Thursday, April 30, 2009

So much for a good day

I guess maybe this is a sign that I just need to get used to how the kids will keep me on my toes for the next how many years...

Yesterday morning we had a good visit with the doctors. They increased Sara's feeding volume to 25mL, which will give her 118 calories per day. Adam was at full feed schedule again finally - 25mL like his sister. No sign of tummy issues. A little spit up developing over the past few days. Dr. Macwan increased his caffeine level from 13 to 15 to assist with his bradycardias.

We went back in the evening - Shannon kangaroo'd with Sara and I fed Adam a bottle. He took 1/4 of it.

And then another one of those dreadful 3am calls came. Dr. Pica informed me that Adam's belly was distended again but this time it was hard, unlike times in the past. He has quite a bit of air in his belly but it doesn't seem to be moving much. She decided to stop his feedings, draw some blood, start him on an IV and antibiotics...and unfortunately he was moved back up to the Neonatal Intensive Care Unit.

I lay awake in the dark in the middle of the night analyzing his progress, searching my brain for questions I could ask the doctors which would lead them to pinpoint why this has started. Of course the doctors have charts to look at and data to analyze but we have also spent a lot of hours so far with our children. They won't reduce his oxygen flow until his bradycardias are better but is it the high flow oxygen that is causing air to get in his tummy and then his body doesn't move that through? Doesn't necessarily seem to be a milk allergy because he is digesting all of it and the distendedness has started at various volume levels. I don't know. I pray that we figure out the combination soon.

An added challenge to visit the kids when they are on different floors of the hospital.

And the struggle it will be of walking into a room they have shared for a week to see Sara's bed and the slot next to her empty, waiting for her brother to join her again.

Wednesday, April 29, 2009

Milestone

It was weigh in day yesterday...drum roll please...

Adam Joseph - 3 lb 1 oz!
Sara Makenzie - 2 lb 13 oz!

Adam also had a superstar performance taking a bottle with Shannon last night - 12mL of his 25mL feed. Awesome effort for his 2nd time at bat!

Tuesday, April 28, 2009

Collaboration

We knew at some point that we wanted to talk to Dr. Hasselman, Adam's cardiologist, prior to them being released from the hospital. It's helpful to get informaton firsthand and learn about any follow up that might be necessary. The nurse asked this morning if she would like for us to call him and he was available to come down for a visit. He drew a diagram of the heart and explained how the heart typically sends firing to beat. Adam's SVT (rapid heart rate that was triggered when his PIC line was inserted) was probably caused by an extra firing node. It is highly likely that this will resolve itself as he grows and develops more. His initial thought was to keep Adam on Digoxin for 6 months and we would monitor him at home and keep tabs on his heart rate. As he gained weight, his dose would remain the same and it would act as weaning him off the medication. However, we were fortunate enough that Dr. Hasselman arrived at the same time as Dr. Macwan, Adam's neonatologist. They collaborated about Adam's total care and decided it would be better to take Adam off the Digoxin now for a few reasons. First, if there are any side effects from being off the medication, the hospital staff will be better equipped to monitor any issues. Second, a side effect of Digoxin is gastrointestinal issues...which Adam is having. They also attached his feeding syringe to a machine that will administer it slowly through his feeding tube over an hour, rather than quickly by gravity. We are hopeful that we are narrowing down the issues causing Adam's recurring tummy episodes. He had quite a few bradycardias yesterday, as well. Once the Digoxin is out of his system, the doctor will consider increasing his caffeine slightly to stimulate him.

Sara plugs right along. I fed her from a bottle again today and she took 6mL of her 23mL feeding - approximately 25%. Still a good accomplishment for her. It really does sap her energy to put forth that effort. Hopefully this evening will go well and Shannon will take his turn with Adam tonight. By the time we discussed options with the doctors this morning, Adam had fallen back asleep and that certainly isn't an opportune time to be challenged with eating from a bottle!

Monday, April 27, 2009

It's a 2 bottle day...


Both of us are exhausted from the excitement of the day!

Dr. Makwan was back from vacation and assessed both kids shortly after our arrival this morning. No new orders for either of them. Adam is taking his feedings well and continues to self-recover from most of his apneas/bradycardias that he experiences. He remains with an IV in his arm in case his tummy reverts to being upset. The doctor heard a small heart murmur this morning but suspects it is due to the high flow canula right now and it is not of concern.

As Dr. Pica says, Miss Sara is a "rock star!" She keeps plugging along with her feeds and has kept her heart rate within range to avoid the blood transfusion. Dr. Makwan explained this morning that when babies are in the womb, they have an ample supply of red blood cells. When they are born, all of those cells die which makes the body anemic. This is a normal process which creates a signal for the body to make more cells. If the body is assisted with a blood transfusion, it gets confused and thinks it doesn't need to make more. That is why they want the body to produce the red blood cells on its own rather than confusing it again with a transfusion.

The real excitement came when both Shannon and I got to feed the kids. Sara and I took a lesson from the nurse while Shannon looked on and then he got his turn with Adam. Sara ate less than yesterday but they were also trying a nipple that allowed her to take more, which could have tired her out a little faster. Adam had a slower start but both of them did very well in swallowing, keeping their breathing steady, and not choking. It really is truly amazing to watch a tiny human being less than 3 lbs learning how to eat.

We were spending some time holding them as they napped from the bottle effort and the nurse asked if we had any pictures of them together. We looked at each other and told her no, that they had never been close enough with all the wires from the beds. She told us Sara was doing well enough she would disconnect her wires from the monitor and we could scoot toward the middle of the room so she could snap a few photos. So, 25 days into their NICU stay and we finally got pictures of all of us together. They were the closest they had been since they were in the womb. Not very awake for the experience, but still a milestone.

Sara takes her first bottle!

What a surprise to arrive yesterday morning to find out the nurse had tried Sara on "nippling", which essentially means she gave her one of her feedings through a bottle to see how she would handle the suck, swallow, breathe process. She gets 20 minutes to eat as much as she can with 1 feeding a day. What she doesn't eat is finished in the syringe that flows through her feeding tube. At the point she eats more than 50% 2 days in a row, she would advance to the next level and nipple 2 feedings a day, etc. Her first attempt she took 7mL of her 23mL feeding - about 30%. Quite good for a 2lb 12oz little peanut. When we were kangarooing last night, she was trying to put anything in reach in her mouth - my hospital gown, her receiving blanket, her fist, even her canula hose that had slipped out and was by her lips!

They continue to monitor her breathing to see if she is working too hard. So far the blood transfusion is on hold.

Adam continues to make strides with his tummy issues. Since he has been tolerating breast milk well again, the doctor adjusted his feeding schedule to increase the quantity at a faster pace (still without the human milk fortifier that would normally be added). In about 2 days he will be back up to full feed volume and they will test him with the forumula milk fortifier. He continues to have more bowel movements so it seems things are processing better. The times his tummy is distended right now, it is due to the air he is swallowing from his canula. The nurse yesterday was going to suggest turning down his canula level but the doctor didn't go for it. She would rather that he focus on one thing at a time and right now it is the feeding schedule. With Dr. Makwan back from vacation today, each doctor is different, so we'll see what his thoughts are. At this point Adam just seems content laying around posing for pictures, and blowing spit bubbles. Maybe one of these times I'll be able to get a picture of Shannon blowing bubbles back at him! I thought they were supposed to be having quality father/son time...

Adam went at it with his pacifier yesterday so we'll see if the nurse tries him on a bottle today, too.

Both kids got a bath yesterday, new bedding, and an updated weight. Adam loves his new green dinosaur sleeper (finally a break from the baseball theme) and Sara is in consistent pink with heart blankets. Adam is hovering just under 3lbs and Sara is 2lb 12oz.

Saturday, April 25, 2009

Saturday medical orders

Sara enjoyed a few days canula-free but after having quite a few bradycardia the other night, the doctor felt it was best to take a small step backward. When I hear a report that one of the episodes she needed breathing assistance, I certainly can't argue. But you can imagine how that can weigh on you as a mom. This canula is a step down in that it's not a high pressure flow like Adam is on right now, merely a little flow of pushing room air through her lungs. The increased breathing episodes led them to run some blood tests to look for an infection brewing or possible anemia. The doctor indicated today that she is anemic but her body is working at a good pace to make red blood cells. At this point, they are monitoring her closely to see if her body is going to correct the issue on its own by watching her resting heartrate. If it is in the 160-170 range, she is resting comfortably. If it is in the 180 range, she is working too hard and they will do a blood transfusion. A bit more involved of a process for preemies as they would stop her feedings for an hour before the procedure. She would then receive separated blood that contained red cells only for 4 hours, take a 2 hour break, and receive another 4 hour treatment. Approximately 12 hours of not eating may make her a little cranky, but it will be worth it if she needs it. Pray that her body will have the strength to make the adequate red blood cells on its own as that would be the best option.

Adam has decided to have another hiccup with his digestive track. Just when he was off IV's, his belly started showing signs of being distended last night. They did an x-ray and blood draw, which revealed no major problems, and held his feedings overnight. He did not look as uncomfortable as he did last week. His belly remains soft and he is in no pain. The doctor decided to try a different approach this morning to narrow down what is causing his tummy issue. They started him back on breast milk feedings this afternoon and will increase it until he returns to his full feeding schedule. No human milk fortifier will be added for extra calories to see if that was what his body didn't like to process. Once he has resumed full milk volume, they will try to add a formula fortifier instead. All trial and error.

When you stop and think about it, they were still supposed to be in the womb for another 9 weeks...eating and breathing amniotic fluid. Here they are breathing air and digesting breast milk, looking around at their surroundings, wearing clothes, and sucking on pacifiers. It really just leaves me in awe.

Dad finally rambles - patients versus children

Most of the time we've been in the NICU we have been treated like the only people in the hospital. Whether nurse, doctor, or support person, they are informative, hospitable, and compassionate. You get the feeling they are really fulfilling a calling to make sure the whole family grows up well together and keep us involved in the kids' care as much as possible. Knowing Adam and Sara are being watched over and cared for by the best NICU in the world has at times made it easier to leave them at the hospital and come home after each visit.

But a couple of days ago I heard one of the nurses talking to someone else and say something about "my patient" and it clicked: Adam and Sara are patients in a hospital but they are still my children. Adam is the son who will carry on the family name and Sara is the daughter who has her father's heart wrapped around her little finger. No matter what kind of care they are getting at OSF St. Francis, ultimately, God has entrusted them to JoLynn and I for a short time. OH MY!

The kids' caregivers at CHOI can only get so involved in their lives. They change shifts, take turns watching over them, go home to their own families, and see some kids go home and grow up; others go quickly to heaven for eternity. Their investment can only go so far. And from time to time we have to help them in the continuity of care from shift to shift, day to day. JoLynn has a tremendous memory for each day's events, vitals, challenges and accomplishments when it comes to the Wonder Twins. Thankfully, too. Sometimes the staff takes a very short view of our 3 week-old kids and make generalizations about their behavior, responses to treatment, outputs, etc. JoLynn has to give them the bigger picture - like when they say Adam has always had trouble with milk. Truth is, he was eating quite well for a few days and inputs and outputs were normal. JoLynn reminded them of that so that Dr. Clark could make a more reasonable attempt at diagnosing his current digestion problem. Without that perspective, they could spend a lot of time guessing at why he's not processing correctly and having him on IV's more than needed.

JoLynn even observed that Adam has enjoyed the all-green pacifier when they were trying to give him a mostly clear one that has a different size and shape. They went back to the green one and he takes it willingly. That wasn't in his chart.

Caring for and seeing preemies develop is complicated. They don't do all the things full term babies do. They don't have an easy way to communicate problems. Even internal systems like bone marrow production of red blood cells isn't up to speed yet, because it wasn't scheduled to be needed until June.

So, I'm thankful there is a facility that has been in the business of bringing up preemies since the 1940s when such a concept was rare. And I'm thankful that we live close enough that we can be actively involved in their day to day care and provide observations to medical staff when they're determining a plan of care and facing challenges. I'm thankful that I have both a son AND a daughter who are wonders of God's creative power and perfect timing.

As with most of the major and sometimes seemingly minor events in our lives, timing is seldom what we plan. I'm just looking forward to finding out what great things God has in store by bringing them here 12 weeks early when I'm unemployed.

Friday, April 24, 2009

You say it's your birthday...

I guess Adam and Sara decided they wanted a new studio apartment for their birthday this week. They were moved to the 1st floor Neonatal Intermediate Care Unit Wednesday night. And last night we celebrated their birthdays as a family by kangarooing together.

The new room is quite spacious and sectioned off by curtains when needed. They even have 3 large windows that bring in nice sunlight during the day for them to bask in the rays. The nurse to baby ratio is still 3:1 so the level of care remains but in a quieter environment. They will continue to see the same doctors. We are adjusting our visit schedule so we can still hear the daily doctor update firsthand - we will visit early afternoon after lunch and in the evening after dinner and shift change. Be sure to call us if you would like to visit as they are in a secure pediatric area and you would need to be escorted by us.

Adam has been making slow, steady progress in working back up his feeding schedule. His IV nutrients were stopped yesterday so he has transitioned back to total breast milk with fortifier for extra calories. The IV was removed last night. He still hasn't had a bowel movement in a few days as his body is working to adjust to the interruption of food.

Sara enjoyed a few days off the canula. However, she had 3 breathing episodes that were all self-correcting. The doctor indicated if she had any more than that or needed assistance, she would go back on the oxygen and we would try again in a few days. We received a call this morning that they did resume oxygen last night at 1am. This is typical and just means she needs a little more time to develop. Her feedings are going well.

You know, I just have to keep everything in perspective. Yesterday we had a conversation with a mom who was taking her baby home that was born with a chromosome birth defect and was expected to die soon. How do you even process that? Another mom in the evening talked about how her daughter was going home this weekend and she went on and off oxygen 6-7 times during her stay. The twins have had such minor bumps in progress along the road that they really can't be considered set backs. Every time we go, we hear comments from nurses about how they are amazed at their progress, how well they are doing for their size, they haven't experienced a "typical" journey for 28 week preemies. When I am overwhelmed by prioritizing things to get done or exhausted at 3am while listening to the sound of the breast pump, it is those comments I keep in mind. And they give me energy to get up and walk through the schedule all over again.

And that is what we will do, whether it is for another 4 weeks, 6 weeks, or 8 weeks.

Wednesday, April 22, 2009

What a good day!

This morning was my first trip to the hospital by myself. Shannon was headed to Springfield for a job interview. It was a little lonely but the kids' progress made up for it!

I walked into the NICU to receive a wonderful surprise from my baby girl - her canula had been removed! Shannon and I had given her the goal that maybe by the weekend but she did so well yesterday with the level turned down that they decided to move forward. She is also doing well on her increased feeding level and gained weight. She is officially above her birth weight and is 2lb 10oz.

Big brother had a good day, as well. His tummy still looks good and he is handling being back on a feeding schedule well. About 1 more day and the IV supplemental nutrients should be turned off again and the IV removed. It will be nice to get him back on track. He is also back above his birth weight and is 2lb 14 1/2oz. He did have a few more breathing issues last night but still in the normal range for him. They were while he was sleeping and he self-corrected most of them. Still good progress for him considering that they lowered his oxygen a little yesterday. Dr. Pica will be measuring Adam's head circumference 3 days a week to look for signs of fluid build up on the brain due to his previous bleeding. Measurements are within normal parameters at this point.

Both kids had eye exams this morning - routine check up for preemies. Results are normal - their eyes are still developing but typical. They will receive another test to monitor progress sometime in May.

The doctors are excited over their progress. They definitely seem like the "wonder twins" to us!

Tuesday, April 21, 2009

A little challenge for the kids

Dr. Clark is attending to the kids this week and decided this morning to challenge them a little. Shhh...we're keeping it a secret from Adam, though!

Sara had no breathing issues yesterday and only 1 the day before so they are turning her oxygen in her canula down another notch to 1. One more step and it will be removed. It is on a trial basis so if it is too much of a struggle for her, they will turn it back up a level. Also, her weight went down a little so they are going to increase her calories by giving her more breast milk. 23mL per feeding every 3 hours, which is a little less than 1/8 cup. Her favorite pasttimes are napping, sucking on her pacifier, and looking adorable.

Adam only had two breathing issues yesterday, which is excellent for him. Since he has had two good days in a row, the doctor is turning his oxygen level down a notch to 2. Like his sister, if he doesn't do well, they will turn it back up. His belly looks much better this morning so they are starting him on a small feeding schedule - 5mL per feeding, which is about 1/2 tsp! As he transitions into increasing the breast milk, they will decrease the IV nutrients he is on but it will be about 3 days before they can remove the IV. Pray that he will take the feedings well and his veins will hold up to the IV. It doesn't seem to bother him but it is a challenge for me to see an IV in his head!

Monday, April 20, 2009

Sore belly

Adam's x-ray on Saturday night revealed that his intestines were a little dilated. The doctor decided yesterday morning to begin his feedings at 1/2 the volume they were and gradually increase. By last night, his tummy was still distended and he seemed very uncomfortable in his bed squirming around. They did another x-ray while we were there and decided to hold his feedings again and increased his IV fluids.

He seemed better this morning and more comfortable. While his belly is bloated, it doesn't hurt him when they push on it and it is still soft. They decided to give him a suppository as his stools had decreased and maybe that was part of the issue. We had a good time kangarooing together and then I got to change his diaper - he left me quite the surprise! Hopefully he feels better after that. They will start him on just a tiny bit of breast milk this afternoon to see if he handles it better. The doctor we talked to today indicated she is pleased with his progress and the issues he is working through are actually normal for a preemie born at 28 weeks.

All blood and urine cultures from the other day have come back negative. His A's and B's - apnea and brady cardia - have been lower the past few days so that is a positive. They will begin measuring the circumference of his head today to make sure there is no build up of fluid on his brain.

Sara...what can I say? She's my strong little girl. All positive things about her - her feedings are going well, she is holding her own temperature, her breathing is good on the decreased oxygen, and she goes crazy with sucking on her pacifier. Her only mishap today was when the syringe of breast milk fell from the top of her bed and was laying on her face! I'm surprised I didn't hear any complaints from her but we had a little clean up before we left for the afternoon.

Tonight...our first bath time together!

Sunday, April 19, 2009

Step away from my baby boy!

We arrived at the NICU yesterday morning to find a nurse standing at Adam's bed with blue gloves on and a blue sterile pad under him from the waist down. He was completely naked, his head had a bruise on it and there was a little dried blood at the area. She was pulling out various things from packages and asked a 2nd nurse to come hold his legs down.

Shannon has been calling me "the mama" for quite some time now...never did it kick in more than at this moment.

I asked what was going on...I'm sure sounding defensive, which I have the right to be cuz I'm the mama...and the nurse said the doctor ordered some blood to be drawn and a urine sample. Shannon suggested putting a cold wipe on him and you would be able to get a sample very easily! But apparently it had to be sterile so she was trying to put in a catheter. After watching her first failed attempt and seeing her go for a second, I had to walk away for her own safety - I was ready to tackle her and take her down!

Her only comment was that he had quite a few "bradies" (brady cardia - heart rate drops below 100) for a number of days now. All I could think of was how the doctor told me the day before "that was just normal Adam" and now there is a weekend doctor there and nurses that had not spent one shift with him.

Dr. Pica, the resident who has been on rounds with both babies every day but one since their first day of life, came to explain things. She knew I would be upset if I walked in and saw that but had no information...darn right! Turns out that Adam had a jump in his number of bradies - he normally has 4-5 a day and the previous was 9. They are just being precautionary to check for things and if they thought it was for sure an infection, they would have started him on antibiotics already. That made me feel better knowing there was a change in his normal pattern and that is what called for the labs. Unfortunately, we will have to wait a few days for the cultures to grow and see if it reveals anything.

I called to check on him at 5:30 this morning. They have held his past 2 feedings because his belly was distended more than they would like. He is on IV fluids and they will do an x-ray of his tummy this morning to see if there is anything abnormal going on. During his first 3 days of life not having a bowel movement, his belly protruded, but the nurse indicated his output seemed good. Hoping for some feedback on the results of his x-ray when we visit mid morning.

Friday, April 17, 2009

No change

Adam's ultrasound results came back the same - the bleeding did not resume and get worse and the clot did not recede, either. This is what the doctor expected. He is showing no other signs of distress - no seizures, no changes in his color, he is eating well and having good "output". They will do another ultrasound in 4 weeks. In the meantime, they will monitor measurements of the circumference of his head to make sure there is no abnormal changes that would indicate increased fluid in his brain. He continues to have apnea episodes where he forgets to breathe, mostly when he sleeps. The doctor feels at this point, that is just Adam. Please continue to pray that there is no damage to his brain that would cause developmental issues down the road.

Little sister continues to gain weight and she is adjusting to the increased feeding volume well. The doctor said today, "I think she has turned the corner." Exciting! She is doing fairly well maintaining her own body temperature. A challenge being by the hallway door and under a vent so I put her little bonnet back on today. She remains on the same oxygen level through her canula and if she has a good weekend, they will assess turning it down a notch on Monday.

Both babies started oral stimulation to develop their sucking skills...putting a pacifier in during feeding time or various other times during the day. Adam wasn't as interested today - must have been tired from the book Shannon read to him. Sara sucked on Shannon's finger for a bit and had quite a grip!

Thursday, April 16, 2009

Empty

My bed...

For a few months our full size bed had pillows on both sides of me to support my growing belly and provide more restful sleep. Between a cat, extra pillows, Shannon, and me getting bigger, our bed got smaller and smaller. And then I came home from the hospital and the bed seemed quite empty.

The crib in the nursery...

I spend many hours in the nursery these days, rocking and making food for my babies who aren't home yet. Step by step, the nursery is getting closer to being ready to welcome our bundles. Right now, there are things in the crib that need to be sorted and put in drawers. Sheets are washed and ready to be put on the bed. But sometimes it is a little lonely at 3:30am while I rock and look at that empty crib.

My belly...

Just when I was getting used to having a belly full of two babies! Yes, I couldn't bend over to tie my shoes, yes I couldn't see my feet, yes it was uncomfortable to sleep, yes it was often a shelf for crumbs to fall on as I ate, yes it drew attention, yes it was convenient to rest my arms there as I sat. But there is something about having something living and breathing inside you. There is a connection when you feel every little movement. And with Sara, most of the time they weren't little! I miss having them in there and knowing we had that constant connection. I know we will develop that in a new way and it has already started. But when I get comments about how Shannon can hug me without bumping bellies or I don't look like I just delivered 2 weeks ago or isn't it great that I can see my feet again...part of me agrees, but part of me feels a little empty because I miss it.

Happy 2 week birthday!

About this time 2 weeks ago I was just getting hooked up to machines at St. Francis. I can't believe how quickly the past 2 weeks have flown by.

We are excited that Adam and Sara have both moved to intermediate care and are in beds next to each other...well sort of, there is an empty bed space between them. But it makes it much easier to visit with them both.

We made it there in time for doctor rounds this morning. Sara has had small strides of weight gain consistently over the past 5 days. She is now at 2lbs 7oz, up from 2lbs 4oz last week. Still not up to birth weight, but making progress. They have decided to increase the amount of breast milk she is getting - 121 calories per day! Tomorrow they will consider turning her oxygen on the canula down a little to "challenge" her and see how she does. She is also receiving an iron supplement in her feeding once a day because breast milk does not have iron in it. Dad dressed her in her first outfit today - Sara wrinkled up her nose so I guess she didn't like what the nurse picked. This stage indicates they are going to turn down her bed temperature and see how she does holding temperature on her own. When we "kangaroo'd" last night, she was lifting her head and trying to look up at me as I would talk to her.

As for Adam, baseball outfits seem to be what he wears most days. Sometimes 2-3 outfits a day if he has an accident...a few of the nurses have discovered how good of an aim our little guy has! He is getting 124 calories a day and is hovering right at his birth weight of 2lb 12oz. They look for babies to return to birth weight at the 2 week mark, but you seldom see that in preemies. He is getting the iron supplement, as well, and continues to be on the digoxin for his heart but they have seen no recurrences of the rapid heart rate. He continues to forget to breathe at times, mostly when he is sleeping. Since the number of times it occurs is consistent and there are no other signs of stress, the doctor is not concerned at this point - that's just Adam. Sound sleeper like Dad. His follow up brain ultrasound was early this morning. If results are posted this afternoon, the doctor will call us. Otherwise, we will discuss with him in the morning.

I tried to ask them what they wanted for their birthday today but neither offered any ideas! I guess we'll keep giving them love - doesn't cost anything and we have plenty!

Tuesday, April 14, 2009

Calling all prayer warriors

We got to the hospital this morning just in time to see Adam transferred to a different bed and then transported to his new surroundings in intermediate care. I held him as they set up his new bed - once a week or so a baby gets a new bed so intense sterilization can happen to the one they have been living in. The day took a quick turn when the nurse told us the doctor had already made rounds and wanted to talk with us.

"I wanted to talk to you about the ultrasounds we performed on the babies' brains. Sara's came back normal. Adam revealed there was some bleeding."

He pulled up a chair and found a piece of paper to draw a picture as he explained the results.

The ultrasound of the left side of his brain is normal. It is the right side that is of concern. A level I bleed would not be an issue because that would be in an empty area of the brain. A level II bleed has moved outside the empty area and leaked into a ventricle. A level III bleed is one that has extended beyond the ventricle and entered the brain. And a level IV bleed has seeped into various areas of the brain.

Adam has a level III bleed. It has clotted at this point so his body is doing what it's supposed to in healing itself. Surgery is not necessary and also not possible due to being located in the center of the brain.

This type of bleed increases a chance of brain development issues or slight cerebral palsy to 25% as opposed to 8-10% for a 28-week preemie.

It is really too soon to tell if there will be any issues with this. As he gets older and his brain continues to grow, it is possible that there is no damage at all. And it is possible that if there is damage, his brain will compensate and work around it. We will not be able to tell that until he gets older.

Next steps are to do another ultrasound on Thursday to monitor the progress. We will discuss the results with the doctor on Friday.

How can you pray?
--- That the ultrasound Thursday would reveal not only that the bleeding has not continued, but that it has receded. In fact, you can go really big and pray that there would be no signs of any previous bleeding.
--- That any damage that may have occurred will be compensated by the brain so there are no development issues. Go big...there is no damage at all.
--- That Shannon and I are strong examples of faith that impact the staff in the NICU.

We look forward to talking to our son about his miraculous God when he gets older.

How is sister? The doctor decided to adjust her oxygen level back up a notch to ease her breathing a little. Nothing of concern. Her brain ultrasound has come back normal. We have convinced the nursing staff to move her to intermediate care to be with her brother. They will slide one low-care baby down a station so she can be right next to him. We expect this to happen this afternoon.

Monday, April 13, 2009

Weekend update

We learned that Adam is in regular clothes now because he is able to hold his own temperature. They have removed a monitor sticker from his tummy that is used to read his temperature and adjust the settings of his bed as needs arise. On Sunday they removed his PIC line from his arm so he has no IV and continues to feed well solely on breast milk. He had a few more breathing episodes last night than usual. The doctor ordered some various blood tests for comparison purposes to see if his levels are different than previous days.

Sara had IV nutrients stopped Saturday so she is feeding on mom's "liquid gold", too. Her electrolytes were checked yesterday to make sure her body is receiving nutrients properly - all levels came back normal. Billy ruben levels are normal - no additional photo therapy necessary. She is not able to keep her temperature yet, mostly due to lower body weight, so she still lets her bed regulate her temp and hangs out in her diaper. She is doing so well with her breathing that they turned down her oxygen level in her canula slightly.

Both kids had an ultrasound of their heads this morning. This is routine to check their brain development and make sure there is no bleeding on their brain. Results should be back later today or tomorrow.

It was good to hear the nurse say last night that both babies are doing well enough to be moved to intermediate care, they have just chosen not to yet. Staffing of nurses is distributed evenly right now and the baby next to Adam did not need any more stimulation. He is such a good roommate - very calm and quiet - so they decided to leave things as they were for now. Once they are moved to a less critical area, they will try their best to put their beds next to each other.

Adam and Sara enjoyed an Easter visit from my family - my mom, my aunt, my cousin, and her 3 girls. LOTS and LOTS of pictures!

Saturday, April 11, 2009

No news is good news

Could we even ask for more? Each day brings another little step forward for our new little arrivals. Adam caught up with Sara on Friday and had his cpap removed. He is now on a canula, as well. I think he is relieved to have that contraption off his head. His feedings are going well and he is officially off all IV nutrient supplements and eating just breast milk. It is poured into a syringe and suspended above his bed to flow into a feeding tube by gravity. They keep just clear fluids running through the IV line to keep it open in case it is needed down the road. Sara caught up with Adam and the humidity in her bed was turned off. With no signs of infection, her antibiotics were stopped.

Today was an "order free" day. The doctors had no tests to run, no blood, nothing they wanted to check...just a lazy Saturday of hanging out in the warm beds, resting, and eating.

With Adam being a day ahead on his feeding schedule, he is back up to his birth weight of 2lb 12oz, while Sara is still down from birth at 2lb 4oz.

It was an exciting parents day, though. When Shannon and I arrived for our morning visit, they had dressed Adam in "street clothes". A preemie sleeper outfit. It was ridiculously large on him!

And Shannon had his first kangaroo experience. Each baby can have skin to skin contact with a parent once a day. So since Sara and I had some quality time together the other day, I thought it was dad's turn. Shannon takes off his shirt and puts on a hospital gown. Then the nurse carefully transports Adam and all his tubes and wires to Shannon's chest. A few warm blankets are laid on top of both of them and they enjoy their snuggle time. We will get on a schedule to do this every day so we begin to bond together as a family. Sara and I will take a turn tonight. I'll let Shannon post about the experience but for me as a mom, it was exciting to see him holding our son for the first time.

Thursday, April 9, 2009

I got to hold her!

First of all, we were elated to talk to the doctors and hear positive reports on both Sara and Adam. It felt so good to have a phone call free morning! They have made excellent progress during their first week of life.

Adam has had no more heart issues with the rapid heart rate (SVT) but he continues to be on a daily dose of Digoxin, which will change to oral administration today. It is possible that could continue even after he comes home. He is still having some breathing/apnea issues so he remains on the cpap with just a little pressure and they will reassess tomorrow. He has gone through a full day on his official feeding schedule and it is going well - he is digesting all of what they are giving him through a feeding tube. Although when we arrived today, he had pulled the feeding tube completely out and was laying on it! He had a few milestones - the humidity was turned off in his bed, which means his skin isn't so sensitive to be losing water through his thin skin...and he finally listened to us and pooped SIX times yesterday. The magnesium has processed out of his body and with the feeding schedule, it is helping things move through his system better.

Sara has given us good reports, as well. The blood work and spinal tap results have all come back negative for infection. They are still waiting for a few culture results. But if things look good still tomorrow, they will take her off the antibiotics since she has made it through 48 hours of no symptoms. She is much more her spunky self today. It was a new nurse today who hadn't been with her before. She made the comment about how she wasn't happy because she was moving all around - I said no, that is normal for her. She is off her test feeding schedule and on to regular feedings. At 11:30 she received her first official meal of breast milk and the IV nutrients were turned down. There have been no more episodes with the circulation in her right hand since moving the pulse-ox to her foot. The humidity in her bed was lowered again (to 65%). She graduated off the cpap today while we were there and it was replaced with a canula. It is possible that she could take a step back and return to the cpap but we'll see how spunky she is!

As I stood at her bed and Shannon was with Adam, the nurse told me it was time to take her temp and change her diaper, if I was interested. Of course I try to get as much practice in as possible. She wasn't real pleased with me that I had to hold her arm down to take her temp. Then we waited for the respiratory therapist to remove the cpap and change her to the canula.

And the nurse said so nonchalant - she is due to have her bed changed...would you like to hold her while we do that?

It was such a surprise, so unexpected!

It was quite the ordeal with 2 nurses lifting her out and untangling wires. As she dangled in the air with arms and legs moving, getting a little irritated, I waited with a warm blanket laid on my chest. More wires caught, more things to untangle.

Finally they placed her on the blanket and I folded both sides around her. No more fussing. Just calm and content. It felt like I wasn't holding anything - she is so tiny. As she laid on my tummy, I pictured just how cramped she must have been in my belly with her brother. We rocked. Shannon took pictures and tried to get her to open her eyes. She wrapped her hand around my finger. It was a wonderful 10 minutes.

Wednesday, April 8, 2009

Another phone call

We got another one of those phone calls you don't really like to get this morning as we were ready to leave for the hospital. Don't get me wrong - we love to be called and informed - it just makes your pulse a little higher even though we try to stay calm...we know God is in control of the entire situation.

This time it was about Sara. You remember a few days ago that her liver levels were a little off. We are still waiting some culture results on that. Last night her temperature was pretty high - 98.8. Being in a controlled environment, her body temperature should not fluctuate much. They turned off her aqua bed that circulates beneath her and in the morning her temp was down to 96.4. Not being able to hold your body temperature is typically a sign that something is off. She also didn't seem like herself - very lethargic and they would lift her arm and it would just drop rather than her holding it up. The combination of all these things led them to run blood tests and do a spinal tap. Her white blood cell count was elevated. The spinal is not back yet. To be conservative, they started her back on antibiotics. They are also keeping her on the test feeding for another day and held off on feedings this morning. Her sodium levels did drop so they turned the humidity down in her bed - it's good to be able to see her well without so much condensation in her bed. By the time we left, she was more alert. Shannon changed her diaper and she received another feeding of my breast milk.

Adam graduated to an official feeding schedule today and got his first dose while we were there. The IV nutrients were turned down at the same time. He was quite fussy while I sat with him but by the time I went to the bathroom and came back, he was alert and had his eyes open. I thought that was interesting until I changed his diaper. So much work for such a small amount of reward. And people aren't kidding when they tell you that stuff is sticky! No further episodes with his heart and he is doing well with his breathing but is not off his cpap just yet. He is pulling out his feeding tube. The nurse put a piece of tape on the line as a marker and the tape is supposed to be up by his lips. Within 40 min he had it pulled out a few inches and the nurse had to re-insert it and put new tape on twice. She told me she thought it was slipping from getting wet with saliva. "Don't be so sure of that!" I told her. After getting it adjusted, she turned around to do a few things and looked back and there his hand was wrapped around it again getting ready to pull!

Medical update

We were a little disappointed that we didn't get to catch the doctors while doing rounds in the morning yesterday, as they had clinicals and were delayed in their schedule. The nurses do an awesome job of updating us while we are there - they are only assigned to 2 babies during their shift and they know there is a twin but sometimes don't even know where the bed is located in the area! - but it is nice to get that report from the doctors first-hand.

Instead, I was surprised to receive a personal phone call in the afternoon from Dr. Pikah, the intern who has given us reports every day since their birth. She knew we missed the rounds for the day and wanted to give me the information. We are so appreciative of the time we get and the level of patience to ask any questions we think of.

Adam had gone through the rapid heart rate episode after putting the PIC line in his arm. Digoxin acts as a liquid defibrilator and returned his rate to a normal rhythm. Dr. Hasselman, his pediatric cardioligist, saw him and wanted to continue another dose today just for prevention. He will also get an EKG/ultrasound of his heart to make sure it is anatomically correct and blood is flowing. They don't think there is anything wrong, just being precautionary. He also got another glycerin suppository - sorry buddy - but it did help give him another bowel movement in the evening. They decided to do another day of "gut priming" (test feeding with breast milk) since he had the heart issues. He has had some issues with his respirations falling below 100 and is back on caffeine to prevent that. He needs to be free of those before completely removing the c-pap and going to a canula. Just leave that hose alone, Adam! We had to have a little talk about that last night before we left. He likes to pull at everything. His billy rubin levels look good so no photo-therapy and he will have a lab-free day today. He had a good test feeding last night and had digested all of the previous feeding. The IV line was removed from his belly and he was laying on his stomach last night.

As for Sara, she has been having some issues with her right hand turning right. They place a warm pack on the left hand and in 5 minutes it pinks up again. The nurse on the afternoon shift removed her pulse ox monitor and she did not have any episodes so the evening/overnight nurse was going to follow suit to see if that is what was causing the problem. Her billy ruben went up a little so they will re-test today. They will also look at electrolytes and other levels today, checking her sodium, etc. She is still on the high 95% humidity. Her blood work on her liver was negative but the viral cultures are still pending. She did not need another suppository. They have also decided to do 1 more day of gut priming with her due to the finger issues. The insertion of her PIC line went well - it is in her leg to avoid any issues that may arise with the right hand. Her umbilical cord IV was removed as well and she was laying on her belly.

Tuesday, April 7, 2009

3:10 am

Hello?

JoLynn?

Yes.

This is Katie. I'm calling about Adam. He's okay.

Our first middle of the night call. They had put in Adam's PIC line - the IV leading to his heart. Everything seemed fine with it. But then his heart started beating fast. 250 bpm. It didn't seem to bother him. He wasn't in distress. His color was still pink. Another sign that he has that calm personality even when his heart is racing! Sometimes the line can get a little too close to the heart and tickle it. They did another x-ray and in fact the line had moved. They pulled it out a little but that didn't bring his heart rate down. Adenocin was administered, with no improvement. A 2nd medication, digoxin was given, and that brought his rate back down to the normal 150 bpm range. The PIC line is still in place and is being used for his IV fluids. 50% of the digoxin dose was given at that time. He will receive another 1/4 dose 8 hours later and the last 1/4 8 hours after that. He will be monitored to see if he needs to continue receiving that med or if it was just related to the PIC line insertion.

We called this morning to check on him and he had no further complications over the past few hours. Anxious to hear the doctor report when we go during rounds late this morning.

Got poop?

When we left the kids Monday morning, we gave them one goal - you need to poop. Sara had one bowel movement on Day 1 of life but none since then. Adam was going on four days and nothing. Considering that they are young, we thought maybe they need to just focus on one goal at a time. By the time we came back in the evening, Sara had accomplished her goal three times. And Adam finally had his first - I am sure he didn't realize how much better he would have felt if he had just done that sooner.

New goals set - Sara needs to improve her sodium levels so the humidity can be turned down in her bed. At 95% it is so steamy in there you have to keep wiping the windows to see her. But we were excited to get there at the time the respiratory therapist was coming around to change her c-pap and do some suctioning. He took all the gear off around her face and lowered the entire side of the bed so we could take pictures. It was very exciting to see her eyes open and looking at us as she squirmed around. Definitely more hair than her brother.

Adam's goal is to leave his c-pap alone. He grabs at everything. When we lifted the blanket on his bed, he had his hand clasped around the hose of the c-pap. The nurse said he had been pulling it off all day and that was causing him to have some distressful episodes. He opened his eyes, as well.

Monday, April 6, 2009

3 1/2 days of life

A lot can happen. Let me catch you up on their medical progress so far.

Thursday, April 2 - They pulled my hospital bed right next to each of them in the NICU as I was too groggy to be in a wheelchair. I know the nurses were talking to me but I don't remember anything they said. I just stared at my babies in disbelief that they were here and was amazed at how small but perfectly complete they were.

My nurse woke me multiple times in the middle of the night to check my vitals and assist me to the bathroom. I was feeling less disoriented and wanted some time to see the twins again. Shannon had gone home to get a good night's sleep and pack a bag of essentials since we were so unprepared. The nurse was kind enough to take me down to the NICU in a wheelchair at 4:15am to see them.

Both were in a bed with a plastic shield over it to create an environment with controlled, high levels of humidity. Because their skin is so thin, they lose a lot of moisture. Their heads are immobilized with cushions for the first 72 hours as the veins in their neck are quite fragile. They are laying on a pad that circulates warm water and are surrounded by a "nesting bed", which provides a boundary for them to feel like they are still in the womb. You would think they would be swaddled in a blanket but they are just in a diaper and soak up the temperature and moisture from the closed container. Sometimes they sling a leg over the bed like they are just hanging out - it's quite comical.

They have multiple wires and tubes leading to their body. One wire is taped to their belly and provides an electrical feed which measures their body temperature so the beds can be adjusted accordingly. Other wires provide a monitor of their respirations, heart rate, oxygen levels in their blood - all with an alarm that will sound if they are in distress. A white IV line enters their body through their umbilical cord and provides antibiotics and nutrients. An orange line enters their body through their mouth to their stomach and will be the source to push breast milk when they are ready.

Both are connected to a cpap machine (continuous positive airway pressure). There are 2 different kinds of masks which are rotated every 6 hours to prevent skin irritation - one has tubes directly in the nostrils and the other is a mask that covers their nose. There are straps that hook over the head to secure it from slipping. They are breathing room air (21% oxygen) unassisted but this machine provides pressure to help them when they fall into a deep sleep and forget to breathe.

Sara's lungs were a little less mature than Adam's. At 1:30am she was intubated to administer surfactant directly into her lungs and then the tube was removed. A developed lung already has surfactant inside it. Without it the lung deflates to breathe, sticks, and has trouble re-inflating. This is pretty typical for a preemie and she has only needed one dose.

Adam needed a little blood upon arriving in the NICU, due to losing some through his umbilical cord during delivery.

Friday, April 3 - Sara's cpap assistance was increased slightly for a bit but overall her breathing is fine. Her sodium levels are up so they raised the humidity in her bed to 95%. There is so much condensation on the plastic that the nurse has to wipe it off in order to see her. She had a bowel movement but is not peeing much. This is probably due to her magnesium levels. I know how out of it I felt so I can't imagine the effects on the babies!

Adam had 4 episodes in 2 hours with forgetting to breathe and the nurse had to wake him. That is also due to his magnesium levels making him so relaxed. And the brain is trying to remind him to breathe since he didn't have to do that in the womb. If it continues at that rate, they will have to intubate him. He gets frustrated with his c-pap at times because it shifts off his nose.

Test feedings begin. For the next 4 days, they will be given very small doses (2, 2.5, 3 cc - think 1/4 teaspoon) of breast milk to see if their stomachs are developed enough for digestion.

Saturday, April 4 - Sara's sodium is normal again so her humidity is lowered back to 85%. Still no further problems with her lungs. Her belly rubin count is high so it is time for photo-therapy. On come the stylin' sunglasses with gauze around them. Between the glasses and the c-pap you can't see much of her head or face. Her urine output is increasing.

Adam's breathing problems have improved and he still doesn't need to be intubated. No bowel movement yet but the doctors aren't concerned. He is still very laid back. To calm himself, he has taken to a pacifier and I can feel him sucking it when I put it in his mouth. I took his temperature by placing a digital thermometer in his armpit and holding his arm down. He was a good boy - no fussing.

They have made it to the 48-hour mark with no signs of infection. Antibiotics are stopped in their IV.

9:30pm and I am being released from the hospital. One last visit for the day to pray over the kids before we leave for home without them. Sara wrapped her hand around Shannon's finger and wouldn't let go. We talk to them often when we are visiting so they know our voices.

Sunday, April 5 - Sara's photo-therapy continues. Her breathing is doing so well they lower her c-pap assistance by 50% in the morning. When the nurse checks her stomach before her next test feeding, it is empty so she has digested what she was previously given.

Adam starts his own round of photo-therapy but on 2 smaller lights compared to his sister. The doctor was ready to turn his c-pap down in the morning but the nurse who was with him all night said "let's wait and see if he is a good boy all day." When we visited in the evening, he had a good day and it was turned down by 25%. He has still not had a bowel movement since birth. They hear noises and have taken an x-ray to make sure there is nothing wrong. The magnesium just has the effect to slow the digestive process. He is not processing the test feedings as well. All of the previous feeding was still in the stomach and had turned a little green. No concern yet.

I got to change both their diapers - I couldn't believe it! I was nervous wondering how to touch them and if I was going to hurt them, as well as all the wires that can get in the way. Shannon changed Adam's diaper at night - dad's 3rd diaper change of his life - and did an awesome job for being on a 2lb baby!

Both of their magnesium levels are down by quite a bit and you can tell they are more awake. The nurse comments how Sara is always moving and kicking - that's my girl!

Monday, April 6 - We start the day with both being removed from photo-therapy. And both having c-pap assistance stopped. There is just a little pressure right now. They are at an interim step - if they do well the c-pap will be removed completely and they will have a little oxygen prong in their nose. They are past the 72-hour mark and their necks don't have to be immobilized. Nurses will begin rotating them on their side every 3 hours. Sara hasn't pooped since Day 1 of life. Adam hasn't pooped at all. Another x-ray reveals there still isn't anything wrong. Both are given a suppository through a syringe. Adam was not happy - he knows things should only go out that place! Sara's sodium is high again so her bed is back up to 95% humidity.

The intern talked to us about putting in a central IV line. You don't want to keep the IV through the umbilical cord long-term as it could be a point of infection. Instead, they insert a line through the upper arm that cuts across to the heart. Of course there can be complications and an x-ray is taken to make sure placement is correct before using it and removing the umbilical IV. We had to sign documents authorizing their first real procedure and allowing CPR if necessary.

Sara has some levels with her liver that are off. They aren't sure why and will be running cultures to track it down. Typically if it's an infection, there will be more levels than just the liver that are off. We are hoping for more information on that tonight.

Whew...lots of information. At least you are now all caught up!

Sunday, April 5, 2009

Not your typical Thursday

We'll get to Thursday...let me back up a few days to Saturday, March 28. My mom had been visiting since Tuesday on Spring Break from her high school duties. It has been a long haul for her working on staining windows, doors, and trim work for our now six year-old house and the end seems to be in sight. Saturday she took a break and we went shopping at WalMart for some essentials and then headed to the mall so I could buy some new maternity pants. I was at the stage that I couldn't keep up the ones I had because my belly was getting so big. Yes, I was only 28 weeks along but when you are carrying twins, being 7-8 weeks ahead in size is common. After being on my feet most the afternoon, I came home quite tired.

Sunday I relaxed the entire day, as well, still worn out. The afternoon brought some discomfort and what seemed to be Braxton Hicks. Off to work I went Monday, Tuesday, and Wednesday. They had leveled off a little by Monday evening so I didn't feel alarmed to call the doctor. I ran down the checklist that he had given me - they went away as I changed activities, felt like a tightening in the stomach rather than a cramp, and I wasn't bleeding at all. At work during the day I made sure to not get up as much and limit my activity. In hindsight, I was apparently in labor for those 3 days. Go figure!

In the middle of the night Wednesday, I had some discomfort but thought the babies were just pressing on something as they were getting bigger so I just changed positions. And that brings us to Thursday...

It started out typical. I woke, showered, dressed for work.

And then it changed. At 7:30am I started having cramps that I knew felt different. Shannon got me breakfast so I could rest. At 8:10, I had a thought that these seemed pretty regular and maybe we should time them. 8:10, 8:15, 8:20, 8:25. Uh-oh. I don't think I'm going to work.

I laid down on the couch on my left side and Shannon got me water to drink - such the rule follower that I am - that was supposed to help things subside. I called the overnight service for my OB and they put a call in to his pager. 30 min later and I hadn't heard from him so I called the office directly when it opened. The nurse indicated I should go to labor & delivery for monitoring just to be safe. Off we headed to Methodist, which is the hospital our HMO is affiliated with. 9:45am.

No problem. Just some monitoring. They hooked me up to three monitors - one for each baby and one to measure my contractions - and ran tests for dehydration and various infections that can cause pre-term labor. What a challenge for the nurses to keep a monitor on Sara, who doesn't sit still! Everything was very calm. Until they did an exam. I was dilated to 4cm and my cervix was paper thin. At that moment, things in the room changed quite a bit. I was in labor and it couldn't be stopped - I was too far along. They immediately called to have me transported by ambulance to St. Francis, the hospital across the street which was equipped with a neonatal intensive care unit.

Turns out I was the best dressed mom showing up for delivery!

How did this happen? Just two weeks ago my doctor reported I had no signs of my body having any strain in carrying the twins and I could continue working full-time with no restrictions. Of course Shannon and I felt a little overwhelmed as we began processing what was about to happen. Both of us hide it well. But how can you not be nervous when you find out you will be having your babies 12 weeks early?

I received a shot of steroids that would assist with the lung development of the babies. Ideally, it would be great to hold off labor for 24 hours so a 2nd shot could be administered but that wasn't going to happen. I received another shot to help slow the contractions. An IV was also started with an intense dose of magnesium sulfate, which would be the main medication used to stop my contractions. The magnesium has an interesting side effect of making you feel extremely hot, like you are on fire from the inside out. Dr. Boyd came in to do an ultrasound and discuss things with us. Sara was now head down - she had been breach for months but I thought the past few days that she had moved - so I should be able to deliver without a c-section. Another bag of magnesium was hung on my IV and I was loaded in the ambulance around noon.

I fully understand that the nurse who went with me for the tranport was trying to be compassionate, but I could have done without her rubbing half the skin off my face as she was telling me everything was going to be okay. I'm just sayin.

Now at St. Francis, I am dilated to a 6 or 7cm and contractions continue so my magnesium dosage is increased. The pain of the contractions is not nearly what it was when I was at home. They adjust my bed so my feet are elevated, trying to keep the pressure off my water so it wouldn't break.

My OB, Dr. Kindred, arrives within the hour. I am now dilated to a 7 or 8 and he can feel Adam's head directly behind my bag of water. He increases my magnesium dosage one more time. Between those meds and having my feet elevated, I struggle with nausea and another IV is started to help with that. The contractions are not slowing or stopping. I just don't feel them as much. I do my best to stay relaxed in order to keep my babies in as long as possible and not focus on the guilt of not calling the doctor a few days sooner.

We decide to put in an epidural line as a precautionary step in case we start heading down the road to a c-section.

More nausea. More pills. More magnesium.

7:30pm. "I don't feel right. I feel loopy." As I try to focus on Shannon's face, it is blurry and I see white spots. I have a difficult time focusing. The nurse runs a blood test to see how high my magnesium levels are. Before the results come back, Dr. Kindred returns to check on me. He can tell by how I look that my body is not reacting well to the magnesium. It's time to shut everything off to start getting it out of my system and break my water. His guess was that my magnesium level was a 6 or 7. Turns out it was 8.6 - off the charts! It took about 18 hours to get it out of my system enough that I finally felt like myself again.

8:45pm. I am wheeled back to the operating room, joined by Shannon and 15 doctors/nurses. The anesthesiologist prepared pitosin so it could be administered as soon as Adam was born and would help keep the delivery moving with no break in between.

9:05pm. Dr. Kindred broke my water. I pushed through 4 sets of contractions and heard my son cry at 9:15. Shannon was taking pictures with his camera phone - it was all we had since we weren't prepared for the day. I looked at Adam in his bed - he was so tiny. Shannon went over to see him and take pictures. I could tell when he came back that he was so excited.

Dr. Kindred broke my water again. This time I pushed through 3 sets of contractions and heard my daughter cry 11 minutes later. Shannon declined cutting the cord, feeling the doctor was fully capable. I watched as they wheeled her bed out of the room just behind her brother.

The most unbelievable 12 hours of my life.

With a last name like Mollenhauer, it has to be short

My family name, Mollenhauer, is German. It was also usually the longest name on the roster throughout school except for one - Riemenschneider. So, having grown up filling out those little test forms where the circles above the letters were often just a couple short, and seeing my test results for "Mollenhauer, Shanno", name length was a conscious criteria when JoLynn and I first started talking about names over 3 years ago.

Adam's name was decided on first. We talked about names we liked, didn't like, brainstormed a list of candidates, and narrowed it down fairly quick. Adam rose to the top because it was short, didn't have too many negative connotations, and except for ending in "m" so his first and last name might run together if not enunciated well, met the criteria.

His middle name, Joseph, is in honor of JoLynn's father, Joseph B. Laughary, who passed away when she was just 4 years old. JoLynn asked if my dad would feel slighted at not getting name rights and I said "are you kidding? He gets my dad's name by default - Mollenhauer! Besides, since my dad goes by his middle name, George, I was pretty sure he wouldn't be offended by not passing on his first name. And, honestly, I couldn't name my kid Merle, anyway! :)

Adam is also the only male Mollenhauer in this part of our bloodline since my cousin Clarence, Jr., has an adopted son who doesn't look German at all. :) He's doing his part to pass on the family name, just not our genetic defects (which also means the boy has a good head of hair). As my firstborn son, Adam, is our first little man. I also hope he will thank us, as I thanked my parents, for not naming him Christopher. (no offense to all the Christopher's out there, but sticking that in front of Mollenhauer is borderline cruel to a kid just learning how to print their name, don't you think?!)

Sara Makenzie may sound kind of familiar to anyone who watched CBS drama shows in the 90's and early 2000's. But first let me point out that her name is also short. Even though her middle name is hefty, I think she'll be quite content, hopefully thankful, that we chose "Sara." We left off the "h" because both spellings are commonly seen on name tags, bicycle license plates, and gift shop junk, so that wasn't an issue. From parents named Shannon and JoLynn, finding personalized items off the rack was actually a benefit we hoped the kids would appreciate.

I also like to borrow a remark from a comedian who said his wife's name was Sarah with an "h" and it was just like her to keep something else she had no use for like a lot of the stuff she bought. I say she's already got enough letters in her last name, one more would be overkill.

Sara's middle name, Makenzie, obviously has many variations, but since it's not going on a name tag, we just picked the version we thought would add flair without being obnoxious to spell over the phone to someone. Sherie Hittinger gets credit for suggesting the combination to JoLynn one day in a conversation when we said "we've got boys' names, but are not making much progress on girls yet." We didn't name her after the Biblical Sarah, even though JoLynn was over 30 when Sara and Adam were born (that's nowhere near 99), and we didn't name her after the several Sara(h)s we know at church or work (although JoLynn's boss thought it was cool, I don't think she's getting a bonus for the surprise). And, we didn't specifically name her after Catherine Bell's character on the TV show JAG because we were enamored with her character. But, we did like her personality and character and I have no complaints about her looks.

So, that's the story of our kids' names.

In case you're wondering - JoLynn's name is the blend of her parents' names - Joseph and Marilynn. Her other combination could've been MariJo. I think the one she's got works well.

My name, Shannon, was because my parents knew a guy in Arkansas who was kind to them in their impoverished newlywed days and they liked the name (at least that's how I remember the story, but this is subject to correction after reviewing it with my parents). So even in 1967 there were already guys named Shannon, and no one in Ireland looks at me funny when they hear my first name.

Editor's notes about the blog page

I just wanted everyone to know that I decided at least for a while to turn on the Google Adsense feature just to see how much traffic might occur. I don't expect to pay for Adam and Sara's hospital bills or college tuitions with this money, but whatever revenue is generated from the click-thrus will be used for their benefit. Don't click on links just to generate money for the kids. You'd be better off just mailing them a check. Use the links if something pops up that's relevant and interesting to you. I noticed the first ads mostly pertained to hair loss solutions - funny, but based on the content of my first post, what do you expect?

They're heeeere! Adam and Sara show up early.

I had no idea the title of this blog would be so appropriate when I started playing with the site weeks ago. Now, since Adam Joseph Mollenhauer and Sara Makenzie Mollenhauer decided to make their arrival before I could even finish compiling my email distribution list or creating a following on Twitter to keep everyone informed, I find myself catching up on our 21st Century birth announcement and infocast.

I just wanted to get an opening post online so I would have something to link to from our homepage and Facebook, so before I catch a quick nap, here are the vital stats:

Adam Joseph, calm, relaxed, compliant son, was born Thursday, April 2, 2009, at 9:15pm in Peoria, IL. Height (if he could stand) is 15". Weight is 2 pounds, 12 ounces.

Sara Makenzie, active, gymnastic, defiant daughter, was born Thursday, April 2, 2009, at 9:26pm in the same town, believe it or not. Height (which she will hold against her brother in sibling rivalries) is 15.75". Weight (which she will also brag about) is just 2 pounds, 9 ounces.

Both have started out with dark hair, but when you show up 12 weeks early, there's just enough to cover the scalp (Adam's fate for long-term hair status is predetermined - JoLynn's father had the same glorious hairline as daddy - sorry son.). Eyes are undetermined at this point as we have barely glimpsed them, and like the hair, is subject to change.

Mom - JoLynn managed a remarkable double delivery after almost 12 hours of trying to hold off pre-term labor and didn't even use pain blockers. She earns rookie of the year in the Midwest Moms league for toughing it out in her debut outing and shaking off the effects of a day's worth of magnesium sulfate.

More about their names, condition, and the whole deal in upcoming posts.