Tuesday, December 29, 2009

A Trivia Question

Riddle me this…”Who weighs four pounds and is painfully adorable?”

Well… the answer is ZAC – a.k.a Zoe Ann Casmer, who managed to hit the 4 lb milestone last night or as Kim so eloquently put it, “She is getting so big and all her cheeks are chubby!”

So what are the long range plans for Zoe, based on her achievement of this milestone? Well, the plan is that in a week or so she is to be moved to an open crib! She will still be monitored to ensure she can maintain body temperature, heart rate, breathing and such, but the constraints of the plastic box will be gone.

As for her feeding, Zoe is continues to do well with her nipple feedings and she has now graduated to bottle feedings twice a day. She is also being weaned off of her caffeine and air support over the next couple of weeks to see if she can "fly solo".

We are praying that the past few days will be a good indication that it will be successful and we invite all of you to join us in our prayers of thanks and praise for what He has done as well as our entreaties for His continued blessings on this child.

- ZAC’s GP

Sunday, December 27, 2009

Kim Provides a Sunday Update

Kim writes,

"Hello all and before you ask, 'How did the ultra-sound go', I'll be proactive and answer...It went alright.

The damaged areas of Zoe's brain continue to dissolve, but it seems that so far there is no clotting. (Which means no additional damage is being created). This is good because it means we can avoid having surgery to put in a reservoir and then later a shunt. So I guess the overall status - stable.

The past couple of days nipple feedings haven't been as good as they have been, but we figured this is due to her still learning.

... And if you live in the 'Great Midwest', I hope you are enjoying the snow.

Kimberly

Friday, December 25, 2009

Thursday, December 24, 2009

Editorial Comments Abound

Hi all,

Hope things are well for everyone.

The nurses and doctors decided not to go with the continuous feed. Rather they just changed her 'High Flow' settings so she is getting more stimulation to help her breathe. (Editorial Comment: Those darn medical-types!)

With this being said Zoe is still on her once a day bottle feedings in order to work on that coordination and built up her strength and stamina. (Editorial Comment: Awesome!) Phil and I got to witness the bottle feeding exercise this morning. 20 minutes later, Zoe had finished the entire bottle! This sight was amazing, especially since the previous day she just got tired out so easily. The therapist and nurses were very excited about her development.

We hope (Editorial Comment: And pray!) that this continues, but know that this was a unique event (Editorial Comment: I disagree!) and working up to regular bottle feeds will still have its ups and downs. (Editorial Comment: I agree, but remain optimistic!) The holiday remains busy and quiet. (Editorial Comment: Just a bit of a contradiction there, Kim.)

Merry Christmas and Blessed New Year,

(Editorial Comment: ZAC's GP & GM say Merry Christmas too!)

Kimberly

Tuesday, December 22, 2009

An Evening Poem

T’was tonight after dinner, when it rang through the house…
My cell phone was buzzing, so I shouldn't grouse.

Kim had called to say hi and to leave a report…
She was heading back out so she kept it quite short.

ZAC was still doing well, but her feedings ‘had issues’
No drama, no tears, and for certain NO TISSUES!

The volume of food ZAC was made to intake…
Was stretching her stomach beyond what it could take.


Thus it was decided that for her own good…
Continuous feedings to happen it should.

Beyond this small hiccup, ZAC was still doing great…
Fourteen inches in length, three pounds six in her weight.

Kim was heading back up to see her dear child…
And I thought of another, quite meek and so mild.

So when hassle and haggard vex this holiday…
Find time for reflection, find time to pray.

Sleep well, little girl.

- ZAC’s GP

Monday, December 21, 2009

Dad says, "SHE CAN EAT!"

All,

Just got a call from the hospital. The nurse said that she caught Zoe at a very calm but wakeful moment and so she decided to try the slow-flow nipple feeding.

She said that for about 15 mins Zoe drank about 5cc’s of breast-milk from the bottle. She did not spiral down in oxygen levels, which means she was sucking, swallowing, and still breathing.

Jenn (the nurse in NICU) was very happy about it. She said they will attempt to do that once a day until she’s a little bigger.

Praying for lots of big miracles, God also blesses us with little, wonderful ones too.

SHE CAN EAT!

Phil

Saturday, December 19, 2009

Eighth Week Anniversary

... And a cool new outfit.

Say, do animal prints make me look fat? I hope not. I want to look my best for my Eighth Week Anniversary.


Happy Eighth Week Anniversary to me... Happy Eighth Week Anniversary to me...


Have a great weekend everybody, because I will!


- ZAC (Okay, my GP helped me type this up.)

Thursday, December 17, 2009

Be Still

"Be still, and know that I am God; I will be exalted among the nations, I will be exalted in the earth." - Psalm 46:10

Zoe achieved the 3 lbs and 1 oz milestone last night.

For us, there will be lots of prayers still...

And lots of hope for the next months and years.

- Kim

Wednesday, December 16, 2009

The Specific Reason…

Yesterday’s post contained few specifics as to what the concerns of the doctors and the staff of WMH NICU were. This was done on Kim and Phil’s request in order to contact and inform the family rather than have them hear about it here ‘first’. Since this is now done, perhaps a bit more of an explanation, concerning Zoe’s condition is in order. I preface this explanation with a simple statement from Kim, “Just praying for a miracle right now.”

The MRI of Zoe’s head indicated that the right ventricles of the brain were growing. This could have been caused by swelling of the brain or perhaps bleeding, but it was not. Instead, what the ‘second opinion’ revealed was that there were large areas of damaged brain tissue in ZAC’s right brain hemisphere which her body was reabsorbing. The space created by this absorption was being filled with cerebral fluid.

The cause for concern surrounding this development was not so much about the absorption or the fluids, but rather the potential for long term damage already having been done that would cause the brain to go into this ‘mode’. The doctors theorize that while in uterus, Zoe may have experience a stroke which both damaged the brain and spurred her premature arrival.

Following the MRI review, the doctors… cautious as always in the choice of words they used, painted a picture that spanned the distance from stark and bleak in outlook [as it applies to the potential from long term disability and brain damage] to the possibility that Zoe might be able to ‘reprogram’ her brain so that the functions performed by the damaged/missing area could be taken over by the other hemisphere, and thus be ‘normal’. [I question the relative merits of normalcy, but that debate is best kept for another day.]

The next milestone is finding out if Zoe can coordinate the suck, swallow and breathe regimen, a function that should be ‘second nature’ by the baby’s 36th week of development. Since ZAC is only at 30 weeks of development there is still time to go on this, and beyond this new hurdle she continues to grow, breathe, her heart is strong and she is active.

On a personal note, after speaking to Kim at length last night, I can only reiterate what I said then. Understanding the will of God is often clouded from the minds of mortals. I would not begin to hazard a guess as to why this has happened to Kim and Phil and Zoe… to all of us, but suffice it to say that regardless of the end result, it will be to His glory.

If Zoe does indeed have to contend with brain damage, Phil and Kim will be most excellent parents, Zoe will remain a child of God and He will be glorified.

And if Zoe has to contend with a limited disability or a learning complication,
Phil and Kim will be most excellent parents, Zoe will remain a child of God and He will be glorified.

And if He allows Zoe to develop, grow and thrive… unhindered by any disability,Phil and Kim will be most excellent parents, Zoe will remain a child of God and He will be glorified.

If He chooses any option other than the third, will He be less glorified? I think not, and while we would pray and plead with Him for this third option to be His option of choice, it must always be remembered what He said to Paul…


"My grace is sufficient for you, for my power is made perfect in weakness."

- ZAC’s GP

Tuesday, December 15, 2009

Prayers Re-Doubled

As days go, this one has been less than stellar.

With the memorial service for ZAC’s great-grandmother still fresh in our minds, Kim called to report a significant and serious complication that the MRI discovered with Zoe. According to the doctors, the ventricles on one side of her brain were enlarging and it appeared that they were filling with fluids. The ‘pictures’ were being sent to another hospital for a second opinion, but the general prognosis was not good.

I know that each of you out there have been in constant prayer for Zoe since this all began eight weeks ago, but I would ask now that your prayer efforts be redoubled, not just for Zoe’s life and health but for Kim and Phil’s strength and peace of mind.

May His will be done, but may He also allow us the eyes to see that it is His will as well as the mind to understand it... or at least accept it.

ZAC’s GP

Sunday, December 13, 2009

Check Out My New Outfit... Heck, check out that smile!

All,

Zoe continues to do well and she is currently eating 24CCs to support her 2lb and 12 oz body.
She is alert when it comes to her occupational therapy and when the nurses come around to check on her. She is also now sucking on her fingers as well as the pacifier.

By all the nurses' and doctors' opinions, Zoe is doing what she needs to do to get home. It will still be quite a while, but comforting to know that she is on the right track.

We are patiently waiting and praying for that day.

Kimberly

Thursday, December 10, 2009

A Time for Everything


There is a time for everything,

and a season for every activity under heaven:

A time to be born and a time to die,

a time to plant and a time to uproot,
a time to kill and a time to heal,

a time to tear down and a time to build,
a time to weep and a time to laugh,

a time to mourn and a time to dance,
a time to scatter stones and a time to gather them,

a time to embrace and a time to refrain,
a time to search and a time to give up,

a time to keep and a time to throw away,
a time to tear and a time to mend,

a time to be silent and a time to speak,
a time to love and a time to hate,

a time for war and a time for peace.


- Ecclesiastes 3:1-8

All,

Well today went very well with Zoe and the "High Flow Canula". She was on room air for most of the day resting peacefully. She continues to gain weight steadily, now at 2 lbs and 8 oz!

The occupational therapist did have to put a splint on her foot to help straighten it out. They said that this is pretty typical for such a small baby that does their growing in a bed.

With lots of prayers and her sheer determination, Zoe is making huge strides to coming home.

Kimberly

Wednesday, December 9, 2009

Patience Practiced in Earnest

All,

I just wanted to give you an update on Zoe.

The doctor found no change on her head ultrasound since last week, which is good, but after last week I was hoping for more. Patience again is being practiced in earnest.

Zoe continues to do well with her feedings, but the staff is looking to get her growing at a slightly faster rate. They have added more protein to her milk in order to do this. She is now up to 22CCs on her feedings. They also did not switch her off CPAP yet since Zoe had a bad night last night, thus they decided to give her another day and hope that Wednesday will be a better day to make the switch.

Kimberly

Zoe, Meet your Great Grandmother…


Josephine Ann (Greisbeck) Lacher,
Died 12/8/2009

She was born almost a century ago in a far away land. She enjoyed great times as well as horrific ones. She married and moved to this country, where she and her husband gave life your grandfather, who gave life to your mother, who gave life to you. She too suffered many ills, yet she overcame them. She too was tried and tested, yet she stayed the course. Though you will now never be able to meet her, suffice it to say that her greatest wish was to see you. You would have liked her, and she already loved you. I just thought you should know.

- Your GP

Monday, December 7, 2009

Mondays Can Be Good


Evening All,

Things with Zoe are going well.

They (WMH-NICU staff) are slowly weaning my little girl off the CPAP and they hope to have her on the cannula (nose tube) on Tuesday. They have also increased her feedings to 22CCs since she has been gaining weight steadily.
Tuesday will be another ultrasound on her head, again we are praying to see the ventricles shrinking and the clot dissolving.

Other than that, it is a fairly quiet Monday.

Kimberly

Saturday, December 5, 2009

Saturday Bath


All,

Today Zoe got her first tub bath! The nurses took out her CPAP, and gave her a nasal cannula (a nose breathing thing) to take her out of her isolette (her little, clear plastic room). She seemed to enjoy bath time once she realized what was going on, she especially enjoyed sitting in the warm tub.

We have also now heard Zoe cry, they are pretty small cries compared to larger babies, but pretty beautiful noises to our ears nonetheless.

The doctor feel Zoe is doing well, especially since they modified her feedings to every two hours and she is still tolerating the CPAP well… room air to 24%. They modified her vent settings to allow her to do more work and this evening they are going to try and go back to 3 hour feedings. We are a bit apprehensive, but the doctor feels that now she has had a few days to get used to the CPAP she may be ready for the next step.

We continue to pray that Zoe and all the other babies in the NICU continue to do well as we celebrate our Savior's birth.

Kimberly

Friday, December 4, 2009

Six Weeks Down


All,


Things with Zoe have been kind of up and down for the last 48 hours...

When Zoe was initially placed on the CPAP the nurses used short prongs to 'attach' it. This worked well for about the first eight hours but the air flow just was not getting to her lungs. To combat this, they decided to use longer prongs, thus preventing Zoe from wiggling out of the device. They also gave her another transfusion to help move the oxygen around. This seemed to do the trick, until until her feedings.


With Zoe on 19CCs every three hours, this combined with all of the breathing she now had to do on her own... well she would quit breathing on her own. (Obviously not a good thing!) To correct this, they now have her being fed every hour 6 cc (small meals, more often) and she has been given a dose of antacid to help.


Since this regimen change [early Thursday morning] Zoe has done spectacularly well!

Her oxygen settings are 21%-24%, she is breathing comfortably on her own and has had no significant drops in her rates.

We are continuing to see her exercise in her occupational therapy. The therapists feel that she is doing well and making progress at the appropriate rate.


Six weeks down :)



Kimberly


Wednesday, December 2, 2009

Goodbye E.T.

With apologies to Steven Spielberg, it was time for E.T. to go home. As important as the ET (endotracheal tube) was in aiding and assisting with ZAC's breathing it did have certain drawbacks, namely it obscured Zoe's face. In addition, Zoe had developed a severe dislike for the device and spent more than a little time attempting to remove it.

The first attempt at the ET removal and moving Zoe to a CPAP was less than a rousing success but at the time, the doctors attributed this to her age and level of development/maturity and decided to postpone the removal. Well, December 1st was the new scheduled removal date. Here is what Zoe's proud mama has to say about yesterday's events...

All,

After a busy Tuesday this is where things stand for our 2 lb and 2 oz little champ.

The doctor called this morning to state that the radiologist saw a decreased size in the ventricles. The clot is continuing to dissolve and soften. They are going to continue to monitor this on a weekly basis.

Also this afternoon they removed her ET tube and gave Zoe the CPAP. She seems to be handling it well, though she will occasionally try to wiggle out of it or get tired of breathing. The nurses are very quick to get her settled or her heart rate back up. We are praying that this continues to go well so she can move forward on the bath to be breathing accessory free.

The remainder of the week will be all about keeping up her feedings and getting her to grow. We are praying that the Lord continue to bless our little girl.

Kimberly

Tuesday, December 1, 2009

So How Did It Go Yesterday?

All,

Zoe is did really well with the kangaroo this evening (Monday evening). She is sleeping and and eating really well also. The plan for Tuesday is to remove the Endotracheal tube (ET) and put in the CPAP. We are praying this goes well and she breathes on her own.

They also did her head ultrasound, though we have yet to hear the results from the DR. Other than those two big things it seems like the staff are keeping it low key for the rest of the week...

So lots of prayers on breathing, brains, and continued growth.

Love,

Kimberly