Ava-Marie's Homecoming

Ava got discharged from the NICU yesterday. St. Vincent's has an interesting set-up in their NICU. They have two family rooms that essentially amount to hotels rooms: a bed, a couch, a tv, and a bathroom. The night before you take your baby home, you spend the night with him/her doing everything yourself. A nurse comes in to check on you every few hours, but otherwise, you're on your own. So that's what we did Wednesday night. Ava was a good little sleeper, waking up not much longer than the amount of time it took her to eat, then going right back to sleep.

Thursday morning, she got her last dose of antibiotics, got all dressed up in a lavender gown and bonnet that her Oma made for her, and left the hospital about noon. Her bilirubin is still a little high, so back to the doctor today for her first follow-up appointment.

It's been pretty uneventful, thankfully. She's starting to wake up a little more surrounding her eating times, but still sleeping very well. She got her first video chat session in, talking to Oma and Pop last night, it was so stimulating, she slept right through it.

More pictures to come soon, and maybe a video or two once she starts doing something other than eating, sleeping, and pooping.

NICU Day 6

Ava's continuing to get better, she's up to drinking a little short of 2 ounces every 3 hours. She has stopped losing weight and should start gaining weight soon. This is about the goal amount of intake before a baby is able to go home from the NICU.

One of the other rules of the NICU is that she has to be moved from the warmer isolette to a regular crib, doing all her own work to keep herself warm. After two days in a regular crib, she's OK, from that standpoint, for discharge.

This morning's labs finally saw a significant drop in Ava's white blood cell count. Hopefully this continues and reaches normal in the next couple days.

All in all, she's shown a lot of improvement over the past couple days. There's still work to do, but it feels like there's a light at the end of the tunnel. The goal has been home this coming weekend, here's hoping that comes true.

Ava-Marie's Birthday

A few pictures, I finally got around to uploading the good camera pictures to the computer.

Todd cutting the umbilical cord.

Proud Daddy

Proud Mommy

Ava-Marie's stats

Ava-Marie's a hefty little chunk!

Ava's still hanging out in the NICU. Continued prayers are always appreciated.

NICU Day 3 - Nothing ever comes easy

Also known as, when it rains it pours.

Ava-Marie's breathing continues to slowly get better. However in the midst of all that, Ava's white blood cell count has been rising. Initally 32k with a normal differential, it's now up to 43k with 55% bands. Essentially, signs are pointing to a bacterial infection. She's continued to be without fevers and everything else is looking better. However, in this setting in such a young infant, the doctor is obligated to do a lumbar puncture to check for meningitis.

Ava's already bought herself a good 7-10 days of antibiotics, signs of meningitis would push this up to 2-3 weeks. They did the procedure earlier today, and the nurse told us the fluid did not look cloudy or bloody. A good sign, though we're still waiting to hear back about the labs they sent. They also sent a culture but that will take a few days to come back.

All that being said, the doctor continued to say she looked good and he isn't worried about her progress. She handled to OG feeds yesterday very well, 10cc every 3 hours. Today they are advancing that to 15cc per feed for 3 times then up to 20cc if that goes well. She also got to take the formula via a bottle for the second 15cc feeding. And as a bonus, Krystal got to hold her for about an hour. Definitely some much needed love and affection passed between mom and baby.

Several times I've told my patients that have prolonged hospitalizations that not every day can be guaranteed to be a good day. That's certainly proving true for us.

Thanks for the continued prayers, we're ready for her to be home, but of course not until she's healthy and ready.

Ava-Marie makes her debut

Yesterday Krystal began having strong and more frequent contractions. They weren't too painful initially, but given that she was already 4cm dilated, she decided to go ahead and call the doctor. A short trip to the office to sit on the monitor quickly became a trip to Labor and Delivery. Unlike the two previous trips, there was no event that preceded the increasing contractions. She was just breaking through the medication at this point. Given that we had achieved 35 weeks, it was felt to be best to take the terbutaline pump off and see if Krystal's body would calm down on her own or proceed into labor.

It took several hours of contractions, but her cervix eventually changed from 4 to 5cm. Similar to last year, Krystal labored in her back, and the pain was approaching unbearable, so they proceeded with an epidural. Once the epidural was in place she was begun on oxytocin to augment the labor, and her water was broken. Things progressed fairly quickly from there. Within 3 hours Ava-Marie had arrived. It just took a little over an hour of pushing from Krystal.

We soon found out why. Despite being just 35 weeks and 2 days, Ava checked in at a solid 7 pounds 6 ounces and 20 inches long. Everything looked good, she was crying up a storm and pinking up quite well. Since she was only 35 weeks, they had the NICU nurse come over for the delivery. Due to her gestational age, Krystal having a fever at the time of delivery, and little Ava breathing 70-80 times per minute, they felt it best to take her over to the NICU at the very least for a 4 hour observation period.

At the end of the 4 hours, Ava's temperature had come down to the normal range and everything was looking good, but she was still breathing in the 70s per minute. Due to this and an elevated white blood cell count, she has ended up having to stay in the NICU. She's been getting IV antibiotics and IV dextrose as she's not able to feed yet breathing that fast. She has improved during the course of the day. At our last trip to the NICU, her last two counts had been in the 50s and 40s breaths per minute.

Temperatures and everything else are looking good. We're hopeful we may get to hold her either later tonight or tomorrow. Still not sure just how long she's going to stay, our primary pediatrician saw her in the NICU this morning and is anticipating 3 days to a week long stay.

Everything is looking good at this point. Prayers have carried us this far, and we thank you for continued prayers to bring her home with us soon. Pictures will follow within a couple days, just have to get home and be able to use a different computer.

And just like that...

We're home again. Minimal contracting overnight with no changes in the cervix this morning. Glad to be out of the hospital.

On a side note, today is 1 year from Sara's due date last year. Definitely saw a couple butterflies around the house when we got home.

Have a good weekend, hopefully you won't hear from us until Ava makes her arrival once everyone involved is ready for her.

The worst part is the waiting.

Wednesday night, after Krystal's medicine pump decided to shut itself off, her body decided it was time for another round of contractions. Unfortunately, getting the pump restarted and giving a couple extra doses of medicine wasn't enough to calm things back down. So off to the hospital we went.

This time around, however, the magnesium didn't work as quickly as last time. 2 days into our stay, it was still requiring a high dose to keep them under control. Today, we're trying the combination of terbutaline pump and magnesium to get them under better control with the eventual goal of just the pump being needed to keep them slowed. Until then, we remain in the hospital.

Prayers are always appreciated. Expect another update when we have a big change from the present, either going home or progression to labor.

Life's more fun when you make it interesting

Not really, but that's what we seem to do anyway.

So anyway, Krystal home alone Friday as I was at the hospital on call. Sometime Friday evening Krystal hears the sound of water running coming from the bathrooms. She goes to look with no evidence of any water running. Later on, the sound gets louder, but still no evidence of water anywhere. Worried about a busted pipe, she goes outside to see if there's any water out there.

Upon turning the corner to the front of the house, she sees water coming from the ground in front of the house. After shining the flashlight on it, she realizes that it's the front yard spigot that's been turned on and is gushing water. Next thing she knows she sees/hears the bushes rustling and gets spooked. She quickly tries to get back inside but falls on the way up the steps to the door, though only hitting her shoulder and knees, belly spared.

Needless to say, Krystal's scared and she calls me freaking out. I immediately work things out to leave the hospital and come home to check on her. I get the water turned off and there's no evidence of anyone hanging out in the brush surrounding the house. Krystal decides to go ahead and call the on-call doctor just for safety's sake and peace of mind. On-call doctor decides it's best for Krystal to come in and be watched on the monitor, again just for peace of mind. At this point, she wasn't feeling any more contractions than normal.

Upon arrival and getting strapped to the monitor, little Ava was doing well, moving all over the place, unfortunately Krystal was having 12-15 contractions per hour. At first they decided to wait and see if her midnight bolus of medication would calm things down. Of course, this didn't happen, and of course, Krystal's cervix changed a little bit, from 1cm to 2ish, so they switched from her terbutaline pump to IV magnesium.

Initially wanting to start out with a big loading dose prior to changing to a lower constant rate, Krystal's blood pressure didn't tolerate this, dropping to the 70s over 40s. A slower bolus of magnesium was given and she was then switched over to a maintenance rate. Slowly things began calm down.

Once morning arrived and the doctor came by on rounds, he decided it would be best to restart her pump and slowly back off the magnesium as contractions would allow. Things calmed down well, and by about 3pm, she was off the magnesium and on a new, higher dose of the terbutaline pump. Everything stayed calm, Krystal continued to have her usual rate of about 2 contractions per hour and we were allowed to go home.

33 weeks arrives Tuesday, just 4 weeks until term. Medications will most likely stop at 36 weeks, so we'll see how long miss Ava will decide to wait.

Thanks to all for continued prayers!

Pregnancy and Infant Loss Awareness Day

Last year we learned that October 15th is the international Pregnancy and Infant Loss Awareness Day. Interestingly, the group that promotes this awareness day uses a butterfly in their logo, something we didn't know last year when we first felt the connection to butterflies last year with Sara.

Krystal is still pregnant, now almost 32 weeks. She's doing well except for going stir-crazy after having been on bed-rest for almost 2 months now. Ava-Marie's arrival is rapidly approaching, to the point of us getting a bit nervous. We're ready for her to be here, but obviously not until it's the healthiest time for her. We breathed a big sigh of relief recently when we passed the 30 week mark. Term is 37 weeks, and Krystal is putting her money down on a Thanksgiving baby. We shall see. It's not too far off.

One year later...

It's hard to believe an entire year has passed since we lost our precious Sara Kay. We have held true to our promises, not a night has gone by that we haven't told her good night. Even when I have to spend the night in the hospital, I make sure to take the time to call Krystal so we can tell her good night together.

A shadowbox holding the gown the hospital dressed her in hangs in our bedroom. A friend of ours created a framed work of art using flowers from her funeral. We always stop by her grave site whenever we are able to make it to Mobile.

We are blessed to have her in our life. We miss her everyday and long for the day when we get to hold her in our arms again. It hasn't gotten any easier over time, the pain still stings just as deep.

If today you see any daisies or butterflies, please remember Sara.

Another Week, Another Doctor's Visit

We had our weekly trip to the OB today. No changes in the cervix so we stay the course with bedrest and the terbutaline pump. We also add another medication in the form of a shot. That's right, in addition to sticking Krystal with a needle every other day to change the site of her pump, I am giving her weekly progesterone shots.

Krystal also got to drink 50 grams of sugar for her 1-hour glucose tolerance test. She failed it last year and had to do the 3-hour test, so let's hope we don't have to go through that one again.

Thanks again for all the continued prayers!

Bedrested

It's been a while since the last update, so this one is going to be a big one. For the past month or so, Krystal has been feeling an off and on tightening, about once an hour, sometimes more, most of the time less. Regardless, enough to worry her. It led to one early appointment (which was actually the one with the ultrasounds from last month) and a trip to the L&D floor to see if anything showed up on the contraction monitor. Nothing did either time, however at our last visit a week ago, the doctor noted her cervix to be dilated 1cm (previously had been completely closed).

We spent that night on the L&D floor so stay on the monitor for a prolonged period of time and when we were discharged the next morning it was on terbutaline and procardia to limit/stop the contractions. Today we went back to the doctor, cervix was unchanged, however due to the medications not completely stopping the tightening, she has now been placed on bedrest and will be put on a terbutaline pump.

Any and all prayers are appreciated, it's going to be a long 4 months.

Ultrasound Videos!

Assuming I did all of this right, and the program I used to convert the video to a usable format worked, here's the ultrasound videos. I can't guarantee they are actually in the correct order. And it's entirely possible there's a bunch of duplication in all of this.

Healthy Ava-Marie

Our latest doctor visit has come with the full growth/anatomy scan ultrasound, which of course means more pictures. Ava measured right on target with how far along Krystal is right now, and all of her various body parts were present and normal, 3-vessel cord, 4-chamber heart, both kidneys, stomach, etc. It felt like a much different ultrasound than a year ago. I think due in part to my questions about cost/timing for 4D ultrasounds, we got a small preview along with some pictures. So without further ado, I give you Ava-Marie Kay McCarty:

You might notice from the above 4D pictures that she was not too keen on giving us a perfect view of her full face. The little diva is already throwing her arm up and turning away.

Yes, I asked if it was still a girl, that's just how I work.

It looks like I can upload videos to the site fairly easily, I'll see if I can't get that up here tonight also. Thank you for all of your prayers.

It's a girl!

We found out back in April that Krystal is pregnant, and had the good fortune of an early ultrasound this week where we found out that we will be having a girl!

Being the kind of people that we are, you know we already had names picked out as soon as we found out Krystal was pregnant. So sometime in December, we look forward to introducing Ava-Marie Kay McCarty to the world.

I plan on keeping this blog up to date with information, pictures, and, eventually, videos. I look forward to sharing our family with all of you.

--Todd McCarty