Posted (Tina) in All Posts on November-30-2007

Ella had a good day. There were no changes in her care. She is still on CPAP at 45% oxygen with a CPAP of 6.
There was peace of mind because Nurse Angie was watching Ella. Although the NICU was busy today, Nurse Angie is one of the best at taking care of Ella. More than anything, it is great because she is just so sweet and cares so much. You just feel it.
I was able to hold Ella for about 1.5 hours today which was nice. I have missed being able to hold her.
The rest of the time, Grandma and I took turns talking to her. We had a good time hanging out with the Bun.
I noticed last night that Ella seemed congested and it was not any better today. She will cough and it sounds like there are a lot of secretions in her airway. A few times today, she was clearly struggling to breathe. I can tell because she gets that frightened look on her face any time that her breathing becomes compromised.
I tried articulating my concerns to the nurse practitioner. However, I was told that this is a normal thing for Ella to experience based on her recent extubation. This may be correct, however it made me feel as if my input as Ella’s mom was completely discounted. All I know is that Ella has been extubated before and yet, I have never seen this type of cough.
More than anything, I wanted to feel heard and to know that since it was a concern of mine, they would watch it closely. It was really frustrating to feel like I was not being heard and that my opinions were completely discounted.
I asked the nurse practitioner about the plan for Ella over the coming days. I was never given a direct answer. Since we have been here so long and Ella’s case is not textbook, I am looking to chart her next milestone. This is important to me and I feel very frustrated that I cannot get a clear answer from the NICU staff.
At this point, Dr. Kays has started to step away from making decisions on her every day care, since most of the surgical work on her is complete. This leaves most of the day-to-day decisions to be made solely by the NICU staff. And it is tough when you a) don’t agree with the approach and/or b) can’t seem to get a direct answer.
Once the practitioner had left, I felt the rise of frustration make it to the surface and I broke out in tears. This experience is so tough and it makes all the difference in the world when you feel like your opinion matters, when you feel like they truly want to take the time to figure out what is best for Ella, when they make the extra effort to give Ella a core nurse assignment, etc. Since I have not felt the love the past 2 days in this regard, I think it just got the best of me and I needed a good cry.
Then, I went to leave the NICU and asked for a parking pass. They were not able to provide me with one.
It just felt like one of those days where every time I encountered anything to do with the NICU, it was disappointing to me.
Finally, we were given a visit by the social worker. She comes around periodically to check in on families. This time, she came to talk about the blog. Somehow, the staff at Shands heard about our blog and came with concerns over privacy. She wanted to know if we had received permission to discuss other babies on our blog, such as Par and Jonathan. I assured her that we had received verbal consent. And although we have received specific consent from these parents because we know them, she advised that it would be the best to only discuss Ella. I’ll be honest, I understood why they have to legally come tell me that information, but nonetheless, it was a bit discouraging (Par’s parents were approached too).
Since we have specific consent, here is the latest update. Par was moved to the NICU 2 today (such a blessing), so Ella will be missing him! We have not talked to Jasmine since Jonathan’s surgery. Unfortunately, Jonathan does not have a blog, so we will just need to ask that you continue to lift him up in prayer.
Once again, I am reminded that we came to Gainesville for Dr. Kays, not the NICU. And that I am so thankful for the other parents we have met on this journey as well as the dedicated nurses and other NICU staff that have come to know and love Ella. In the midst of all my frustrations over the past 4 months, those individuals are like a ray of sunlight.
Please continue to pray for sweet Ella’s recovery as well as strength for me and Josh. We need prayer for endurance. Also, we need strength to interact with the NICU staff in a godly way while still being Ella’s advocate.
Psalm 59:16
But I will sing of your strength,
in the morning I will sing of your love;
for you are my fortress,
my refuge in times of trouble.

Posted (Tina) in All Posts on November-29-2007

Ella had a rough day.

Her ET tube got clogged with a mucus plug. They tried to suction it out, but they were not successful. In the meantime, Ella was having a tough time breathing and got scared. She turned her bluish/purple color and got very upset. Once she gets this upset, it is tough to console her.

They opted to extubate her since they were not able to clear her airway. From there, they placed her on CPAP. But she was so annoyed, the CPAP was not helping her much. Then, they gave her versed (sedation) to try and calm her down. That was not effective either. Next, they placed an oxygen mask over her mouth to help her. She seemed to respond to that treatment the best, but they can’t stand over her and hold it. So, they opted to try a high flow nose cannula. Initially her stats were not doing well, so they increased the cannula to the highest amount of oxygen. This seemed to improve her stats and get her to a place where she could calm down.

They took a blood gas and it was in the acceptable range, so they left her on the nose cannula and were intending to simply monitor her clinical signs and go from there. Unfortunately, Ella had a nurse that was not familiar with her. This just made the situation more stressful for Ella and the nurse.

By the time I was able to visit in the evening, she was still on the nose cannula. The nurse and respiratory therapist were noting that this was the best she looked all day. But as soon as I saw her, she did not look great. She had a difficult day, but right in that moment, her breathing was labored. Her saturations were low to mid 90s. She was having a tough time – – more than normal for Ella.

My intuition told me that this was too big of a step for her. Immediately, I asked what the plan was for her care. I was told that they were intending to leave her on the nose cannulas and just monitor her. To me, it was obvious that this was not the right thing for Ella.

I asked to speak to Dr. Kays. If in fact they were going to continue down this path, I wanted my concerns voiced to him and/or I wanted a better explanation as to why this was the right choice for Ella.

Dr. Kays had already left the hospital for the day, but he called in. After talking with the nurse practitioner on staff, she came back and stated that sedation was not the answer and the plan was to place her back on CPAP. This felt like the right decision.

The nurse and respiratory therapist were so hesitant to place her back on CPAP because of her negative reaction earlier in the day. But I could just tell that Ella still needed the pressure to keep her lungs expanded.

Since I knew this was going to be tough for Ella and not something that she would like, I suggested that they let me hold her and then switch her to CPAP. This way, I could place her binky in her mouth and try my best to console her with the change (she has missed her binky over the past week).

Thank the Lord – – it went off without a hitch. She made a sad expression, but was over it in about 2 seconds. She let me hold her and began working away on the binky. From there, her saturations increased and stayed pegged at 100. CPAP is exactly what she needed.

I was able to hold her for about 30 minutes and then it was time for shift change, so I had to put her back in her bed. Fortunately, she seemed to stay in a good mood and I stood by her bedside until I couldn’t any longer.

Some other good news for Ella: her Grandma decided to make a last minute trip out to Gainesville! So during shift change, I went to go pick up Grandma, so that we could go back and visit Ella.

When we arrived, I offered to let Grandma hold Ella. This was her first time holding Ella. The last time that she saw Ella was only a short time after her repair surgery in late August, toward the beginning of Ella’s fluid issues. So, Ella looks a lot different!

Once they settled, Grandma didn’t move for 1.5 hours. Her and Ella seemed content to stay put. At this point, it was obvious that Ella was doing much better. She was interactive and looked comfortable. Thus, it was a difficult day with a good ending.

We are unsure of the next steps other than watching her lungs carefully and monitoring her. There is a good chance that she may need to be re-intubated if she continues on CPAP for a while. As we learned last time, her nares can get so swollen that the CPAP is no longer effective in providing pressure and places Ella in a position where she cannot breathe. We are going to try and avoid that scenario and try our best to be proactive. I’m finding it more important than ever to be a vocal advocate for our baby girl.

Par did well today and I did not get an update on Jonathan, but can peek over and see that he is still on ECMO. Grandma Kathleen is hanging on and fighting for her life.

Please continue to pray for Ella’s strength in her lungs as well as the needs of Ella’s roommates. Finally, please lift up Ella’s Great Grandma and ask that the Lord would heal her body.

We thank you for your support and continued prayers. It means so much during this time.

Posted (Tina) in All Posts on November-28-2007

The Bun had another solid day of recovery.

She slept most of the night for Nurse Janet, one of her favorites. Then during the day, she spent a lot of time sitting up in her chair listening to her baby Christmas tunes and eyeing those that passed by her bedside, hoping to reel them in for some attention.

In the morning, her fentanyl was decreased slightly from 3.5 down to 3.0. Hopefully, they will wean this pain medicine just slightly every other day or so by .5 until it is discontinued. They have warned that since she has been on fentanyl since she was born, she may have withdrawal. On that note, we will be watching closely for changes in behavior.

Also, they decided to start Reglan and Zantac up again to help Ella digest her food and move it through her system. She was on both of these meds before the nissen surgery when they were feeding her, and just started them back today since she has reached full feeds. Her belly seems to be tolerating the full feeds of Portagen (20ccs per hour continous) and once again, we are happy to report several poopy diapers. This just means that everything is moving through her system as it should since her nissen surgery one week ago today.

Ella had another chest x-ray this morning, but Dr. Kays did not come by till around 2pm to assess and make any needed changes. The chest x-ray did look improved, but only slightly. He moved the vent settings down to 6 breaths per minute at 40% oxygen. His plan is to extubate tomorrow.

When I was visiting Ella, it seems about right to extubate tomorrow. We did not want this too soon, but at the same time, you can tell that the tube is becoming more and more uncomfortable for her. Although she was happy and we were having a nice time together tonight, she paused several times to gag on the tube.

We hope and pray that this is the last time that she needs to be intubated. Once we go back on CPAP, we would like to not look back and visit this stage again. It is just a matter of making sure that her lungs are strong enough and that she does not have any setbacks.

Par is doing amazing. In fact, he is doing so well that he will probably get moved to the NICU 2 within the next day or so. Today, his UAC line was removed and they had a chance to try feeding him with a bottle containing 1cc of formula. Although it was a bit different for him, he did seem to respond and swallow. Such great news. Please continue to pray that he can cruise through the next challenge of feeding.

Jonathan had surgery today starting around 3pm. When I left the NICU around 11:15pm, I could still look over and see Dr. Kays performing surgery with his team at Jonathan’s bedside. That is a really long time for surgery. I ran into Jasmine in the waiting room and she filled me in. Apparently, his liver was in his chest which came as a complete surprise to Dr. Kays (not apparent on the x-rays prior to surgery). In addition, Jonthan formed blood clots in his chest around his lungs. So Dr. Kays had to spend extra time delicately removing the blood clots. Please continue to pray that having the repair surgery will make a big difference and his body can truly begin to heal.

Two more baby girls have joined the NICU that are in the “CDH area”. We know one baby girl has CDH for sure, but are not 100% positive about the other baby. Either way, they are both on ECMO. We do not know the families or the baby’s names, but ask that you lift them up in prayer as well. Being on ECMO means that they are both very ill.

Josh left yesterday afternoon to go and visit his Grandma at the hospital in Southern California. She has been having a tough recovery. Her diagnosis is congestive heart failure. This means that her heart is not pumping as well as it should to deliver oxygen-rich blood to her body’s cells. It happens when the heart’s weak pumping action causes a buildup of fluid or congestion in the lungs and other body tissues.

So, it is somewhat similar to what has been going on with Ella. Grandma’s lungs are too “wet” and so they are giving her lasix to help get rid of the fluid. Earlier, they were not sure if her kidneys were functioning. Later tonight, we received a praise that her kidneys are functioning and therefore some of the fluid is leaving her body, making it easier for her to breathe. She still needs a lot of prayer. Unlike Ella, Grandma has an infection in her lungs which is making her recovery even more difficult.

Lord, help us to surrender and trust in you at all times, in all circumstances. You know the petition of our hearts. Help us to lay down everything in complete submission and wait on you for your direction, guidance and peace.

Psalm 9:10
Those who know your name will trust in you,
for you, LORD, have never forsaken those who seek you.

Posted (Tina) in All Posts on November-27-2007

It is hard to believe that it has been 18 weeks.

Nurse Andrea had a great day with Ella. She was a bit fussy this morning, but apparently they were trying to place a new IV line and Ella was not appreciating the hands-on treatment! I don’t blame her!

When they drew her blood this morning for labs, her hematocrit count was low (the hematocrit count calculates the percentage of red blood cells per micro liter of blood). So, they ordered some blood for her and needed a new IV line to deliver it, thus the bandage on her head.

Ella’s food continued to be increased last night and throughout the day. They are capping her feeds at continous flow of 20ccs per hour and she will be at that volume by 10pm tonight. So far, she seems to be tolerating the feeding well. This is a blessing.

You can tell that having the nissen surgery was the right move for her. Even though she is almost at full feeds, I have not seen any reflux symptoms and she is in a great mood.

Apparently, a couple of staff members were trying to get her to smile today. After several unsuccessful attempts, Dr. Kays approached the bed to check in on her and she gave a HUGE grin. Nurse Andrea said it was just priceless.

Dr. Kays thought about extubating Ella today and asked the nurse and respiratory therapist. After collaberating, they opted to wait until tomorrow morning, get a chest x-ray and make a decision from there. Please pray that her chest x-ray tomorrow looks better. We are hoping that her lungs are no longer “wet” and that she is ready for CPAP.

Par took another huge step today – – he is off CPAP and is breathing via the nose cannulas. So far, so good. We’re so happy for the amazing progress that he has made. Thank you for all the prayers. I have not seen Jasmine today for an update on Jonathan, but either way, please pray for Jonathan. He is scheduled to have his repair surgery on ECMO tomorrow, which is very risky.

Finally, please pray for Josh’s grandma (her name is Kathleen). Ella wants to meet her great Grandma some day, so we lift her up and ask for the Lord to heal her body. She is in the intensive cardiac care unit at Hoag Hospital in Newport Beach, CA (heart and lung issues currently). She went in the hospital this past weekend and is having a tough recovery.

Thank you for all the prayer support. We couldn’t do it without the love of the Lord guiding us each day in His truths as well as the support from all of you out there. You minister to our hearts each day with your thoughtful words and prayers (even those of you that don’t post – – we know you are with us too).

Psalm 103:1-5
1 Praise the LORD, O my soul;
all my inmost being, praise his holy name.

2 Praise the LORD, O my soul,
and forget not all his benefits-

3 who forgives all your sins
and heals all your diseases,

4 who redeems your life from the pit
and crowns you with love and compassion,

5 who satisfies your desires with good things
so that your youth is renewed like the eagle’s.

Posted (jooosh) in All Posts on November-26-2007

Ella Bun had a good day. At this moment, Mom is doing what she can to calm her down and put her to sleep.

We noticed that Ella’s breathing is a bit more labored this evening. Her breaths per minute have been in the high 90’s. She has been awake, but this is higher than we’ve seen the last couple days.

Ella did have a chest x-ray this morning and her lungs still look “wet”. Her IV fluids could be contributing to her edema, and is probably the reason for her increased breaths. To help with this, she going to be given Diamox in between her Lasix regiment. She’s been on this med before, when she was more edemic, and it seemed to do the trick. We’re hoping for similar success this round as well. She definitely doesn’t look as swollen as times past, but it’s still something to keep an eye on.

Clinically speaking though, Ella looks great! She was happy and interactive tonight, and slept real solid last night. Her scar from surgery is healing nicely, and she’s handling her increased feeds like a champ so far (she’s up to 8ccs per hour right now). On that note, her food is going to be increased 2ccs every 4 hours until she reaches a total of 22ccs per hour of continuous feed. In the same way her IV fluids will also be decreased in the same manner. At this rate she should reach full feeds in about 36 hours.

Baby Par continues to do excellent, and we’re praising God for his phenomenal progress. Baby Jonathan is doing a little better too. His liver function has started to improve, and his swelling has gone way down. His kidneys are not doing so good, but he’s scheduled for repair surgery this Wednesday on ECMO. We hope this surgery will help him take the next steps to getting better.

Father God, you are worthy of our praise in all things. We pray that you will be glorified though these children. Thank you for their lives, and the lives they touch. Let us seek your face in our daily lives, and with every breath praise your name. You are awesome Lord. Hallelujah! Amen

Posted (Tina) in All Posts on November-25-2007

Ella had a great day.
Nurse Andrea said that Ella spent a good amount of time sitting up in her chair and being social. She even fell asleep while sitting upright in her chair!
By the time we arrived this afternoon, Dr. Kays had reduced her ventilator settings down to 8 breaths per minute and 40% oxygen.
Also, Dr. Kays decided to start feedings of the Portagen via the g-tube (2ccs/hour of continuous feeds). This is the first time that the Bun has had any food in her belly since her surgery (they have just been giving her IV fluids the past few days).
Ella’s nose seems to be healing quite well. We really wanted to see the swelling and inflammation decrease before she is placed back on CPAP.
When we first approached Ella’s bed, she was asleep. Then, she must have heard our voices. All of a sudden, she opened her eyes, recognized Mom, and then gave a big smile! It was so cute.
We had a fun time hanging out. Dad sang improv tunes to her which made her grin (there is a video below for your viewing pleasure). Then, Mom read her stories and talked to her. She was full of smiles which means that she has to be feeling better. It was the first set of grins and giggles that we have seen in several days.
We are not sure of when Dr. Kays plans to extubate Ella. If not tomorrow, I’m sure it will be sometime over the next few days. We’re not in a hurry to have this done because we feel like it is just giving her extra time to gain her strength.
Par is progressing along just wonderfully – – praise God! Please join us in praying that he will make huge strides forward, so that he can take on the next challenge of feeding. Jonathan still needs prayer for his liver and kidneys. They continue to not function at a level where Dr. Kays is willing to perform the repair surgery. Please pray for this need specifically as well as providing strength to Jasmine, his mom. Finally, pray that Ella’s lungs get stronger and that she tolerates the feeds via her g-tube.
Father, we thank you for sweet little Ella. We praise you for the successful surgery and the progress she has made over the past few days. Lord, you know exactly what she needs to heal and get stronger. We pray for wisdom for Dr. Kays and staff.
Also, we lift up Par and Jonathan to you and ask that you watch over their parents and that you continue to work out your perfect will in their healing process.
Lord, we thank you for Ella’s smiles…they are a reminder of your unfailing love for us. We trust in your timing of all the details on this journey.
Thank you for loving us…in your precious name, Amen.


Posted (jooosh) in All Posts on November-24-2007

Another good day for Ella. She looks to be healing well. The swelling in her belly has gone down, and her scar is less inflamed.

The Bun spent a good amount of time sleeping today. Nurse Kelly had her sitting up in her chair for a couple hours today while interacting with her. She was so pooped out when we arrived that she barely woke up for us.

We did get about 30 minutes of awake time with her. During that period we switched her back to a regular crib. Once Kelly got her positioned in there, Ella zonked back out. Nurse Kelly is so great at positioning Ella and getting her comfortable. She says she envisions how she would like to be positioned, and just does that to the baby. Honestly, I just think she has a magical way with the beanbags she uses.

Dr. Kays saw Ella briefly today. He talked about extubation tomorrow and starting up her feedings. Tina thought that Ella might do better with just one change and suggested that maybe we just start feeds tomorrow, and hold of on extubating for one more day. Ella’s nose still has a scab on it, and we’d like to see it heal just a bit more before we put her back on CPAP. Plus, she’s doing so well, we’d rather push her a little slower this time versus making too many changes. Ultimately though, we trust in Dr. Kays wisdom and will be content with what he recommends.

We were excited for Liz and Rusty today. The were able to hold Par for the first time! What a wonderful gift that is. Thank you for your prayer support for this family. Praising God for this great milestone! We’ve not had any recent update on baby Jonathan, but we continue to pray for his liver and kidneys.

We do have a specific prayer request for Ella. She looks fine clinically, and she’s behaving like she’s very comfortable. However, her x-ray has not improved since Tuesday when she was intubated. We are not real concerned about it at this time, because it might be just a leftover indicator of her micro-aspirating from the reflux (might just take more time to clear up). That being said, we hope it is not actually a sign of anything significant (i.e. fluid issues).

Please pray that Ella’s x-ray will clear up in the coming days and that her breathing will continue to grow stronger. With her reflux under control, and her food soon to be delivered via her g-tube, our main hurdle is getting her lungs better so she can breathe without the support of a ventilator.

Heavenly Father, we thank you for these wonderful children. They are such a precious gift from above. I pray that you will strengthen them, and that their lives will be a living testimony of your love.

We praise you for Par’s progress and ask that he continue on this track. We lift up baby Jonathan and pray for healing in his liver and kidneys. We ask for Ella’s x-ray to be clear in the coming days, and for her breathing to grow stronger so that she can be extubated with confidence.

We surrender all these things to you, knowing that your in complete control. We offer these requests in the Holy name of Jesus. Amen.

p.s. Can you believe Ella is four months old today!!! =)

Posted (jooosh) in All Posts on November-23-2007

What a great Thanksgiving yesterday! Ella did real well, resting up from her surgery, while Tina and I enjoyed two Thanksgiving meals. One with some friends in town, and the other with Par’s family and Jonathan’s mom.
We spent the morning with our girl before we headed over to have our first dinner. Our first meal was fantastic, complete with all our favorites: turkey, dressing, a incredible whipped sweet potato casserole, cranberries, green beans, and mashed potatoes. My grandmother overnighted her special cranberry sauce for us to enjoy, and it really made us feel like we were home. We then finished the meal off with an amazing home-made apple & pear pie. Man, I getting hungry just talking about it! =)
After stuffing ourselves there, we headed over to our second dinner. Par’s grandmother Barbara, with some help from others, put on a wonderful Thanksgiving feast at the Homewood Suites Hotel. The hotel staff allowed them to use their kitchen and dining area to put on the dinner. How nice of them!
Our time was spent appreciating each others company, and sharing what we were truly thankful for. It was so incredible that God ordained that we all come together in that moment. We are so blessed to have met the friends we have here.
Afterwards, we headed back to the hospital to be with our children. Upon our arrival we were excited to find out that nurse Michelle was taking care of our girl. She hadn’t been with her in weeks. It was nice to see her familiar face.
The Bun woke up for us to say hello, but went back to sleep after about 30 mins. We then headed home for the night.
Upon our arrival today our girl was asleep. She was very peaceful and looked real comfortable. She’s been real alert a few times, and we’ve had a good time interacting with her. At this moment, Mom is reading her “The Very Hungry Caterpillar”, and Ella’s enjoying it.
It’s not too fun with her ET tube these days because Ella’s very aware of it. When she was previously intubated I think she was still on a good amount of sedation, and it was all she knew. This time around she recognizes this tube in her mouth and isn’t liking it that much. Plus, it is giving her a pretty good gag reflex. In spite of this, her nose is looking a lot better which is good because she’ll probably be going back on CPAP in the coming days.
The IV in Ella’s foot came out today, so they’ll be using her central line to deliver all her meds. Her feedings were supposed to start up tomorrow, but her belly is still pretty swollen from the surgery. This is to be expected, but Dr. Kays indicated that we’ll be holding off on her food until the swelling goes goes down. She’ll be fed intravenously until then.
Our girl is scheduled to have another chest x-ray tomorrow to see how her lungs are doing. We’d expect it to look pretty good considering how she’s been behaving. Her vent settings have also been tweaked a bit. She’s now down to 16 breaths per minute and her O2 is at 50%.
Baby Par has been moved out of his private room and is in a space right next to Ella. Par is doing incredibly well, in fact he was extubated today! Praise God! So great to see the progress Par has made. He’s now on CPAP and I’m sure in the coming days he’ll get his first taste of some food. Please pray that Par’s lungs will strengthen, and that he will do well when comes time for feeding.
Please continue to pray for baby Jonathan. His liver and kidneys are not doing the job they need to be, and Dr. Kays won’t be able to do surgery until they do. We’re asking for healing in these organs, and peace for Jasmine and Chris (Mom & Dad).
We pray for Ella’s lungs to strengthen, and for her overall breathing to improve. We also pray for no infection to occur during this time of healing.
Thank you for being here with us during this extended journey in Gainesville. You’re words of encouragement in the comments, emails, cards, and prayers mean so much to us.
God Bless you all.

Posted (Tina) in All Posts on November-22-2007

I had a chance to talk to Dr. Kays post-surgery last night.

He said that Ella did well through the procedure. First, they placed a central line. They tried through her right leg and it wasn’t working, so they switched to the left leg. From there, it was threaded sub-cutaneously up to her right side near her chest.

Normally, they place a central line through the neck area, but based on Ella’s history of having a collapsed superior vena cava and all the work she has had done in the chest region, they wanted to avoid that area. Also, since the surgical repair was on the left side, they threaded it over to her right side to remain out of the way.

Dr. Kays hopes to use the central line as much as they need to over the next several days. It has risk of infection just like any lines they place in Ella, so he does not want to see it in there any longer than 2 weeks.

The nissen surgery went well. Since Dr. Kays could not find a piece of paper, he began drawing a visual of the procedure on his scrubs! (Here is a great page that I found if you want to read more about the overall reflux issue, nissen procedure and g-tube). They took the upper section of her stomach and tied it around the lower part of her esophagus. This creates a drawstring-like effect. When Ella’s stomach becomes full, it will tighten and not allow for reflux. Also, he noted that she now has a “cute button” (he was referring to her g-tube).

If you remember from Ella’s repair surgery, her appendix was relocated to her left side beneath her tummy. Apparently, it is common to remove the appendix during a nissen procedure. It is not something that they look for or search for, but when it is apparent and seems like it might provide future complications, they remove it. So, just like her parents, Ella no longer has her appendix!

Dr. Kays was able to remove the gortex patch that lined Ella’s abdominal muscles (note: this is NOT her diaphragm gortex patch. Ella’s tummy was going to be too tight when he moved all her organs back into her belly during the repair surgery, so he had to line her abdominal muscles with an additional gortex patch when he closed. Since she is bigger, he was able to remove that extra patch). That was a positive. He did note that her liver had adhered to the patch slightly, but he was able to safely pull it away.

Ella will be off of food for 3 days (yep, no food for her first Thanksgiving). The first time they will try food through the g-tube will be Saturday. From there, they will give small amounts and build her back-up to full feeds through the g-tube.

He ordered for Ella to be given steroids 2x per day for the next 5 days. This should help her healing overall, but especially for her lungs to gain strength.

She was given a one-time dose of versed (sedation) yesterday for the surgical procedure as well as an increased amount of fentanyl (pain meds). The fentanyl was bumped slightly to help with her healing over the next several days. Once she has stabilized, they will begin to slowly wean it.

Since she was sedated last night, he bumped the ventilator to 40 breaths per minute at 50% oxygen.

The plan is to get another chest x-ray on Friday and see how her lungs have progressed. As soon as possible, he wants to extubate her and put her back on CPAP.

Dr. Kays did mention that we are not sure how CPAP and the nissen procedure will work together. Most babies have the nissen procedure when their lungs are in a better state and they do not require CPAP. So he warned that we are going into a bit of uncharted territory. The potential side effect is that since the CPAP is blowing continuous pressure into her lungs, that part of the air can also go into her tummy. Now with the nissen procedure complete, she will not be able to get rid of the air as easily. This might cause her additional discomfort.

Also with the nissen, he mentioned that Ella might do something called “retching”. If her belly gets too full, her body might try to spit up, but she will not be able to. Again, just another side effect of the procedure. As we discussed before though, the benefit is no heartburn/reflux symptoms for Ella as well as no aspirating into her lungs!

We are hopeful that this surgery not only solved her reflux issue, but will play a big part in helping her lungs to get stronger. Dr. Kays thinks that the reflux was contributing to the issues she has had with her lungs recently.

We pray that this is the last major surgery for Ella. She has been through so much already in her short life. Please pray that her body will heal well and that when they begin to feed her via the g-tube on Saturday, she will tolerate it. Also, please pray for good chest x-rays over the next few days. Already it has been nice to have her off CPAP because her nose is getting a much needed break. However, we want her to get strong enough to move to the next step.

Thanks for all the love and support for Ella and her roommates. On this day of Thanksgiving, we are thankful for these little ones. They are truly a gift from above.

Psalm 107
1 Give thanks to the LORD, for he is good;
his love endures forever.

Psalm 111
1 Praise the LORD.
I will extol the LORD with all my heart
in the council of the upright and in the assembly.

2 Great are the works of the LORD;
they are pondered by all who delight in them.

3 Glorious and majestic are his deeds,
and his righteousness endures forever.

4 He has caused his wonders to be remembered;
the LORD is gracious and compassionate.

Posted (Tina) in All Posts on November-21-2007

Ella has stabilized since being re-intubated yesterday morning – praise God!

Most of the day yesterday, she was sedated. They tried to place another picc line in her arm, but it was unsuccessful.

Also, the IV line in her foot came out again this morning. So, the nurse had to locate a vein to place another temporary IV. Apparently, the largest visible vein was on her head, thus the bandage.

She had a chest x-ray done this morning, and it does look improved but she still has a long way to go. They did take a blood gas and it was good – ph of 7.54, cO2=47, pO2=71. Based on these results, they did make some adjustments to the pressure on the ventilator.

When Dr. Kays visited Ella this morning, he decided he would take Ella to the OR to place a central line today since they need a more permanent solution for access. After looking at her recent stats and pacing around for a bit, he decided that since he was taking her to the operating room, he would do the nissen surgery and g-tube today. Although the chest x-ray isn’t quite as good as he would like, she is stable enough overall. This came as quite a surprise.

We are told that the surgery will be taking place around 1 or 2pm EST. As always, we will keep you updated with information as soon as it is available.

When I arrived to visit Ella this morning, she was awake and looked comfortable. Her beautiful blue eyes were staring around and her color was good.

She has not required any additional sedation since yesterday when they tried to place the picc line in her arm. The fact that she has not required extra sedation is a good sign: as her parents, we know that this means that she must be feeling better.

As I finish this post, she has peacefully fallen asleep.

Looking around at Ella’s roommates, Par continues to make strides forward – – please continue to pray for his journey.

Also, I had a chance to talk to Jonathan’s mom this morning. She was in the waiting room because they are switching out the ECMO circuit. This is the 2nd time they have switched it out. Right now, Jonathan’s liver and kidney are not performing well. Both of these need to improve before Dr. Kays will discuss the repair surgery. Keep in mind that Jonathan was born on 10/17 and has not had repair surgery yet – – he has not been stable enough. Please pray for Jonathan and his family.

And, please pray for Ella and her surgery. Pray that the Lord would keep her strong and stable throughout the procedure. Finally, Josh and I have not been feeling 100% health-wise the past few days. So, please pray for our health to return – – not quite as much fun wearing masks in the NICU and taking a risk of infecting Ella!

Thanks to all for your love and support during this time.

UPDATE 2:30PM EST (by Josh): Ella was just wheeled off to surgery. Please continue to pray.

Father, we lift up our baby girl to you. We know you are there with her right now. I pray for the skilled surgeons hands, Dr. Kays, Dr. Paddock, and the entire staff. Let you presence be sensed, and let your will be done. We praise you Lord for bringing us this far, and that we even have the opportunity for this procedure to be performed. You are a loving and gracious God, and we know that nothing is out of your control. Thank you Jesus for Ella Renae. Amen.

UPDATE 5:10PM EST (by Tina): I am in the waiting room of the NICU. Brenda, someone who is assisting Dr. Kays, just called the front desk and asked to speak with me. They just completed the central line and now they are beginning to work on Ella’s belly. Ella is doing fine – – she just wanted to call and let us know that everything was progressing along. Thanks for all the support and prayers.

Psalm 92:1-5
1 It is good to praise the LORD
and make music to your name, O Most High,
2 to proclaim your love in the morning
and your faithfulness at night,

3 to the music of the ten-stringed lyre
and the melody of the harp.

4 For you make me glad by your deeds, O LORD;
I sing for joy at the works of your hands.

5 How great are your works, O LORD,
how profound your thoughts!

UPDATE 7:00PM EST (by Tina): Dr. Kays just called up to the NICU wait room. He let me know that Ella behaved herself during the entire procedure and that they were able to get everything completed. They are on their way to bring Ella back upstairs to the NICU. Although he was short and did not give any details, at least we know that Ella remained stable and that the procedure is finished. I hope to see Dr. Kays a bit later to see if I can get some more information. Thanks for the prayers.