He was doing well. They'd weaned completely off the Fentanyl and had started a small amount of Methadone to try to counteract any withdrawal symptoms he may have. His feeds were up to 18cc/hr, still on the continuous feed pump. He was still on the Amphotericin B to continue treating for the yeast infection he'd had a few weeks ago. He'd had a decent amount of output from his ostomy, and some urine in the catheter as well. He was only on 35% oxygen, and was gaining weight slowly.
Everything was still going well. The pump was running fine, his heart rate, bp, respiratory rate was fine. His vent settings were low and he was doing well. They had increased his feeds to 21cc/hr. He was tolerating being off the Fentanyl. They received the results from the rectal biopsy they did during surgery the week before, and everything was normal, which is awesome. No real issues.
Both my phone and Gary's somehow ended up off during the night. We woke up to a voicemail from one of the nurse practitioners, asking us to call her asap. Zeke had had an extremely rough night/early morning. His blood pressure had dropped to means in the 20's (they want it between high 40's-60's). His blood gas was terrible - ph way down, CO2 way up. He was on 100% oxygen, and still only satting in the low 80's. They thought there may have been a clog in his vent tube, since they'd try to suction and weren't getting much, and they weren't really hearing any breath sounds. They extubated, and tried to reintubate, but couldn't get the same size tube in because his airway was so swollen, so they had to go with a smaller size (down to 3.5 from 4). Because the tube was smaller, he had a substantial air leak (that continued to get worse after the inflammation in his airways started going down). They bumped his vent settings way up, and stopped his feeds. They started him on more antibiotics, in case it was a bacterial infection, and sent blood cultures and a viral panel. The cultures would take several days to grow, but the vrp came back positive for Rhinovirus, which is literally the common cold, but because Zeke's immune system is so compromised already, and his lungs aren't very strong, it hit him extremely hard. They'd done a few albuterol treatments to try to open up his lungs, as well.
Zeke turned 5 months old! I got back up to Birmingham Saturday afternoon. He was still on fairly high vent settings, and was pretty irritable and agitated.
Zeke's weight was up a tiny bit from Saturday (from 5010 to 5030g). His blood cultures were negative, but they weren't sure if it was a false negative, because when they took the cultures, his perfusion (the amount of blood in his capillaries) wasn't great, so they couldn't get enough blood to get an accurate result. His CRP (a blood test to look for signs of inflammation) was up almost double from the day before. They gave him another dose of the two antibiotics (vancomycin & tobramycin) to be safe. They started his feeds back at 16cc/hr. His heart rate and blood pressure were good, but not great. His blood gas was also good, and they had weaned both his pressure to 37/7, and his rate to 35, and he was getting 45% oxygen.
Monday was a Monday... Zeke had an extremely rough day. He was really agitated and couldn't calm down or get any good, restful sleep all day. He was due for a new pump in the afternoon, but his pump clotted early in the morning, so he was off dialysis for a while. His blood pressure was pretty low (means in the low 40's), and his heart rate was high (averaging 180's, sometimes jumping over 200 when he was mad). They didn't want to chance his blood pressure crashing when they put him back on dialysis, so they put him back on the max dose of Dopamine (20mcg/kg/min) to get his bp up. Pump change went well, but he continued to be extremely agitated throughout the day. HIs gasses weren't great, so they went up on his vent settings and oxygen a bit. They did change his vent tube out today. They sent blood cultures from one of his dialysis lines as well.
Zeke's weight was up slightly (4860g) on Tuesday. His blood pressure was still low - means dropping as low as the 20's at times - so they gave him a one-time dose of hydrocortisone, as well as giving some blood for more volume, and that seemed to help. He was still on a dose of 20 on the dopamine. The pump was running fine, and they were leaving on 10cc/hr of fluid. They changed some of his antibiotics. He did run a slight fever, but it didn't last long. HIs methadone was weaned, and he's tolerating being off the Fentanyl with no issues. Still getting his dose of Ativan every 6 hours for agitation. Feeds were increased to 18cc/hr, and he's been tolerating feeds well. Gasses were better on Tuesday, and his vent settings got weaned twice, his rate to 35 (down from 40), and pressure to 32/7 (down from 37/7). He was on 45-55% oxygen most of the day. Zeke seemed like he was feeling a ton better Tuesday. He was awake when I got to the hospital at 10am, and had been for a while. He only napped for about an hour and a half, and finally fell asleep around 8pm. He was content all day, just watched us walk around, and looked at his 'friends' (his toys).
Wednesday was another rough day. Zeke was pretty irritable again most of the day. Weight was up to 5170g - 11lb 6.3oz (up 310g overnight). They had weaned his vent settings to a rate of 30 and pressure of 31/7, but around 9pm went back up to a rate of 35. He'd seemed like he was retracting a lot, and working a lot harder to breathe throughout the day. He was on 50-60% oxygen most of the day. His dialysis pump clotted again and had to be changed. They left it at I=O. His heart rate was better (averaging 120's) and BP was better as well (means in 40's-50's). They were able to wean the dopamine down to 13mcg. The blood cultures they took from the dialysis line on Monday came back positive for yeast. They decided to redo the cultures, and sent cultures from each arm and also from the dialysis line today. Nephrology wanted a CT scan to look for a possible abscess, somewhere that's harboring the yeast infection, but neonatology and infectious disease both agreed that a ct scan was too much radiation, and decided to do ultrasounds instead.
Weight was down 60g (2oz) to 5110g (11lb 4.25oz). The pump clotted again, so he got a new setup. His dopamine was still at 13, and his blood pressure means were in the 60's. They want several over 65 to wean the dopamine. They went up to 20cc/hr on feeds, and as they go up on the amount of breast milk he's getting, they're also weaning the amount of IV nutrition. As of now, 30-33cc/hr is a full feed (which would equal out to about 3-3 1/2oz every three hours). They started a low-dose versed drip, and changed the ativan to a prn (as-needed) med he can have every 6 hours. His vent settings were way up, due to bad gasses. (Rate of 45, pressure 33/7, oxygen between 60-70%) They decided against doing a ct scan due to the excess amounts of radiation. They did an echo (heart ultrasound) and renal (kidney) ultrasound, and both looked normal. They're waiting on the blood cultures to come back before deciding what course of action to take regarding the yeast.
Today has been a somewhat better day. Weight is 5305g (up 195g). Vent settings are still the same (rate 45, pressure 33/7). Heart rate is better (140's) and bp has been good as well (means in 50's-60's). His dopamine is still at 13mcg. The pump has been running fine today, and he's holding steady at I=O. His urine output today has been 18ml, and his ostomy output has been pretty high at 58ml. He decided to extubate himself tonight, and when they reintubated, they put in a larger tube (went from 3.5 to 4.0). He still has a small air leak, but nowhere near what it was before. They took more blood cultures from his dialysis lines today - from both sides of the line this time. He's also been having a lot of issues with his PICC line not wanting to run or flush.
All in all, it's been an extremely stressful week. He hasn't been feeling well or doing very well, so neither have we. It's been especially stressful with him getting a cold virus, and especially learning that he still has yeast, because he's on a fairly high dose of a pretty strong antifungal (amphotericin b), and has been for several weeks, and that should have wiped out any yeast that he had. Yeast infections can be fatal, so we're pretty concerned about it at this point, that it's back, or still around, despite the meds. Apparently yeast cling to plastic, which is pretty much everything that's stuck in his body, and it's hard to get rid of the yeast while you still have the plastic lines in place. We're waiting on all of the cultures to come back to see what the next course of action is. On one hand, if he has to have his line replaced, it would be a good time for them to place the tracheostomy, as well as potentially put in a larger line that will be compatible with larger dialysis machines in the future.
4690g (10lb 2oz)
He's finally started getting used to laying on his right side, and doesn't fight it AS much anymore.
Most of the time.
4490g (9lb 14.3oz)
Zeke in his special hat called a Tortle for physical therapy
5010g (11lb .5oz)
Officially FIVE months old!
5030g (11lb 1.5oz)
He wasn't feeling well on his 'birthday' day, and I didn't want to mess with him too much, so I waited a few days to do his five month photo
"Hey, Mom... What's going on?!"
You can see LOTS of red in his hair in this one!
4840g (10lb 10.75oz)
Not liking his Tortle much today
4860g (10lb 11.4oz)
5170g (11lb 6.3oz)
Mom got to hold me while I was off dialysis
5110g - 11lb 4.25oz
5305g (11lb 11oz)
*On one foot, under a sock, is his pulse-ox (oxygen monitor).
*Taped to his leg is his urinary catheter.
*On the left side of his belly is his colostomy, and below that (you can't see it) is a tiny opening to the bottom portion of his intestines, called the mucus fistula.
*In his chest (purple line) is his dialysis catheter. It has two tubes - one tube pulls blood out and sends it into the dialysis machine, the other puts the clean blood back in. The tubes at the top of the picture are the dialysis lines, to and from the pump. The fat blue tube is actually a heater, to warm the blood before it goes back into his body to keep him from getting too cold.
*Also on his chest/belly are his leads -three stickers with wires attached. These monitor heart rate and respiratory rate.
*On his right arm is his blood pressure cuff.
in his left arm is his picc line (a central IV line). This is where he gets his meds, his iv fluids, etc...
*In his mouth are his vent tube (the big clear one), and his OG (feeding) tube (the small clear and orange one).
Post-bath. Happy and clean
Post-bath. As soon as he was clothed and swaddled, he fell asleep. Literally, almost immediately.