My goal date...

So today is the 32 week mark for the girls - my goal date. Makes me so emotionally torn. Happy that they are here, yet sad for the same reason. I was hoping that I'd be able to stay pregnant until at least today. Giving the girls another 3 weeks inside of me would've made a huge difference - and that became even more evident last night.

Madison hasn't quite been herself over the past few days. It started out with her needing the transfusions that I spoke about in the previous blog and now it's turned into something more. After the transfusions Maddie was looking significantly better than she had, but then yesterday she once again started looking a little off to us. She just wasn't behaving like herself. During the day she was very cranky. Now, one of Madison's many gifts is letting the world know that she's here! When there's a problem, she let's us all know about it. But usually, she'll immediately stop crying and be content once the problem is solved - if she's hungry and you feed her, happy - if she has a dirty diaper and you change her, happy - but yesterday, nothing would make her happy - she was completely inconsolable and none of the nurses, nor Mike and I could figure out what was wrong with her. We chalked it up to gas pains and acid reflux - and thought that it was possible that her tummy wasn't agreeing with the fortifier that started being added to her milk. Before her blood transfusion she was taking 20ml every 3hrs without fortifier - then she's taken off of food for over 24hrs and put back on at 22ml with fortifier to provide extra calories, making it much heavier and not as easy to digest. So we thought that maybe all the changes in her food, topped off by her stomach being so empty and having the transfusion, just threw her off a bit. We left in the afternoon because I had my postpartum visit with my ob/gyn (all is well with me and my battle wound) and we were hoping that by the time we'd return in the evening, that she'd be feeling better. Unfortunately, by the time we returned, she was too quiet. She was clearly not herself again. As I tried to hold her hand, she was completely unresponsive. The nurse said that maybe she was just lethargic, having screamed her head off all day and wiped herself out. With tears rolling down my face I told the nurse that I really believed it was more than that and I simply stated "she's not okay, she's not right". Mike agreed that while she had a rough day and could've just been tired, there seemed to be something more there. She was continually having apnea/bradycardia episodes - serious ones where the nurse had trouble waking her and at one point she even turned blue. As the nurse would hold her up and try to get her to respond, her body was completely limp. So the nurse went to get the neonatologist on staff at the time to give Maddie an exam. The doctor, who isn't Maddie's regular doctor, but who has seen her before said almost immediately, "I know this baby, she's usually much more active than this" and that's when I really knew that there was reason for concern. The doctor ordered an immediate x-ray, drew blood, ordered that antibiotics be started and put Maddie back on the IV that had just been pulled out only hours earlier. She stopped her feedings until she could figure out what the problem was and had her taken out of her isolette and put back onto a radiant bed so that they could have easier access to her if anything needed to be done. So here it is - the other shoe has dropped. I'd hated to vocalize it, but Mike and I had said in the past few days how things were going frighteningly well - and while we hated to say it, we couldn't help but feel like something was bound to go wrong to knock us off of our high horse.

They x-ray showed that her stomach and bowel were distended. Her blood work showed that her white blood cell count and CRP counts were high, indicating that there was in fact some sort of infection. The doctor's main concern was that this could be an early sign of NEC, which I forget what exactly it stands for and I refuse to google because I'll end up self-diagnosing and driving myself nuts - so feel free to google it and keep whatever you find to yourself. :-) But anyway, what I do know about NEC is that it's a gastrointestinal disease that causes an infection of the bowel and it would typically begin at this exact stage of a premature baby's life - this stage being when IV fluids have stopped and full milk feedings have begun and become increasingly larger. All these changes can be too much for the immature bowel of a premature baby to handle and can cause bacteria build up, inflammation and infection. Because as Dr. Kamtorn said, and I am reminded of everyday, this little girl isn't supposed to be here yet. Her 32 week old stomach shouldn't have food being introduced to it. She shouldn't have to digest food at this age. The doctors aren't sure that this is what Madison has, but all signs seem to point in that direction. It seems to have been caught early enough that it hasn't caused too much damage to her intestines so the x-rays are inconclusive as to whether or not this is the beginning stage of NEC. NEC is treated by stopping the feedings (which they did last night) and giving the stomach and bowel a rest - in addition to the introduction of antibiotics which will hopefully knock the infection out before it gets any worse. While the doctors aren't sure that she even has NEC, they are treating her as if she does as a precaution. If NEC gets to a higher stage, it could require surgery - so to avoid something like that, they're treating her as if she does have it. So she's not allowed to eat for a 5-10 days (depending on how long they feel the need to keep her stomach resting, which will depend on upcoming blood work and x-ray results - poor little thing, her 1/2oz per day weight gain will be put on hold for a while, as of last night she is 2lbs 8.4oz, so we'll see where it goes over the next few days) and she'll stay on a double course of antibiotics to try to knock the infection out of her system. While she does have some symptoms of NEC, she's lacking some other symptoms that Dr. Kamtorn believes would be present if she has NEC. So we really have no clue at this point what exactly is going on with little Maddie. If this infection isn't NEC, it could be some sort of blood infection caused by the blood transfusion. But it doesn't look like we'll know for sure what it is until they continue to do testing every few hours to see how her body responds to the medication.

On the other hand, Melia is doing extremely well. She has maxed out at 28ml of milk every 3 hours and is handling the extra fortifier very well. She's tolerating all of her feedings and is like a little superstar of the NICU. As of last night she is 3lbs 3.7 oz and looks bigger and bigger by the day! She hasn't been having any significant apnea/bradycardia episodes. When she does have a quick episode it's usually self-limiting, meaning that she can bring herself out of it without any help from the nurses - so she'll forget to breathe and then remind herself to start back up on her own. But, watching Madison get all the attention yesterday and today must have taken it's toll on Lia, since this morning, she showed me who's boss! We're there at the NICU, trying really hard to split our time and not ignore Melia due to Madison being sick. But of course, it's really difficult when Melia looks so perfect and Madison looks like she's just gone 12 rounds with Tyson. So truth be told, Madison has gotten more of my attention in the last 2 days, regardless of my efforts to split myself in two. So Melia started fussing this morning and I went over to her, talked to her for a bit and checked her diaper. Sure enough, she had some poopies in there, so I ask Mike to wet some towelettes for me and I start to change her diaper. Now, I've changed probably a thousand diapers in my day. I've been pooped on by all of my nieces and nephews at one point or another - and some of my friends kids. I figure, at this point, I've mastered the art of the poopy diaper. So I'm doing everything the right way and I'm just about to slide the new diaper under her little tush when all of a sudden there is poop everywhere!!! I mean, EVERYWHERE! I've seen projectile vomit but I've never, until today, seen, or even heard of, projectile poop! This thing loosely shot out of her like water through a garden hose and projectiled out of the door of the isolette and all over me - not just on my hand that was in the isolette with her - outside the isollete and ALL OVER ME! This little 3lb baby, confined to an isolette with plastic walls all around her, found a way to have her poop strategically fly out of a small doorway and she totally slimed me! As Mike said, it looked like a crime scene if only the poop was blood. Her isolette couldn't even be washed down because it was all over the place. They had to call for a new, sterilized, isolette to be delivered to the NICU and her house was changed. I can't even do this poop story justice. I really think you had to be there. But, lesson learned, I will have to get better at splitting myself in two because when Melia doesn't get attention - she gets even!! That, and next dirty diaper of Melia's has daddy's name written all over it! :-) Even though she didn't have all of my attention, Melia did have the attention of daddy and Nana (Mike's mom) today. Mike got to hold Melia while I was off doing my pumping duties and Nana got to hold Melia for the very first time today. I guess they're off the shit list (pun totally intended). ;-)

My goal date....bitter sweet as I see how great Melia is doing right now...as I get to hold my girls, engage with them and look at their beautiful little faces...yet I watch Madison struggle, as her little 32wk old body is forced to do things that it's not ready for because she still belongs inside her mommy.