Wednesday, October 30, 2013

Home Sweet Home

Our Bittersweet Journey

Going Home

Yes you read that correctly.  We are going home...at least three of us are.  Zoe, Isabelle and I are going home.

Zoe and Isabelle have been making major strides and the doctors are confident that they are able to go home.  Both girls had their caffeine discontinued last week and have had no episodes of apnea or other difficulties.  Both girls are taking all of their feeds by mouth.  Both girls are ready to go home. 

Adam and I are beyond excited and scared out of our minds.  Will the girls survive off their monitors?  Will we be able to recognize the signs of something going wrong?  Will we be able to handle their needs at home?  We've been wishing for this day but now that it's here, we simply do not know how to feel...

What complicates matters is that Cecilia must stay in the NICU.  Our family will be separated...again.  It is incredibly difficult to be excited about bringing Zoe and Isabelle home without feeling guilty for leaving Cecilia in the hospital.  And at the same time it is hard not to be happy about walking away from the hospital and celebrating the health of two of our beautiful daughters.  It is completely bittersweet.

Friday, October 25, 2013

Happy Birthday Popa Tom!  Your present is Zoe and Isabelle coming home!  Friday afternoon we packed up an entirely overfilled Suburban along with Zoe and Isabelle and made the trek back to Eau Claire.  Before we left, I was holding Cecilia having an incredible time leaving her.  Thankfully Patti was her nurse, and she was able to take Cecilia from my arms so we could leave.  I cannot describe how heartbreaking it was to leave the NICU without her.



As we drove away from the hospital, leaving Cecilia in our rearview mirror, we had to hold onto hope that one day we would all be together again.  So many people would comment as we left about twins and Adam, bless his heart, corrected each one saying, "No triplets."  One day we will all be together again as a family. 


Humpty Dumpty Surgery

When will that be...Well the doctors are hoping by Christmas, needless to say Adam and I are hoping for much sooner than that (like Thanksgiving!!). 

Cecilia will undergo her Humpty Dumpty Surgery on Friday, November 1, 2013.  She hit the magic number of 1900 grams on Monday and was 2 kilos today.  Dr. Ishitani checked on her and said she's ready to be put back together.

Friday she will go back downstairs for her sixth, and hopefully last, surgery.  The surgery is quite complicated and extensive lasting approximately 5-6 hours from start to finish.  Adam and I will make the surgery back to be with Cecilia and would appreciate all of your prayers for her safe keeping during this time.  Zoe and Isabelle will spend the day with Grandma Jan (we are incredibly lucky to have Adam's mom staying with us while we learn how to parent our girls).

Thank You Grandma Jan

We could not do this without you.

Love,

Adam & daneille







Another Surgery for Cecilia...

This time it's laser for the eyes...

Wednesday, October 16, 2013

On Wednesday, Cecilia had another ROP check on her eyes, which unfortunately revealed signs of worsening ROP.  Dr. Brodsky consulted with Dr. Iezzi, the retina specialist, who immediately, without seeing Cecilia, stated she needed to have laser surgery - the next day!

We knew that one day Cecilia would probably need to have laser surgery, as the avastin injections were simply a way to buy us more time.  What we did not know, or what I wasn't anticipating, was Cecilia having to have surgery this quickly. 

On the bright side, if there is one, Cecilia was already intubated and inpatient. 

Thursday, October 17, 2013

Dr. Iezzi took Cecilia down to surgery this morning for laser surgery and I anxiously awaited word on the outcome upstairs with Isabelle and Zoe.

Dr. Iezzi came up about 2.5 hours later stating Cecilia did wonderful and that he actually was required to use less laser than even he had anticipated.  Cecilia needed less surgery than even Isabelle and Zoe had required.  Overall, the surgery was a tremendous success with follow up to occur in one week.

Zoe Elizabeth

Before leaving for a conference in Chicago, and right after performing surgery on Cecilia, Dr. Iezzi completed the second follow up check on Zoe's eyes following her retina detachment surgery...She's healing well and Dr. Iezzi plans to see her next week for another exam.

We continue to hold our breath and pray for wonderful outcomes for our daughters...

Friday, October 18, 2013

Happy Birthday

Day of Life 107 ~ Gestational Age 40 Weeks ~ Adjusted Age Day 0


Wednesday, October 16, 2013

My original Due Date

The girls arrived 107 days ago

Today was full of bittersweet moments.  While we are amazed that our due date has finally arrived, it is a challenge to realize our baby girls have been suffering and thriving for 107 days. 


Our girls are simply wonderful and we are completely blessed.  While the road may be rocky for us, we are so incredibly blessed to even have the luck to be on this journey. 

I won't lie, there are times it is difficult to remember that notion.  There are many times when it is easier to get lost in the sadness and frustration of our NICU stay.  However, on those days, we just need to step back, take a breath, and look at our beautiful baby girls.  We are blessed.



Thank you for all of your love and support over the last 107 days.  We love you all.

Always,

Adam & daneille

Retinal Detachment Surgery

Hi Ho, Hi Ho, It's Off to Michigan We Go...

Our family was placed in what felt like an impossible situation.  Zoe needed to go to Michigan while Cecilia and Isabelle would be left in Minnesota.  No one could tell us how long Zoe would need to be gone but there was no question we needed to go.  Someone needed to go with Zoe, but someone needed to stay with Cecilia and Isabelle.  I needed to do both, but I could not do both.

On Sunday, October 6, Zoe and I got on a plane and flew to Michigan to see the top retina surgeon in the country.  Little did we know, Adam had driven to the airport to watch our flight take off.  We flew on a fixed-wing private jet ~ truly the only way to fly. 

We arrived in Royal Oaks, Michigan, at Beaumont Hospital on Sunday afternoon for surgery on Monday morning.  As the transport team left us in Michigan, we felt very much alone missing our family.

Monday Morning


Zoe was prepped for surgery and we met with Dr. Trese (a very nice man I might add).  Dr. Trese explained that Zoe would once again be placed under anesthesia for an exam before he performed a vitrectomy on her left eye.  Unfortunately the exam revealed bleeding in the eye between the cornea and the iris, as well as fibrem (excess debris, inflammatory material and blood) on the lens, both of which blocked Dr. Trese's ability to see the back of Zoe's eye thereby circumventing his ability to perform the surgery.

Zoe would need to wait until the blood drained and fibrem dissipated before the vitrectomy could be performed.  However we had a very small window of time in which to complete the surgery.  Most retinal detachment repair operations are urgent. A detached retina lacks oxygen, which causes cells in the area to die. This can lead to blindness. 

The window of time to preserve more of Zoe's vision was closing fast.  Her best chances were to have the surgery performed prior to reaching 40 weeks gestational age (at the time Zoe was 38 weeks, 5 days).  Surgery before 40 weeks would allow Zoe's retina to possibly reattach itself post surgery.

To assist in the process, Zoe needed to be placed at a 45 degree angle to allow the blood to drain out of her eye.  If we could not get the blood to drain, Zoe would still require the surgery the following Monday, October 14, however the surgeons would be required to take her lens, which in all essence would negate the hard work of trying to preserve her vision. 

Each day the surgeons would come up to the NICU to examine Zoe's eye to see if the blood was draining and the fibrem was clearing.  Each day we held our breath, hoping for the best...Upon Zoe's exam on Wednesday, we got some promising news, there was improvement.  Enough improvement that an OR was booked for Friday, October 11.  Zoe would still need to be examined on both Thursday and Friday to ensure the surgeons could see to the back of the eye to perform the vitrectomy, but easier to cancel the OR than get one the same morning.

Friday morning Dr. Capone (the younger version of Dr. Trese) arrived to exam Zoe and gave us wonderful news!  The blood, while not 100% gone, had drained almost completely and the fibrem was gone!  Both would allow Zoe to keep her lens!  The vitrectomy was performed and Dr. Capone, in addition to saving Zoe's lens, was able to perform the surgery without placing an air bubble in the eye, which would allow us to travel back to Minnesota much sooner.

Most patients are required to stay in Michigan for 2-3 weeks post-op.  Zoe had surgery on Friday and Dr. Capone cleared us to travel on Saturday!!  The Neonatologists in Michigan however were not too keen on transporting us that soon despite the fact that Mayo was more than willing to take us back (they missed Zoe!).  As a result, we spent the weekend in Michigan until the neonatologists were able to have a conversation with Dr. Capone. 

So we waited...

On Monday, after multiple conversations with Dr. Capone and Mayo, transport was set up for Tuesday!!  That was only 4 days post-op!!  Dr. Capone felt there was no need to keep us in Michigan given our circumstances of having two more children in a NICU at Mayo and the availability of Dr. Iezzi to examine Zoe upon our return to Minnesota. 

Transport was set up for Tuesday morning and we could not be more excited to go back to our Mayo-Home!! 

While waiting for transport, Uncle Ken and Aunt Linda were able to travel to Royal Oaks to meet Miss Zoe.  We had a wonderful visit and Zoe enjoyed showing off.

Tuesday we traveled back to our Mayo-Home and were able to see Isabelle and Cecilia...Speaking of which...

On the Sunday Zoe and I flew to Michigan, Cecilia developed a staff infection and was under respiratory distress.  She underwent a series of antibiotics but unfortunately was not getting much better.  Upon our return to Mayo, Cecilia was having a much more difficult time and within 30 minutes of our arrival home, Cecilia needed to be intubated...

Surgery for Zoe

Two Different Kinds

Thursday, October 3, 2013, Zoe was taken down to surgery...again.

First she was placed under anesthesia for a general exam for both glaucoma and follow up for her laser eye surgery.  She had three surgeons poking around in her eyes while I patiently waited in the surgical waiting room for word on how extensive her glaucoma surgery would be...I never expected what I heard...

Dr. Mooney came out to inform me that in fact Zoe did appear to have congenital glaucoma requiring a goniotomy in both eyes.  Unfortunately, Dr. Iezzi, upon his examination of Zoe's retinas (follow up from the laser surgery), showed the initial beginnings of retinal detachment.  Talk about a punch in the gut!  But more to that later...

Dr. Mooney and Dr. Sit (glaucoma specialist) went back into Zoe and performed a goniotomy on both eyes.  Additionally, Dr. Sit diagnosed Zoe with angle closure glaucoma in the left eye. 

http://www.surgeryencyclopedia.com/Fi-La/Iridectomy.html

As a result, Dr. Sit performed an iridectomy.  He removed a small portion of Zoe's iris on her left eye.  It's been explained to us we will never be able to tell unless Zoe opens her eyes really wide (which she tends to do). 

Overall the glaucoma surgeries were a success.  Small victory numbers 1 and 2 for the day. 

After Zoe's glaucoma surgeries and before she was brought back upstairs, Dr. Ishitani performed hernia surgery on Zoe!  Zoe had an inguinal hernia, which required surgery before going home, and timing worked out for Dr. Ishitani to piggy back onto her eye surgery. 

Dr. Ishitani prepared the hernia on her left side and explored her right side to confirm there was no hernia there as well.  Post op note:  Dr. Ishitani cut designs into her dressings to cover her incisions.  He cut her a puppy (for Gus) and a star (because she is a rockstar).  Dr. Ishitani is wonderful and I trust him 100% with the girls. 

Back to the retinal detachment...

Remember Zoe underwent laser eye surgery weeks ago to protect her eyes due to her advancing ROP disease.  Unfortunately, a very small number of patients who under laser treatment will still suffer a retinal detachment and Zoe has fallen into this category.

Dr. Iezzi identified a level 4A retinal detachment (4A is the smallest detachment as opposed to a 4B or 5).  If the retina detaches Zoe could lose her vision entirely.  Accordingly, Dr. Iezzi made numerous phone calls while Zoe was undergoing her glaucoma procedures to arrange for another surgery for Zoe.

Unfortunately the retinal detachment surgeries are not performed at Mayo Clinic.  There are eight surgeons in the country who perform retinal detachment surgeries are babies of Zoe's size.  One just so happened to be located at Children's Hospital in the Cities - Just so happens though, he was on vacation for a week and a half.  Zoe could not wait a week and a half.

Thankfully, Dr. Iezzi is friends with Dr. Trese, the top retina specialist in the country.  Of the eight surgeons (including himself) he has trained 6 of them!  Dr. Trese, however, is located in Michigan...

Dr. Trese agreed to take Zoe's case and scheduled her for surgery on Monday morning (October 7).  Surgery was scheduled before transport was even arranged...yes Zoe has to go to Michigan.

Thursday, October 3, 2013

Riding the NICU Rollercoaster...

13 Weeks, 3 Months, Corrected Age 38 Weeks...

Please forgive me if my writing is somewhat truncated this post.  I will do my best to update you with everything that has occurred in the past two weeks.

Room Air

Saturday, September 21, 2013 Adam and I arrived at the NICU to find both Zoe and Isabelle on room air.  That's right, neither girl was receiving any respiratory support.  We were ecstatic!  Ok, truth be told, it took me a little bit to catch up because I was not expecting the doctors to make the jump, but we were ecstatic once we caught up.

Sunday, September 22, 2013, Cecilia was able to join the room air club as well. 

All the girls have been doing wonderful on room air and we are hopeful that once we are finally able to go home, we will not require any oxygen!  YEY!

It's Time to EAT!!

As a result of the girls coming off their respiratory support they have all been cleared to start nursing!  Talk about a milestone!!

The boys might want to skip this section  : )  Nursing is not natural.  I don't know who ever thought it was.  It hurts.  It's awkward.  It's exhausting and frustrating.  The lactation consultant stops by to assist with the first few nursings (or in my case after the first weekend) and jumps right in with her hands.  After her tutorial, I was like "You know I only have two hands right?!?!" 

With my two hands, her two hands and an assist from a nurse, we finally were able to get a latch.  I kept thinking to myself there is no way I am only to be able to maneuver my hands and body to become proficient at breastfeeding. 

Fast forward one week ~ I am able to get all three girls to latch on by myself!  Yes, I am patting myself on the back for this accomplishment.  Don't get me wrong, it still hurts.  It's still awkward.  It's definitely still exhausting and frustrating.  BUT, I can do it by myself now.

The challenge is trying to learn the nuances of three separate babies and to get in separate fees for all the girls so they can learn themselves.  An additional challenge is to not get frustrated when the feeds don't go well along with not pushing too hard despite the pressure from certain nurses to move in fast forward rather than learning at a comfortable pace.  Sometimes it feels as if the nurses don't adjust the "normal" learning curve to accommodate for triplets...Oh well.  We'll get there.  It will just be on the girls' timetable and no one else's.

To make you smile ~ Isabelle acts like she has never eaten and goes nuts when it is time to nurse.  She is definitely our monster baby!

The Eyes Have It...

Glaucoma.  No it is not just a word/disease associated with adults (or our grandparents). 

Glaucoma.  Yes it is just as scary, if not scarier when hearing the term muttered in relation to your children. 

Glaucoma.  Congenital Glaucoma.  1 in 10,000 babies. Zoe.

Zoe has been diagnosed with congenital glaucoma and will undergo a goniotomy on Thursday, October 4, 2013.  The surgery will be performed by one of the hospital's pediatric ophthalmologists along with a glaucoma specialist.  Poor Zoe will have to be put back under general anesthesia and intubated for the surgery. 

While Zoe is under anesthesia the retinal specialist will also take a look at her eyes to ensure she has not developed any retinal detachment as a side effect of her laser ROP surgery from last month.

Additionally, Dr. Istitani will step in an repair Zoe's hernia while she is under.  Poor little girl will have two examinations and two procedures under anesthesia in one afternoon. 

Please say your prayers that the surgeries go well and are successful.  The goniotomy will hopefully be a success and Zoe will not have to undergo multiple repeat surgeries to repair her eyes and will not go blind from the disease. 


Sick Baby

Unfortunately not everyday is a good day in the NICU.  On Thursday, September 26, 2013, Zoe got very sick.  She started the day being paired with another baby and by 11 a.m she was solo.  She kept dipping her oxygen saturations and dropping her heart rate.  The neonatologists ran tests for infection and everyone was nervous.  At one point the nursing staff could not leave her bedside. 

Needless to say, neither could I.  I wound up spending the night at the hospital and while I was huddled up next to Zoe, in walked Adam.  He couldn't stay away either.  We had a sick baby. 

She's struggling to do better and has had better moments recently.  However on Tuesday night she decided she didn't want to breathe at all and a code was called.  Codes are always nerve wrecking, but oddly reassuring, as an onslaught of people come rushing into the room all with the same vested interest of saving your daughter. 

Zoe decided she wanted to breathe again, and gave everyone a little squawk.  We are hopeful that she will feel better after her surgeries on Thursday.

Still Our Runt Baby.

Poor Cecilia is having the most difficult time gaining weight and has become a medical mystery for the doctors.  As it stands Cecilia has been struggling her entire life but in the last three weeks her weight gain has become non-existent.  For comparisons, she is over 500 grams behind in weight than her sisters. 

The neonatologists, along with the dietician, have tried everything supplement wise they can think of to get her to gain weight and stop dumping out of her ostame.  Unfortunately, nothing is working.  As a result, the pediatric gastrointestinal team has been consulted.  A complete workup was done on Cecilia including blood cultures, liver enzymes, and thyroid tests. 

In order to help Cecilia gain weight she will be going back on TPN (intravenous nutrition).  This is not ideal, but we are definitely in a situation where we hope the ends will justify the means.  We need her to reach 1900 grams in order for Dr. Istitani to do her "Humpty Dumpty" surgery (get put back together again).  This is the "friends and family discount" as most doctors will not consider the surgery until a baby is at least 2500 grams.  I'm about ready to start sewing weights into her diapers...

Grandmas' First Time

Despite all the negative going on, we did have a couple good days which allowed the grandmas to come visit which allowed us to give them a very special gift.  Grandma Jan and Grandma Jamie have not each been able to hold their granddaughters. 

It was such an emotional moment for each Grandma and the girls absolutely loved being loved by them.  We are so incredibly blessed to have such wonderful mothers who in return are amazing Grandmothers to our daughters.  Thank you Moms.



Another One Bites the Dust

Sadly, we have lost another one of our favorite nurses.  Nurse Ashley dropped the bomb that she was leaving Mayo and Sunday would be her last shift.  Thankfully we had the pleasure of having Ashley take care of our girls for three months.  She ended her time at Mayo by watching Zoe and Zoe in return baked her farewell cookies.  Ashley will be greatly missed but we wish her and her family nothing but love on their new journey.  (She better keep in touch ~ if for nothing else but to talk college football with Adam!).  Ashley you will be greatly missed!



We love you all and are so incredibly grateful for your kindness, consideration, and generosity.  Thank you.

Love,

Adam & daneille