One-Stop Shopping

It looks like James's surgery will be on Friday. They'll remove the strictures, hopefully do the reconnection of his intestines, fix a small hernia that he has, insert a G-tube, and do his circumcision. Whew! It sounds like a lot (and it is), but it's good to get it all done at once so that he only has to be under anesthesia once.

The G-tube is a tube that goes directly into his stomach for feedings. He's currently being fed with an NG-tube, which goes down his nose into his stomach, but babies can't go home with that kind of tube. Sometimes babies with feeding intolerance have to be on continuous feeds for a long time (months), and so if he has the G-tube, we would be able to do that at home. I hope that he won't need it for too long and will be able to transition to regular bottle/breast feeding, but who knows -- as we've seen, James seems to like to take things slowly.

He's still doing well with his feedings, and we had a nice long visit with him today.

[Photo is Matthew -- and don't worry, Mike was right next to him. We don't leave him on the edge of the couch by himself!]

Little Angel

Apparently Matthew thinks his brother's things are better -- when we were visiting today, we put Matthew (with a blanket under him) in James's crib while we were holding James. Matthew was fascinated with the mobile -- the same mobile which we have at home and which he has more or less completely ignored. And he seemed happy enough in the crib, too, something which also rarely happens at home! Maybe we need brighter lights and maybe some monitors beeping to make Mattie feel comfortable.

James is doing fine; they're still adjusting his blood pressure medicines, but otherwise things are the same.

Big Boy

See? We told you Matthew was going through a growth spurt!

(Just kidding, this is Cousin Daniel.)

Say Uncle

Jamesie got to meet his Uncle Adrian (again) today! (And Mattie got to meet some new friends as well!)

And the late night report was a good one -- 20 ml of poop, James's best yet since restarting his feedings!

Cousin Daniel can say a handful of words, but his favorite one is "dog." He's been walking around the house correctly identifying Stanley as "dog", Abby (his beagle) as "dog", and our metal sculpture of a dog playing guitar as "dog." However, he has also decided that Matthew is "dog." We've corrected him that Matthew is "baby", but he doesn't believe us. (I guess this is what we get for referring to Daniel as the "human puppy" when he was first born!)

Pod E

Jamesie was still in Pod E when we went to visit this afternoon. When we arrived, his nurse had him propped up in a sitting position in his crib, like a little Buddha. He also got to sit with his Auntie Nora for a while. He peeked up to see who it was, but mostly was sleeping peacefully while we were there. (He'd had another busy morning, with both speech and occupational therapy coming in to work with him. He's doing well with the pacifier dipped in formula -- next step would be back to the bottle.) All is still going well with tolerating his food (the same 5 ml/hour).

I liked the Earth painting above James's temporary spot, but I have to say I prefer Pod F. :)

Mattie's exciting day included meeting his cousin Daniel (age one), having a blowout poopy diaper that necessitated a change of clothes for Daddy, and sleeping through a lovely gathering of neighborhood friends. Our friends' little daughter C was there, and she very gently touched his foot and rubbed his head. It was sweet -- I said we'd remind them of that when they were teenagers. :)

Mattie's also been eating a lot today (we call him the hungry hungry hippo), so maybe we're coming up on a growth spurt.

Matthew in the Mirror

Because James liked his mirror so much, Grandma got one for Matthew. He didn't show any interest in it until last night, but now he seems intrigued by it. (It seems to us that at this point, Matthew is definitely ahead on his physical skills, but James may be a bit ahead on paying attention to things around him.)

The morning report for James was good -- he's still doing fine with his feeding. (Yay!) His blood pressure continues to be high, so they're adjusting his medicine (labatalol) dose to try to get it under control. (I wonder if they'll end up with the same combination that Matthew has.) As with Matthew, the blood pressure isn't causing immediate problems, but they want to control it to avoid long-term stress on his system.

He had a field trip last night to Pod E. They moved all the babies next door overnight while they cleaned the floors in Pod F. I'm a little disappointed that we didn't go visit while he was there; I've never been in Pod E and I'm curious about what it's like!

Better Afternoon

James's morning X-ray was reassuring to the doctors; they actually thought it looked better than one they had taken last week. He still had some dilated bowel loops (which is unfortunately usual for him), but they weren't as dilated. So they restarted his feedings around 10:30 AM. We were there in the afternoon and stayed until about 5 PM, and he seemed to be doing pretty well -- no more spit-up, and he mostly seemed comfortable when I was holding him. (He had a couple times of squirming and acting like he was pushing, but I never know how to interpret that -- sometimes it seems to be a sign that he's not tolerating the feeding, but on the other hand, Matthew does that kind of thing all the time, so a little bit of it is probably normal.) I don't know if he had any more poop, but there were also a couple instances of a distinctive odor wafting up, so I'm guessing there was some kind of action down there!

So, we'll see how the evening goes -- the 8:30 PM report from his nurse was that he was doing well (and had some stool).

Early next week, we'll be having a meeting with the surgeons and the neonatal team to talk about the plan for him. (The basic plan of having his reattachment surgery will be the same, but there may be other treatments that emerge or ideas about how to help his motility issues, and this way we can also make sure that everyone is on the same page going forward.) Unfortunately, the surgeon that did his first intestinal surgery is leaving for another hospital, but hopefully either he or the resident who assisted him will be able to come to the meeting.

We took Matthew's stroller in when we went to the hospital (we have a fold-up one that his car seat snaps into), and it was more convenient than just lugging the car seat -- and it doesn't seem take up too much more space in the room. And on our way home, we stopped for dinner at a Mexican restaurant (we had the place practically to ourselves -- if it had been crowded we probably would have passed), and Matthew slept like a little angel in his carseat.

Uggh

This morning's report from the NICU wasn't very comforting. James was a bit fussy for the night nurse, and early this morning he spit up a few times. Not a lot, but this are usually James' early signs that he isn't feeling well. His stomach girth had also increased by 3 cm (1.5 inches; from 37 to 40 cm -- this is a lot!) in the past 24 hours, although after his nurse sat him up and he burped, it went back down a bit to 37.5 cm and he seemed more comfortable. (Although this is definitely better, we're pretty sure there's more going on than just some air in the belly -- we wish we had a problem simple enough to be solved by burping!)

And, he didn't produce any stool in the most recent irrigation (though he did have some yesterday evening). So, they have stopped his feedings for a while, they are increasing his dose of a medication intended to improve his intestinal motility (it also reduces reflux), and they are doing another belly x-ray. Naturally, all of this is happening as the weekend approaches.

We're going to go in this afternoon, and hopefully we'll be able to have a conversation with the doctors and see where we go from here.

(To fill in the "not much news" from yesterday -- he had a session with the occupational therapist, working on hamstring stretches and turning his head to the left, since he tends to favor his right, and he also had a session with speech therapy. He was sleeping on his side in his bouncy seat all snuggled up when I (Melanie) arrived -- very cute! And his bilirubin levels had gone down a little, from 7 to 6. Of course, the normal range is from 0 to 0.3, so they're still high, but at least had moved in the right direction.)

Sleepy

Not much new today; everyone is doing fine.

Doh!

So, yeah, we totally jinxed ourselves by saying how well Matthew had slept the night before last. Ah well, tonight is another night! We'll lull him to sleep with the gentle sounds of America's Got Talent.

Jamesie is doing fine; he's had a little more poop (yay!) and we enjoyed hanging out with him today. His blood pressure is still a bit high, though, so they're going to give him labatalol (which is one of the medicines that Matthew is also on).

Changing of the Guard

As we may have mentioned before, the attending doctor (as well as some of the residents and interns) changes every three weeks. (The doctor who just finished up was on duty when the boys were born, and also was on when we were trying to decide whether James needed surgery for his PDA/heart murmur. Our favorite quote from her was, "If I thought he really needed the surgery, I'd be on you like a yappy dog!") Anyhow, we're on to a new doctor, one we hadn't met before. One of the first things the new team discussed doing was going up on James's feeds. Noooo! Fortunately his primary nurse was on today and told them that wasn't a good idea, and they seem to be listening.

They did put him on a new medicine, Actigall, which is supposed to help with his bilirubin levels (and his liver). The latest word on his surgery is that it will be in "early September." I can't believe that's right around the corner.

When we arrived at the hospital today, James was being held by one of the cuddlers. He'd also been held by his nurse and spent some time in his bouncy seat, so it was a good day for James! (We each held him as well.) When we left, he was wide awake and enjoying watching his mobile.

Matthew was actually awake for his stroller ride around the neighborhood today. He seemed to enjoy it! And we even got a halfway decent night's sleep last night, since he slept four hours or so before his middle of the night feeding, and then another three or so after that. (Our current -- and presumably temporary -- improvisation is that he's sleeping in his car seat with the car seat placed in the crib. The motion-sensing monitor in the crib, which is designed to go off if he stops breathing, works even when he's in the car seat, although we think it has a somewhat greater tendency for false alarms that way.) Of course, typing that probably means we're in for a sleepless night tonight!

Mattie also made his first foray onto Franklin Street (the main campus street) tonight, since we stopped to pick up some food on our way home. Even though the students are all back, the restaurant wasn't crowded, which was nice -- we've been a bit wary about taking Mattie out in public, because we don't want to stumble into any hotbeds of swine flu. (Of course, this is the great irony of having to take him to the pediatrician so frequently -- when we go there, we have to sit in the waiting room, which seems to me to be a cauldron of infectious disease. But no one has coughed on him yet.)

Favorite Pictures (recently)

I am posting these for no other reason than I like them!

Lazy Sunday

They restarted Jamesie's feedings yesterday around noon. He's not showing any signs of discomfort with it (but he's also not pooping yet, so we'll see how it goes.)

We took Matthew (and Stanley) on a walk around the neighborhood this morning, and he got to meet some of our neighbors. (Okay, he slept through it, but they got to meet him!)

UPDATED 10 PM: I had a nice visit with James this afternoon. I held him for a while, and he was wide awake and watching his mobile when I left. And, he'd been having some poop! It's not a lot, but it's a start.

Bye-bye Barium

This morning's X-ray looked good -- the barium was out, or at least most of it was -- so they're restarting James's feeds this afternoon. They'll be doing a fairly small amount (5 ml/hour), so hopefully that will work.

What are You Wearing?

By coincidence, both of the boys had on little baseball outfits today! (Mattie's says All Star, and Jamesie's says Handsome.)

We had a nice visit with James today -- Mike got to hold him for a while. (Oh, and James is out of newborn size diapers and into Size 1!)

And Eight

Not to be outdone, James now weighs over eight pounds! However, he's had two days of big gains to due fluid retention (again!), so his "real" weight should be several ounces lower, we're guessing. But he is taller than his older brother -- at yesterday's measurements, Matthew is 47 centimeters and James is 50 centimeters long.

James is still working on getting the barium out, so no food yet. But he had a good night and seems to be feeling okay, and his nurse said he had a good time with the occupational therapist this morning. They're giving him a drug (Reglan) that might help improve his intestinal motility (the ability of the intestines to move the food -- or in this case, the barium -- through more quickly). As we may have mentioned before, these drugs don't have a great track record of effectiveness, but it would be nice if it works.

Grandma had to go home today -- we're very sad to see her go, and we miss her already! Poor Matthew will have to adjust to a little less time with someone holding him. Fortunately, he seems to enjoy his swing, so maybe that will help ease the transition a bit.

Seven

Matthew has joined his brother in breaking the seven-pound barrier -- at his pediatrician visit today, he weighed 7 lbs, 1 oz. (They were pleased with his growth, and decided that he didn't need to be seen again until his well-baby visit in a month.) Hooray for Mattie!

Jamesie got to spend a couple of hours of quality time with Grandma. (He's also off his nasal cannula again and back on room air.) He still hasn't gotten all the barium out of his system (although there is less of it than there was yesterday, which is good), so they're not feeding him yet, but hopefully tomorrow. He seemed to be feeling better today, too, and his belly isn't so distended.

Not Much News

The upper GI did not show any obstructions, but the barium was very, very slow to go through. James is still putting out the barium into his ostomy bag and it is almost 24 hours since they put it into him. We are hoping to speak to the doctor this afternoon to find out more details.

UPDATED 10:30 PM: There's still not much news; they're waiting for the final report from radiology and surgery, but the NICU doctor doesn't think there are any other strictures or obstructions. So the plan is that once the barium has cleared out of his system, they'll start feeding him again, at a relatively low level (probably 5 ml), which hopefully he'll be able to tolerate until the surgery. The NICU doctor wants them to do the surgery in two weeks (six weeks from the original surgery), and the surgeons would prefer to wait a bit longer, so we'll see where they end up. The reason for doing it earlier is because the IV fluid feeding is putting stress on his liver, so doing the surgery earlier means his liver will be in better shape to handle it. The reason for waiting is that if his intestines have a longer time to heal from the first surgery, it's easier to do the reattachment.

James was unhappy this morning; his nurse said he was inconsolable and fussy and generally not like his normal self. (Probably he was uncomfortable from trying to move the barium through his intestines.) When we went in this afternoon, one of the volunteer cuddlers was holding him, and he was sleeping peacefully and sucking on his pacifier. Thank goodness! I held him for a while, and he was pretty calm, with just a couple little bouts of crying. Mom and I went in this evening, and the nurse said he'd been fussy since she'd been there, and he'd just gotten settled. Mom held him for quite a while, and he was perfectly happy sleeping in her arms.

Matthew

Matthew and I were up early this morning, and he was very alert for about 2 hours. Right now he's in his crib sleeping. Let's hope he sleeps until 9:30 when it is time for him to take his medicines.

Nothing Yet

We won't know the results of the upper GI study until tomorrow sometime. According to his nurse, James was not amused by the procedure, but he was mostly sleeping peacefully when we were in visiting him.

[Top picture is James, bottom is Matthew.]

More Studies

* UPDATE * They are wheeling James down to radiology right now (1 pm Eastern) for his upper GI test. This test takes a few hours because they have to allow time for the fluid to make its way from his tummy through (hopefully) the end of the GI tract, that is, his ostomy.

-------------------------------

They're going to do an upper GI study on James, probably tomorrow, just to make sure there aren't any additional problems that they've missed. (They have to wait a certain amount of time since the last study to make sure all the contrast material is out of his system.) I'm glad they're being thorough, but at the same time, I don't like to think about the possibility of more problems.

Mattie slept well in his crib for about an hour or so last night, but then threw up his 4 AM feeding when we tried to put him down again. Oh well, baby steps!

Results

James had his GI study this afternoon. They put contrast material in through his stoma (ostomy opening) to examine how it flowed through the intestines. James pretty much slept through the procedure, which made it easier for the radiologists (it's hard for them if the babies squirm too much). They let us stay down there while they were doing it, which we didn't expect. (They gave us snazzy lead coats to wear -- that pink thing isn't a normal part of Mike's wardrobe.) It was kind of interesting in a Discovery Channel sort of way, although we couldn't have told you what the results were just from watching on the screen.

The preliminary report from the surgeon was that James had developed two more small strictures, close together (a centimeter or two apart). Of course we didn't want him to have more strictures, but on the positive side, 1) this provides an answer for why he had problems this time around, 2) it sounds like these strictures can be relatively easily removed when they're in doing the already-planned surgery to reattach his intestines from the first surgery, and 3) the two new strictures are close together, so he won't have to lose much more bowel. Assuming that a more detailed examination of the pictures confirms these results, they'll decide when to do the next surgery, and whether he can have small amounts of feedings before then.

They've been getting a lot of stool out with the irrigation procedure, which is good because it will probably make him more comfortable.

Meanwhile, Matthew has been doing normal baby activities.

UTI

The urine culture came back positive -- James has a urinary tract infection. (Little did we know we should have been giving him cranberry juice along with his formula.) The antibiotics they've already been giving him treat whichever bacteria it is (the nurse mentioned which one, but I don't remember it), so that's good. And UTIs can cause intestinal slowdowns, so it's possible that his feeding intolerance this time around was a consequence of the infection. (It would be good to do the GI studies to make sure nothing else is going on, though, and as far as we know they're still planning that for tomorrow AM.)

If you are eating I'd recommend skipping the next paragraph.

Today they've been doing "irrigation" of his colon -- putting saline into his ostomy opening every two hours to help clean the poop out. It seems to be working to get some poop out, which is good, but it's also apparently having the very disturbing (to us) side effect of also pushing the poop out the other way. Specifically, he has a replogle tube in which suctions out his stomach; they put this in to try to reduce the belly distention and make him more comfortable. He's had it several times before, and I've developed a hatred for it, mostly because while it serves a useful purpose, it often makes James gag and it sometimes seems to irritate his stomach (it moves around and can stick to or scrape against the stomach lining). But today after the irrigations, they've been seeing what looks like poop coming out the replogle -- so I'm grateful that it's contained in a tube rather than having him vomit it up. Either way, I hate that my baby has to go through this. If I understand correctly, though, the doctors actually seem to think that this is somewhat encouraging, because the irrigation is providing enough pressure to go through the whole intestine.

Sunday Plan

James is still stable this morning; he's still on the cannula, but hasn't been really having respiratory problems. His blood pressures have been fine, and his sodium is also on the rise, which they're happy about. Nothing has grown in the cultures yet, but it hasn't even been 24 hours yet, so it's still possible they might find evidence of an infection.

The surgeons put a little probe into the stoma (the ostomy opening), and James pooped around it and pooped a little more afterwards. So that suggests that the stoma is open and the problem isn't there, but the procedure also maybe helped to make him a little more comfortable by moving some things through.

The plan is for him to have the GI studies tomorrow, assuming his vital signs continue to be good. (It's possible they would delay it if something turns positive in the blood cultures, however.)

More Waiting and Seeing

We visited James late Saturday night. He is on a canula to assure that his oxygen stays saturated and he is receiving a couple of different antibiotics. The doctor and nurse think that something is brewing inside him, but they don't know what and the cultures have not shown anything. They weren't able to test for meningitis (because his belly is distended, they couldn't get him in the position needed for the spinal tap), but there is speculation that he could have an infection in his cerebral spinal fluid (CSF), which is what meningitis is. His blood pressure is OK and he doesn't seem to have a fever, which would suggest that he doesn't have an infection, but his sodium levels were low, which suggests that he does. So, we're back to the standard weekend ritual of waiting to see what unfolds and hoping for the best.

The picture of James is from yesterday (Friday).

It's the Weekend, It Must be Trouble, pt 2

So now the latest word is that James had a few episodes of 'de-stats' (low oxygen levels in his blood) so the doctors are looking at urine, blood, and spinal fluid for infection. He is already receiving antibiotics just in case. This is a routine way of dealing with the possibility of an infection, so the course of action is not especially alarming, but it only adds to our stress and to the little boy's discomfort. The doctor called us to say she thought he looked a little 'punky', by which she meant he didn't look like his normal self. The fact that he had some de-sats was itself a bit unusual, and can be an early sign of being sick. His sodium levels were also low, which can be another indicator. So, we won't know the results of the tests until 48 hours or if one of the cultures returns a positive (infectious) result.

Stupid Weekend

They didn't end up restarting James's feedings, because his belly is still distended. Stopping the feedings has definitely made him more comfortable, though.

They're going to do the GI studies to see if there's a blockage anywhere. One possibility is that the opening from his previous surgery (the stoma) may have narrowed. Given the pattern that we've seen -- not much stool, many days of feeding, no clear evidence of other blockage on the X-rays -- this seems plausible to me, but of course this is based just on my own guess, not on any medical knowledge. (Also, according to Google, stoma strictures occur in about 2% of ostomy patients, and James seems to have a talent for hitting low probability events. I am going to encourage him to play the lottery when he's older.) It seems like this would be one of the easier things to fix, though I could be wrong about that.

But the very frustrating thing is that they don't do these studies on weekends, because it's not an emergency. I totally understand that no one loves to work on weekends, and that doctors have a tough job and a grueling schedule, and that they need to see their families too. But that means two more days that my son is hospitalized (and for which our family, and Blue Cross, and the state of North Carolina have to pay), two more days of increasing stress on his liver from being on IV fluids, two more days of having a central line IV which increases the risk of infection, two more days of not having the best developmental stimulation, two more days of delaying his skills at feeding by mouth -- so yes, it's not an emergency (and believe me, I'm grateful for that), but it's certainly not trivial either. I'm really angry about this. Just because he had the bad luck to have his problems on a Friday, we're being punished with this delay. It seems like there would be a way to schedule this so that sometimes, someone would work a weekend to help these babies get home sooner.

Three Months

This wasn't exactly how we wanted to celebrate the boys' three month birthday.

We went in to the hospital in the afternoon, and James was not very happy. They had restarted his feeds at 9 ml/hour, and he was grimacing and crying a lot, and spitting up a bit as well. The doctor thought that his discomfort might be due to reflux, since he'd been getting reflux meds in his IV fluids, and those had been steadily decreasing as the formula volumes increased -- so they added the reflux meds to his formula, and she thought that continuing to feed him would start to make him feel better. But then when she was in talking to us, he had an episode where his oxygen saturation dropped, so that made her decide to stop his feedings again. Within just a few minutes, James seemed to be feeling much better; he opened his eyes and was looking around, with only the occasional expression of discomfort. I don't really know what this means for helping to identify the cause of the problems, but it suggests to me that it's something more than just reflux.

They're pausing the feedings for six hours and then are going to try again. If he has problems again, they'll do a contrast study to see if he has any additional blockages or narrow areas in his intestines. (The surgeons didn't think he did, but it's possible something may have developed in the meantime.) The contrast study would also help "clear the pipes" in case it is some kind of other difficulty with the poop getting through (not necessarily constipation per se, but something like that). Also, his morning X-ray also didn't show clear evidence of any obstruction -- it just showed a slight dilation of the bowels, which is probably contributing to him being uncomfortable but isn't something that was cause for concern among the doctors. So that's good, but an X-ray isn't really definitive for ruling out obstructions.

They also took him off Lasix and put him on hydralazine for his high blood pressure, and are giving him a drug that might help intestinal motility (Reglan, I think). Motility drugs don't have a great track record of effectiveness, but it's probably worth a try.

So, we don't really know what's going on with him. Maybe we'll be lucky and he'll do well when they restart this evening, but we're not wildly optimistic about that.

In better news, Matthew slept in his crib for a few hours last night! (He sleeps like an angel when someone is holding him, but squirms and fusses in the crib.) The winning combination seemed to be 1) swaddling, including wrapping up his arms, 2) noise machine set to "rain", 3) a little light in the room, 4) a pacifier, 5) mobile turned on, and 6) motion monitor (this one is for me, so I don't have to keep checking to see if he's breathing). Oh, and letting enough time go by after feeding him so that he doesn't spit up. So, hopefully this will continue to work.

If it's Friday it must be Trouble

Talked to the nurse this morning after 8 am.....James is not tolerating his food any longer. He spit up and dribbled food out of his mouth all night and this morning his tummy is distended and he is very uncomfortable. The nurse didn’t know what the next step is. The doctors haven’t completed their rounds yet so we don’t know much except that they stopped feeding him and took an x-ray of his tummy. His sodium is also very low, but I don’t know how or if that is related to his feeding problem. We’re planning to go in this morning to see what is going on and what’s next.

Survey Says

Matthew received a survey today in the mail from the hospital. Given the context, the questions are hilarious.

Q: Was your admission unexpected?
Well, yes.

Q: Did you have a roommate?
Quite a few!

Q: Were you placed on a special or restricted diet during your stay?
You might say that. And he's still on it!

Then he gets to rate the pleasantness of the room decor, how well the nurses kept him informed, the courtesy of the person who took his blood, and so on. (You'd think they'd have some screening process for age of the patient, and address it to the parent instead!)

James is up to 10 ml/hour of food, two-thirds of the way to their goal. However, his nurse thought he wasn't feeling as well today, and he was fussing and acting like he was pushing. The nurse practitioner (nurse practitiones are the "super nurses" who have extra training and loads of experience) looked at him and thinks he probably just needs to poop, so hopefully he'll be able to move things through sometime soon. (We've been saying that for the past couple days!) But his belly is still fine and he's not throwing up, so that's good -- they're going to keep feeding him but not increase the amount yet.

The Open Road

We took Mattie on his first stroller ride today. Mike had been eager to do it, but we weren't going to take him out in the heat wave that we'd been having the last couple of days. However, our timing was less than perfect -- it started to rain when we were just past our neighbor's driveway, so we turned back. (Matthew didn't mind -- didn't even wake up, in fact -- but the dog was disappointed in this extremely short walk!)

They went up to 9 ml/hour on James's feedings at 4 AM last night, and he's continuing to do well. From the morning report, it sounded like the doctors weren't too concerned about his low poop output -- apparently they're more concerned if there's a lot, because that might mean that the food is going straight through without being absorbed. He lost a little weight last night, which is good, because it probably means he's getting rid of some of the extra fluid.

Due Date

Today is Matthew and James's due date. I have mixed feelings about this -- on the one hand, they're definitely out of the preemie stage, which is kind of a cool milestone. On the other hand, though, it reminds me of just how early they were, and that's still painful. It's hard to think about all the problems they would have avoided if they could have stayed inside a bit longer.

But today was a good day. Jamesie continues to do well with his feedings, and he had his first session with a "cuddler" today. These are hospital volunteers who hold and snuggle with babies who are old enough and stable enough to be held. It's nice that someone can be there with him when we can't! (The nurses also hold him sometimes, which is nice.) Mike and I both got to hold him today, too.

James's blood pressure has been starting to creep up, so they're giving him some Lasix (a diuretic), which should both help decrease the amount of excess fluid he's still retaining, and hopefully help his blood pressure as well. We told him that blood pressure was Matthew's problem, and that he didn't need to do it too.

Meanwhile, Mattie enjoyed another day of being spoiled by Grandma. :)

[Top three pictures are James; bottom is Matthew.]

Warming Trend

I admit it -- I thought wipe warmers (little machines that heat up the baby wipes) were unnecessary. I thought they were just one of those gadgets from the Baby Industrial Complex designed to get parents to spend more money and clutter up the nursery with stuff they didn't really need.

But...Mattie seemed to really hate the wiping part of his diaper changes, and I can see where having a cold cloth unceremoniously delivered to your private parts wouldn't be much fun. So Grandma picked up a wipe warmer for him, and I have to say that diaper changes are a lot more pleasant now! He still doesn't love them, especially if we're slow about it, but the level of frantic screaming has definitely decreased. So, yay for modern technology.

Jamesie continues to do well with his feedings. They'll go up to 8 ml/hour this afternoon. And he's had a little bit of poop (4 ml last night and 1 ml this morning, if you want the specifics), which is a start -- hopefully he'll keep up the good work.

Mani

Jamesie got a manicure today, compliments of Dad. (His nails were getting long and we didn't want him to scratch himself!) We also read him "Barnyard Dance", which he seemed to enjoy. They've gone up to 7 ml/hour of formula, and so far he's doing well. The goal is to get up to 15 ml/hour (which would be "full feeds"), so he's almost halfway there.

They also did a lab test on his stool to see if he was absorbing nutrients from his food, and he is, so that's good!

All Wet

Mattie didn't mind the first part of his bath too much, but when the hair-washing portion began, he screamed that waterboarding was torture, and demanded to see his lawyer.

(The morning report is that Jamesie is still doing fine on 6 ml/hour, although he still needs to poop!)

Saturday Pictures

Grandma got to hold James for the first time today!

They went up to 6 ml per hour at noon today for James's feeding, and as of this evening, he was doing fine. (We'd like to see a little more poop, but he doesn't seem to be in any discomfort.)

[Top picture is Matthew; bottom two pictures are James.]

Five at Five

We had a nice visit with James today. He's still doing well with his feeds, and they're up to 5 ml now (starting at 5 PM). He didn't sit in his bouncy seat while we were there (because we were holding him), but they might give it a try tonight if he's awake. He was alert at the end of our visit, and really enjoying his mirror!

We also brought in a couple of books, and read him "Goodnight Moon." Despite the fact that this a beloved children's classic, it was the first time either Mike or I had read it. :) James mostly slept through it, which I suppose is the point.

Two other milestones today: we finished the first of what will no doubt be many packages of diapers (though, in fairness, there are a couple still in the diaper bag). However, thanks to Grandma and Auntie Nora, we're still well-supplied for the time being. And the boys joined the great bureaucracy -- they received their Social Security cards. (Which reminds me that we also need to order copies of their birth certificates, so that no one gives them a hassle if they decide to run for President.)

We also had the first "mistaken for a dog toy" baby toy casualty today -- Stanley chewed the leg off of one of the stuffed animals on Matthew's bouncy seat before we realized he had it. I took it away and told him no, but I couldn't really bring myself to be mad at him, because how was he supposed to know that it wasn't a dog toy? (He'll have to learn somehow, though! In the meantime, we have learned to put the stuffed toys up high when they're not being used.)

Matthew had his visit from the home nurse today (insurance has approved six visits for now), and despite his thrown-up medicine dose yesterday, his blood pressure was still fine.

Another Team

Little did we know that James had established his pro football loyalties already -- when Uncle Henry said, "You can come visit and I'll make you a Steelers fan", Jamesie smiled in his sleep!

James and Mattie are both doing fine today; Mattie is sleeping in his bouncy seat, and we're assembling James's bouncy seat to take in to him.

Reflection and Regurgitation

Good afternoon report from the nurse -- James is still tolerating his food (and had a little bit of poop -- hooray!!). They're up to 4 ml an hour now. The occupational therapist came to see him again, and he was awake for her. They also showed him his mirror, and he was fascinated by it. Cool! We plan to go in this evening (more relatives in town).

Matthew was the troublemaker today. He gets his medicine in his morning and night bottles, and we usually give it in a very small amount of milk (about 10 ml) to make sure he drinks it all. Well, this morning I knew he was hungry because it had been a little longer than usual between feedings, so I put the medicine in about 25 ml of milk -- which is still not a lot for him (he drinks anywhere from 35-60 ml at a feeding). Of course, this was the morning he threw it all right back up. (I think he's only vomited once before, back when he was in the hospital; he's had a bit of spit up here and there, but this was definitely different from that.) I guess I get to check off the "getting puked on" box on my parent list! We called the pediatrician to see if we should give him more medicine or just skip that dose, and when more than an hour went by before we heard back from them, we called the NICU doctor (who told us just to give the evening dose).

We took his temperature (after putting the battery in the thermometer the wrong way, and having to dig the instructions out of the trash to figure out what was wrong), and it was fine, and he's been acting fine and keeping his food down ever since. So, we don't think he's sick -- maybe he just ate too fast and it didn't agree with him.