Questions

People (strangers, mostly) constantly ask me questions when I’m out and about with Shirley, “How old is she? Oh, she’s 18 months old? She’s so little! Was she a preemie?” or “is she walking yet? I bet you’re chasing her all over, huh?” I don’t mind these kinds of questions, really. But I am often unsure how to answer them. Do they want the long answer, or the short answer? I could just say “No, she wasn’t a preemie. And no, she isn’t walking.” Or I could go into detail about her medical condition and how we really have no idea why she’s so small or why she’s not walking yet (or crawling, for that matter). I mean, we know that her muscles are weak, that’s why her gross motor skills are behind. We also know that she struggled with eating her entire first year. But what we don’t know is WHY her muscles are weak, or WHY she has feeding and weight gain issues.

Rewind to the very beginning of the year. I had begun questioning, just to myself, why Shirley’s gross motor development was so slow. I mean I KNEW that delays were common for kids like her… but were other heart babies with her similar histories as weak as she was? Were they as bendy and flexy as she was? Did they have as hard of a time eating as she did? Were they all as TINY as she was? So, I started digging. I asked questions on my heart parent groups on Facebook, consulted therapists, read blogs and articles from medical journals. These are really hard questions to answer because every cardiac kiddo’s story differs from the next, especially ones with Shirley’s condition. One thing I did find was that most children who have the same struggles as Shirley (heart defect, extreme low tone, and feeding issues simultaneously) are also often diagnosed with a genetic disorder. At birth Shirley was tested for the genetic disorders that are most commonly associated with her heart defect, but they came back negative. Are those the only possible disorders she could have, you ask? Absolutely not. But, at the time, her team didn’t see a need for further genetic testing.

At long last, I brought it up with both her GI doctor and cardiologist. They both agreed that her low tone, short stature, and difficulty gaining weight were enough for a referral back to the Seattle Children’s genetics clinic. Especially taking into account that she has only had one heart surgery, and never went through a period where her body lacked oxygen. We were referred in April, but since there are not really any “genetic emergencies” appointments are being scheduled out 9-12 months. So, we’re still waiting. 

Shirley had her 18-month check-up last week. She weighed in at 18lbs 2.5oz, which means she’s gained a pound since her cardiology appointment last month. But, she has only gained 2lbs total since her 12-month check-up (most of which was gained in the last 3 months). Her pediatrician was also puzzled by her slow physical development and began immediately bouncing around different ideas regarding a possible genetic component to her diagnosis. When he heard how long the wait was for us to get into the SCH genetics clinic he decided to put in a referral of his own to the Mary Bridge genetics clinic in hopes that they would be able to get us in sooner. We're scheduled to see them next month.

Let me be clear on this, we are not fearful about the possibility of Shirley having a genetic condition; it is not a source of anxiety for us. We are purely interested in finding out more about what’s going on in her little body so that we can better support her growth and development. In addition, many genetic disorders bring along with them other potential medical issues that we wouldn’t know to look for without a proper diagnosis.

So, we wait. While we wait we’re focusing on the task at hand. We are spending our time teaching Shirley to feed herself, working with her therapists and practicing her gross motor skills. We’re also trying to figure out how to treat her like the 18-month old (non-toddling) toddler that she is. Our girl looks and moves like a baby but she thinks and understands like a toddler. If we aren’t careful about interacting with her at a level that is developmentally appropriate for her age, her cognitive progress may just slow down to match her physical development. In other words, she will live up to our expectations of her. We have our work cut out for us... in the very best way. I have never felt more fulfilled in my life. 

Shirley is a precious gift. We have been thoroughly enjoying every single stage with her. We often ask each other “How did we get so lucky to be her parents?” 

Keep our sweet girl in your prayers while we search for better ways to support her as she grows.

I've included some fun pictures from the last couple weeks. 

- Brianna

The Second Honeymoon.

Today marks the 1 year anniversary of Shirley’s open heart surgery. I recall the doctors and nurses telling us that the days before her surgery were often referred to as “the honeymoon.” A time when everything is beautiful and new and the little babies display no serious symptoms of their CHD. They told us, however, that the honeymoon would not last. The symptoms of her TA would become more pronounced and the need for surgery more apparent.

When they wheeled her away, just after we gave her little kisses, our hearts sank. A visceral sense of grief weighed on us like a ton of bricks and we sobbed.

Would we every hold her again? Would she ever stare back at us with her beautiful blues eyes, so full of life?

The grief did not last though. Long before she was out of surgery we were blessed with an overwhelming sense of peace.

Shirley’s surgery was successful and we have enjoyed an entire year of what feels like a honeymoon.  Although not everyday is easy, the vast majority have been filled with such a great sense of joy and peace. We don’t know how long our honeymoon with Shirley will last but I also cannot recall anyone guaranteeing us that life would be easy. We do not feel entitled to an easy life. We hope for one... but know that it is not certain. Our hope and joy in life is not dependent on our good fortune, it cannot be. If we put our hope in finite things we are certain to lose it when those things pass. Instead we hope in Christ.

People often ask us how we stay so positive. There are many answers to this question but a few things stand out to me.

First, we choose to dwell on the promises of God rather than the expectations of the world. We believe that God loves us, as we are today, redeemed in Christ. The events in life do not occur outside of God's love for us. Shirley's CHD is not God throwing us to the wolves. We believe that God is here with us and is using Shirley's CHD for His glory and our good. We firmly believe that no matter the trials in life, God has meant them for our good. If we believe this to be true, to be a matter of fact, just as we view gravity to be the reason that when we jump we will certainly come back down, then how could we maintain anything but a positive attitude? The world would have us believe that our life is difficult and that we drew the short straw. That, somehow, we have been treated unfairly or that we don't deserve to have such a needy and broken child. There is about as much truth found in that kind of reasoning as there is in a pile of bull's excrement (Brianna made me censor it). We are owed nothing and we deserve far worse.

Second, we simply feel blessed to have Shirley. We believe that children are a blessing, no matter what difficulties might come along with them. Shirley may have more challenges than some children but we are blessed just as much as anyone to have the opportunity to be parents. If Shirley is simply a blessing, then how on earth could we justify being negative? 

Here are some throwback photos of Shirley the day she had surgery. I put a couple recent ones in as well!

-Joseph

One

Shirley is one today! We could write for hours about the past year but we won't. 

We are so blessed to have Shirley in our lives. It has been a wonderful year! 

Please continue to pray for us and our little girl as the years go by. The support we received over the past year has been unbelievable, thank you.

Shirley's heart will never be perfect and she will need other surgeries to keep it beating, but we look forward to the days, months, and hopefully years to enjoy our little girl.

There are some exciting things coming up for us and Shirley. We will be doing some work with the American Heart Association this year as we continue to spread joy, hope, and awareness to those who find themselves in similar shoes.

Please enjoy these pictures we took for Shirley for her first birthday.

-Joseph

No Surgery

Shirley won't be having surgery on Thursday!!!!

Shirley has been without an NG tube since Friday morning and has eaten enough by mouth to keep her hydrated and healthy!!!

We are so so so happy! Shirley's struggles eating over the last 9 months have been the greatest challenge next to her actual heart condition. Brianna has been putting in an amazing amount of effort into everything feeding and 9 months later it has finally paid off. Brianna has been so dedicated and determined to have Shirley feed by mouth. Please pray that Shirley continues to eat as she has been over the last week, indefinitely. There is certainly a chance that she will regress but we want to celebrate such a wonderful achievement

We are continually reminded that there is no exact schedule for Shirley's progress. We can look back on the last 9 months and see how this has helped us grow in patience and brought us closer together. We have not always responded to the stress appropriately but we have been brought closer together by every trial thus far and we look forward to growing together even more in the future. This is certainly not the last trial we will face with Shirley but we are confident that there will continue to be good that comes out of any trial.

Her is a picture of Shirley eating some fruit puree without a tube in her nose and irritating her face!!!!

Thanks everyone for your support and prayers!

-Joseph

Ummm...

Look at that beautiful face!

Virtues

Life is crazy and life is hard, but is that a bad thing?

 

Virtues

Brianna and I knew that life with Shirley would bring challenges that the average new parents wouldn't have to face. Even though we knew that, there was no way we could have been prepared for or even known about half of what it would actually require from us. Recently I have been thinking a lot about how I think about the challenges that have arose from having such a wonderfully different child. Shirley's care is very demanding and sometimes it simply feels unreasonable. Her care takes a lot of effort. Shirley has at least one appointment per week and often times up to to three. She has a cardiologist, gastroenterologist, pediatrician, nutritionist, physical therapist, and a speech-language pathologist (our feeding therapist).  We also have a medical supply company and pharmacy that we are constantly in touch with to ensure we have Shirley's everyday essentials met. When Brianna isn't busy with one of these appointments or phone calls she is all of these things to Shirley every day. The Dr(s) and therapist don't care for Shirley they really just monitor and give advice. Brianna actually has to implement these things in her everyday care.

Brianna gets up multiple times a night to pump and store milk, heats the stored milk, loads the milk into the pump, starts the pump, an hour later shuts off the pump, flushes Shirley's tube and then goes back to sleep for a few hours before repeating the same thing. That is all done while Shirley is asleep... Around 6am Shirley gets up for the day, and if the excitement of waking up doesn't cause her spit up her entire previous feed she is having a pretty good day. She gets meds at 6am and 9am and a feed somewhere in between. Each feed while Shirley is awake starts with trying the bottle. Heat the bottle for 5 mins just to have Shirley reject it almost entirely, now that you've devoted 20 minutes to feeding orally she has to the be tube fed in order to get the majority of milk. You can't tube feed her without it being a two handed effort so now you are about 45 minutes into feeding her. You can't move her much within an hour of being fed because of her chronic reflux and the worry of her spitting up all over herself and Brianna. By the time she is done eating its nearly time to pump again, or time for an appointment, or time to pick up a prescription, or time to go shopping, or time to get something done around the house, or simply time to take a 10 minute break and catch your breath. 

Brianna will tell you that I can't really stand complaining... and as I write these things I think I am realizing how little I understand how much work it is to care for Shirley every day. I have never had to spend a significant amount of time with Shirley alone and quite frankly I'm not sure how long I would last. I know I would be capable but I think I would be a compete mental wreck after the first day. I don't really have a major role in Shirley's care until I get home from work and as most people can attest the last thing you want to do when yo get home from work is feel like there's more work to be done... But there is, and its not a bad thing. Thankfully Brianna and I can double team Shirley's care on the weekends. 

Now if you think that sounds like a bunch of complaining it wasn't intended to sound that way. We love our life and we love having Shirley here with us! We were just talking about how good we have it in the greater scheme of things. Shirley Requires a lot... but man is it great being her parents. She is so wonderfully unique, so happy, so cuddly, so content, and so darn cute its almost irresistible! Right now as I'm typing this Brianna is tickling the crap out of her and she is just laughing it up, smiling and holding her feet with a face that seems to relate that she doesn't want you to stop!

The whole reason for this post was a thought that has been creeping into our minds recently. That is, that we just wish it were easier, or that we could skip ahead to when Shirley doesn't have a tube and its not as difficult to care for her. When I really start thinking about those thoughts though, as I have been over the last few weeks, I can't help but think that by simply thinking that that we are missing out on a great opportunity. We accomplish nothing by wishing it were easier or hoping the time passes quickly to when she will need less hands on care. Instead we will miss out on the opportunity to grow as people and parents. Isn't patience a VIRTUE? Doesn't hard work build character? In fact what many people consider to be virtues (diligence, patience, charity, humility, temperance, and kindness) are all things Brianna and I have to gain from the apparent difficulties of Shirley's care. By wishing it all away and viewing some tasks as necessary evils we gain nothing... We have everything to gain however by accepting the challenges placed before us and taking advantage of the opportunity we have to grow. Above any of the worldly virtues to be gained from our circumstances we have the opportunity to build our faith as believers. Our faith has certainly been tested and we have both grown and we look forward to the opportunities we will have to grow as life continues on in whichever direction it goes.

So rather than complain about things, we want to see all things as opportunity.  Though sometimes it will be easier said than done, with only a little foresight it can clearly be seen as the best choice.

Medical Update and Major Gains

Shirley weighs in at over 13lbs and looks like a very plump and proportionate baby. She is a tiny little girl according to the stats though. She is in the 6th percentile for weight and the 1st percentile for height among her peers. Her height to weight ratio is very good though, somewhere in the 60th percentile. We were also able to start introducing some solids into her diet. I've always struggles calling mashed up nearly liquid food "solids" but I guess anything that consist of more than milk, water or juice can be called a "solid." 

Her last cardiology appointment went well. She had an echo and everything was looking great. Her function is so good currently that they have begun to decrease her drug schedule. Within a few months if everything goes as planned they would like to have her on only one medication for her heart function. She will still be closely monitored but it feels like a huge step in the right direction. 

Brianna has been doing a ton of research on how to wean Shirley off her tube and we have been having an ongoing discussion with her feeding therapist, GI doc and cardiologist about how to do it well. Its not very easy to make an infant eat orally that has never had to rely on eating orally for nutrition. Shirley knows pretty well that she will be fed by the tube no matter how much she takes by mouth... because of that most people say that kiddos in her shoes can go days without actually having normal hunger cues. It is a little daunting to think of taking Shirley's tube out and more or less forcing her to eat by mouth, but it is really one of the best ways to get her away from being tube dependent and eliminating her chronic reflux. We are pretty confident, though, that Shirley will be able to pick up the skill and within the next few months its our hope to get rid of the tube once and for all.

She does have one new medication being added but its not for her heart. The GI doc wants to try one more med to help Shirley's stomach digest more efficiently before we attempt to wean her by simply taking the tube out. For whatever reason children with heart condition like Shirley's have what is called delayed gastric emptying... pretty much sums it up in the name. Because her stomach isn't doing its job as well as it could Shirley's already insufficient hunger cues are hampered even more by the fact that her stomach is never really that empty. Maybe this treatment will help, maybe it won't, but ether way we think she will be tube free in the coming months!

We have a ton of Shirley pictures and videos to post so... yeah... feel free to marvel at her cuteness.

-Joseph

These Days

A New Normal

With Joseph being back at work and a lot busier than he was before, I (Brianna) thought I'd take the time to post an update. I know you have all gotten used to Joseph and his writing style, but we're probably going to tag team the updates from here on out. His posts are going to be a tough act to follow... so bear with me. 

Things have settled down and we've begun to feel like we are living a new kind of normal. We have gotten pretty good at packing everything but the kitchen sink when we go out (you'd be surprised by how quickly we can load up and go!). I've even gotten comfortable taking Shirley out alone, on a walk, to coffee or lunch with a friend, things are just getting a bit easier. We've gotten used to strangers asking questions about her NG tube. Although these questions can be repetitive, they have been the start of several surprisingly meaningful conversations with people we've never met before. 

There are moments I find myself forgetting about Shirley's heart condition entirely, which is something I did not think possible just a short time ago.

Struggles 

We are having a difficult time waking up for her middle-of-the-night feeds. Shirley sleeps through them, so we don't have a crying baby to wake us up. We have accidentally slept through them right along with her more times than I'd like to admit. I usually wake up frantically pawing around in the dark for my phone, only to find that it's right next to me and that I must have silenced my alarm several times in my sleep. Then a wave of guilty thoughts rushes into my mind "she's probably starving!" "Do I not care about her enough to wake up for her?!" Although powerful in the moment, these thoughts are fleeting and usually do not last until the morning. 

Shirley has not been improving with oral feeds. For a while she was very interested in breastfeeding, but she has recently decided that she doesn't like it so much anymore. The fact that my milk supply has been rapidly dropping ever since her discharge from the hospital is probably a contributing factor. Bottle feeding is slow going as we work with the feeding therapist to find the right flow rate and nipple shape for Shirley's comfort. We want feeding to be a positive experience for her, so we can only push her so far before she gets upset or overtired. We give her as much as she will tolerate by bottle, and then feed the remaining amount through her NG tube.

Appointments

Shirley doesn't have as many appointments as she had the first several weeks after her discharge. She has in-home physical therapy and feeding therapy appointments that rotate every Monday. The therapists are wonderful! They have been so encouraging to me and I can tell that they truly care about Shirley.

We had a cardiology appointment last week with Dr. Penalver at the Tacoma SCH cardiology clinic. I had seen him once before when I was about 30 weeks pregnant, so this was the first time he officially met Shirley. The appointment went well overall; Shirley was a champ, smiling at everyone! Although she is still quite small, she is healthy and gaining weight (11lbs now!). She had both an EKG and an Echocardiogram done; both had positive results. Her heart hasn't changed much, and any slight changes have been for the better. 

Because of Shirley's difficulties with oral feeding, both Dr. Penalver and her dietitian (Tran) mentioned the possibility of getting a G tube placed instead of her NG tube. A G tube requires a small surgery to place a tube from the outside of Shirley's abdomen directly into her stomach. It has a small button that can be opened for feedings and closed when not in use.

Initially, this would seem like a step backward, but it really isn't. There are several issues that could be resolved by switching the NG tube out for a G tube. First, the NG tube holds Shirley's esophageal sphincter open, which causes reflux and throat irritation; both make it more difficult and uncomfortable for her to feed orally. Second, the NG tube also causes Shirley to have a heightened gag sensitivity, since the tube is hovering at the back of her throat; this also makes oral feeding more difficult. Third, the adhesive used to keep the tube in place on Shirley's face really irritates her skin. It is an obvious discomfort for her, and the older she gets, the better she is at ripping it off and pulling her tube out. For the past several weeks we have considered ourselves lucky if we could keep a tube in for more than 3 days. Although we don't like the idea of Shirley going through another operation (albeit a very minor one), the NG tube has been such a headache for all three of us that the idea of a G tube is beginning to appear like a breath of fresh air. Also, selfishly, I would like to see Shirley's beautiful face without that pesky yellow tube getting in the way!

We have not made a definitive decision to move forward with the G tube yet. We're going to see if her oral feeding improves over the next couple weeks and then make a decision.

Meds and Labs

The other positive thing that came from her cardiology appointment was that she was taken off digoxin. She is now only taking three medications multiple times a day. Digoxin was never meant to be a longterm treatment for Shirley's heart failure and because it is by far the most dangerous drug with the least benefit, we were all itching to be done with it. If you don't remember digoxin is the drug synthesized from foxglove. Shirley also had her blood drawn last week and this revealed even more positive news. If you recall a post a while back about BNP you will be glad to hear that Shirley's BNP levels are at 63. Thats down from about 3500 at its peak in the hospital. It is still high, relative to the average child, but its not that bad for a child with heart failure! It also confirms that she really didn't need to be on digoxin anymore and that her current meds are doing the job just fine.

Shirley is still the happy, chubby, sweet baby she's always been. See pictures below:

-Brianna

Breakthrough

Best Yet

Shirley is breastfeeding like a champ as I type this! She has been at it for a solid 20 minutes and doesn't show signs of wanting to stop! Brianna has been working so hard with Shirley ever since she has had the opportunity to attempt nursing around 3 weeks old. It has not been easy. There have been a lot of tears and mixed emotions surrounding nursing over the last two months but right now it's euphoria. For a mom who wants to breastfeed, not being able to do so is extremely challenging. There have been times that Brianna wanted to throw in the towel. Failed attempt after failed attempt took a toll on her but she never stops trying and it paid off big tonight! Hopefully this is just the first of many nursing sessions for this little girl and her mom.

Other Shirley News

She is a whopping 9lbs, 8oz as of her last appointment! That is a full two pounds more than her birth weight! When we first got home from the hospital Shirley was just about 8lbs and during the first few weeks we could literally feel her gaining weight everyday! The doctors want her to pack on as many pounds as possible. In the event that something unforeseen happens, they want her to be stout and able to handle whatever intervention she may need. Each Dr. appointment goes better than the last it seems. Each cardiologist raves about how great she looks in light of her heart failure. There was also some concern about her hormones being out of whack but the endocrinologist ran some tests and said that she has no concerns for Shirley and doesn't expect we will need to visit her again! 

Shirley was enrolled in "early intervention" which is a program for children that helps with developmental delays. Because Shirley spent so much time on her back the first few weeks of life she still has rather poor head control and will behave much like a rag doll if we don't support her. She is also going to get some help with her oral skills due to the fact breast feeding has been such a difficult task for her. It's unlikely that Shirley will have any pressing developmental delays and even if she didn't go to her little appointments she would probably be just fine. Cognitively, Shirley seems to be doing very well. Her drugs can make her drowsy at times but when she is awake she is alert and very interactive! 

New Work

We have been very busy over the last few weeks and its been hard to do much writing. I started a new job a few weeks back! No more UPS!!! No more brown! No more packages! UPS was a great job for what it was and I'm very thankful to have had the opportunity to work there. UPS bought us our house, put food on the table, and paid our medical bills. I didn't love my job but that didn't matter. Our needs were met and sometimes thats all you need to get out of work. 

During the majority of Brianna's pregnancy I was interviewing with different local law enforcement agencies. The week after Shirley was diagnosed I had an interview with the City of Federal Way. The interview went well and a few weeks later they called me in for a background interview. A couple weeks after that I was sitting with the Chief of Police and some of the command staff. My first interview was Oct 10th and I had an offer of employment on Nov 29th. I related the complication of Shirley's condition to them very early on and they were more than willing to work around Shirley's birth and hospital stay. Four and a half months after being offered a position I started as a recruit police officer. There were a few times I thought that I was making a mistake and being irresponsible by leaving my job at UPS during such a critical time in our lives but I'm very glad I did. It wasn't ideal quitting while Shirley was in the hospital recovering form open heart surgery but sometimes you just have to take risks. The Federal Way Police Department has been unbelievably supportive of our needs over the past few months and I couldn't be more excited to start a new career with such a great agency. 

Brianna has been a trooper taking care of Shirley on her own over the last few weeks. It certainly hasn't been easy for her but She really is doing a remarkable job! 

Not sure how many of you saw this but Jimmy Kimmel recently had a son the was born with CHD his announcement on the show was tear jerking. 

Thats all for now I think! Enjoy this little video of Shirley being adorable!

-Joseph

Good News

Routine

We have been home for a few days now. Shirley is one time consuming child! With her current feeding and med schedule it’s more or less impossible to string together periods of sleep longer than 2.5 hours. Stumbling through the house at 3am to prep milk and draw meds is almost comical. I’m very serious about her medications and somewhere deep in my subconscious I have an irrational voice that tells me I am the only one that can do it correctly. When 3am comes around though I’m probably no better than mole that has wandered to the surface (click here for a visual). Once I’ve made it to the kitchen I go up to the fridge and look carefully at her schedule posted there. I wait as long as possible to turn on the lights but I don’t know why! I have yet to draw her medications in the dark and I could probably save some time by flipping the switch earlier but instead I wait until I’m about to draw her med and then turn the lights on to ensure I’m dosing the right one. Now that I have completely destroyed my night vision I go back to her crib and search about for the NG tube. It really would make for a funny video. It’s a ridiculous process that must be undertaken to really understand why it’s funny! If you imagine myself as the aforementioned mole it really is the best way to read this first paragraph. We love this time at home though, when we go to bed and look back on our day we just smile to ourselves and think, “what an interesting, crazy, life we have.” Brianna and I started to talk about having kids probably around week two of our dating relationship and this is certainly not what we had in mind. Life rarely goes as we expect though and the ability to adapt to the reality of things is very important. Not putting too much stock into your expectations of the future is something I have learned the hard way a few times but I have never been disappointed by the outcome. We love our life and we love caring for Shirley, no matter how time consuming it may be. I hope you are not reading negativity into the phrase “time consuming.” I can’t see anything wrong with the fact that our time might be consumed with our daughter.

Adventures

Going anywhere is an adventure. We have ventured out a few time over the last week and each time has presented us with challenges and obstacles. Two of Shirley’s medications must be kept refrigerated. That, along with the breast milk for feeds requires carrying around a small cooler everywhere we go. Our diaper bag has all the normal stuff parents might pack for the day and topped off with syringes, large and small, a stethoscope and other random medical supplies required to adequately care for Shirley. We tried to go to worship service on Sunday and we made it there but after a big spit up in the car, changing clothes and diaper, feeding, and giving meds we spent a total of ten minutes in the actual service. It gave me a whole new understanding for why some people with small children might just stay home some weekends. Nevertheless we were glad we went. Our church community has been so supportive throughout this process and many people were itching to meet Shirley. Unfortunately, I have no idea what the sermon was about but we certainly heard the Good News.

We have gone out a few different places and each time has offered us a new scenario to learn from. The other most notable trip was to Seattle on Sunday afternoon. Many, many people have offered us televisions and dvd players to replace ours. Friends, family, and family friends alike have offered to replace the stolen goods. One gentleman even offered us his entire entertainment center complete with TV, Apple TV, Blu-ray player, sound bar and cabinet! We don’t have room for anything like that so we respectively declined not wanting to cherry pick the man’s goods. It was quite the offer though and we were very humbled. Instead though we drove to Seattle to meet with a wonderful couple (the Kirby's) that contacted Q13 after seeing our story on the news. They were wanting to just drive to the hospital and drop off a brand new television they had acquired but instead I convinced them to at least get coffee with us after we were discharged. So on Sunday we packed Shirley up and headed to Green Lake and had coffee with the Kirby’s. We had a wonderful time meeting these complete strangers and talking for a couple hours before loading up the car with a new TV. We didn’t really have any way to decide who to accept replacement goods from, but after the Kirby’s contacted us it was a no-brainer for me. Shirley’s life has put us into contact with so many people that we wouldn’t have met outside of her being with us. I love meeting new people and to have complete strangers be compelled to reach out in generosity towards us was something I didn’t want to pass up. 

Medical

Shirley had her first follow up appointment with the HFT at Seattle Children’s today. It went surprisingly well! Her echo revealed that her heart function had increased slightly from the previous echo. The doctors were pleasantly surprised and said that they don’t think that she needs to be monitored as closely as they originally thought. So now, instead of going to Seattle for appointments with the HFT we can simply drive down the road to a SCH satellite cardiology clinic in Tacoma! Shirley is also gaining weight consistently and we can see the pudge being added to her legs and cheeks. It’s very cute.

We may never be back to life as normal but we are finding a new normal and that is ok by us.

Thanks to everyone that has helped with meals since we’ve been home! It made adjusting to our new routine a little easier without trying to fit meal prep in between everything else.

-Joseph

Homebodies

First Night

Shirley had a great night at home. It was a busy night for us but Shirley slept the majority of the time. Her med schedule is pretty intense! There are 7 different med times between the hours of 3am and 10pm. We have been giving meds for about a week now but yesterday was the first day we had to prep her meds. Being that it was our first time dosing her drugs, it took a while but I think it will get easier as the days go on. On top of her med schedule she has a pretty strict feeding schedule. Shirley still doesn’t feed very well at the breast but she is working on it. Including breastfeeding there are 4 ways we feed Shirley. I’ll try to get a picture of her gravity feed and pump system. Every three hours we pick a method, sometimes two methods, and make sure she gets her nutrients. Hopefully Shirley will begin to put on some serious weight and take the majority of her feeds by mouth. Once that happens the NG tube will come out and feeding will feel much more natural. It’s kind of strange but we have to haul around all of these interesting things if we want to go somewhere. I have a feeling we are going to be homebodies for the next few months. Who wants to set up an IV stand, hang a bag, load the milk, prime the pump, survive the 30min run time all for a 12oz cup of coffee? Not me! I think it will probably be a circus trying to get from point A to point B but who doesn’t like a circus??? Always something interesting going on and you may even laugh. No doubt we will be the spectacle of many a people watcher.

Sleeping in your own bed, assuming you like your bed, for the first time in 5 weeks is an eye closing experience! Even though we didn’t sleep a ton last night, the sleep we did get was fantastic! I can tend to be a picky positional sleeper, rolling from side to side, flopping back to front, but last night it didn’t matter! When my head hit the pillow, no matter how contorted my body was, I was out cold. I was a little scared when I woke up thinking about how poorly I had actually been sleeping over the past month or so! I think it also had to do with simply being in the comfort of our own home again. The other thing that worried me when I woke up was what the heck I was going to eat! I haven’t prepared my own meal in the last five weeks, breakfast lunch, or diner. After writing that I ALMOST (keyword) feel a hint of shame. The food options at the hospital were phenomenal. The fear didn’t last however, I made a few simple breakfast sandwiches comprised of a piece of Dave’s Killer Bread (DKB), avocado mayo, spicy kimchi, and an over easy egg. I’m not sure how that combination of ingredients came into play but I’m glad to say that it works well.

Waking up this morning was many years of dreaming come true. Brianna got Shirley out of her bedside crib and had her all snuggled up and for the first time we had a morning in bed as a family. Having little Shirley close at hand and being able to doze off then wake up and smile at my wife and child was a fantastic feeling. Marriage and now being a parent have certainly yielded my happiest days, as I often thought they would. I look forward to more of the same.

BTW Shirley’s instagram is up and running! There will be a separate link under the news tab that will display photos from instagram. So if a few days pass and you need a Shirley fix, there may be little piece of info attached to a cute photo of her there. You can follow her @shirleysgrandadventure 

-Joseph

Home Sweet Home

Home

We are finally home! Our wonderful family and friends cleaned our house from top to bottom. There will be a lot of adjusting but it will be good. I could go on and on but I think that keeping it short is best.

We are thankful to have Shirley home. Thank you all for your continued prayers and support. This is only the beginning of Shirley's Grand Adventure! 

Tonight we will sleep in our own bed with Shirley under the same roof. 

-Joseph

Outside

Today wasn't very eventful in regard to Shirley's medical condition but it was a great day. We now have a room all to ourselves (neighbors went home) and Shirley's bed gets natural light for the first time. Out of the blue the nurse asked us if we wanted to take Shirley on a walk! Shirley got to take a stroll around the hospital, made a Starbucks run (there are three in SCH), and went outside into the fresh air for the first time! 

This is the kind of update that I'm thinking will be better for Instagram. 

The natural light really brings out Shirley's highlighted hair as well as her blue eyes. Not sure if either of those traits will last but they sure do make her look cute right now.

-Joseph

Practice Makes Perfect

Feeding

Shirley has been getting consistently better at eating by mouth. Her feeds are so condensed now that what she used to take in over the course of three hours she now receives in 30 minutes. The OT/PT team has been working hard on her oral skills and three times a day Shirley eats by bottle, if she is up for it. The last three days have been hit and miss as far as her actually getting a sizable portion by mouth but today we saw some real progress. She drank 25ml from her first bottle this morning and 35ml from her bottle this afternoon. The OT that swung by this afternoon was shocked and was probably more excited than we were. It was difficult to get her to take 10-12ml by bottle the last few days and even those feeds were celebrated. If Shirley can keep it up she won't need to go home with an NG tube placed. We are confident that she can do it.

Next Steps

Thankfully there hasn't been much to report concerning Shirley's condition in the last few days and we hope that is a continuing trend. Shirley is still monitored very closely and tomorrow is lab day... not her best days in the past. Shirley is very hard to get blood from for whatever reason so let's hope tomorrow goes smoothly. Labs will tell us a lot about how she is responding to her medication and if it is going to be something viable for us to continue at home. The doctors expect that it will be. She will be starting another heart failure drug in the next few weeks that will also be a longterm addition. Our days here are coming to a close and you can almost feel it. The D word was used this morning (discharge), but with no definitive date attached. There is a lot to be done before we can walk out the doors with Shirley. Brianna and I will both have to complete infant CPR classes and Shirley will have to pass the "carseat challenge." The test involves securing Shirley in her car seat while in the hospital room hooked up to all the monitors. Shirley has to prove that she will be able to handle the trip home. Two hours seems like an awful long time to have her in there but I think it will go fine. She sleeps so much that I can't see her being awake for the majority of it anyway. Hopefully I don't have to eat my words.

Insta

Yep, I'm so hopelessly obsessed with taking pictures of Shirley that I've decided to take it to the next level: Instagram. That is only a part of the reason. Although I plan on keeping this site and blog updated, I may start to spread them out over a few days or weeks. A lot of people follow Shirley's progress and Instagram may be a better way to do short updates. Shirley will be in and out of the hospital and cardiology clinics her entire life and we hope that documenting it will provide hope to other families that find themselves in similar circumstances. We have been greatly encouraged by others and we can only hope to do the same. 

-Joseph

One Month

Fast Month

Today marks a month with our little Shirley. It was a quick month, literally and figuratively. February 23rd to March 23rd is exactly 4 weeks. I know there are some people that calculate months in terms of weeks but I can't really make any sense of that. Children born in February on a non-leap year have a short first month (4wks) but after that it's simply back to however many days make up a calendar month. I know there are people out there that say pregnancy is ten months but just because it's 40wks doesn't make it ten months... The same logic would yield a 13 month calendar year... Seems more than a little fishy to me. Sorry for all this nonsense. It really has seemed to have gone by quickly for us. Hard to believe that we checked in 4wks ago with a cone-headed little Shirley. It has been such an amazing month! So many blessings, so much love. We have many people to thank.

Easy Days

I hope every day from here on out is as uneventful and enjoyable as the last few have been. We feel an awful lot like average parents. We didn't get much sleep the last couple of nights due to the simple fact that little Shirley needed a little attention. We aren't the "cry it out" type so we just took her cries as wonderful excuses to get up and soothe her back to sleep. She is a very cuddly little baby and we are very cuddly parents. It works out well! Now that we are in the step down unit there is much less supervision by nurses and the docs only come in periodically to look at Shirley. Brianna and I pretty much get to hold Shirley all day long, give her bottle feeds, change her diapers, and dote.

Pastime

I thought reading was going to be the pastime most associated with our stay here but it hasn't. This blog has certainly taken up much of my time and I'm very thankful for it. Also, Brianna and I go on three dates a day: breakfast, lunch, and dinner. We are spending so much time together and we love it. Before Shirley was born we pretty much did everything together besides go to our separate places of work. For the last 4 weeks we haven't spent more than two or three hours apart and the vast majority of days we don't spend more than 5 minutes apart in a 24 hour period. Brianna and I truly are the best of friends and we rarely look for opportunities to "get some space." Lots of time is spent talking with Shirley, taking every opportunity to bond with this sweet girl. I must admit though that we have binged on rerun episodes of "Forensic Files" late at night while Brianna pumps. In the last few days I have been glued to the senate confirmation hearings for Judge Gorsuch! It obviously hasn't been all roses and butterflies though. There have been some very difficult days but they have been sandwiched between the best of days as well. We often reflect about being on cloud 9 while walking the hallways and hours later be in the "depths of despair"  contemplating the unknown. As cliche as it may be, I wouldn't trade these days for anything.

Perspective

The perspective shift, for myself, has been very noticeable after Shirley's birth. I have always loved children and my mom may know best how much I have coveted the idea of family, marriage, and having children of my own. I used to love babysitting for friends from my previous church community and feel very fortunate to have had the trust of those wonderful couples! So many hours with those cute little babies just made me want my very own. It seems like a long time coming though, considering that in my early teens I often thought and hoped I would be a father by 20. I may have been nearly 10 years late according to my own schedule but it was worth the wait. I also may have scared more than one woman away because they thought I was too serious about getting married, Brianna included. I also used to have thoughts about what my children would be like and who they would become. When Brianna was 20wks pregnant, we found out about Shirley's condition as well as the possibility of her being born with a genetic disorder called, among a host of other names, 22Q. Shirley has been tested a couple of times for 22Q and each has been negative for the syndrome. Once during her pregnancy via Brianna's blood and the other after Shirley was born. The prenatal test is about 80% accurate and we thought about the results often. We welcomed the idea of Shirley with a genetic disorder but we were uncertain about how it would affect her life and, if I'm honest, how it would affect mine. The night Shirley was born though put all of that to rest and it wasn't because of some genetic screening result. It was very simply put to rest by Shirley herself and the love of a parent that, hitherto, I had never fully understood. While sitting in a recliner with Shirley in my arms I began to cry thinking about her and saying to myself, "I don't care what defects or disorders you may have, I just love you." Her second screening came back negative a few days later and there was no sigh of relief, just us saying, "ok, thanks" to the doctor reporting it. Shirley's full screen is still not complete and there are other possibilities as far as her genetics are concerned but they don't worry us. As we walk the halls of this hospital there are children with every kind of condition imaginable. Now, more than ever, I don't see them defined by their genetics or whatever it may be, I simply see beautiful children and their proud parents. I look forward to what else being a parent may change in me.

Last Thing

A wonderful woman contacted me about a week or so ago and said she had heard about Shirley through the American Heart Association (AHA) where she works. Her name is Kami Sutton and she too has CHD and has had upwards of 20 procedures here at SCH. Because of her fundraising efforts the CICU is named in her honor. We had actually heard about her after Shirley's surgery when our nurse was talking about caring for the woman whom the unit was named for. Shirley and Kami shared the same nurse nearly 14 years apart! To have Kami contact us a few days later was very special to us. Kami sent Shirley a few crocheted items made by volunteers of the AHA here in the Puget Sound and also a wonderfully crafted card with a hand written note. We continue to be in awe of the support we have received and the people who have encouraged us out of the kindness of their hearts. The card made our day, thanks Kami!

-Joseph 

Long Night and a Short Day.

Possible Infection

Shirley had a long and eventful night. We were up until midnight and decided to stay the night here sensing that it was going to be an active one. Around 3am Shirley spiked another fever just over 101. They pulled all the stops this time.  It was pretty much non-stop activity from 3 to 8am. Shirley wasn't the most cooperative and just getting an IV placed took a considerable amount of time. Two nurses and a few pokes later they were finally able to get into a vein that would draw. They swabbed her nose and throat and tried to place a catheter for a urine sample. The urine sample was also very hard to come by. They wanted to start a broad spectrum antibiotic at 6am but didn't want to begin until after they had urine. One more try for a catheter at 8am worked out well and got enough to send to the lab. Her nose and throat swabs came back negative but her blood did show very high levels of c-reactive protein (CRP) which is an inflammation marker and also a good indicator of a possible infection. Still waiting on the full blood results but the initial urine sample came back positive for leukocytes and protein. Lets hope that it is as simple as a UTI. The complete urine and blood results will hopefully single something out. Until then, she is on a very broad spectrum antibiotic that will be changed out for something more specific once her results are in. Thanks for praying for our little girl.

Short Day

I wrote the first half of this post at 10am, it's now 9pm and I'm going to try to finish. Shirley responded almost immediately to the antibiotics. Her fever subsided and she slept the majority of the day. She was pretty much crying for 6 straight hours this morning so you can imagine how exhausted she was. There was a slim chance that she could have had an infection in her heart tissue and an echo revealed nothing. There was also the possibility that her heart was failing which could cause the temp and tachycardia but the echo showed no signs of decreased function beyond what she already has. Although her complete labs are not back yet they are pretty confident that she has a UTI and that the first dose of antibiotics hit it pretty hard. They are going to continue antibiotics for 48 hours. 

Family and Friends

We almost canceled Shirley's visitors today but her Uncle John, Aunt Tish and baby cousin Lillie Belle traveled from San Diego to see her. She was either going to get worse from her infection or get better and we thought either way they should just come see the little girl. Some family friends also stopped by to say "hello." We had a few games of cribbage, doted on Shirley, and ate dinner.

Scare 

Last night was scary but the nurses and doctors taking care of Shirley are amazing. They also let me be involved in almost every situation. I had a role throughout the entire night/morning and didn't want to be anywhere but next to Shirley. It was very difficult but it was also another good experience. There was nothing we could do to actually make Shirley better so we prayed... a lot. Last night and this morning proved to be the most difficult day for me. Surgery was a difficult time but it wasn't as scary. Surgery seemed so much more controlled and the outcomes so well explained. Last night was just tense, waiting on answers, and praying that it wasn't a worst case scenario. The sadness of thinking that her best days are behind us and that it was possible that these events could be the end. Those are the scariest thoughts I've ever had and it felt like a heavy weight on my chest. It's strange to me, but for whatever reason when I think of losing Shirley what scares me the most is not being able to look her into her eyes and tell her I love her. Her eyes have such a unique grip on me that I can't bear the thought of not being able to stare into them. 

As I write this now Shirley is sleeping peacefully in her bed as if nothing ever happened and we went through the day almost as if last night was just a very bad dream.

Here are some pictures from this evening just after her bath. She looks like the Shirley we know so well, alert and content.

-Joseph 

Digging In

New Doctors

Along with the physicians that care for Shirley in the CICU a team of doctors that primarily work with "heart failure" have been brought on to consult in her everyday care. Shirley has had poor heart function since being taken off milrinone (the drug used to help the heart contract). Technically speaking there is a better phrase to describe her current state: Heart Failure. That sounds very bad and of course its not great but don't freak out. Heart failure is a very broad term used to describe the symptoms of a patient, in our case Shirley. She has been in a state of heart failure from birth. The large structural defects of her heart that were repaired during surgery can often times be the cure for neonatal congestive heart failure (CHF) but in Shirley's case her leaky valve combined with her heart not contracting with greater force are holding her back. Shirley's case isn't that severe, mind you, she is still functioning rather well given her issues. The doctors will simply be monitoring her and providing medications that will hopefully help her heart to work more efficiently. There still is some hope that her heart will rebound and function well enough to not need medication but now two and a half weeks post surgery they would have expected to see it already. It is highly likely that she will be in some state of heart failure until her valve is replaced.

Foxglove

This one is for the budding botanists out there. Shirley is starting a medication today to help address her minor case of heart failure. It's a drug called digoxin (wiki is a great source for this kind of stuff) and it's from a pretty little flowering plant called Digitalis, commonly known as foxglove. I was intrigued today when I found this out because I can remember being a child and having my mom tell us to not touch or play with foxglove while we tramped around in the woods. I knew it was poisonous and that it had something to do with it's effect on the heart but not much more than that. Crazy to think that the little plant we weren't allowed to play with as kids is now the same thing being used to treat our daughter's condition. There are many treatments for heart failure and digoxin is only one of many possible things they may try. The history of the drug goes way back and it's actually an interesting read. Hopefully she will respond well to it and won't need something more intense like milrinone. Digoxin is administered orally so it is a drug that can be given easily while at home if need be.

Rough Evening

Shirley is having a rough evening. I wrote the majority of this post earlier today but never got around to publishing it because Shirley started to get very fussy while I was holding her around 5pm. Shirley is a pretty relaxed baby so a few unprovoked fits put myself and her nurse on edge. They took her temp and it came back quite feverish at 101 and her heart rate jumped up between 180 and 190 BPM (she had been in the 130s and 140s all day). She was pretty upset for about 4 hours. They used some ice packs to cool her down and the doctors came to check her out. They are still waiting on the lab results to rule out infection. They also took a good look at her stomach to make sure there weren't any issues there. She has calmed down a little bit since but it is now 10pm and 5 minutes haven't passed the whole evening without some sort of unprovoked fit. Honestly they are hoping that it's just really bad gas that she is having difficulty passing but it's an unknown currently. The fever has come down which is a good sign but its also just a little strange.

Long Day

It wasn't a bad day but it wasn't a great day either. Shirley got to meet some new people today when my cousins came by to visit and also some aunts and uncles on Brianna's side. Today was the first day the term "heart failure" was used and that isn't really something that sits easy with anyone but they are confident that it will be manageable. Minus her fits and some issues this evening Shirley is still looking pretty comfortable and not too stressed on the whole. Hopefully she will have an uneventful night and be back to normal by the morning. The first half of the day went by very quickly but the last 6 hours have dragged on trying to calm little Shirley and being fixated at the live stream of vitals that is ever present on her monitor. Please continue to keep Shirley in your prayers. Now that the (very poorly named) "heart failure" team is monitoring Shirley we will be extending our stay in the CICU until they find a medication that works well for her overall. There is also the possibility that her heart starts to kick butt and pump like mad but they aren't waiting to find out.

Sorry if this post is all over the place but its just been a very interesting day. Here is a picture of Brianna feeding little Shirley her bottle this morning. I can't begin to relate to you how impressed I have been with how she has handled these extraordinary circumstances.

-Joseph

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Pinch Us

Dream Land

None of us are wearing green and we feel like we are living in a dream state. Our current reality is a lot like a dream with unbelievable twists and turns, the occasional terrifying scenario, a strange environment, and a very cute baby. Seriously though, there are times this all feels like a dream. Maybe it's that we have, more or less, been in a 15x20ft box for three weeks putting us in a kind of non-drug induced trip. Well, maybe Shirley's is drug induced... but we are clean!  Shirley is our little dream child as well. Although there is certainly a sense of what things could be like with an average child we couldn't be happier with the not so average child we were given. We still hold to the same belief we held before she was born, that is: Shirley has CHD for a reason beyond what is material and understandable. We also believe that no matter the outcome, Shirley's life is meant to bring good to us and others. With this hope and expectation we can charge into the days, months, and hopefully years ahead that we will be able to enjoy Shirley and the good she will bring to our lives and others. We don't know how many days are in any lifetime but that shouldn't cause us to live in fear. I think we both have a very clear understanding that this world does not revolve around our child, our family, or our lives. There are people suffering and enduring trials far worse than we can even imagine. I'll end this section with this: "Count it all joy, my brothers, when you meet trials of various kinds, for you know that the testing of your faith produces steadfastness."

Slow Going

We had a great talk with one of the "critical care" doctors today (about 10 minutes in length) and he explained Shirley's current status to us. They would love for us to leave the CICU but they just don't have the level of confidence in Shirley's heart that they would like. He said to think about it as a kind of pendulum; one side being a need for CICU care (possibly another procedure) and the other being a well functioning Shirley. He explained that she is just swinging back and forth somewhere in the middle. He was honest and said he has no idea when Shirley will be able to go home but they will do everything they can to make sure it is sooner rather than later. Shirley's leaky valve is the real concern for the team in the CICU and it will be the concern even after we are out of the CICU. What they are monitoring right now is whether or not she will present symptoms that will lead them to take action and attempt to correct her valve issues now rather than years from now. Years from now is by far the best option. During her surgery they thoroughly evaluated her truncal valve and concluded that it was, at the time, not worth the risk to attempt any kind of repair. The heart of a newborn is already extremely small (think strawberry) so imagining the precision needed to repair the valve is almost impossible. Valve replacements aren't really an option this early in life. What is more likely though is that she will need a host of drugs to help her heart to beat efficiently. Like my previous posts have said, her heart just isn't up to par. The Dr. did warn us that Shirley may need a much longer stay at SCH and that should at least be something we are aware of moving forawrd. Now, if you are thinking, "well that is typical hospital care, treat you more than you need and make tons of money on you in the process." I would caution you. Shirley is not the only child in the CICU. We met a family who arrived on Wednesday and will be discharged this weekend. Their son had OHS that same day and was closed and extubated immediately after surgery, sent to the step-down unit the next day and is now only taking the occasional Tylenol to help with pain. Their stay, from beginning to end, is likely to be less than a week. That is impressive and truly a reflection of how hard the team here is working to get children home where they belong. So, think whatever you would like. No two children are the same and I have no doubt that Shirley will leave SCH as soon as possible. 

This just in (literally), Shirley drank 17ml (an hour's worth of milk) via a bottle in about 10 minutes. That is great work for a baby that has had so little practice feeding orally.

I hope you are enjoying these posts and find them informative! I am certainly enjoying writing them! The second photo is just killing me! I can't believe how cute Shirley is!

-Joseph

Week Three

Three Weeks

Shirley was born three weeks ago today! I can't believe how fast these few weeks have passed. The hospital environment has been amazing believe it or not. We are here with our wonderful and beautiful daughter, what more could you possibly ask for?

Seattle Children's

Seattle Children's Hospital has been unbelievable. I heard that it was a great place but actually experiencing it has been something else entirely. I have yet to meet a single person that has not genuinely cared about Shirley's or our needs. Whether you're talking with a Dr. or janitor they all show you the same amount of respect and care. The diversity of the staff here is also very impressive. It doesn't matter where in the world they may be from you get a sense of confidence, humility, smarts, and care from every person. I'm not sure how they do their hiring but they are doing something right. It's very hard to convey the level of confidence I have in the staff here but it's off the charts. "Do you have any questions?" and "is there anything I can do for you?" are some of the most common things you hear from nurses and doctors alike. They will explain just about anything to you and hear you out on any concern you raise. So much more could be said.

Heart Function and HFNC

Shirley had another echo today because they were concerned about her overall function. She is looking great in person but poor on paper. The last echo showed that she had some decreased heart function and this echo showed that it was a little worse than a few days ago. It sets off alarms in my head but the doctors aren't overly concerned. They still haven't given her drugs to help her function but its definitely on the table. Her best option is to go back on melirinone to help her heart contract with more force. The electrophysiologist took a look at her EKG today and said that her PACs and PVCs are not concerning given her recent surgery. Its possible that her heart tissue is still just irritated from surgery and that it may be causing the premature contractions. Also treating them right now isn't even an option. Her BP won't even allow them to add the β-blocker used to treat the arrhythmias. Her diastolic pressure is on the low side because of the vasodilator she is on to help with perfusion and the β-blocker is pretty much a "chill pill" for the heart. They are going to continue monitoring Shirley in the CICU for another few days. Shirley is only receiving 2LPM at "room air" through her HFNC now! Her breathing is still looking pretty good and the hope is she will be weaned off shortly.

Breastfeeding 

On a very positive note... Shirley is a breastfeeding pro! OT/PT came today and observed her breathing and how she had no mercy on her pacifier and decided that it was time to try a feeding at the breast. Shirley latched immediately and was able to pause her breathing in order to swallow perfectly. That is one of the huge hurdles for a lot of children. Shirley gets 10 minutes three times a day at the breast now! It made me so happy to see Brianna get to bond with and feed Shirley the way she always wanted to. The possibility of not breastfeeding was something Brianna had already come to terms with and now being able to is a great boost in morale.

If you can handle all 3:27 of this video you will be able to see the little one fall asleep at the very end! If she is getting tired it only take a little pass down the forehead to the tip of the nose with a finger and she will pass out 90% of the time!

-Joseph

Normal Baby Stuff

Dress Up

Today is a big day for Shirley! Nearly three weeks old she will be able to wear her first outfit today! You didn't miss much yesterday but her last IV was taken out of her foot and her HFNC was decreased to 4LPM. Now that her IV is out we can dress her in one of her cute snap-down outfits! Brianna has probably been dreaming of dressing her child ever since she was wearing her own snap-down onesies, so its a huge day for her. Shirley has also been wearing little pink mittens to protect her face from those razor sharpe nails she sports.

Foot Prints

We did some footprints today. Now that her feet are free of those clumsy IV's we jumped on the opportunity to do the frivolous sentimental things! Like most baby feet, Shirley's feet are cute as all get out and to have an ink stamped representation of them is even more cute! I joked before we did the stamping that it may be a more accurate representation to keep the band-aid on her foot. Shirley thought so too, I guess,  because if you look closely at the picture you can see a band-aid mark on her right heel! Having spent the whole three weeks of your child's life in an ICU, normal things become extraordinary things. When the plan of the day changes from open heart surgery and ensuring she doesn't have a stroke, to baby clothes and footprints it's a great feeling. We are moving on from truly sad and scary days to happy and fun days, though each day with Shirley has been filled with a real joy and peace no matter her condition. Joy and hope should not be overshadowed by fear and uncertainty. I want to write an entire post about joy, hope, fear, sadness and the like but its a work in progress. That, along with a post about wondering why Shirley has CHD have been brewing since day one.

Medical Jargon

Like I said earlier, Shirley was weaned to 4LPM on the HFNC and had her last IV removed yesterday. Sometimes the critical care docs will backtrack on the IV's though and want one just in case they need it. Let's hope they don't. Shirley is getting a full blood work-up today and had another echo ordered for the beginning of next week. She has been having some issues with premature ventricular contractions as well as premature atrial contractions, PAV's and PAC's respectively. These are both somewhat common for children with CHD and specifically those with large structural defects such as Shirley's. They can also be caused by an imbalance/deficiencies electrolytes. It can be difficult to pinpoint for her though because of some of the medications she is receiving. She is currently on two diuretics that make her pee quite often in order to help her fluid levels stay balanced and reduce the risk of acute pulmonary edema (this is a great link with tons of information). The diuretics would be the likely culprit for a electrolyte imbalance but its not that easy. Her labs come back with differing results, sometimes she might be low on an electrolyte or two sometimes her levels look great, yet the PVC's and PAC's remain. She is receiving breast milk which contains everything she needs as far as nutrition plus it is being fortified to help add calories so she can plump up. The moral of the story is that she is getting plenty of electrolytes with her feeds. There are also genetic things to consider concerning her electrolyte balance but the results are still out on her comprehensive screen.

Respiration Rate

Her HFNC has been weaned rather quickly and is likely the only thing keeping us in the CICU. There have been rumors of possibly shipping her out tomorrow. She is currently on 4LPM of "room air" for support and her RR is fluctuating from from about 50 to 70. Her last few x-rays have shown that her lungs are relatively dry thanks to the diuretics and the HFNC having been set to 8LPM for almost 48 hours a few days back. This is a great sign that she is at low risk for acute pulmonary edema and its likely not affecting her RR. Hopefully her breathing will continue to improve and that she will be able to make the jump to zero support shortly.

Heart Function

Her heart function is still slightly decreased but they're hopeful it will perk up. Labs will come back today with her most recent BNP levels as well as some other markers that may help them determine her cardiac function. I think her next echo is scheduled for Monday, which will be more definitive. That being said, heart function, believe it or not, is not one of the things keeping us in the CICU at this moment. Shirley has a troubled heart and to ever expect it to function like the average heart is out of the question but there is hope that it will function better than it does today.

Thanks

Thank you all for the continued support. I have no doubt that this entire experience has been eased by the tremendous amount of support we have received in every way. I can't imagine what it would be like without it. There are many families here in the CICU that are not as fortunate. Please keep them in your prayers as well. We are just one family here in an ever changing manifest of patients. We are very thankful to have meet a few of the families here and exchange stories. Its been our goal to attempt to brighten the days of any person we meet by being helpful and hopeful in our interactions.

Until next time, here are some pictures from this morning. Don't worry, it's okay if you return multiple times a day to check out how cute she is or to see if she is as cute as you remembered. No one is judging you except you!

-Joseph

Pressing On

Breathing and Pooping

Shirley is having a pretty good day. Her HFNC was set to 7LPM this morning and then 6LPM this afternoon. Her RR has continued to hover in the 50-60s. The faster they wean her the sooner she can get to the step down unit. She has to be <4LPM for 24 hours and maintain a RR that doesn't strain her too much. Shirley is starting to make us feel more like parents these days. It used to be a real adventure to change her diaper. After surgery we had to take extra precautions to change her diaper and we still do but we have come a long way. She used to be on a medication that made her bones very soft. They even have a sign that warns people about "fragile bones." Before her PICC line came out you had to ensure that her foot was nowhere near her bottom when changing a poopy diaper. If her foot came in contact with her fecal matter you ran the risk of getting a blood infection. Those things are behind us now but a lot of the wires remain. I've changed a few diapers so it not just a learning curve! Today was the first time though that we changed her diaper, went through the whole ordeal and then 2 minutes later changed it again because she soiled it immediately after we were done. Even changing diapers can be the highlight of the day.

Heart Function

Shirley had another echo today, the first since she was taken off milrinone. In case you forgot, that was the vasodilator that also helped her heart contract. The echo wasn't the most positive but it's also not bad news. Her heart isn't contracting as well as it was when she was on milrinone which they expected, they just wanted it to be better than it is. The right side of her heart is also not up to par in the function category. These aren't things that will necessarily keep us in the CICU but they may be things that will need to be treated with drugs. If her heart is stressed beyond what it can handle and left to try and fix itself, there can be some rather negative results. They are going to give her a few days and continue to monitor her BNP levels. If her heart is up to the challenge she won't need more drugs but if there is no improvement they will add something to help her heart contract. Its a fine balance though. They don't want to do all the work for her but they also don't want her to begin to struggle. Pray that her little heart can strengthen before they have to intervene with more drugs.

Shirley keeps turning heads in the CICU, doctors and nurses are always stopping mid-sentence to remark about her cuteness or her calmness.

I'm still new to this whole blog thing but I figured out the comments and subscription thing today. There is a comment box at the end of the post as well as a link to receive e-mails when there are new posts!

I got some really great photos of Shirley being her usual happy self. Hope you enjoy.

-Joseph