly room air.  On occasion she needs to have the back of her throat suctioned to remove some thick saliva that pools there, but otherwise she is doing just fine.  She gained a little weight, making her now 1076 g (2 lbs. 5.95 oz.).

Leah is still using the oxygen cannula at 0.04 L oxygen.  The nurse said they have orders to reduce the flow, but haven't yet because she is having occasional apneas and having the oxygen keeps her from getting too tired to self-recover from them.  They are getting less frequent though, so that's a plus.  She is taking 20 ml of fortified breast milk by NG tube every three hours. Her weight  is 1370 g (3 lbs 0.32 oz.).  The good news for Leah is that she is now taking all of her nutrition from her NG tube - no more supplemental nutrients for her and therefore, no more PICC line!!!

Micah is also PICC line free!  He is still alternating his feedings between bottle and NG tube and is now up to 25 ml of fortified breast milk and its showing in his weight - he is now 1850 g (4 lbs. 1.25 oz.)!

That's all for now.  We will be visiting all three today.  I will update again tomorrow!  Happy Rosh Hashanah!

Day 10 Update

Hi Everyone.  Yesterday was a good and exhausting day.  We went first over to Sukon's to check out their tent sale, but the furniture was way to big for our needs.  We did get a few little things though.  Then we had a quick lunch and headed to North Shore to make it in time for the 2pm bottle feeds.  We actually got there a little before they were ready to eat so I quickly pumped some fresh milk for Leah.  The nurse let me try to bottle feed her, but it was apparent pretty soon that she was having difficulty sucking with the NG tube in her mouth.  It has to stay there until she is off her oxygen cannula, so it will probably be a few more days until she can really give it a good try.  We switched over to NG tube though and she took 16 ml of breast milk without any problem.  She is doing well today on 0.04 L of 100% Oxygen.  She has some bradycardias (where the heart rate slows down way too low) but she always self-recovers, meaning the heart rate increases without anyone stimulating her (a good sign).  She is now taking 16 ml of breast milk and weighs 1385 g (2 lbs. 0.85 oz.) and she has stopped her supplemental lipids.

Daddy got to feed Micah yesterday (see pictures below) and he did a great job (and got a smelly noseful as a reward!).  Micah is, as of today, taking 25ml of breast milk, supplemented with human milk fortifier to add extra calories.  Heis still alternating NG and bottle feeding every other feeding.  And, tonight, when his TPN (extra nutrient supplements) runs out around 4 or 5 pm, they will stop all supplemental nutrition for him and remover his PICC line!  He will then only have his NG tube and monitors attached to him!  He now weighs 1815 g (4 lbs 0.02 oz.).

When we went to visit Golda yesterday she was still off CPAP and only needing to have her saliva suctioned every so often to keep her oxygen levels up.  We got to hold her and get a nice look at her little face and eyes (see photos below). We spoke to the NICU fellow and asked about the results of her sonograms.  She had a head and kidney sonogram to check for brain hemorrhage and to ensure her kidneys had no malformations (often associated with esophageal atresia).  Thankfully, both were negative for any real findings, although the head sono did show signs of prematurity, which is to be expected (her brain sulci (those deep ridges on the surface of the brain) aren't as deep as they would expect for a newborn, but they will become fully formed as she puts on weight and continues to grow). 

Unfortunately, last night around 11:30 pm Golda started having "episodes", her blood oxygen was decreasing, she was having bradycardias and apneas and they needed to put her back on the CPAP.  She is still on room air though.  One of the reasons she could need to return to CPAP could be an infection so they immediately did a blood culture and started antibiotics just in case.  The culture hasn't grown out anything yet, but we have to wait 24 hours for the complete results.  If it is negative then they will stop the antibiotics and try her of the CPAP Monday or Tuesday.  They are also starting her on caffeine, which is commonly given to preemies as a stimulant to try to raise the level of alertness to stop the bradycardias and apneas.  However, in spite of all this action last night our little Golda still managed to gain a bit of weight.  She is now 1081 g (2 lbs. 6.13 oz.).

Jon and I have decided to take today to rest.  We are both close to falling down on our feet, falling asleep at the drop of a hat, so we are going to stay home and relax and regroup, not to mention pay some quality attention to Harry.  My parents are going to deliver the breast milk to the hospital and look in on our little ones.  I am going to call the hospitals later today for updates, though I will still post the next update tomorrow :)

Leah in Mommy's arms, with a great confused expression on her face.  She is wearing a hat knitted by volunteers.  The tubing is her PICC line.  We think she looks like Daddy.

Leah catching some zz's.

Leah, getting her yummy breast milk by NG tube in her isolette.

Daddy feeding Micah his bottle.  Doesn't he look like his big brother?  That's his PICC line on his left arm.

"Why am I hanging like this!??!? You mean you want me to burp?"

Mommy, Daddy and Micah in the NICU.

Golda and Mommy.

Golda's cute little face - we think she looks like her Mema.

Golda, resting in Mommy's arms.  That hat was knitted by volunteers.  Daddy thinks it makes her look like a Beastie Boy!!!

 

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Day 9 Update

Good Morning!  I have been having a little bit of a lazy morning today, but I will have to get going shortly so I will try (ha!) to be brief. 

They are all doing very nicely.  When we (me and Deena, Jon slept in the car) got to LIJ to see Golda yesterday she was still on her CPAP even though they had told me she was going to be trialing off it that morning and they expected good results.  We had to wait a while for the nurse since she was doing a procedure on another baby, but when she came over she told us that they had tried her off but she needed to go back on within five minutes. I was disappointed, but it didn't last long.  The nurse offered to let me hold her and I very quickly agreed!  I was finally getting to hold my little Golda!  And, even better, the nurse said that since we were there, she would trial her off the CPAP again.  So, I actually got to hold her and see her cute little face.  Since she is so small it still has a more skeletal appearance than her siblings so its hard to see what she will look like when she plumps up more, but she definitely has my pointy chin.  When I called to check on her this morning they said she was still of the CPAP and had no problems all night!  And she is still off her bili lights.  Her weight is 1054 g (2 lbs 5.17 oz.) now.

Leah was back on her bili lights yesterday so I didn't get to hold her and she was still under them when I called to check on her this morning.  However, the lights are doing nothing to stem her appetite and she is now taking 16 ml of breast milk every three hours. They tried to feed her the other day by bottle, but she really wasn't interested and they haven't tried again since they don't want her to waste calories trying to suck.  They have discontinued her supplemental lipids though since she is doing so great on the breast milk.  Her weight is now 1365 g (3 lbs. 0.14 oz.).  She is now the only one using any supplemental breathing assistance - her oxygen cannula. 

Micah is doing great.  He is now taking 20 ml of breast milk every three hours, alternating bottle and NG tube.  The nurse thought that they would increase his feeds today at rounds and maybe tonight stop his lipids, with the remaining supplemental food stopping tomorrow.  That would mean he could have all his IV's removed!!!  I won't get my hopes up for that though since that was her speculation and not a plan for treatment.  Micah weighs 1780 g (3 lbs. 14.78 oz.).

We are going to hit Sukon's tent sale to see what they have and then head to the hospital.  I will update tomorrow!

Day 8 Update

Good Morning.  We went to see all three yesterday in spite of my ordeal with the staples.  I don't know if it was the two percacet I took or if it really wasn't that bad, but I was feeling okay afterwards.  We were just in time to feed Micah yesterday by bottle!!!  I was so excited.  They had to show me how to feed a preemie though - he has to be more upright and needs a little "chin help" - you put your finger under his chin to keep it up for him while he sucks.  He downed that bottle so fast I didn't realize how much he had already had and so hadn't stopped to burp him.  He took care of that though and burped himself while still hanging on to his bottle!  He finished it off and then I handed him off to the expert burper - Daddy.  He laid him across his arm and got another four burps out of him!  Daddy held him for a while, making faces at Micah and getting really cute responses.  Then I got him back and he fell fast asleep.  It was so nice!  We had him for about an hour, then put him back in his isolette so he could get some real rest. 

Then we moved over to Leah.  Daddy had fed Leah by NG tube while I feed Micah so she was quite content as well.  The nurse took her out for some Kangaroo holding - she slipped right in under my shirt and snuggled up.  Whenever Daddy would rub her back I would feel her entire body wiggle and relax. 

We then headed over to see Golda.  She was doing great - feisty as ever.  They had her velcro band back in place to keep those little fingers from her tubes - she tries and tries to yank both the NG drain and her stomach drain - both really good signs that she is a real fighter and will make it through this.  I heard her cry for the first time.  Wow was that upsetting.  It is a small, high pitched cry and she was basically crying from frustration, which, again is a good sign, but makes is upsetting nonetheless.  Since she didn't have her sun glasses on because she is off her UV light, we got to see her with her eyes open.  It is amazing how alert she is, looking around and trying to take it all in.

My mom went to see all three yesterday as well.  She reported that Golda was still moving all around, but seemed less agitated (which was good for me to hear!).  She really enjoyed seeing Golda's beautiful eyes (Mema thinks they might be blue).  Then they went over to North Shore and she got to see Micah and Leah's beautiful eyes (they are a mix of brown and blue, so we are thinking they might be hazel like Jon).  When she had completed her visit, she went downstairs and brought Harry up.  Since Micah had been moved near a hallway window, the nurses held him up to see his big brother.  Harry was very excited and waved to Micah.  Micah (with the nurses help of course) waved right back.  Then Leah came to the window and waved to her big brother too.  Harry was beside himself at getting to see them both before Monday's scheduled visit.

I called for my morning updates and found out that Golda is now off her CPAP and so far so good!  It had only been a half hour, but her nurse was hopeful that she would be staying off it.  Her weight was the same and her bilirubin was still low, so no more lights for today!

Leah lost a small, inconsequential amount; she now weighs 1345 g (2 lbs. 15.4 oz.), but she is now eating 13ml of breast milk every three hours, sometimes by bottle!  The first time they tried the bottle with her she was not impressed and wouldn't drink anything so they went back to NG tube, but I suppose she has warmed up to the idea and is now taking some feedings by bottle.

Micah hasn't had any problems taking food by bottle and is up to 16 ml of breast milk every three hours, alternating bottle and NG tube feedings.  The nurse said that if he keeps this up, they will start decreasing the temperature support they are giving him in his isolette and maybe by next week (the magic 34 week mark) he can transfer to a crib!

That's all for now!

Day 7 Update - 1 week old!

Good Morning!  Yesterday we went to visit Leah and Micah, then Golda.  They were all doing well.  Big happenings?  I got to "Kangaroo" Leah because she was off her UV lights!  That means they brought out the big screens to block us and she came out of her incubator to lay on my chest, skin to skin.  She seemed to enjoy it, trying to snuggle in.  Daddy came over and smooched his little girl's head and we both talked to her.  She finally dragged those heavy eyelids open to take a look at us and seemed surprised.  It was kind of cute - she would look at me then at Jon and then close her eyes, then repeat, like she didn't believe what she was seeing.  I guess it is partly because no one has really ever been that close to her face before and maybe we were the first people she has seen really in focus.  It was wonderful to be able to really hold her and after about half hour, forty five minutes I had to put her back in her incubator and go pump! 

Jon tried to donate blood while I pumped, but his blood pressure was too high - I couldn't imagine why!  I visited with Micah for a few minutes then we headed out to see Golda.

It was very good timing because when we arrived the surgeon was there just finishing up his exam of Golda.  So I finally got to meet him and discuss his long-term plans for her.  Golda will be allowed to heal with no stomach feedings until next Friday (two weeks from surgery) when they will do a repeat contrast X-ray to see how she has done.  If the stomach appears to be fully healed they will begin giving her 1ml of food every hour to see how she does.  If it doesn't appear to be fully healed, we delay feeding another week.  There is no rush to feed since her stomach healing is most important.  Once she does feed they will slowly increase the amount up to a full feeding by gastric tube.  When she has done that and meets all the other criteria for a preemie to be released she will come home (that means maintaining body temp, gaining weight steadily, moving her bowels and emptying her kidneys, being of sufficient size to do the above things).  She will be coming home with the gastric feeding tube and drain still in place so we will be trained in how to feed her with this method and how to clean out her drain (draining saliva from her mouth and the blind ending of her esophagus).  She will be checked frequently by the surgeon and when she reaches approximately 6 months of adjusted age (the age she would have been if born full term, 8 months actual) and the average weight for that age (14-18 pounds) they will schedule the reconstructive surgery.  That's a lot to come to terms with since it really differs from what we had been told while still pregnant so I am really glad we ran into him yesterday.

Okay, now for this mornings updates:  Golda had a good night, nice and quiet.  She is off her UV light and was looking up at her nurse while we were on the phone (yeah, no mask!).  She weighs 1056 g (2lbs 5.24 oz.)  slightly down from yesterday, but they think she might be started to level out and will start putting on real weight now.

Leah is up to 9 ml of breast milk in her NG feeling tube (a tube that goes down the throat into the stomach) every three hours.  She is up to 1365 g (3 lbs 0.14 oz.) and her bilirubin count is down so she is finally off her UV light too!

Micah had a wonderful night!  In fact, I was so happy by this report that I forgot to ask about the results of their brain ultrasounds (all three normal by the way)!  Micah is up to 12 ml of breast milk every three hours and he is now taking every other feeding by bottle!!!!!  I was so excited because I had just asked about the process yesterday and they estimated it would be another week before they even tried to give them a bottle and here he is showing them up :)  His bilirubin was down, but not enough to get him off the UV blanket.  He now weighs 1730 g (3 lbs. 13.02 oz.). 

All in all, better than we could have hoped for after only one week.  I spoke to the doctor at North Shore the other day and she thought I seemed bothered by her good news. I explained that I keep waiting for the bad news because I know that NICU stays are usually roller coaster rides and I don't want to be taken by surprise by a dip so I can't believe they are really doing this good. She said I could believe it and enjoy, they are really healthy, strong babies, in spite of being eight weeks early and they should continue to steadily progress.  I am still trying to prepare myself for any eventual downward turn, but with each day of great progress its getting harder to do.  When they told me this morning about Micah's bottle feeding I started crying with relief - another big hurdle down.  When they finally do come home I will probably completely lose it!  But, it will be fully worth it!

I don't know if I will get to see my little ones today (sniff).  I have to go buy some nursing bras (quite desperately), then go to my doctor to get the staples removed.  I am anticipating that will be quite painful since any pressure on my stomach cuases extreme discomfort and that will not be just any pressure, so we are figuring that after the doctor I will be fit for bed and that's about it.  My parents and / or Jon will most likely go visit so the babies don't have a day without visitors.

Okay, another update tomorrow!

Day 6

Good Morning!  I will combine the update from yesterday afternoon and this morning to give you the latest!  Yesterday Dad brought me to North Shore and we went up to see Leah and Micah.  They are both doing great.   When we got there we got a big surprise - Leah was also off her CPAP and was breathing room air with the help of an oxygen cannula (regular old oxygen, like you always see)!!  Her brother was still doing great on room air with no assistance!  They were both on the UV lights for high bilirubin levels.  However, I asked if I could hold Leah, not realizing I was asking Micah's nurse!  She said she couldn't answer for Leah, but I could hold Micah!  Well, that was all I needed to hear since I have only held him for two minutes once.  She took off his little UV mask and placed him on his tummy against my chest (Kangaroo care).  It was amazing!  I was so happy I started crying and so did he!  We both calmed down and he started snuggling in so much I had to remove his tiny little face from my cleavage!  Ah, boys.  I got to hold him for about a half hour.  He just laid there all snuggly and comfy, so comfy in fact that he forgot to breath (apnea and bradycardia) and his heart rate fell.  Quite scary.  I remembered from previous times to pat his tush, but that didn't work, so the nurses in the room said to tickle his feet.  When I did that he jumped and started breathing again and was fine.  I know these are normal occurrences for premies, but I am doubly glad that our NICU won't let them leave within five days of having one.  It will absolutely suck if it happens when we think they will be coming home, but even worse would be for it to happen at home without nurses around.  He was fine afterwards and when the nurses returned they said I should take it as a complement that he was so comfortable with his mommy.  NICU logic is strange sometimes!  The best part of course was that I got to kiss his little head all I wanted (and so did Pepa for a few minutes before he left).  Oh, and Micah has his first nickname - since the CPAP mask was so irritating to his nose his nurse realized that the mask they were using to cover his eyes from the UV light was equally irritating.  She went on a search around the NICU and found a smaller black mask for him, kind of like the mask Robin wears in Batman - thus his nickname - Batman!

I had to leave there right after that since it was sibling class night at LIJ and Harry was getting to see Golda for the first time.  I made it down stairs and Jon and Harry were waiting.  We headed right over to LIJ and left Harry with the class.  Golda was doing fine, same as the day before which for her is the best we can expect.  I asked the nurse if they were going to try to remove her from the CPAP or if they would just leave her on it until she heals or until the next surgery.  She said she wasn't sure and would ask the surgeon, but her guess was that they wouldn't try to wean her off it since they don't want her wasting energy on breathing, but would prefer her to use it all for healing from the surgery and getting bigger.  That made sense to us.  Harry came in with someone from child-life and he was very happy to meet Golda.  They had taken a photo of her with all her tubes and wires to explain everything to him so he was prepared for what she looked like.  Jon picked him up and the child-life specialist said he could touch her.  Harry was so excited since they don't let them touch the babies at North Shore.  He held her little foot and hand.  They took a photo of that as well (and in fact, Jon signed a release so they can use it in promotional material!).  It was really nice seeing him bonding with his littlest sister.

Okay, that stats:  Golda is now weighing 1060g (2 lbs. 5 oz) down a bit form yesterday.  They aren't concerned though since they feel it was mostly liquid weight from the extra fluids she received during surgery.  The nurse said they expect her weight to stabilize in the next few days and then start increasing with real calorie-fat ounces.  Micah is 1670g (3 lbs. 11 oz.), up from his 1650g at birth.  He is eating 8ml of breast milk every three hours.  Leah is 1270g (2 lbs. 13 oz.) still down from her birth weight of 1360g.  No worries there though as she is taking 5ml of breast milk every three hours, oh and according to her nurse this morning, her bilirubin count is down and she is anticipating they might take her off the UV light today (which translates into more holding time for mom!!!).

As for mom, I am doing okay I guess.  The pain is a little less each day, but get really bad towards the end of the day.  Tomorrow, the staples come out.  I am not looking forward to the process, but I hope the tugging sensations will be less after they are out.  I was able to walk into the hospital and up to the NICU without assistance yesterday, but leaving again and the whole LIJ trip were quite difficult.  Again, hopefuly that too will get easier.  We are going to run some errands this morning and then head to the hospitals to see the babies.  I will update again tomorrow morning!

Little Leah, 1 day old.

Micah, 1 day old.

A better shot of Micah's cute little face.

Harry meeting Golda - this is the one they want to use for promotional material.

This is the one they took to explain what Golda will look like.  You can see her scar from her surgery, her stomach drain, her Broviac in her chest for feeding, her mask protecting her eyes from the UV light, and her CPAP.  It does look scary, but she is doing remarkably well for a baby with her problems and is incredibly fiesty - fighting the nurses and kicking Harry.

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Day 5!

Good Morning!  I am now home again.  I was released yesterday and actually left the hospital at 5:45pm.  Wow was it difficult to climb up into the car!  Not to mention how difficult it was to be leaving the hospital without a baby in my arms.  I think I did good though - I only teared up once during the trip downstairs to the car, although I did lose it for a bit in the car. 

Once we were all settled in the Odyssey, we headed straight for Golda at LIJ.   Smartly, Jon had put Dad's wheelchair in the car so he wheeled me through the hospital to see my little girl.  I have no idea why, but she too is right near the door to her NICU room (I think it's kinda weird that all three are near the doors to their NICU rooms).  She is incredibly tiny, but I think she is beautiful already.  Her scars weren't as bad as I was anticipating, but they do take up a good portion of her tiny little belly.  Her Broviac central line is covered by a little square of gauze, fully taped down.  Her stomach drain is a little upsetting to see since it is apparent that it comes straight out of her skin, but all in all not too bad.  She is, like her sister and brother, very fiesty!  The nurse taking care of her said that she will grab that drain any chance she gets (and we saw it last night too) and try to pull it out!  They have a piece of cloth they velcro over her belly to keep her from reaching it.

Once I scrubbed up I reached in and held her hand and told her I was her mommy.  She jumped a little at the sound of my voice and tightened her hand!  Can I tell you how good that made me feel???  Then Jon put his hands in from the other side and held her other hand and had his other hand on her chest and belly.  I told her she was so lucky to have both mommy and daddy here now and she squeezed tighter again.  I was so happy and relieved that she obviously remembered my voice since she hasn't seen me for four days.  The nurse was very nice and actually let me change her little diaper.  To let you know how much seeing all three of my babies in one day affected me, when we finally made it home and I pumped, I produced twice the amount I had that morning!

Before we left North Shore, Harry got to attend the Siblings class and meet his brother and sister, who by the way are now in the same room together. On a side note, for all those who were wondering, I asked the nurse the other day what the difference between rooms A and H was and why my babies were in separate rooms.  She explained that while they are both level III NICU rooms, room A offers "intense" care while h offers "intermediate" care.  Micah is in H while Leah was in A.  She was only put in there because they had one spot in each room and since she was smaller, they put her in the intense room.  But a spot opened in H and she moved over.  Okay, back to Harry.  He was incredibly happy and excited to finally meet Leah and Micah.  He had his temperature checked and looked at photos of what to expect inside the NICU, then scrubbed his hands to the elbows with Daddy's help (not the slightest complaint about washing his hands!).  We then went into the room and I introduced him to Micah.  He got this amazing grin on his face and said Hi Alvin!  He asked lots of questions about what he was seeing and Jon and I explained what every tube and wire did and showed him where the monitors were and what the normal values were.  He took it all in and enjoyed looking up at the monitors to assess how well they were doing.  After a few minutes with Micah, he headed over to Leah's isolette and met her.  He was equally happy to see her and, as he did with Micah, he asked us to open the little door so he could talk to her.  He really showed that he will be a great big brother to these little ones!  Tonight, LIJ will be having their class so he will get to meet his other sister, Golda.  Jon took some nice photos of Leah and Micah and will try to get one of Golda today, then we will post all three.

I called this morning to see how they are all doing and received great reports.  Golda had a quiet night.  She received platelets (left over issue from the surgery combined with prematurity) and is still on room air with her CPAP at a pressure of 5 cm H2O.  Her bilirubin counts went up a little so she was back on the UV light with her shades on yesterday.  She is also receiving prophylatic antobiotics for five days from the surgery so that should be ending soon.  Leah also had a quiet night.  She too is on room air with her CPAP at a pressure of 5 cm H2O and is under the UV light with her isolette covered in aluminum foil (it looks like she will make a tasty duck!).  She tolerated her feeds of 3ml of breast milk through the night, but she needed the full three hours to digest it (if they tried to do a feed a little early, there was still some food left undigested).  They will discuss whether to increase her feeds to 4ml at rounds this morning.  She now weighs 1220g (2 lbs 11.03 oz - down from her birth weight of 3 lbs 2 oz).  Micah had a good but eventful night.  He tolerated his feeds all night and is now up to 4ml every three hours.  He weighs 1660g (3 lbs 10.55 oz - a few grams below his birth weight).  He too is on the UV lights. The happening that made his night eventful: the bridge of his little nosie was becoming irritated so they (trumpet sound please) removed his CPAP and are trialling him off it!!!  They had already changed his CPAP from a nasal prong tube to the triangle shaped mask because the septum of his nose was getting too irriated, so the next step was removing it.  From the way the nurse said it, I think they expect him to fail the trial since he is only five days old and need some assistance, but most likely that will be a nasal canula (the thing they put on adults to give them oxygen).  How awesome is that!  I can't wait to go today and see his whole little face!

All in all our little ones are doing really well for 32 weekers, especially for 32 weekers needing surgery!  So, whatever good vibes and thoughts you are all sending our way, keep them coming!

I am feeling exhausted and very crampy.  It was quite difficult to make it up the stairs last night and to get comfortable in bed.  Jon helped me with both, plus got me up and back down again in the middle of the night when I got up to use the bathroom and to pump.  What a trooper - he didn't even complain about it!  I will be seeing my doctor on Thursday to have the staples removed, then next week for a wound check.  My six week post-partum is also scheduled already for four weeks after the wound check.  I will be re-tested for glucose intolerance once I stop breastfeeding since that can cause irregular readings. 

 I am going to take it easy for a bit this morning, then we will head out to buy a couple of nursing bras.  This afternoon Dad will take me to the hospital to see Leah and Micah, then Jon will bring Harry and pick me up.  We will head over to the Sibling class at LIJ so Harry can meet Golda. 

That's it for now!  I will try to keep you posted.

Our Triplets Are Here

Hi Everyone!

Our Triplets are Here!  They were born on Thursday, September 18, 2008 at 11:46 am (A), 11:47 am (B), and 11:49 am (C) by c-section.  We would like to introduce Baby A, now known as Leah Morgan Fessler (3 pounds 1.25 ounces), Baby B, now known as Micah Alvin Fessler (3 pounds 10 ounces) and Baby C, now known as Golda Rae Fessler (2 pounds 0.5 ounces).

Since I haven't been mobile enough until now I will just bring you all up to date on each baby.  Leah had APGAR scores of 6 and 9 at 1 and 5 minutes after birth.  We heard her give out a nice cry when she was born - which made me feel much better.  She is doing the best of all the triplets according to our pediatricians (who have stopped in to check on the triplets every day, even though they aren't officially their doctors yet).  She was taking one ml of breast milk at each feeding, but has decided that she really isn't ready for that yet (her stomach wasn't digesting the milk or formula three hours later) and is now back to taking all her nutrition from her IV.  She is very responsive to outside stimuli - for instance, if she is crying I can talk to her while holding her back and she calms right down.  If Pepa puts his hand on her she kicks him. 

Micah had APGAR scores of 8 and 9. He also gave a very lusty cry when he was born, making us feel much better. He is in a different nursery from his sister.  The biggest concern for him is his breathing.  He is showing some signs of respiratory distress - his oxygenation tends to fall below the 90% mark they would like to see (usually because he won't keep his mouth closed!) and his respiration rate tends to be too high (above 60, 70 breathes per minute).  He will also respond to outside stimuli - he loves to have his back cupped and will curl himself into your hand.  When Great Aunt Terry visited him he followed her with his eyes and listened to every word she said.  Today he got a PICC line (Peripherally Inserted Central Catheter) so they don't have to keep sticking him to get the IV lines started.  He seems much more comfortable since they got it inserted.

Golda had APGAR scores of 6 and 8.  She was already proving herself to be the trouble maker - no crying when she was born leading mom and dad to worry!  She stayed at North Shore for about two hours while they worked to get her stable.  Once she was stable enough for transport she headed out, with a quick stop into Recovery so mom could see her briefly.  Then she was off to Schneider's Children's Hospital with an ambulance full of attendants.  Daddy hung around for about a half hour then followed his little girl to Schneiders.  Once they got her to Schneiders they changed all her tubes and labeling to meet their Level IV NICU standards and got her fully stabilized.  They repeated her x-ray in an attempt to visualize her stomach one last time prior to surgery.  They still weren't able to make any determinations about the status of her stomach, even though they were sure of the esophageal atresia.

Golda underwent surgery on Friday with the goal of inserting a feeding tube in her stomach, if it was present, and determining the actual status of her stomach and esophagus.  The surgeons told Jon they expected to be in the OR for 1-1.5 hours.  When no one emerged after 2 hours Jon became worried.  The surgeon finally emerged after almost 5 hours.  He explained that part of the procedure involved inserting a feeding tube with a small air bladder that was intending to anchor the feeding tube in the stomach as well as to expand the stomach slightly.  He completed the procedure as scheduled with no apparent problems and checked his work with a contrast x-ray.  At that point, they found contrast fluid had permeated the entire abdomen indicating something had gone wrong.  They re-opened her using another incision and found that even though they had used the smallest bladder available, her stomach was still too small for it and it had caused her stomach to rupture in three places.  They repaired these ruptures, inserted a different type of tube which did not use a bladder for an anchor and installed a central feeding line (Broviac) because they would not be able to use the stomach feeding tube for two weeks to allow adequate healing to occur.  The surgeon explained that there should not be any long term complications from this complication.  The good part is that the central feeding line will allow them to feed her many more calories more quickly than if they used the stomach tube only which will hopefully let her reach her target weight of 5 pounds sooner (so she can have the reconstruction surgery).  The bad part is that they have to watch that her stomach and intestines don't atrophy due to disuse during the two weeks.

When I called the NICU at 3:15 last night they said she was stable and resting comfortably.  She had finally come out of the anesthesia but was still groggy (in preemie terms, she was opening her eyes, looking around but not moving much).  Her blood pressure was low and they tried to treat it with several boluses of saline, but wound up giving her a dopamine drip to bring the pressure back up.  She also had a low hematocrit for which she received a unit of blood.  After these two interventions she had very stable vital signs.  When Jon visited her this morning, she was completely over the anesthesia and was opening her eyes, looking at him when he talked to her and got thoroughly annoyed when he dared to tickle her foot (i.e. Daddy got kicked!).

All in all, the triplets are doing very well for their gestational ages, even Golda.  I keep having to remind myself they are only two days old and that I can't expect too much from them.  The nurses keep telling us how good they are doing as are the doctors.  This weekend they will be doing ultrasounds on their brains to ensure that they haven't had any intracranial bleeding (precautionary only) and we are hoping to be able to hold them by the end of the weekend.

As for me, I am doing as well as can be expected.  The c-section took a while which I guess is par for the course when delivering three!  I wound up staying in recovery for nine hours.  The anesthesiologist was concerned that for someone who is overweight and receiving narcotics via an epidural, that there could be episodes of apnea and so he wanted me monitored for  a longer period of time than is standard.  Luckily, I had 98-100% O2 saturation and was sent to a room shortly after 10 pm.  The knew how desparate I was to see my babies and transferred me directly from the recovery room bed to a wheel chair and we went straight down the hall to the NICU.  Yesterday, the day after the surgery, they took out my epidural so I could re-start the Lovenox so the pain was much worse.  I finally got onto a four hour schedule with Percacet and starting feeling much better.  I have no idea when I will get out of here, but I am not in such a rush.  It is much easier to get around and up and down from bed here and since moving is really hard, I am glad to be here for now.  Plus, I am able to see my babies more often this way.

That's all for now.  I need to go see Leah and head back to bed for some rest.  Jon will try to post some photos tonight.  If anyone would like to try to catch me while I am in the room my number is 516-684-5096, otherwise I will try to post daily.

32 weeks, 1 day - T-1 for B-Day

Hi Everyone!

We are back from the doctor.  Baby A is weighing in at 3 lbs. 5 oz (20th percentile), Baby B at 3 lbs. 15 oz. (45th percentile) and Baby C at 2 lbs. 5 oz (less than 10th percentile).  For those of you who have been keeping track, this means that Baby C has fallen off her growth curve.  Her cord blood flow is still high, but adequate and her breathing is good. 

After our sonogram we had a talk with the doctor to "take some decisions".  We were basically offered two options - deliver within 48 hours or stay in the hospital from now until delivery at some future time with daily monitoring.  The monitoring would be daily BPP sonograms to determine whether Baby C was taking a turn for the worse.  From our visit with the neonatologist last week we know that Babies A and B should be fine if delivered now.  So I asked the doctor today, if we choose the daily monitoring and see a decline in Baby C would this be guaranteed to be before the decline caused permanent problems?  She said no.  Therefore, there was no real decision to be made - she is doing okay now and holding her own, why wait for problems?  We are home now doing last minute things, then we will drop Harry at my parents and head to the hospital.  I will be monitored through the night and am scheduled to delivery tomorrow at 3:30 pm.  This time is flexible as is all things to do with babies, but as of now, tomorrow is B-Day for the triplets! 

Jon has promised to try to update the journal tomorrow after their arrival - hopefully with some photos too!

31 weeks, 2 days

Hi Everyone!

We are back from the doctor's office.  Today we had a BPP scheduled (the Biophysical Profile) and a doctor visit.  The BPP ultrasound was a little more painful than usual since Baby A is so camera-shy and I am really retaining fluid at the bottom of my belly (where she is hiding) and the technician's have to push really hard to see anything, but at least she was able to get the readings she needed.  So, for all three, the results were holding steady since last time.  The good news is that Baby C had intermittent end diastolic flow in her umbilical cord - a step up from the previous scans!

We then went to the exam room.  The doctor checked my cervix since I have been having a lot of pressure and a few contractions - all closed!  He also repeated the fetal fibronectin test since it's been more than seven days.  We get the results tomorrow.  He also told us that they had their big full practice meeting yesterday and discussed us.  Everyone was in agreement that unless Baby C demands it (by slowing her growth or reversing her end diastolic blood flow), we will wait to deliver.  They wanted us to meet with the neonatologist at the hospital to discuss the varying risks between delivering at 32, 33, 34 or 35 weeks.  They arranged the meeting for today, so off we went to North Shore.

The neonatologist was very nice and reassuring.  Basically, the really big risk things (like brain bleeds, heart surgery, retinal problems) decrease in likelihood after 30 weeks - so we are in the clear for them for the most part.  She said that if the babies were born today in their hospital, at least A and B, would most likely be fine.  Since we aren't really sure of what we are dealing with with C, it's hard for them to give us hard numbers.  What we took from the meeting is that the risks for various problems including lung defects decrease each week up to 34 weeks, after that 34, 35 and 36 weeks are all pretty much the same with the additional weeks meaning more weight, but not translating into much better outcome odds.  We have therefore decided that we will try our best to keep these babies cooking until at least 34 weeks, then see how they are doing and I am doing (apparently at this point maternal discomfort becomes so great that it can be a reason for delivery!) and make our decision then.  This is all assuming Baby C continues to grow at our scan next week and does not reverse her cord blood flow.  So, once again, fingers crossed!

Our next appointment is scheduled for Wednesday, September 17.  I will hopefully not be posting again until then!

30 weeks, 2 days

Hi Everyone!  We are back from our doctor appointment.  Today was a Biophysical Profile ultrasound and a doctor visit.  They saw breathing motions for all three babies and normal fluid for Babies A and B.  Baby C didn't have any further increase in her amniotic fluid and the increased blood flow resistance in her umbilical cord was the same as last time as well.  All things considered, a good report!

My blood pressure was good, no protein or glucose in the urine, and, believe it or not, I actually lost 5 pounds!  I can't imagine how since I am eating all the time, but since the doctor isn't worried neither are we.  We discussed the switch to heparin in light of our visit to labor and delivery but the doctor didn't think it was necessary right now - he would like to save me an additional injection a day as long as possible.  Speaking of additional injections, I will be taking additional insulin before dinner through the weekend to try to get better control of my glucose levels.  Depending on how they respond I may be able to drop the shot after the weekend.

I am feeling exhausted most of the time these days, hauling around this belly is getting harder, sleeping is in one hour stints, and various aches and pains are becoming more insistent, but given that I am 30 weeks pregnant with triplets I am quite glad to still be at all mobile and definitely to still be at home.  Jon is trying to settle into a pattern with working at home and taking Harry to school.  It's getting a little better, but it's still a challenge for him.  Harry is really enjoying kindergarten.  He loves his teacher and says the whole class is friends!  He starts gymnastics again Saturday and Sunday School again on Sunday.  I guess the summer really is over!

Our next appointment is Thursday, September 11.  Hopefully, this week will be uneventful and that will be my next posting!