Bringing Isaac back from the hospital is like a second birthday. It is wonderful, wonderful, wonderful, to have him home again! I like hearing his little chirps and grunts in the night and it is much nicer to wake up to nurse him rather than go to a pump. We check his blood glucose levels every three hours and he receives a minute dose of Lantus twice daily. His levels were great through the night, but climbed sharply this morning, so the endocrinologist advised giving him .75 units rather than his usual .5 units this morning. (You have to have eagle eyes to draw up such a tiny amount...) Checked again 30 minutes ago and his sugars are back to a respectable level.
Isaac also gets NaCl 4 times daily (mixed with milk to get it down) in order replenish that which he loses in urine. I've also found that I still need to pump some, despite Isaac being a great eater, so it works out. Our freezer has a good sized bin overflowing with milk containers that I pumped while he was in the hospital. I'm pleased that I was able to keep up with him and then some.
He's now about 7 and a half pounds. Between Thursday and Friday night he put on 205 grams. The nurses couldn't believe it, so he was weighed 3 times. I think this child would have been a good 8+ pounder at birth if it weren't for the diabetes.
While it is great to have him back, whatever I was drawing energy from these past two weeks seems to have evaporated. I am tired. Happy, but tired. The thought of getting behind the wheel of a car feels a bit too daunting right now. I don't even want to get dressed!
But Isaac is home and I am at peace.
Showing posts with label NICU. Show all posts
Showing posts with label NICU. Show all posts
Sunday, August 31, 2008
Friday, August 29, 2008
Rocking My Baby
Came back from lunch today to find Isaac's nurse rocking and cooing over him. He'd woken up a little early so she was keeping him busy until I got up to feed him. He is a snuggly baby. I do wish I could request specific nurses. Isaac and I both approved of her. While some nurses are all business, others really seem to enjoy the little ones.
Endocrinologist
Spoke with the endocrinologist today. He showed me some insulin graphs. Apparently even on Lantus, individuals who don't produce insulin will have higher peaks and valleys. Isaac has been fairly stable, leading the endocrinologist to believe that Isaac is able to produce more insulin now. He does well for about 18 hours on one dose of Lantus and then the endo theorizes that his pancreas cells give out and the Lantus also peters out. It trends upwards fairly sharply after that point. I asked about doing another C-peptide test, and he said that was something we could definitely do down the road. It would show whether his insulin levels have increased, but he was sure just by looking at his glucose levels that he was producing more.
Great news! Perhaps, perhaps, this is transient diabetes. Still not possible to tell, but maybe! At any rate he only needs a small dose of Lantus, so that in and of itself is great.
Great news! Perhaps, perhaps, this is transient diabetes. Still not possible to tell, but maybe! At any rate he only needs a small dose of Lantus, so that in and of itself is great.
Thursday, August 28, 2008
Glucometer Saga Part ??
After lunch I came back up to feed Isaac. His nurse swapped with another nurse at 1:00 because the NICU had some new admits and the nurses got shuffled around. I found her with the phlembotomist using the ISTAT reader (lab reader) to test his glucose. I inquired as to why...his sugar was supposed to be read by his glucometer throughout the day, and 1x in the morning compared with the ISTAT. She'd been led to believe that his sugar was supposed to be read with the ISTAT throughout the day and the glucometer used once in the morning.
So she tracked down Isaac's nurse practitioner who clarified things and wrote a clear (I hope!) order in his charts. Isaac's bedside nurse apologized up and down. Really it wasn't her fault, I understood. I sure was glad to be there to correct this, though. The ISTAT requires so much more blood, and to have it done 8 times a day would have Isaac terribly anemic in no time. The ISTAT lab reader ended up erroring out, so it didn't even get a glucose reading. I showed his nurse how to use the glucometer (she'd never used this type before) and got his glucose number. His nurse in turn made a very clear sign in large letters explaining how and when Isaac's sugars were to be tested and hung it on his crib.
I'm hoping that this is the end of the glucometer saga...
So she tracked down Isaac's nurse practitioner who clarified things and wrote a clear (I hope!) order in his charts. Isaac's bedside nurse apologized up and down. Really it wasn't her fault, I understood. I sure was glad to be there to correct this, though. The ISTAT requires so much more blood, and to have it done 8 times a day would have Isaac terribly anemic in no time. The ISTAT lab reader ended up erroring out, so it didn't even get a glucose reading. I showed his nurse how to use the glucometer (she'd never used this type before) and got his glucose number. His nurse in turn made a very clear sign in large letters explaining how and when Isaac's sugars were to be tested and hung it on his crib.
I'm hoping that this is the end of the glucometer saga...
6 lbs 13 ounces
His sugars are much more stable, and they are starting to talk about a going home time line!
Isaac is off of the glyburide and has been for 24 hours. The doctors (and Jonathan, who put the data in a spreadsheet and graphed it) didn't think it was affecting his sugar levels much. Going to keep an eye on him during the day today, and if his sugars shoot back up then perhaps the glyburide was playing a role...but I don't think it will.
He's on Lantus twice a day, and none of the regular quick acting insulin. This morning his sugars were actually a little on the low side, so there's still some tweaking still going on. His doctor commented that in a week he will likely need the current higher dose with the rate he is eating and growing. They aren't used to such great eaters, but this is a typical Ellis kid for me.
Things are looking very good. I am a happy mama!
Isaac is off of the glyburide and has been for 24 hours. The doctors (and Jonathan, who put the data in a spreadsheet and graphed it) didn't think it was affecting his sugar levels much. Going to keep an eye on him during the day today, and if his sugars shoot back up then perhaps the glyburide was playing a role...but I don't think it will.
He's on Lantus twice a day, and none of the regular quick acting insulin. This morning his sugars were actually a little on the low side, so there's still some tweaking still going on. His doctor commented that in a week he will likely need the current higher dose with the rate he is eating and growing. They aren't used to such great eaters, but this is a typical Ellis kid for me.
Things are looking very good. I am a happy mama!
Tuesday, August 26, 2008
Unhappy Mama
This is a pity post; you have been forewarned.
Took the kids to see Isaac tonight, and went to his room only to learn he'd been moved. I get to his new location and the phlebotomist is there using the lab reader to check his glucose. I ask his bedside nurse what was going on, why weren't they using the glucometer? Apparently someone is in a tizzy again about the glucometer being used because there isn't a protocol written for it for the NICU and the nurses aren't trained in how to use it. What the?!? Aren't trained??? It takes less than 5 minutes to be "trained" to use this device. I look around the room and see pumps, drips, lines, ventilators, and other complicated pieces of equipment, and a glucometer is out of the realm for training!?! ARHHHH! The bedside nurses who have used it with Isaac have had no problem, and the lab reader requires much more blood than the glucometer. Isaac has already had 2 blood transfusions due to all the blood they've needed to take out of him; I'd like to avoid a 3rd, thank you very much. Plus, when we go home, we will be using a glucometer, not a high end lab reader. Later that evening I spoke with the NP when she finally got out of a meeting. She agreed to allow the glucometer for the evening, but it looks like we may be in for round 3 in this fight tomorrow. I don't get the bureaucracy, his doctors have approved it for his use. They've gone all the way to the head of the NICU. Why, oh why does this keep coming up?
I looked at Isaac's poor heal this evening. It seems the nurses favor his right heal, and it is dark purple and scabbed over with pokes. His other heal is not bad, and neither are his fingers. Tomorrow I'm going to talk with the nurses about using other parts of his anatomy to stick.
The room we were in was an isolation room. Isaac was placed there because he came from home. It was quiet and somewhat private. Now he's in a big open room with lots of other babies. It is incredibly loud. Nearly every baby was crying, and we seemed to be right next to the nurses' gossip station and they were quite loud too. It was yak, yak, yak, amid the wailings, and beeping of the monitors. Poor Isaac. I'm also concerned because he is right next to another baby with the same name (though spelled slightly differently). What if someone isn't paying attention or gets careless with medication or procedures?
Isaac is also sharing a nurse with a baby on the opposite side of the room that has many wires and tubings. This has me concerned that little attention will afforded to him because it's just not possible. I know his basic needs will be met, but no one will hold and rock him when I'm not there. And he needs to be held! Who will comfort him when he cries? No one will be there to love him, when I'm gone. I hate, hate, hate this situation!!!!!!!
It just rends my heart to leave him, and now I am very worried. My heart is torn in two. I worry and miss Isaac when I'm home, and I feel terrible about missing out on time with Matthew and Melissa when I'm at the hospital. I should be there to pick Matthew up from kindergarten and hear all about his day when it is fresh on his mind. I should be snuggling more with Melissa and taking her to story time at the library. Instead I am a tired, sometimes cranky Mama, who is insufficient for any of my children.
[Jonathan's postscript: when we called at 4 AM during a pumping wake, his nurse said she'd found the authorization for the NICU head for the glucometer and was printing a sign to hang on his crib to let everyone know that It Was Approved Thank You Very Much.]
Took the kids to see Isaac tonight, and went to his room only to learn he'd been moved. I get to his new location and the phlebotomist is there using the lab reader to check his glucose. I ask his bedside nurse what was going on, why weren't they using the glucometer? Apparently someone is in a tizzy again about the glucometer being used because there isn't a protocol written for it for the NICU and the nurses aren't trained in how to use it. What the?!? Aren't trained??? It takes less than 5 minutes to be "trained" to use this device. I look around the room and see pumps, drips, lines, ventilators, and other complicated pieces of equipment, and a glucometer is out of the realm for training!?! ARHHHH! The bedside nurses who have used it with Isaac have had no problem, and the lab reader requires much more blood than the glucometer. Isaac has already had 2 blood transfusions due to all the blood they've needed to take out of him; I'd like to avoid a 3rd, thank you very much. Plus, when we go home, we will be using a glucometer, not a high end lab reader. Later that evening I spoke with the NP when she finally got out of a meeting. She agreed to allow the glucometer for the evening, but it looks like we may be in for round 3 in this fight tomorrow. I don't get the bureaucracy, his doctors have approved it for his use. They've gone all the way to the head of the NICU. Why, oh why does this keep coming up?
I looked at Isaac's poor heal this evening. It seems the nurses favor his right heal, and it is dark purple and scabbed over with pokes. His other heal is not bad, and neither are his fingers. Tomorrow I'm going to talk with the nurses about using other parts of his anatomy to stick.
The room we were in was an isolation room. Isaac was placed there because he came from home. It was quiet and somewhat private. Now he's in a big open room with lots of other babies. It is incredibly loud. Nearly every baby was crying, and we seemed to be right next to the nurses' gossip station and they were quite loud too. It was yak, yak, yak, amid the wailings, and beeping of the monitors. Poor Isaac. I'm also concerned because he is right next to another baby with the same name (though spelled slightly differently). What if someone isn't paying attention or gets careless with medication or procedures?
Isaac is also sharing a nurse with a baby on the opposite side of the room that has many wires and tubings. This has me concerned that little attention will afforded to him because it's just not possible. I know his basic needs will be met, but no one will hold and rock him when I'm not there. And he needs to be held! Who will comfort him when he cries? No one will be there to love him, when I'm gone. I hate, hate, hate this situation!!!!!!!
It just rends my heart to leave him, and now I am very worried. My heart is torn in two. I worry and miss Isaac when I'm home, and I feel terrible about missing out on time with Matthew and Melissa when I'm at the hospital. I should be there to pick Matthew up from kindergarten and hear all about his day when it is fresh on his mind. I should be snuggling more with Melissa and taking her to story time at the library. Instead I am a tired, sometimes cranky Mama, who is insufficient for any of my children.
[Jonathan's postscript: when we called at 4 AM during a pumping wake, his nurse said she'd found the authorization for the NICU head for the glucometer and was printing a sign to hang on his crib to let everyone know that It Was Approved Thank You Very Much.]
Sunday, August 24, 2008
Quick update
Isaac does well on the Lantus, but at rounds yesterday they said they were taking him off of it to see how the glyburide (the sulfonylureas) affects him without the Lantus muddying the waters. This week's neonatologist (a new guy, not Dr. Chan) pointed out that even if the glyburide just reduces the amount of insulin he needs, it's still worth it.
He was up to 6 lb 5 oz.
Yesterday morning was the first time I've fed any of our newborns. Rachel took the older kids for some Mommy Time so I went up with Grandma (Linda) to see Isaac and bottle-fed him. He was very alert afterwards, just looking around and chilling with me in the rocking chair. He fell asleep just before it was time to check his glucose again. At least at 11 he didn't need more insulin, so he just got a shallow poke. Then Grandma took a turn feeding him and he fell right asleep. In the evening, it was Rachel's turn to go up.
Rachel pointed out the other day that little Isaac's already had far more needles in him in his two weeks of life than she has had in almost thirty. Poor kid.
He was up to 6 lb 5 oz.
Yesterday morning was the first time I've fed any of our newborns. Rachel took the older kids for some Mommy Time so I went up with Grandma (Linda) to see Isaac and bottle-fed him. He was very alert afterwards, just looking around and chilling with me in the rocking chair. He fell asleep just before it was time to check his glucose again. At least at 11 he didn't need more insulin, so he just got a shallow poke. Then Grandma took a turn feeding him and he fell right asleep. In the evening, it was Rachel's turn to go up.
Rachel pointed out the other day that little Isaac's already had far more needles in him in his two weeks of life than she has had in almost thirty. Poor kid.
Friday, August 22, 2008
When Isaac Comes Home...
I intend to rock him all through that first night. Just the two of us.
In the hospital, we rocked, nursed, and snuggled then I had to say goodnight and walk away. Not to complain, but this is very hard.
In the hospital, we rocked, nursed, and snuggled then I had to say goodnight and walk away. Not to complain, but this is very hard.
Two Weeks Old
Hard to believe, it seems so much longer...
Glucose levels are all over the place ranging from the mid 200s to over 500. A normal baby's glucose ranges from 50-100. The doctors are trying get it around 100-200. Going to start the long acting insulin Lantus again, which seemed to work pretty well. One of the docs said he's going through insulin like water. On the bright side they now have a pre-diluted solution of insulin upstairs that the nurses can draw from rather than waiting for the pharmacy. So much faster! They've bumped up the sulfonylureas (glyburide) to the maximum dose today...so far nothing. Sigh.
He had a head ultrasound yesterday to rule out very rare Bad Things sometimes associated with NDM (I didn't ask and I didn't want to know). I asked about the radiologists report during rounds today. Dr. Z said reassuringly that it looked perfectly normal. Dr. C, with a gleam in his eye deadpanned, "Well, normal for your family anyways." Wasn't expecting that one, so I didn't have a good retort at the tip of my tongue. I just shook my head while everyone else had a good chuckle.
Isaac graduated to a crib since he doesn't need a warmer. He still eats very well, downing 3 to 4+ ounces at a time or however much he nurses. For once having an overabundant supply of milk is a blessing. The refrigerator and freezer at the hospital are well supplied for Isaac.
Glucose levels are all over the place ranging from the mid 200s to over 500. A normal baby's glucose ranges from 50-100. The doctors are trying get it around 100-200. Going to start the long acting insulin Lantus again, which seemed to work pretty well. One of the docs said he's going through insulin like water. On the bright side they now have a pre-diluted solution of insulin upstairs that the nurses can draw from rather than waiting for the pharmacy. So much faster! They've bumped up the sulfonylureas (glyburide) to the maximum dose today...so far nothing. Sigh.
He had a head ultrasound yesterday to rule out very rare Bad Things sometimes associated with NDM (I didn't ask and I didn't want to know). I asked about the radiologists report during rounds today. Dr. Z said reassuringly that it looked perfectly normal. Dr. C, with a gleam in his eye deadpanned, "Well, normal for your family anyways." Wasn't expecting that one, so I didn't have a good retort at the tip of my tongue. I just shook my head while everyone else had a good chuckle.
Isaac graduated to a crib since he doesn't need a warmer. He still eats very well, downing 3 to 4+ ounces at a time or however much he nurses. For once having an overabundant supply of milk is a blessing. The refrigerator and freezer at the hospital are well supplied for Isaac.
Thursday, August 21, 2008
Wednesday, August 20, 2008
Poor Baby!
When I came up to see Isaac, he was crying in his bed. I picked him up and bounced and talked to him. His nurse came in and said that the poor little guy was starving. She'd just now received his insulin. Apparently he'd last eaten at 3:00 and it was now 8:00! They are now doing ad-lib feedings (on demand) and he woke up hungry right at shift change so everything took much longer. Poor hungry baby!
He is gaining weight like a champ though. He weighed in at 2710 grams or 5 lbs 15.5 oz. Back to his birth weight!
Tonight I bathed him in the tub. He wasn't too sure what to think of that, but he was pretty sure he didn't like it. Except for washing his head at the end. He did like that.
He is gaining weight like a champ though. He weighed in at 2710 grams or 5 lbs 15.5 oz. Back to his birth weight!
Tonight I bathed him in the tub. He wasn't too sure what to think of that, but he was pretty sure he didn't like it. Except for washing his head at the end. He did like that.
And Odds and Ends
Isaac is now dressed in a little onsie since he doesn't have many tubes or wires in the way.
His cord came off yesterday morning. Yay!
There is rumor that they want to transfer him to the children's unit one floor down. On this floor the nurses are trained to handle diabetic children. Also the NICU is getting more sick babies in and want to move the less sick babies out. Currently there are still beds available in the NICU and none on the floor below. Dr. Z and Dr. C are both very much against transferring him, and are fighting to keep him. Dr. Z contends that the doctors on the floor below may not want to continue down the same treatment path using the sulfonylureas (it is new and a there isn't a lot of research on it), they don't know his case history well and have not done the research the docs on the NICU have done and this may delay treatment, plus his blood sugars still are not stable. I think she may want to keep him too, because his case interests her and she would like to see it resolved. I found out that she's read hours of articles each night on his particular condition, and I think she is loathe to not see him through to the end. We'll see what happens. I kind of hope he stays as well.
Since he is doing so much better, he now shares a nurse with another bed and has for the past few days. Just another sign that he is getter more stable, anyways.
His oxygen levels still dip up and down, but not wildly so. He is on a minimal amount of oxygen. They did an echocardiogram yesterday, and the results are a normal looking heart, but one of the fetal shunts hasn't completely closed off yet.
They are still trying to track down a geneticist who would know what labs to draw and where to send them. Either the labs would show what the problem was, or it would eliminate some possibilities...
His cord came off yesterday morning. Yay!
There is rumor that they want to transfer him to the children's unit one floor down. On this floor the nurses are trained to handle diabetic children. Also the NICU is getting more sick babies in and want to move the less sick babies out. Currently there are still beds available in the NICU and none on the floor below. Dr. Z and Dr. C are both very much against transferring him, and are fighting to keep him. Dr. Z contends that the doctors on the floor below may not want to continue down the same treatment path using the sulfonylureas (it is new and a there isn't a lot of research on it), they don't know his case history well and have not done the research the docs on the NICU have done and this may delay treatment, plus his blood sugars still are not stable. I think she may want to keep him too, because his case interests her and she would like to see it resolved. I found out that she's read hours of articles each night on his particular condition, and I think she is loathe to not see him through to the end. We'll see what happens. I kind of hope he stays as well.
Since he is doing so much better, he now shares a nurse with another bed and has for the past few days. Just another sign that he is getter more stable, anyways.
His oxygen levels still dip up and down, but not wildly so. He is on a minimal amount of oxygen. They did an echocardiogram yesterday, and the results are a normal looking heart, but one of the fetal shunts hasn't completely closed off yet.
They are still trying to track down a geneticist who would know what labs to draw and where to send them. Either the labs would show what the problem was, or it would eliminate some possibilities...
Isaac Update
Yesterday afternoon, the doctors decided to try the long acting insulin, Lantus. The long acting insulin acts kind of like the form of a mesa. The insulin level jumps up sharply, plateaus for roughly 12 hours and then drops down. Judging by his glucose levels, which were all in the low 100s to 200s throughout much of the night, he responded beautifully. He did need a small dose of insulin (it's on a sliding scale and is determined by his latest glucose reading). This morning his sugar reading jumped up again to 430.
Today he has the blessing of two endocrinologists to start the sulfonylureas treatment. According to the endocrinologist it has about a one in four chance of working, and if it works, it works much, much better than insulin. We do know he is able to make very low amounts of insulin. His C-peptide test showed that. This gives me some hope that it is the transient form. It's also oral so if it works, it will save him some pokes. The doctors had to wait until 3 PM to start to make sure the Lantus had completely worn off. Otherwise if it works, it could drop his sugar too dramatically; something his doctors have been extremely careful to avoid. So he is back to the 6 hour insulin doses on the sliding scale.
Speaking of pokes, yesterday they brought up a glucometer to in order to use less of his blood with each glucose test. When the phlebotomist does the testing, she has to use a small thin tube of blood, a glucometer requires just a drop. The glucometer is slightly less accurate, however, and you can't get the K and Na readings from it. The charge nurse didn't approve the glucometer because there isn't any protocol for the NICU department. His doctors were dismayed when they learned that the glucometer had been removed, so his fellow, Dr. Z, talked with the person in charge of the entire NICU and got a special exception for Isaac. When/if his blood glucose levels get below 80 or over 400, then they will also use the regular lab reader.
I listened in on rounds today and they also discussed allowing demand feedings once his blood sugar is better under control. Currently he is bottle fed or nursed every three hours. Before he can eat, his blood is drawn and tested. (His poor fingers and heels are covered with little bandages) Then his insulin is ordered up if it is needed. Unfortunately the insulin must be diluted for him and the dose varies each time so it can't be made up in advance. So the NP writes the order, the bedside nurse sends the order down to the pharmacy, the pharmacy sends the insulin up to the floor, and the bedside nurse must then pick it up. Then she must confirm the dose and patient with another nurse, and finally he gets his insulin and can eat. This is a process that can take as long as 45 minutes. Meanwhile poor Isaac is getting hungrier and hungrier. This morning I bounced him, rocked him, gave him a pacifier (which he rejected), my finger which he accepted for a while, talked to him, and tried every distraction technique I could think of. He didn't cry but was clearly rooting, smacking his mouth, and looking for something to eat. He is a very patient baby. My other two would have been screaming full throttle if required to wait.
Here's hoping that the sulfonylureas works!
Today he has the blessing of two endocrinologists to start the sulfonylureas treatment. According to the endocrinologist it has about a one in four chance of working, and if it works, it works much, much better than insulin. We do know he is able to make very low amounts of insulin. His C-peptide test showed that. This gives me some hope that it is the transient form. It's also oral so if it works, it will save him some pokes. The doctors had to wait until 3 PM to start to make sure the Lantus had completely worn off. Otherwise if it works, it could drop his sugar too dramatically; something his doctors have been extremely careful to avoid. So he is back to the 6 hour insulin doses on the sliding scale.
Speaking of pokes, yesterday they brought up a glucometer to in order to use less of his blood with each glucose test. When the phlebotomist does the testing, she has to use a small thin tube of blood, a glucometer requires just a drop. The glucometer is slightly less accurate, however, and you can't get the K and Na readings from it. The charge nurse didn't approve the glucometer because there isn't any protocol for the NICU department. His doctors were dismayed when they learned that the glucometer had been removed, so his fellow, Dr. Z, talked with the person in charge of the entire NICU and got a special exception for Isaac. When/if his blood glucose levels get below 80 or over 400, then they will also use the regular lab reader.
I listened in on rounds today and they also discussed allowing demand feedings once his blood sugar is better under control. Currently he is bottle fed or nursed every three hours. Before he can eat, his blood is drawn and tested. (His poor fingers and heels are covered with little bandages) Then his insulin is ordered up if it is needed. Unfortunately the insulin must be diluted for him and the dose varies each time so it can't be made up in advance. So the NP writes the order, the bedside nurse sends the order down to the pharmacy, the pharmacy sends the insulin up to the floor, and the bedside nurse must then pick it up. Then she must confirm the dose and patient with another nurse, and finally he gets his insulin and can eat. This is a process that can take as long as 45 minutes. Meanwhile poor Isaac is getting hungrier and hungrier. This morning I bounced him, rocked him, gave him a pacifier (which he rejected), my finger which he accepted for a while, talked to him, and tried every distraction technique I could think of. He didn't cry but was clearly rooting, smacking his mouth, and looking for something to eat. He is a very patient baby. My other two would have been screaming full throttle if required to wait.
Here's hoping that the sulfonylureas works!
Short update
I went back to the office yesterday so this is second-hand via Rachel. I'll just give a summary and Rachel can fill in details later if she likes.
The doctors decided that the short-term insulin just wasn't working on its own, and gave Isaac a dose of slow-release insulin as kind of a baseline. Then they supplemented that with additional short-term doses. His glucose reading was in the 100s and low 200s all day and night, and at least once he didn't need the extra short-term shot.
They also got Isaac a glucometer that just needs a small drop of blood to read instead of a pipette's worth. A pipette is already pretty small but this should make things just a little easier on him.
Isaac continues to eat well.
The doctors decided that the short-term insulin just wasn't working on its own, and gave Isaac a dose of slow-release insulin as kind of a baseline. Then they supplemented that with additional short-term doses. His glucose reading was in the 100s and low 200s all day and night, and at least once he didn't need the extra short-term shot.
They also got Isaac a glucometer that just needs a small drop of blood to read instead of a pipette's worth. A pipette is already pretty small but this should make things just a little easier on him.
Isaac continues to eat well.
Tuesday, August 19, 2008
Some Pretty Special People Work in The Newborn Intensive Care Unit
Take for example Gary, one of the NPs. His son was born premature 24 years ago. From his experience in the hospital and taking care of his son, he decided to become a nurse. So he went back to school and has now been caring for other little people for decades. Not only is he good with little people, but he is great with "big people" too. He says he understands that it can be overwhelming, and to never be afraid to ask questions, even if it's a question you've asked before. He feels it is part of his job to help the parents as well. Really nice guy. The bedside nurses (with just the one exception) have been fantastic as well.
It is so very hard to leave Isaac each night, but at least I know there are good people watching over him.
It is so very hard to leave Isaac each night, but at least I know there are good people watching over him.
You Know It's Time to Go Home and Get Some Rest When....
You dump 2 oz of just expressed milk down the front of your pants while trying to pour it into the sterile containers. Wasn't sure whether to laugh or cry...so I laughed.
Isaac gets an incompetent nurse
Isaac's nurse tonight did not project the aura of competence that his other ones have. In fact, the adjective that comes to mind is "bumbling," like a well-meaning kid who cleans your mirror with sandpaper. No, our kids have not done that. Yet.
Rachel and I broke for dinner at 9, and when we came back up Nurse Incompetent was poking about in poor Isaac's wrist with a needle trying to put an IV in. After two pokes and much subcutaneous probing, she gave up and called for The IV Team. (Kind of like the A-Team, only, you know, for IVs. Rachel has never seen the A-Team. Makes me feel old.) But as the IV team was about to poke him again, Garry the NP arrived and said, Stop! I could tell he was pissed. "I didn't ask for an IV in him!" What he had done was express regret that the earlier IV had been taken out, in his opinion prematurely, but "you don't put an IV in unless you need to use it. He doesn't need one right now."
Nurses are only human and as NICU mistakes go this was relatively benign, but we are going to request that Nurse Incompetent not be assigned to Isaac again. Rachel didn't think it was worth complaining about for tonight's shift but once was more than enough.
(Later, after taking Rachel's expressed milk to the fridge, she got out formula to feed him. Rachel caught her and reminded her to use the breast milk. This woman just did not bring her A game tonight.)
[Rachel commentary: She also kept putting the diaper over the umbilical stump rather than folding it below the navel so that the cord stump doesn't become contaminated with urine or poop. Twice I fixed the diaper after she changed him. The next day we talked with the charge nurse and requested that that particular nurse not be Isaac's nurse again.]
Rachel and I broke for dinner at 9, and when we came back up Nurse Incompetent was poking about in poor Isaac's wrist with a needle trying to put an IV in. After two pokes and much subcutaneous probing, she gave up and called for The IV Team. (Kind of like the A-Team, only, you know, for IVs. Rachel has never seen the A-Team. Makes me feel old.) But as the IV team was about to poke him again, Garry the NP arrived and said, Stop! I could tell he was pissed. "I didn't ask for an IV in him!" What he had done was express regret that the earlier IV had been taken out, in his opinion prematurely, but "you don't put an IV in unless you need to use it. He doesn't need one right now."
Nurses are only human and as NICU mistakes go this was relatively benign, but we are going to request that Nurse Incompetent not be assigned to Isaac again. Rachel didn't think it was worth complaining about for tonight's shift but once was more than enough.
(Later, after taking Rachel's expressed milk to the fridge, she got out formula to feed him. Rachel caught her and reminded her to use the breast milk. This woman just did not bring her A game tonight.)
[Rachel commentary: She also kept putting the diaper over the umbilical stump rather than folding it below the navel so that the cord stump doesn't become contaminated with urine or poop. Twice I fixed the diaper after she changed him. The next day we talked with the charge nurse and requested that that particular nurse not be Isaac's nurse again.]
Monday, August 18, 2008
Cyborg Baby No More
They lost the artery line this morning and decided against replacing it. For testing glucose, they are now using heel sticks. The IV in his hand is gone as well. This afternoon they took out the needle in his scalp. So Isaac only has some monitors and oxygen on. Hooray!
Rounds
Back at the NICU after staying away for a couple days because of my cold.
Little Rygg's blood sugar was higher last night, from the mid-250s up to 400s. We were here for rounds this morning as they discussed what to do about this. One of the doctors pointed out that the insulin he's getting every 6 hours will be completely gone from his body by 4 hours. Typically it's not recommended to give it more often than six but Dr. Z, the fellow (her name is long and Polish-sounding, and I can't spell it) said she would watch him closely today and possibly order insulin every 4h. For now they just increased his next dose (right now) by 10%.
Dr. Chan, the neonatologist, added that they'd be presenting his case at a meeting of doctors and professors from the university at 3 this afternoon to see if anyone has any useful suggestions. After that Dr. Z has another meeting at 4, but we should be able to grab her in the evening to see if anything came from that.
I have to say that, having seen the rounds process, where the fellow and nurse consulted their three-ring binders frequently, I'm a little surprised at how low-tech a lot of the NICU is. The vital signs monitors are electronic but everything else is just a paper record. While the doctors were trying to correlate insulin times with blood sugar readings and feeding times in their heads I couldn't believe there wasn't a way to just chart those numbers on a graph on the station's computer. It would be trivial if these records were digital but apparently they are not. To someone in my line of work that's a little scandalous. Not to mention that there's just that much more of a factor for human error that could be avoided with modern tools.
Little Rygg's blood sugar was higher last night, from the mid-250s up to 400s. We were here for rounds this morning as they discussed what to do about this. One of the doctors pointed out that the insulin he's getting every 6 hours will be completely gone from his body by 4 hours. Typically it's not recommended to give it more often than six but Dr. Z, the fellow (her name is long and Polish-sounding, and I can't spell it) said she would watch him closely today and possibly order insulin every 4h. For now they just increased his next dose (right now) by 10%.
Dr. Chan, the neonatologist, added that they'd be presenting his case at a meeting of doctors and professors from the university at 3 this afternoon to see if anyone has any useful suggestions. After that Dr. Z has another meeting at 4, but we should be able to grab her in the evening to see if anything came from that.
I have to say that, having seen the rounds process, where the fellow and nurse consulted their three-ring binders frequently, I'm a little surprised at how low-tech a lot of the NICU is. The vital signs monitors are electronic but everything else is just a paper record. While the doctors were trying to correlate insulin times with blood sugar readings and feeding times in their heads I couldn't believe there wasn't a way to just chart those numbers on a graph on the station's computer. It would be trivial if these records were digital but apparently they are not. To someone in my line of work that's a little scandalous. Not to mention that there's just that much more of a factor for human error that could be avoided with modern tools.
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