Day 10

Good evening all. Here is Zoe’s update for 11/3/09.

The doctor listened earnestly at Zoe’s heart today and then reported that the murmur sounds much softer. This, as well as the sustained urine output [which is up] and her ability to digest the milk she is receiving [she no longer is using suppositories] indicates that it seems the ibuprofen is doing its job. Last round of medicine tomorrow and then we will see what develops.

Her stats seem great and from what the nurses say, she is using the ventilator less. The staff is slowly working toward getting the tube out of her mouth. We are hopeful! Since she is so stable, the plan is for Phil to hold Zoe tonight. I will make sure that we get some pics posted tomorrow.

They did move Zoe to a more quiet part of the NICU, hopefully she will be less fussy since there is less noise. Of course this means that she will no longer reside next to 'Elvis'. Well, she was too young to date anyway!

The only ‘bad news’ of the day was that the brain scan did reveal some bleeding {Level 1}, which means that I am counting on time and prayers (I am fairly certain that prayer wasn't prescribed by any doctor but that doesn’t mean I can’t prescribe it. Did everybody get the hint?) to heal the bleeding and ensure that it will leave no ill effects on my daughter. The new doctor, Dr. Lagatta, will be sharing these scans with some more doctors at the Children's Hospital to get additional opinions [just because she can]. Everything I read about this problem says that it is typical, especially considering her age, and that up to a Level 2 is no reason for alarm and we should not be too concerned. Still… I would rather trust in prayer. After all no one cares for bleeding on the brain. So, do I need to drop that hint again?

Well hope you had a good Tuesday.

Zoe is having a good Tuesday!

10 days down, working toward two weeks.

Love,

Kimberly

Is anyone up for a movie?

... and in the "Best Picture" Category, the winner is 'ZAC gets her pacifier'. Look out 'Gone with the Wind'... this one is destined for greatness.

- ZAC's GP

Keeping out the Noise

ZAC is the sensitive sort and as previously reported, the sound of babies crying, loud background noises and the din of the NICU has the tendency to cause her 'stats' to diminish. Well, we simply can't have that, can we! Hence... the spiffy looking headphones Zoe is now sporting. They may not be the latest in Bose noise cancellation technology but they do seem to do the trick, and what they forfeit in their stylish design they more than make up in their effectiveness, so you just keep them on girl! Trust me... "On you they look good!"

As for other events of the day, Kim and Phil did their parental duties (it was a labor of love, mind you) and have been up to see Zoe, with an additional visit scheduled for this evening. As of this moment, the emphasis by the WMH-NICU staff is to concentrate on correcting the PDA. As a result, a 4th, 5th and 6th round of ibuprofen treatments are slated for the next 3 days. From comments made by the neonatalogist, the first go-round seemed to have helped but they would like to see additional development (they still hear a murmur)... and failing this treatment's effectiveness, the surgical option will have to be employed. Let's not go there, okay?

As for Zoe's respiratory functions, when Phil was visiting her this morning, she was at 23% O2 but the RNs had increased the air pressure in the intubation tube. As we all know, the goal for now is to get the O2 level as low as possible (21% is room air) and have ZAC able to cope with just those 'nose pieces. For now however, this takes a second place concern, with the focus being treating/correcting the PDA.

The NICU staff also reports that Zoe continues to be alert (when she is awake, mind you) and is still eating via the feeding tube. She had lost a bit of weight (seems she had been retaining water... the bane of all females) but since that last increase of her urine output, this is no longer a concern and she has added 20 grams of 'good weight' rather than just water weight.

The only other major event of the day was Zoe's ultrasound, which was to ensure that there was no inter-cranial bleeding. The results of this test should be available either later this evening or tomorrow.

Lastly, it looks like Phil will have to wait for his opportunity to do the 'kangaroo hold'. Both Kim and Phil have opted to wait until such time as ZAC is ready again. With Phil's parents coming later this week, they will still have a busy schedule.

Well, that's about all for today... Your prayers and petitions are still requested but today, with emphasis for Zoe's heart.

- ZAC's GP

Kangaroo Holding

The goal for today was to have Kim and ZAC do their best kangaroo imitation. Kim and Phil (and maybe Zoe) have been looking forward to this for the past few days, but Zoe’s stats had to be ideal and remain steady. This was all of our hopes yesterday and today these hopes were realized. The reason they call it a ‘Kangaroo Hold’ is that the mother is made to lie down and then the baby is placed on her chest. Think of it as a bonding event between mother and child. Now I ain’t no doctor nor am I a fancy-pants psychologist but this has to heal both the body and mind of Kim and Zoe. (Does that mean that Zoe gets to be Joey today?)

Praises to God resound this evening for Kim and Zoe being able to do this together, but enough from me, let’s let Kim tell you how the day went:

11/1/09 -

Hello all,

We spoke with the nurse on duty and she reports that Zoe had a great night. There is still a definite murmur sound from Zoe's heart, but the fact that it can be heard leads them to believe it is small. The new neonatal doctor will be in tomorrow she will decide if the murmur requires a new echo-cardiogram or if they will let time and Zoe work to heal herself. As for the lungs, the right one is acting funny again so they will let gravity do its thing.

In the dietary department, they also started some feedings today; 1 c.c. of milk every three hours [for the time being]. This seems to be going well since she pooped today without the help of a suppository. [One of life’s little joys!]

Best of all, I got to hold Zoe for an hour. It was quite the ordeal to get her moved, especially with all of her tubes. She did great and even was able to get to room air for a bit.

Noise really upsets her so once other parents came in and babies started crying her stats dropped and she had to have her O2 increased to 28%.

Other than that she slept comfortably on my chest with a pile of blankets on her to keep her warm. It was the best feeling in the world and the only time I felt relaxed this week. We will find out if this will become a daily routine or if they want to hold off in order to let her body rest. If it is allowed again, Phil will be next.


Kimberly

1 Week Down...

... a lifetime to go! It's hard to believe that it has only been seven days since ZAC arrived and brought joy, anxiety, awe and a humble heart all at the same time. Well, kids will do that for [and to] you. Kim reports that today was another good day, but why should you here it from me? Tonight Kim will give you the report:

10/31/09 - Family and Friends,

Today was a quiet day. Phil and I went in the morning to spend some time with Zoe before we ran some errands.

She was looking around with her big eyes with some giant earmuffs on her head. The night nurse said that one of Zoe's neighbors would not stop crying and her stats were falling till those earmuffs blocked out the sound. The nurse practitioner informed us that the heart beat still sounded strong with one more dose of ibuprofen and that her right lung sounded as if it had improved as well, though her left lung sounded a bit shallow so they were having her lie on her right side, letting gravity do its job there now. We visited for about an hour and a half, talking with her, holding her hand, and calming her down when she got fussy.

We went back this evening to do some our reading of Tale of Despereaux. She was having a great day but for some reason could not settle down when we got there. We decided just to let her rest and within an hour she was fast asleep. Her oxygen levels that the machine was set on dropped quite a bit 30 down to 24 percent. We did finish reading to her while she slept and that only seemed to relax her more. Before we left we did get to help with her check up. I got to change a diaper and witness the age old tradition of the baby going as soon as the diaper is off and before the new one was on. (Daddy decided pics of that would be too embarrassing, even for his girl.)

The hope/ plan for tomorrow will be the kangaroo hold. As long as Zoe's stats are stable and she is able to, the nurses will lay her on my chest for an hour. It will be the first time that I get to hold my little girl. Phil and I are very excited about this prospect and hope that she is ready.

We are continuing to pray that heart has healed, her lungs inflate, she gets back to breathing room air, her next head scan (Monday) continue to show no bleeding, and a whole other list of items and that we know our Lord can do. We also are thankful for the blessing our little girl is and that she is one week old today.

Filled with a mother's love,

Kimberly

Zoe Enjoys a Good Book

As we were getting our week’s shopping done we were blessed to receive a call from Kim with an update on Zoe’s status. As hoped for (and prayed for) the day produced more ‘ups’ than ‘downs’ and ZAC continues to exhibit a great deal of tenacity, spirit and courage. Perhaps this is due to the book that Kim and Phil have chosen to read to Zoe. Perhaps these stories are inspiring her. Is it life mimicking art? Only Despereaux truly knows. Well, enough idle chit-chat, on to the report:

10/30/09 – On the respiratory front, the partial re-inflation of the upper area of the right lung was again deflated today. The staff, while concerned, were far from frantic and simply decided to prop little Zoe up on her other side and allow gravity, air and time to do the rest. She continues to be intubated and her O2 level is hovering at 29-30%. While this is a tad high, the doctors and nurses have reassured Kim and Phil that considering her age and development; this is not unusual and is not cause for alarm. Not being one to trust only in medicine, petitions for prayer concerning her lungs are requested.

Zoe continues to have an active set of kidneys and bladder and this is something to take great comfort in. As for any other major events of the day, the ibuprofen seems to be working well [to correct the PDA] and the nurse reports that, based on what she can hear, it sounds like the valves are working better. Zoe has had two administrations of the drug with the third scheduled for tonight. The echo-cardiogram, slated for next week, will reveal the effectiveness of this treatment. For now, the staff seems hopeful; however petitions for prayer concerning her heart continue to be requested.

The only thing left to be said is that Zoe is becoming quite vocal when she is not getting her way or is uncomfortable. She fidgets and gets fussy when she is wet, when her breathing tube is ‘slimy’, when she wants to be left alone or when she wants company. Let’s face it… she has attitude! In fact, the only time she seems to be really at ease is when Kim and/or Phil is reading to her. Let’s see the skeptics explain that one!

Enjoy listening to your story, sweetie!

- ZAC’s GP

Today was a Better Day

On my way home from work today I called Kim and she was able to give me an account of the day’s activities and provide me with an update on ZAC’s condition. Kim sounded better and even managed to make it to Wal-Mart in search of a 40 watt, frosted light bulb in order to replace one in the kitchen. She was having a hard time locating her elusive prey and, as she put it, “Every light bulb known to man is here except the stupid one I need. Grrrrr!” In the end she did find it and all was once again ‘well with the world’. As you can see, Kim’s temperament is better and she is beginning to regain her sense of humor. She and Phil are also trying to bring some normalcy and regularity to their lives. Time will tell if they are successful. Now, on to the ZAC Update!

+ + +

The staff at WMH-NICU, while not entirely good to their word, did limit their actions with Zoe today and the results of their effort were all good. After previous attempts at getting a second IV line inserted, today’s efforts were rewarded and there are now two lines, thus providing the staff with twice the access. On a ‘down side’ that became an ‘up side’, this second line was used today to perform a transfusion. This was necessary both to stimulate ZAC’s kidneys as well a supplement/replacement for the numerous blood samples that had been taken. (Hey, she only has so much to give. Give the girl a break!)

Once transfused, Zoe calmed down, was able to rest and the floodgates of her kidneys (or is it her bladder?) opened. This is a great thing! On a ‘neither good nor bad side’ the doctors confirmed that Zoe does indeed suffer from PDA, patent ductus arteriosus. On a related note, GP was able to expand his medical knowledge today when he learned that PDA is not another name for a Blackberry (I though it rather strange that ZAC would have one of these already) but rather it is when the valves of the heart need to fuse/develop more, in order to ensure that there is good ‘sealage’ between beats. Zoe is being administered ibuprofen in order to spur this fusion/development. (And this is why pregnant women are not allowed to take it! Wow, I am learning so much.)

An echo-cardiogram that is scheduled next week will/should reveal whether or not this treatment is effective. Until then… well, you know… PRAYER!

On a final note, Zoe was, when she was awake, looking around. This evening, Kim and Phil are going back up to WMH to read to their little girl. I wonder what she thinks about as she sees and hears all these strange, new things.

Some would say that she is too young…

Not developed enough…

Unable to comprehend.

I am not a believer in that point of view. I believe that anything is possible.

I believe this because I have already seen the impossible happen, and it’s has only been six days.

Welcome to our world little girl.

- ZAC’s GP

Dear brothers and sisters in Christ...

You may have already heard that, on Saturday, October 24th, Kimberly gave birth unexpectedly to our new daughter, Zoe Ann Casmer. She is a blessing from God to us, weighing in at 1lb. 3oz. and measuring out to 11” long. She came in the 24th week of Kimberly’s pregnancy, which was 16 weeks earlier than expected.


Needless to say, we baptized her on the very first day. Zoe is currently under the care of the wonderful team of doctors and nurses at the Waukesha Memorial Hospital NICU (Neo-natal Intensive Care Unit). This will be her home for the next 3-4 months. Preemies this early have quite a long road and many hurdles to jump along the way. Zoe has done well so far but has also had setbacks and difficulties. The doctors and nurses consider her to be doing well, but are always very cautious about her treatment and the outlook for the future. We have enjoyed wonderful blessings like seeing her open her eyes for the first time, as well as struggles like watching her be poked and prodded. We rest in the comforting Word of our God for hope and confidence, patience and strength while we wait and visit with her. As one of Kimberly’s former students wrote to her:

"For we know that in all things, God works for the good of those who love [him], who have been called according to his purpose." Stay strong…God will work good out of this. You taught me what this passage really meant. Don't forget it.

We won't.


Zoe’s name is the Greek word for “life” (ζωὴ). We liked that name, but didn’t really have any idea of God’s intended application at the time – seems a fitting goal now. More importantly, in baptism, the beautiful poetry of the first chapter of St. John’s gospel is true for Zoe too as she struggles with life:


In the beginning was the Word, and the Word was with God, and the Word was God. He was with God in the beginning. Through him all things were made; without him nothing was made that has been made. In him was life, and that life was the light of men. (John 1:1-4)


Her life in Christ is our confidence, hope, and guiding light.

We are also greatly helped and encouraged by all of the prayers you have offered to the throne of God on our family’s behalf. Through the wonder of the internet and telephone, within hours of her birth, hundreds of people were praying for Zoe; by now thousands have continued to do so for all three of us. We thank God for every prayer of yours and every word of comfort you have sought to give. We have also appreciated all of the offers of support and assistance. While we are still figuring out exactly what our life-schedule will be in the days and weeks ahead, we will gladly look forward to resting on all of you a bit as you lovingly support us. Thank you so much.

Zoe’s struggles will be many. As the few days we’ve had so far have borne out, the future will be filled with up and down days and hours. Our prayer is that God fill her with tenacity and life to grow and develop so that we can be a family at home together. We ask that you continue to pray for us as a family and for Zoe as she struggles. Paul’s words remind me of the wonderful working of God’s Holy Spirit among his people:


“Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves have received from God.(2 Co 1:3-4)”


He has greatly blessed and comforted us through all of you.

Resting on the strength of God,

- Phil, Kimberly, and Zoe Casmer

A Down Day

As I stood over the incubator, looking down at the newest child in my ever growing family, I realized how tired Zoe looked. Her assisted breathing was slow and rhythmic but I saw an exhausted look on her lovely face and tiredness emanating from every one of those breaths. The day had started well enough… Kim had made the ‘morning run’, attended Zoe’s feeding and even had the opportunity to get a little practical experience at #2 diaper changing. It had all the makings of a stellar day, and with Illinois visitors coming up to visit, it definitely looked like it had all of the makings of being an ‘Up Day’.

In retrospect we all knew that it would eventually happen… The doctors and nurses had said that there would be ‘Down Days’-they should know, it’s their job… our good friend Cheryl had said there would be ‘Down Days’ – she should know, she had been through this herself… and intellectually Kim & Phil knew that there would be ‘Down Days’- but she was doing so good!

In retrospect, the ‘Down Day’ was far less ‘Down’ than it could have been. Zoe had to be intubated again with a slightly elevated O2 level. It was because her right side upper lung is not fully inflated. In addition, the attempts to correct the inflation issue have been stymied by Zoe herself not allowing the doctors & nurses to have their way with her. Lastly, the efforts of the staff to draw more blood has been thwarted by Zoe refusing to offer up any more… simply put, she wanted to be left alone.

The X-Rays of ZAC’s chest did show good development of the respiratory area but its SO EASY to forget that this child is 16… oops, make that 15 weeks premature. We expect so much of this small one… but it will happen in her and in His time.

In the end, Zoe got her way since it was decided to put all of the poking and prodding aside for a day and let the girl rest… seems Zoe knew what was in her best interests the whole time.

So… what’s up with all of the ‘exhausted looks’? Well, while it is true that Zoe did looked very tired, it is more true that Kim & Phil look far worse and this is affecting the way they see each bump in the road and each day that produces less that ‘stellar’ progress. There is a very thin line between worry and anxious trusting in the Lord. It is easy to see why. The incessant beeping of the machines, the clinical nature of the NICU and the medical-speak gobbledygook of the doctors takes a toll on one’s spirit.

That there will be prayers lifted up for Zoe across this world is a certainty that I trust in… but I would also ask that a measure of prayers also be offered up, on behalf of Kim and Phil, that they can rest their concerns in His hands and have a measure of His peace.

“Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.” - Matthew 6:34

ZAC’s GP

Zoe...

… from the Greek; meaning life.

• Zoe of Rome, (died ca. 286) martyred saint
• Zoe Karbonopsina, (died ca. 920), Byzantine empress
• Zoe the Macedonian, (ca. 978 – 1050), Byzantine empress
• Zoe Palaiologina, (1455 - 1503), wife of Tsar Ivan III
• Zoya Kosmodemyanskaya, (1923-1941) Russian martyr
• Zoë Caldwell, (born 1933), Australian-born theatre/stage actress
• Zoe Wanamaker, (born 1949), British/American actress
• Zoë (singer), English pop star
• Zoë Ball (born 1970), English television and radio personality
• Zöe Lucker, (born 1974) English actress
• Zoë Bell (born 1978), New Zealand stuntwoman and actress
• Zooey Deschanel, (born 1980), American actress and musician
• Zoe Dimoschaki, Greek freestyle swimmer
• Zoe Kazan, (born 1983), American actress
• Zoe Laskari, Greek actress
• Zoe Lister, (born 1982) British actress
• Zoe Saldana, (born June 19, 1978), American actress
• Zoe Strauss, (born 1970), American photographer
• Zoë Poledouris, (born 1973), American actress & film composer
• Zoe Belkin, (born 1993), a Canadian actress
• Zoe Ann Casmer, (born 2009), child of God

+ + +

The following is the text of Kim's evening report along with a new picture of ZAC. I spend a lot of time looking at computer screens, but this was the best thing I have seen all day today. May the Lord Most High continue to shower us all with with His blessings! May the Most Holy Redeemer bless this child of God!

-ZAC's GP

Evening 10/27/09 - We just returned from the hospital and here is where things stand.

This morning they took out her intubation tube and placed the high flow nasal tubes in. They had to bump up her oxygen however this evening she was back to room air. The nurses continue to say they are amazed at how well she is doing, however they are reminding us of the bumps that are most likely to come in the coming days and weeks. [For example, she may need a transfusion because of all the blood work they are doing... and if she has PDA, patent ductus arteriosus.] This is common in all newborns, just more critical in premies as it may cause breathing difficulties.

Zoe continues to be fussy and feisty. Letting her nurses know when there is slime in her passage by dropping her stats and making faces. Which by the way she opened her eyes this morning. She only has the ability to see shadows but those eyes are definitely looking for those hands poking her and changing her diaper.

This evening Zoe had her first feeding. They rubbed a bit of milk on her mouth which she sucked and enjoyed and they placed the rest of the food down a tube into her belly. While we are there she didn't spit it up or throw up. She got fussy, but again some secretion was in her mouth and throat making it difficult to breath. It was great to see the nurse there go through the steps of suctioning her and all the other stuff to get her stats up. It was comforting to know that each small bump is completely taken care of. It will be great to see what she does through the night with her new food so her digestive system becomes active.

Phil also got to change Zoe's diaper. I haven't been brave enough to do it yet, but he was a pro. Zoe seemed to enjoy it since her stats stayed high and she didn't get too feisty. Obviously a daddy's girl.

We are continuing to pray for each day with our daughter and that her little faith and body grows.

In Christ's Mercy,

Kimberly & Phil