Ella has been having a good day – – she is still very sick.  But, her stats have been stable on ECMO throughout the day.  So, ECMO is doing its job and she has been holding steady!  Thank you for all your prayers…let’s continue to pray that her stats can remain this way!

Ella went on ECMO this afternoon.
 
When a child has a severe condition that has not responded to the normal therapy of a respirator, medicines, and extra oxygen, they could die but ECMO can be used to help save their life. ECMO stands for Extracorporeal Membrane Oxygenation. The ECMO machine is very similar to a heart-lung bypass machine that they use for open heart surgery. When a child is placed on ECMO, the blood receives oxygen from an artificial lung in the ECMO circuit. The artificial lung in the ECMO circuit provides the child’s blood with oxygen needed to live until her lungs are able to function on their own.
 
In Ella’s case, the surgical procedure to connect her to the ECMO machine requires tying off her carotid artery. If you think about it, this is surgery in and of itself! Dr. Kays reported that Ella did well during the procedure.Although ECMO has its own risks, we are hoping that this machine helps to stabilize her over the next few days. As you will see in the photos, this is a MASSIVE machine that requires a specially certified technician to monitor the machine at all times.
 
For the first few days, Ella had a nurse 24/7 at her bedside monitoring her stats. In addition, she will now have a respiratory specialist that is certified to operate ECMO equipment at her bedside to monitor the machine and make sure that the levels in the machine are proper (all the blood gases in the machine, platelet count, etc.) and try to minimize any failure of the machine, since that can have devastating consequences.
 
Her first hour on ECMO was very promising. All of her stats looked the best that they had been since she was born (good heart rate, blood pressure, blood gases in line, etc.). This is the result of the ECMO machine. Since the ECMO machine is doing the work of the lungs, it will give Ella a chance to rest. Her body has been taxed the past few days; it has tried very hard to work…and yet unsuccessfully. The ECMO machine should bring all her vital signs of stability more in line where they should be while giving her body a little break.
 
Please continue to pray for her…we want to see her get stable enough so that she can have surgery to move the extra contents in her chest back down to her abdomen…which will give her lungs the room they need to grow! The next few days are very important!

Today, we connected with Tracy, the mom of Baby Jonathan. As we mentioned earlier, it has been 12 weeks since Jonathan was born and he was admitted to the NICU. He spent the first 30 days of his life on ECMO and went back on ECMO for a second round at the end of June till now.

Each day, he has continued to become more and more ill. His stats have not been improving. Tracy has been at his bedside each day. Jonathan is very alert and responsive to his mother. They hold hands and spend lots of time together. When he is sleeping and hears his mom’s voice, he wakes up from sleep and responds. They have a special bond with each other.

Since Jonathan has been on 2 rounds of ECMO and his stats are not improving, Dr. Kays is recommending that they remove Jonathan from ECMO tomorrow morning, July 27, 2007 and just wait and see how he does. Dr. Kays is not relaying positive vibes that his condition will improve – – if anything, he has prepared Tracy for the worst.

Tonight, Jonathan’s father Keith is arriving. Tomorrow is a big day for the Mitchell family since they are unsure how Jonathan will respond when he is removed from ECMO. Josh and I will be getting together this evening with Tracy to pray for Jonathan…to pray for the Lord’s will in his life. God can choose to take Jonathan tomorrow to be with Him, which is not what we want. But in the end, we all really want the Lord’s will, since we know that is best.

Please say a prayer for Jonathan…

Our baby girl is not doing as well as we hoped. We knew putting her on ECMO was a high probablity, but now it’s happening for sure. Dr. Kays tried all other methods to stabilize her, but her stats have continued to be unstable. As I write this they are preparing her area for surgery. She’ll be placed on ECMO today. Please pray for a smooth surgery and a overall successful outcome. We continue to trust God through this time and thank you for all your prayers.

Morning Update
Ella had a rough night last night (Tuesday night into Wednesday). She continued to fight but her levels were all over the place – – one area would improve, but it would worsen something else. They are trying some more tweaks with medications this morning.

Mid-Day
Ella’s vitals and latest blood gas check-up looked promising (they draw her blood and measure the amount of gases in her blood). As we visited with her, it was time for another blood gas check-up. As we left, she had 2 good blood gas reports. We are leaving to go update the blog and hope that we can deliver more good news later.

Evening Update
Ella had some pretty big swings this evening. Unfortunately she’s been hovering more on the bad side. So much so that Dr. Kays will be staying the night at the hospital. Thank God for the amazing staff here and their dedication to our baby girl. Do well tonight Ms. Ella Renae. Mom and dad are going to bed…

So, birth is traumatic enough! And as you know, Ella has a condition called Congenital Diaphragmatic Hernia. So as soon as she was born, she was unable to breathe due to her underdeveloped lungs. This is the entire reason that we came to Florida – – so that Dr. Kays and his team could work on Ella and give her the best chance of survival.
 
Upon birth and within the first few hours of life, Ella’s biggest challenge is the amount of carbon dioxide in her system. The ventilators were doing a great job at making sure that her body and brain were receiving enough oxygen. Yet, since her lungs are so immature, she is having a tough time getting the carbon dioxide out of her system. Her levels were too high. For a baby, they should be around 60-70 – – she is at 130.
 
So each hour, they have been monitoring her vitals: heart rate, blood pressure (don’t want too much hypertension from the additional stress this condition places on her heart trying to pump the blood to the lungs), oxygen levels in her brain and body, pH levels, etc. They are working diligently with 24/7 monitoring and care to try their best to stabilize her. They want to stabilize her before they perform surgery.
 
She is very sick and has done well adjusting to the various therapies and medications during this first day. Continue to pray that her vitals will improve and that she can be stablized without requiring ECMO. Keep in mind that it is very likely that Ella will need ECMO at some point during her recovery. However, her recovery will be significantly delayed and make her fight for life even tougher, if she has to go on ECMO prior to surgery, where they move the contents from her chest to her abdomen.
 
We just checked on Ella before we decided to go to bed. Her carbon dioxide levels improved, but then it swayed the amount of oxygen she was receiving in her body. So, better progress on one vital sign, but it threw off another. We have asked God to watch over her throughout the night as she fights.

…we drive up to the Emergency Room and walked-in. Fortunately, the waiting room was empty. Josh explained to the front desk that he thought I was in labor. She sent me through the doors and asked me to sit and wait for a nurse to come get me. As I waited, the pain was continuing to get stronger and stronger. The lady rolls up with a wheel chair. I ask her to wait for a minute…as a contraction passes. Wow, whatever is going on…it is painful!

They wheel me to a bed and the nurse begins to gather all our information verbally and states that she will have a doctor come in to check my cervix. The doctor on staff arrives to examine me. She informs us that I am 9 centimeters dilated and fully effaced. Josh’s jaw drops and with his mouth wide open, he is sitting there in complete shock! Say WHAT@#$%$#@!???

This confirmed three things: first, I was not imagining this pain that I was feeling; second, the emergency staff was now going to take me seriously and third, I was about to give birth to a baby girl! This was such a big surprise for me…wow, was this really happening?

I begin to worry.

Where was my OBGYN? And more importantly, where was Dr. Kays? Did they try and reach him? Was he around? Moments later, Dr. Richards walks in. Phew…there was the doctor that was going to deliver. That part was good.

The pain every couple of minutes was so intense. I was begging for an epidural. I was so far along that I wanted to make sure that I could still have one. Finally, it was 6:00am and the anesthesiologist was getting ready to place the needle in my back when a very strong contraction arrived. I asked her to wait. Simultaneously, I lose my dinner from the night before in a projectile manner out my mouth and my water breaks between my legs. What a strange feeling…

Once the drugs begin to take effect a few moments later, I am a happy woman. It was the first break I had received in hours! This gave me the strength to push on…literally.

Dr. Richards came back to check on me. I was now 10 centimeters and fully dilated and effaced. At this point, he let me know that they were able to reach Dr. Kays and that he was on his way. This made me feel so much better – – that was the entire reason we came to Florida.

Later I found out that it was the first shift back for Dr. Kays after concluding a 2 week vacation. And didn’t I just arrive in Florida less than 48 hours ago? Wow, God was watching over me!

My labor was moving along so rapidly that they wanted to try and slow it down. Dr. Richards wanted the opportunity to get some antibiotics in my system (I had tested positive for Group B Strep virus).

Ideally, you take antibiotics up to 4 hours before you deliver. Between waiting for the antibiotics to get into my system and waiting for Dr. Kays and team, we only had a small window left…this baby wanted out!

At 6:30am, they moved me to a surgical room where I would deliver. This room would provide the space and equipment necessary for Dr. Kays and his team to work on our baby girl once she was born.

The clock was ticking and we were just waiting for everyone to line up and be ready. Once the signal was given, I was asked to push. All it took was a few times…

It was about 9pm. At this point, I was starting to feel some pain in my lower abdomen, like menstrual cramps. Since I had not felt any contractions up to this point, I started to think that they were Braxton-Hicks contractions. Before we left for a late dinner to Olive Garden, I researched the so-called “false-labor” pains on the Internet. I wasn’t sure, but at this point, I was experiencing the pain about once every 20 minutes or so. It noted that dehydration could bring on these type of contractions. So, I drank lots and lots of water. The episodes were short and brief, so I just figured that my body was prepping for the big day that was around the corner, about 2 weeks from now.

When we turned the lights off around midnight and tried to relax, the pain was getting greater. The frequency was around every 15 minutes or so, and I was having a tough time sleeping. As the pain would sneak up, I would try and relax and breathe my way through it. Josh was so tired and I was trying my best to not make noise and let him sleep.

In between, I would find myself fading off into sleep but would wake up abruptly with the pain. Since I drank so much water, I would get up and go to the bathroom each time. The rest of the night was a blur…all I know is that I spent most of the night in the bathroom at the Extended Stay America, trying to not wake up Josh and trying to make sense of all of the pain.

For the next 4 hours, the pain intensified. Although I was not real alert, I did begin to note that the pain was getting longer in duration and more frequent. Finally at 4am, I woke up Josh and went outside the bathroom to watch the clock and time how far apart I was experiencing the pain. Keep in mind that I was still unsure about what I was feeling – – were these false labor pains?

What I know for sure: I have a high tolerance for pain – – and I was feeling a lot of pain. By watching the clock, these waves of pain were timing out to once every 3 minutes. Josh watched me experience the pain for one round and although I was not complaining too much, he knew. He shot up out of bed, “Tina, those are not Braxton-Hicks contractions. Those are not supposed to be that painful. We need to go to the hospital – – right now!” Fortunately, it was just 5 minutes down the street…

So, we found a place to live…thank goodness! This apartment community accepted cats and short-term leases. The only drawback – – they do not provide furnished units. So, we will have to rent the furniture on our own and set up utilities. But, it is a nice property only 15 minutes from the hospital. Bonus – – it has a nice screened in porch for the cats and an extra bedroom for any visitors that want to come to Florida!