Yesterday Ambrose switched from a Jet Ventilator to a conventional vent. We went to the hospital during the switch-over and great care was taken while the vents were swapped out. His pressure is still a little high, but he seems to be tolerating it. The team is monitoring him closely, in case it's too much for him. This is a great sign of progress for Ambrose. The morning nurse told us that he didn't have any breathing problems all night. She even mentioned that Gina may be able to hold him today!

He is up to 5cc of milk every 3 hours, with only a little residual and spit-up last night, so they skipped one of his feedings.

Charles is still doing very good. He had his PICC line removed a couple days ago. He is at full feeds with 24 cal fortifiers and caffeine.

Charles awake and with Gina


Today we were told that Ambrose's right lung was not functioning at all. There was no air and it had possibly collapsed. The nurse told us they were going to go ahead with the procedure (Selective Intubation) that was cancelled last week. They moved his breathing tube lower into his right main bronchial to reinflate the right lung. His left lung was then expected to collapse. After they did the procedure, we were able to view the x-ray. It appeared there was a small amount of air in the right lung, but the doctor still had to review it. The left still looked bad, but not like the right.

Charles had an evaluation today by a Physical Therapist and an Occupational Therapist. His right foot turns outward to the left and should be flexing straight up and down. It's just a small movement that he does and could have been caused by his position in the uterus. They are going to have him in a splint for two hours and then off for two hours throughout the day to see if that helps.

Gina was able to hold Charles a few times this weekend. Today he had his eyes open for her and even groaned as she went to put him back into his isolette. He was very cute.

We hope to find out more information on the plan of care for Ambrose's lungs.

God bless you.

Kangaroo Baby

I was able to hold little Charlie last night. The nurse helped me stuff him into my shirt, where he lounged happily for almost 3 hours. He would have stayed there forever, but I had to go home and go to bed. I'm going back for more today. By this time tomorrow he will be receiving full feeds (17mL) every 3 hours, so he won't need his PICC line anymore. They're going to cancel his fluids and IV nutrition and just add Human Milk Fortifier to the breast milk which are kinda like a Jamba Boost of calories and calcium and other supplements.

Ambrose suffers from chronic lung disease, which the doctors are trying to manage. They even phoned and spoke to Dr. Bunnell, who developed the Jet ventilator, to see if he had any suggestions for Ambrose's care. There are different things they can try as far as adjusting the settings and such, but there's really nothing else to be done for him; we'll just have to wait and see how well he works through it. Even though his lungs are in very poor condition, they do continue to develop and repair themselves every day. But on the other hand, the ventilator causes continual damage as well. Sort of a "damned if you do, damned if you don't" situation, to quote the nurse practitioner. So we just continue to pray and hope for the best, while preparing for the worst - same as we have been since December.

Procedure Cancelled

Today we were told that, after reviewing this morning's x-ray, the doctor has cancelled the Selective Intubation procedure, due to both lungs now appearing to have Chronic Lung Disease. The plan is for Ambrose to continue receiving nutrition and grow. The nutrition will add more calories, because his body uses more energy than normal to breathe and to fight infection. He will also receive diuretics to eliminate excess fluid from building up in his lungs. Another thing the doctor mentioned was that he will try to decrease the O2 and allow the CO2 to increase a little to make the blood more acidic.

Charles is now down to 1/2 liter of O2. He is done receiving TPN and Lipids and will progress to Dextrose. He is doing well with his feeding and is now up to 13cc every three hours. We will go to the hospital tonight and, hopefully, Gina will have the opportunity to hold him for the first time.

Ambrose is proving to be quite the little fighter. As bad as he's doing, he still continues to throw his arms into the air swinging left and right. Apparently, he's not done yet. He appears to have a few more rounds in him and is refusing to go down without a fight.

We continue praying...

Ambrose Procedure

On Thursday, Ambrose will undergo a procedure for his P.I.E. (Pulmonary Interstitial Emphysema). The doctor said today that the procedure is necessary, because Ambrose has small "air bubbles" in his lungs and his left lung is getting worse. The procedure is called Selective Main Bronchial Intubation. I was told it's more like a therapy. The doctor will move the breathing tube a few centimeters down from the center of the trachea into the right main bronchus, which will cause the left lung to collapse. The doctor is hoping that the pressure of the collapsed lung will force the air bubbles out. The amount of time the lung will be collapsed will be determined by the doctor and how well Ambrose is able to maintain breathing with only one lung. The doctor also mentioned that he's never performed this procedure before nor has it been done at this hospital.

As you can imagine, this brings a lot of stress and worry to us. We're still hopeful that he will pull through and keep growing---getting stronger every day.

Charlie is doing well, is up to 12mL of expressed breast milk four times a day and had "two giant poops" today according to his nurse.

Today our 3 year old, John Paul, had his first experience with snow. His Grandpa took him up to Flagstaff to go skiing! He was so happy when he came home. Mostly he was excited that he went FAST down the hill and that he rode the swing (ski lift)!

Gina is doing well at home. She's been able to spend lots of time with Josef. She's patiently waiting for her doctor's appointment next week to see if she'll be cleared to drive again. If so, then she'll be able to spend more time at the hospital with the boys.

Please try to say a little prayer for Ambrose. I'm not sure what time the procedure will be, but any prayer at any time will be beneficial. Thanks!

Ryan

St. Gerard, who, like the Savior, loved children so tenderly and by your prayers freed many from disease and even death, listen to us who are pleading for our sick child. We thank God for the great gift of our son and ask Him to restore our child to health if such be His holy will. This favor, we beg of you through your love for all children and mothers.
Amen.

Daddy Holds Charles

At tonight's visit, Ryan had the opportunity to hold Charlie for about 40 minutes. He's super tiny and feels like nothing in your arms. He opened his eyes and looked up at his Daddy, who gave him a goodnight kiss.

The nurse called us at home today to get our permission for a blood transfusion for Ambrose. Premature infants often develop anemia for several reasons: they don't make many new red blood cells in the first few weeks after birth; their red blood cells have a shorter life than an adult's; and the frequent blood samples which must be taken for laboratory testing, makes it difficult for red blood cells to replenish (A Primer on Preemies).

One type of care St. Joseph's encourages is Kangaroo Care. Similar to "wearing" the babies in a sling, Kangaroo Care provides skin-to-skin contact between preemie and parent. Although it was offered to Ryan tonight, he decided not to expose his man-chest to the night nurses. Actually, he wanted to save that first experience for me.

Please continue to pray for Ambrose. He is still really sick and struggling. The poor little guy was in bad shape tonight, but the nurses were working hard to stabilize him.

1 Week Old!

Gina feeding Ambrose.

Well, the boys have made it through one week of life! We were very excited to see the boys today and to be bedside as the clock hit 5:01 and 5:02pm.

This weekend they celebrated St. Valentine's Day with decorative blankets and Charles even had a red cap! They've dealt with so much this past week. The ups and downs are still hard for us to get used to. As soon as things begin to look good, then one of the boys takes a small step backwards.

In the last few days, Charles has been receiving milk every three hours. He started at 1cc and was increased every 12 hours. Today he was going up to 6cc per feeding. There was some concern that his stomach was distended and some thought he had Necrotizing Enterocolitis (NEC) with bowel loops. After an x-ray was performed, it was determined that he was quite backed-up with stool and gas. The plan was to give him a glycerine suppository today to "free" him up. Also, he had his central line removed and now has a PICC line, through which he receives all his meds.

A couple days ago, Ambrose was taken off the Oscillator and placed on a standard vent. He tolerated it for a small amount of time, but the decision was made to move him to a Jet Vent. He is currently receiving 420 breaths per minute. The doctor also told us that he has Pulmonary Interstitial Emphysema (PIE), which is a leakage of air from alveoli into the pulmonary interstitium, lymphatics, or subpleural space, that occurs in infants who are being treated with mechanical ventilation. Today we were told that the PIE is getting a little better, due to some positioning of Ambrose's body and some changes to his ventillation, but it is still a concern. If this wasn't enough to deal with in itself, we were next told that he also may have a Patent Ductus Arteriosus (PDA). Simply, he has a blood vessel in his heart that has failed to close after birth and is sending blood from the aorta to the pulmonary artery.

On the bright side, Ambrose is no longer on the Nitric and had his chest tube removed the other day. His O2 fluctuates throughout the day, but he is most comfortable at around 30-35%. He has been receiving 1cc of milk since yesterday and seems to be tolerating it. He is still receiving Lipids, TPN, and antibiotics. Gina was able to change him today and give him his 1cc of milk. He had good bowels and even had consistent stools, which, given all the excitement over it, must be a very good thing!

Thanks again for all the prayers, especially all those from around the world. This afternoon we heard a wonderful story of school children in Granada, Spain praying for Gina and the babies. How beautiful is the power of prayer! Also, there have been numerous Masses offered for the boys. Today at Mass they were mentioned in the Prayers of the Faithful and brought tears to Gina's eyes. We continue to pray for each of you and your families.

Mommy's Home!

Indeed, she is...but first to the boys.

Charles has begun to receive small amounts of milk every 3 hours. He is still receiving 2 liters of Oxygen, but no support to help him breathe. He's doing it all on his own. Gina has helped change his diaper and feed him through a bolus syringe. He's starting off with 1cc of milk and they'll see if he's able to tolerate it. If so, then he'll go up to 2cc every 3 hours and, probably, increase the amount depending on how he handles it.

Ambrose has been weaned from his blood pressure meds. He is still receiving Lipids, TPN, and two antibiotics. He also can receive morphine if he appears to be in pain. His O2 has been lowered to around 35% and the Nitric is down to 3.5 or so. The doctor today lowered Ambrose's pressure on the oscillator, but his O2 Sats started to drop into the 70s. The pressure was then returned to its previous number and the doctor said they will try again the next day. Overall, he is pretty much the same. He's still a sick little boy that needs lots of prayers. They may remove the chest tube Friday and they have a few x-rays still to do. I think they mentioned chest, head, and stomach. There is still a long road in front of him and we have to be really patient. It's hard to go from Charles to Ambrose, because we've seen so much growth already from Charles and we're still waiting for some glimmers from Ambrose. It's all a matter of time.

Gina was discharged today around 5pm. It was quite a shock for her to be back in the real world. She said all the colors were so vibrant and everything seemed so hectic to her. Her transition to home life will be slow, because she needs lots of rest still to recover from the cesarean. She's also dealing with her hormones diving, her milk coming in, constantly pumping and bottling, two eager kids at home that want to hold her and have her attention, leaving a hospital that she's stayed at for the last four weeks, and, most obviously, knowing that her two sweet babies are still in the NICU and she can't walk down the hall and see them whenever she wants.

She really appreciates all the emails, letters, calls, and visits she's received over the last four weeks. I want to encourage you to continue to support and pray for her. She's an incredible wife, mother, and friend. I'm so proud of her and all that she's done in taking care of the twins throughout this difficult pregnancy. I know how fortunate I am to have her in my life and I'm sure many of you are, too. So please keep praying for our little family and we'll keep all of you in our prayers as well. If you want to see the babies, let us know and we can tell you when we'll be at the hospital. It requires a parent to take a visitor into the NICU.

God bless you.
Ryan

FIrst Videos in the NICU

Since Ambrose is on an oscillator he has quite a jiggle to his tummy. We took this video yesterday. Hopefully, you're able to see the jiggle.

Charles really likes to stretch and move around. Here he is before he pulled a tube out of his mouth.

A Day of Peace

We anointed the twins Monday with Lourdes water and Padre Pio oil and they have shown some improvement, but it's still a little early in the game. We still anticipate a long road ahead of us with small victories and defeats along the way.

Ambrose had a really rough first day, as Ryan mentioned in the previous post, but has shown significant improvement. He's been weaned from the Debutamine entirely and they are decreasing his other meds very slowly. His appearance has definitely improved: his color is much better now that his oxygen and blood pressure have stabilized and he has been producing urine, so he's not as puffy.

As Ryan said, they are receiving nourishment intravenously. When they are ready they can start on the colostrum and breast milk that's waiting for them in the fridge. Charlie's little belly will probably be ready in the next couple of days.

They both have the bili lights on them to help prevent jaundice. So they look like they're in little tanning beds with their cute little foam sunglasses on, soaking up some rays. Charlie is still covered with lanugo (fine white hair that is usually shed before birth), which shows up nice and shiny in the blue light.

The nurses try not to disturb the little boys while they sleep, so they change their diapers, linens, reposition their bodies, and do whatever else is needed, while the boys are able to rest at long intervals in between rounds. This afternoon we were able to see the nurse do rounds with Ambrose. It was a wonderful glimpse at this little one. With the bili lights off and his mask removed, he became alert and active with his eyes opening and looking around. The only unfortunate part was that we forgot to bring the camera! Charlie is much more active, of course, flailing his long skinny arms around, kicking his legs, tugging at his nasal cannula and so forth. In fact, today he yanked a tube out of his mouth and had to have it taped down!

The NICU staff has been wonderfully informative and communicative as far as offering detailed explanations, updating us on progress, and not hesitating to tell us their concerns so there are no surprises. We are confident that they will continue to take good care of our little boys and are doing everything that can be done for them.

It's pretty convenient living just down the hall from the NICU, but I'll probably go home in a couple days, which would be a nice change of scenery, too. The last couple of days have been pretty busy - especially compared to my level of activity for the last two months. I feel good, am walking and sleeping well, have a good appetite, am producing milk, and am in a pretty good mood most of the time. I did get a little cranky today and had to go back to my room for some pain meds and a nap.

While spending so much time in the NICU these last couple of days, you can't miss seeing all the young, teen mothers there with their babies. One of the nurses told us that the highest percentage of preemie babies were to teen mothers. These poor girls who had just given birth looked very overwhelmed, while standing by their babies and observing the nurses adjusting breathing tubes and being told their child still has a long road in front of them. One young couple near Charles today was being told about a surgery their baby was about to undergo within that hour. We were happy to hear that the nurse really explained everything to them about the procedure (they were so close to us we couldn't miss overhearing). Our hearts went out to them and we pray that the surgery went well for the little one.

One request: Monday night one of our dear friends suffered a miscarriage, after managing to make it through a rough first trimester, which included a week in the hospital for dehydration. Please keep her in your prayers as she lives out of the country with her husband and does not have any other family with her.

God bless you!

Recap and Update

Charles Robert Iker

Ambrose Augustine Iker

Ambrose receiving Baptism.

Wow...what a crazy two days! There are some who are not aware what happened over the last couple days. Let me recap.

Sunday afternoon Gina was having contractions and was given Terbutaline. The contractions stopped briefly, but started up again a couple hours later. She again was given Terbutaline. The contractions stopped, but soon started up again. Terbutaline can only be given twice in 12 hours. The plan that was agreed upon with the doctor was to give Terbutaline and if it did not stop the contractions completely, then to deliver the babies. Gina's contractions became more frequent to 2-3 minutes apart and the decision was then made to deliver the babies in an hour's time. I was about 30 miles away and really flew up the freeway.

Dr. Chavira came to Gina's room and we said a Hail Mary together. He took Gina to get her prepped and I put on my bunny suit (I think I pulled a muscle in my neck trying to get the shoe covers on!). There was quite a large team of nurses and doctors that arrived to take the babies once they were delivered. It was great to see how prepared they all were. During the cesarian, Gina was pretty medicated. I stroked her head and let her know everything was looking good and that I was able to see the babies. Once the babies came out, they were quickly whisked away to be with their teams. It was craziness after that. I ran around checking on the babies hoping to hear some sort of cry or any noise from them. I did hear a few grunts from Twin A, but could see Twin B was having difficulty taking a breath.

The babies were then taken to the NICU and Gina was sewn up. I went to see the babies after I knew Gina was ok. There was a lot going on in the NICU and a large team was assembled around Twin B, now known as Ambrose. They had him connected to O2, but he wasn't responding very well. Remember, his amniotic sac ruptured at 20 weeks, so he didn't have much fluid pass through him to develop his lungs. Next they connected him to a standard ventilator to expand his lungs and get a better flow of air into them. The decision was made that the ventilator was not helping him, so they brought in an oscillating ventilator, which "shakes" the oxygen into his lungs and "shakes" the carbon dioxide out. It's really amazing to watch the little boy's chest while the oscillator works. At some point an x-ray was done and they discovered he had a pneumothorax (air that is trapped inside the chest between the chest wall and the lung, causing the lung to collapse). The small hole was probably caused by the high pressure on his lungs by the oscillator. They placed a chest tube and were able to take out the trapped air. On the last x-ray I saw, the doctor said he did not see any other pneumo and part of Ambrose's right lung inflated.

If it wasn't one thing, it was another. If his O2 saturation levels were up, then his blood pressure was extremely low and vice versa. At one point, Gina and I went to check on him and his O2 sats were so low he was turning grey. Very sad sight to see. Eventually, the team was able to get his sats out of the low 40s to the high 80s and low 90s. He was given Dopamine and Debutamine for his blood pressure and then the doctor decided to give him a steroid, hydrocortisone, to improve his respiration. This was probably because he had Pulmonary hypoplasia, which is "a developmental abnormality of the lung characterized by a decrease in the number of alveoli, cells, and airways, eventually resulting in decreased size and weight of the lungs." The day was a roller coaster. So many ups and downs today made it really physically and emotionally draining. There are still more things that occurred to Ambrose today, but I'm not able to recall them all. He also received Lipids and TPN...and he was able to produce some urine.

Twin A (Charles) had a pretty good day overall. He was on a CPAP to give a little pressure to his breathing, but he was not intubated like Ambrose. They also had him on phototherapy to prevent jaundice. At one point, after he had his little protective mask taken off, he opened his eyes and looked around. He stretched and moved his limbs around quite a bit today. Ambrose made small movements, but he was also on morphine and sedated. Charles may be ready for food in a couple days. He received some lipids, fats, and a sweet glucose cocktail full of goodness. Meanwhile, Gina has been pumping and they're freezing the colostrum, until the babies are ready and able to eat.

I'm sure there's much more to say. When Ambrose took a downward turn this afternoon, we really thought we were going to lose him. He's a really sick little boy and it would take a miracle for him to survive. We know that these last eight weeks have been on borrowed time and we're grateful for the safe delivery of the babies and for Gina's health. God has a plan for each little boy and we respect His Will. We're also very grateful that both boys were baptized. Ambrose was given a more shortened form of the Baptismal Rite, due to his condition and the fact that he began to spiral downward at the time, while Charles was able to receive the longer, Extraordinary Form. Please continue to pray for our little boys. Wonderful things can still happen. We thank you for all the prayers you've said for our family over these last eight weeks. They're greatly appreciated! God bless you all. We'll continue to update this blog as events occur.

Ryan

Happy Birthday Iker Twins!

Charles Robert Iker (Baby A)
delivered by cesarean section 5:01pm 2/8/09
2 lbs 2.5 oz 14.5 in

Ambrose Augustine Iker (Baby B)
delivered by cesarean section 5:02pm 2/8/09
2 lbs 2.5 oz 14.5 in

Both babies received the Sacrament of Baptism from Fr. John Muir. Ambrose is having some problems with his lungs, we'll know better what to expect over the next few days. We will continue to post as we learn more.

Borrowed Time

Today my nurse mentioned that this unit where I've been living is mainly for multiples, ruptures, contractions and bleeders. Great, I'm all of the above. And I've been here longer than any of the other current multiples, ruptures, contractions or bleeders. I don't know if I should feel proud or worried. Worried that we're not going to be able to get away this much longer. We'd like to milk it for at least another 4-5 weeks.

I did have some more bleeding yesterday, which turned into lots of contractions by evening - some of them very strong and only 3-5 minutes apart. The nurses kept asking me about my pain, on a scale from 1 t0 10 with annoying corresponding smiley faces. It wasn't the physical discomfort that was bothering me so much as the disappointment in that I was probably going to deliver very soon. The bleeding didn't last very long, and once the nurse administered some terbutaline the contractions stopped as well. I can have up to two doses of the terb within 12 hours, but it may not always work as well as it did last night.

The babies are happy as clams. They tolerated the contractions just fine, no decrease in their heart rates. An ultrasound this morning show they're just as cute as ever (they get that from their Dad).


And a hearty "Hip Hip Hooray!" to Fr. Jim Wall for his appointment by Pope Benedict XVI as the new bishop of Gallup, NM.

One more thing: this baby is super cute.