Got Milk?

Elise getting some peaceful rest today.

Proud mama and baby. Elise got poked again, well five times, in a second attempt for a PICC line. It was unsuccessful, but she did get a badass 80s trim; if we're careful to grow it out just right she'll be sportin' the mullet.

What's missing in this picture? Well, one pump, and the lit screen on her epinephrine.

Proof of rest: I told you Kristin is getting rest. Another great day for Elise. Today she is epinephrine (adrenaline) free and making enough on her own. Her other two blood pressure medications, dopamine and dobutamine, are alternately being weaned hourly as her mean arterial pressure stays above 65. Our progress? Her dopamine has gone from 20 mcg/kg/min to 12.5. The dobutamine drip has been decreased from 15 mcg/kg/min to 10. She has tolerated all of this so well. We are also weaning her respiratory support. We began today at 100% O2, and are currently running at 88%. Her respiratory rate has been lowered in order to synchronize with her efforts. In other words, we are slowing down the ventilator to a more natural rate so that she can begin to breath on her own. This doesn't mean that the tube will come out yet, just that her diaphragm will be doing more and more work. Her rate setting began at 60 today and is now down to 38 (SIMV), letting her breath above that at a PC above PEEP at 21. The 21 is her mean airway pressure that we are trying to reduce as well. Babies normally are around 14 at her age. This will all improve with time. With these new settings she is still having PaO2s of 250-300. On another subject she has been servin' up some real hot ones. You know, some roasters, rug burners, and turd trumpets. So her bowels have been working great, and she was given a nasogastric tube. This is a tube through her nose into her stomach for feedings. After Gaila and Debbie, two of our favorite nurses, were unsuccessful in establishing a PICC line (IV access) they gave her a little reward in some of her mother's colostrum. She can't tell us "thanks" but I think she spoke through the other end. They pulled the peripheral IV from her hand as she was having some swelling in that arm. It wasn't being used for any medication administration. Currently all medications are running in her umbilical vein catheter, and blood draws are being taken from the umbilical artery catheter. There is still the need to establish other access, but we are happy as we sit now.

What does the future hold? We will further reduce her FiO2 (fraction oxygen inhaled), work on taking her completely off pressors (dobutamine and dopamine), establish a weaning schedule for her steroids (hydrocortisone), and see how she tolerates the milk, currently at 2 ml/hr. This all won't happen tomorrow, necessarily, but is coming soon. More distant future will have her coming off the inhaled Flolan and weaning off the inhaled nitric oxide. She is still receiving the versed and fentanyl (sedation and pain), ampicillin and gentamicin (antibiotics), and nutrition (TPN). She has been moving around for us, and trying to show her eyes when Kristin talks to her. She really wants to see her mom! We are really happy with the progress and were able to get away to the adjacent Forest Park to enjoy the beautiful afternoon. I'm even thinking about checking out their Beer Fest this weekend. We are still staying at Ronald McDonald house on Pine, about 6 blocks from the hospital, and that is a true gift. Thanks for all the support. Elise really wants to meet all of you, Kristin has been telling her about all her crazy cousins. Keep the comments coming, we read them daily. Expect updates between 5 and 6 PM and don't worry about checking at other times. We love you all,

Jason