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.
Showing posts with label doctors. Show all posts
Showing posts with label doctors. Show all posts
Sunday, August 24, 2008
Friday, August 22, 2008
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.
Wednesday, August 20, 2008
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...
Monday, August 18, 2008
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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