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Day 3 -- 07/22/04

I got up at 6 a.m. to pump, and called the NICU to check on Joshua.  Said that he's doing fine and that he stayed stable through the night.  The pressure on the ventilator is at 40, and his oxygen percentage is at 30.  He's lost a little weight, down to 2 pounds, 4 ounces, but we shouldn't worry about that.

Chris talked to the day nurse at 8:30 after he got off work.  She said that they're doing an echocardiogram today to check to see if he has a PDA (Patent Ductus Arteriosus...a condition in which a blood vessel near the heart stays open or reopens after birth.  The opening causes a heart murmur (and I think makes respiration less productive because of leakage).)  It can be treated with medication (called Indomethacin), but if medication doesn't work, surgery is an option.  From what I understand, one "round" of the medication consists of 3 doses, 12 hours apart, and they'll do up to 3 rounds of the medicine. After each round, they do another echo to check and see if the valve has closed.  Joshua is also scheduled tomorrow for a cranial ultrasound to check for fluid or bleeding.  The nurse said that his head is "firm," which usually indicates that if there is any fluid or bleeding, it is probably minor.  The leakage is classified in levels, from 1 to 4, 1 being the best and 4 being the worst.  From what I understand, level 1 is very little to no leakage, and 4 is a pretty major bleed.  In the worst cases, if the bleeding/fluid leakage continues, a shunt can be placed later on to help to drain the fluid from the brain.

We got a call from a genetic counselor today.  She had been by to take a look at Joshua because he was born missing his pinky finger and pinky toe on his right side.  The other three fingers on his right hand are currently fused together, but the doctors think there is complete bone structure, and he has three fully developed fingernails, so separation of the fingers at a later date should be pretty minor.  His right foot is also turned in slightly, but it hasn't been determined yet if it's a defect or if it was just "squeezed" around while he was inside me.  The genetic counselor said that although he's very small and she didn't get a really good look, her gut instinct is that there are no other "hidden" or "invisible" abnormalities.  She thinks the issue with his foot is possibly due to constraint, and that physical therapy could help straighten it out.

We talked with one of his doctors this evening about his echocardiogram.  She said that it appears that he does have a PDA, and that she wants to get him started on the first round of medicine to see if that will take care of it.  She did warn us that one of the side effects of the medicine is that as it constricts the blood vessels to attempt to close the PDA, it also restricts other blood vessels, and as a result, they'll have to watch his kidney function a little closer, but she did not indicate that it would cause a major problem.  She said that right now, she would give the medicine about a 50/50 chance of working (I get the impression that she errs on the side of caution/worst case scenario when giving projections of success/failure of procedures).  She said they gave him his first dose of medicine to treat it around 5:30 this afternoon, then another tomorrow morning, and the last one tomorrow evening.  After that, another echocardiogram would be done, and a decision about the next step of treatment could be made.

Saw Josh before bed tonight.  His blood pressure kept going very low and setting off the alarm, but Christy, his night nurse, said that a decrease in blood pressure is a common side effect of the Indomethacin (since it restricts blood vessels, it makes sense that his blood pressure would decrease).  She was keeping a close eye on him, and making sure that his pressure doesn't get too low.

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