Feeding and feeding

     We have been back in the NICU for almost two weeks now. Breckin did so well after surgery that she no longer needed to be in the cardiovascular ICU. She has been doing so great since her heart surgery. Her respirations are so much better now-she breathes maybe 30-40 times per minute instead of 80-100. Sine being back in the NICU, we have mainly just been working on feeding by mouth. Because of her cleft palate and her heart defect, she has difficulty taking her full volume by mouth. She also was aspirating on her milk after her surgery. This means that the breast milk was going down her trachea to her lungs, which was why she would just give up eating after a few swallows. Our speech therapist is the one who saw the signs of this and ordered what is called a modified barium swallow. During this test, it showed that she aspirated on the breast milk in her bottle. So, a thickener called nectar was added, and this solved the problem.
     Since the swallow study, we have been feeding her with the thickened breastmilk. We are also adding fortifier to the milk to give her extra calories. As of today, she has surpassed her birth weight by a few ounces so she is back to gaining weight. We have been working on giving her as much volume by mouth as she will take. She was eating every three hours and it didn't seem like she was getting hungry enough, so we changed it to every four hours and that seems to have helped a little. She is now taking about 40-45cc pretty consistently by mouth. This is about 1 1/2 ounces. Her goal is to take 70cc by mouth every 4 hours or 60cc by mouth every three hours. We have come a long way, but I still feel like we have a long way to go.
     We have had so many great nurses here who have truly loved on our baby, and for that we are so grateful. However, because so many different nurses rotate through, I feel like there is some inconsistency. Every nurse has their own way of doing things and their own way of feeding Breckin. When Josh and I are here, we will feed her, but through the night, we let the nurses feed her. I feel like this is when she loses ground. It is just very frustrating being here day in and day out knowing the only thing keeping us from going home is her eating. I know that she will eventually get there, but I'm afraid it could take several more weeks for that to happen.
     We have recently been considering the idea of getting a gastrostomy tube or G-tube. This is a feeding tube that goes directly into her stomach. We can still do what we're doing now-offering her milk by mouth and then give the rest in her tube. However, we can go home with the G-tube and continue to work with Breckin at home. The G-tube is a simple procedure, but it is another surgery that Breckin would have to undergo. This is my only hesitation with going ahead with this. I hate to put my baby through another surgery where she will undergo general anesthesia, but I feel that Josh and I can make more progress with her at home.
     I have seen God working so much in Breckin's life, and I am just ready to get her home to actually start living life with her. We are so blessed with her and she is such a joy in our lives already. I know we have a long road ahead of us filled with many more doctor's visits, surgeries, therapy, and challenges down the way. However, I know that God is going to be with us through it all. I never thought I would make it past that first week here. I thought I would lose all hope, but my hope is continuing to be renewed each day that we spend with our baby girl.

 Christmas Eve

 Doing some feeding with her big sister and the speech therapist

Snuggle time with mommy

Breckin's First Heart Surgery

     Breckin had her first heart surgery last Tuesday evening on December 9th, just 6 days after being born. The cardiac surgeon, Dr. Knott-Craig was thinking it would be two to three weeks before she needed it, but she was showing that she was over circulating too much and was ready for it sooner. One of the conditions that Breckin has is called double outlet right ventricle which causes too much blood to be circulated to the lungs. This causes her to work too hard to breathe. So, at about 4:30 that evening, we walked with our little girl to the surgical floor, kissed her goodbye, and handed her off to strangers. It was one of the scariest moments in my life. The thing I kept thinking was, how in the world am I going to be able to do this two to three more times?
     The surgery only took a couple hours and Dr. Knott-Craig was so pleased with the outcome. He said the pulmonary band they put in place was a perfect fit. It was just loose enough where she could grow into it, but not too tight where it wouldn't last long. He also said she only lost about two teaspoons of blood so she didn't need to receive any blood.
     We transferred to the cardiac ICU that evening where our sweet girl was lying in her bed hooked up to all kinds of monitors and intubated to help her breathe. Her nurse, Morris, would be taking care of her all evening. He was so great to explain everything that was going on and give information about every piece of equipment she was hooked up to. He stayed in her room with us that evening and watched her every move. It was a little awkward getting up to pump every three hours with a strange man in my room, but I was glad he was there. The next morning, he said the night went great with no complications. He only gave her one dose of morphine, and she never required anything but a dose of Tylenol the next day.
     I am truly amazed at what my sweet girl has already gone through since being here. Besides having heart surgery, she has had more needle sticks than I can count, multiple tubes in her nose and throat, several IV lines inserted, and she even suffered a terrible wound on her ankle from a blister that opened up. She has been such a trooper and I am humbled by her strength. All of the nurses comment on how strong she is, and I am so grateful for that.
     Since her surgery, she has done so well from a cardiac standpoint. She was intubated for about 36 hours after surgery because she was just unable to wake up and breathe on her own. After that, however, she was back to her old self of being feisty and demanding :) The biggest hurdle that we have faced since surgery has been her not eating. The next three days after being extubated were just awful. She was hardly taking anything by bottle, and not seeming to make any progress from one day to the next. I was feeling so hopeless and sad about this. I know this is our last task before getting to go home. She has to be eating!
     Today, thanks to our wonderful speech therapist Amy Clare, we had a breakthrough! At her morning feeding, she noticed that Breckin looked like she was aspirating her milk. She worked quickly and within 20 minutes, we had her downstairs doing what's called a modified barium swallow. They took an x-ray of her being fed to see if she was aspirating the breast milk. After a few swallows, they saw that she was aspirating. To fix this problem, they thickened her milk with stuff called nectar to prevent it from going down her trachea. The first feeding with the thickened milk seemed to go okay. Amy Clare fed her and said she was doing great coordinating her suck, swallow, breathe actions. She only took about 7cc at that feeding, but Amy Clare was very pleased with this. At her next feeding, I was on my own. We had a nipple that had been cut at the top to make the hole larger to try to help Breckin get more milk. At this feeding, she was much more interested in eating and she ended up taking 17cc-more than half of what she took at her last feed! I was definitely one proud mama!
     I am so thankful for everyone's prayers and I can totally see God doing amazing things in Breckin's life. She has been in this world not even two weeks and already she is making a lasting impact on so many people. She has more strength already than I imagine I ever will. It's strange even saying this but despite all of her health problems, God has truly blessed her. She is already such a blessing to me and I cannot wait to get her home and live with her as a family of four.


Love,
Brooke

   Getting her barium swallow test

Right after her heart surgery                                          

Week One

     This may be a long post because so much has happened since our sweet baby girl came into this world. I guess I should start at the beginning. Breckin Elizabeth Helms was born on December 3rd at 3:14 pm with an uncomplicated and quick delivery. When she first came out, her whole body was blue. She was rushed over to the corner of the hospital room where all the NICU people were waiting for her. Her oxygen was very low and her heart rate was low as well. They immediately attempted to intubate her, but were having trouble. It was minutes before she pinked up, but they were the longest few minutes in my life. The thing that kept going through my mind was that we were going to lose her. She made it through the pregnancy, but this was going to be it. Thankfully, she survived and she is still with us.
     I got to hold her for about two minutes and then they sent her to the NICU at Methodist Germantown Hospital. A couple hours later, Josh and I got to go up there and see her. To me, she looked like a normal healthy baby. She had good color and she wasn't on any oxygen. She was hooked up to all kinds of monitors though. After about 30 minutes, the transport team from LeBonheur came to get her and sent her off to the CVICU at Lebonheur. Josh went down there immediately afterwards, and I was discharged a couple hours later to come down. I left the hospital 5 hours after giving birth and it was by the grace of God that I was feeling ok enough to do that.
     When I got to the CVICU, Dr. Johnson, a cardiologist, was there to update us on Breckin. She had just gotten an ECHO done of her heart and he was about to go over everything. He said she does not technically have hypoplastic left heart, but more like just hypoplastic left ventricle. The right ventricle is working overtime to pump blood out to the lungs and body. She also has what's called double outlet right ventricle where the aorta connects to the right ventricle instead of the left ventricle. Also, both the pulmonary artery and aorta are on the right side carrying blood to the lungs. The good thing is that this is a little less severe than HLHS, but will still require two open heart surgeries, along with her first surgery that will not be a full open heart surgery, but a less complicated procedure.
    So along with anticipating some type of heart surgery relatively soon, Breckin also has several other congenital problems. She has what's called a Dandy-Walker malformation, which we knew in utero, but she also a cleft palate and poorly developed structures of her eyes.
    The Dandy-Walker which was confirmed on MRI, is considered a moderate one. For now it is not causing any problems, but if it were to grow, it could cause seizures. It will likely cause Breckin to have cognitive, motor, and speech delays. As of right now there are no interventions being done, but she will start therapy early on to help with these issues. She will be followed by a neurologist and will probably undergo another MRI once the brain has grown to assess it and see if it has worsened.
   The cleft palate will be able to be surgically repaired when she is 9 months-1 year of age. The ENT who saw her says it is one of the less severe ones he's seen. This has caused some problems with her latching when trying to feed with the bottle, but she has taken some milk by bottle. The main reason that she has been having trouble eating however is because of her heart. Because she is working harder to pump blood through her body, she tires very easily. The cardiologist said that trying to eat for Breckin is like me trying to climb up flights of stairs.
   The issue with her eyes is one that we are not certain of. The ophthalmologists who came by to initially assess her have not been by since we received the MRI results. The neonatologist just said that by the looks of things, there is a poor prognosis that she will have some type of vision.
   Since we have been here, Breckin has been seen by neonatologists, cardiologists, ENT doctors, neurologists, ophthalmologists, and geneticists. This whole visit has been so overwhelming, stressful, frustrating, anxiety-ridden, and scary. We do not know what all this will mean for our little girl. We do not know what type of life she will lead, but I do know this: Jeremiah 29:11 states,"For I know the plans I have for you...plans to prosper you, not to harm you; plans to give you a hope and a future." I just keep reciting this over and over in my head and praying this verse over my sweet Breckin.
  I am devastated that my daughter was born with all these problems and my heart breaks for her that she will have to overcome so many struggles. My prayer is that the worst-case scenarios that these doctors are giving us do not come true. However, I feel that I need to be fully prepared for Breckin not to be able to see, walk, talk, etc. I do not know why God picked me to be her mother; why he thought that I could handle all this. I do know that He will give me the strength I need to be her mother and to get through each day with her. This week has probably been the hardest week of my life, and I'm not really anticipating it to get easier anytime soon.
   Please continue to pray for us and our sweet baby girl. As I write this, Breckin is recovering from her first heart surgery. I plan on writing a separate post on that soon.

Love,
Brooke
 

God is With Us

    I will be 38 weeks pregnant tomorrow! I never would have thought that this time last year we would be preparing to have another baby. I was pregnant last year, and we had what's called a fetal demise at 15 weeks. At a routine doctor's appointment, there was no heartbeat found in our baby. We were completely devastated. I mourned the loss of that baby for a long time, and there are still days when I think about him or her resting with Jesus.
    A little while after our loss though, we started trying to get pregnant again. Months went by with no luck. I was convinced I just wasn't able to get pregnant and we would never have another child. God, however, knew what he was doing. He was already creating this wonderful baby girl to be ours. In our church bathroom nearly 8 months after losing our baby, I held my breath as I waited with a best friend for the results of a pregnancy test. It popped up positive and I truly couldn't believe it.
    This past year and a half has been full of surprises, unknowns, and heartbreaks. But it has also been a time where I have come to know my Lord even more. I have come to know Him as God Most High, who is sovereign over everything that happens in my life. I have also known Him as the Creator, who has created each and every person on this earth for a purpose-to glorify His name. These are just a couple of the names of God that have stood out to me through this season, and I know He will reveal Himself to me in even more ways in the days to come.
    We had an appointment this week with Breckin's cardiologist to get a last look at her heart, and to make a final determination on whether I could try for a vaginal delivery or not. The time with him was once again reassuring. He was very pleased with the condition of her heart and is very optimistic about her surgery. He told us most babies that he sees delivered with HLHS are born around 36 weeks and weigh about 5lbs. Here we are already at 38 weeks, and Breckin weighs over 6lbs! Her heart rate was a little lower than normal, but from everything he looked at he didn't see any concern with it. He also said he sees no problem with me having a vaginal delivery. So, I am scheduled to be induced December 3rd. In a week and a half, we will get to meet our baby girl!
    There are still so many unknowns in this situation, but through my past I can see that God has been with me and will continue to be with me. The unknowns to me are not unknown to Him. This reminds me of a song I heard recently that says:
  I don't need to know what's next
  You'll be with me every step
  Through it all, I can see
  You carry me


Love,
Brooke

Getting Stronger

     We went to our last cardio appointment before Breckin will be born yesterday. Dr. Joshi greeted me with a "You've gained weight!" He tried to clarify by saying, "Well I didn't say you look fat." After some confused looks by me and a reprimand by the US tech, he went on to explain that it was a good thing. It meant that the baby is growing and he would be worried if I wasn't gaining weight. So it was nice to start the appointment off with a little laugh :)

     Breckin's heart rate was a little low during the beginning of the ultrasound, so the tech had me lie on my left side for a few minutes to try to "make baby happy". Her heart rate soon came back up to normal, thankfully. They began looking at every little part of her heart, and taking measurements. Dr. Joshi was very pleased with the size of her aorta. He actually said it had improved! She has great blood flow in it. He checked her pulmonary veins and all her heart valves, and everything was working properly with pro grade flow (meaning the blood is flowing in the direction it's supposed to). 

     He finally measured the Dandy-Walker in her brain and checked the ventricles in her brain. Everything there was stable, and there was no enlargement of the ventricles or fluid in the brain. The US tech said it has actually improved since it has not grown at all with the growth of her head!

     After the US, we talked with Dr. Joshi. He told us about a possible alternative surgery for Breckin called a Hybrid procedure that could be done since her condition is not as severe. This would be done a few days after birth and would be a less complicated surgery than the Norwood. The Norwood would then be done when she is a little older around four months. If the Hybrid is done, it would make things a little easier on her and us in the beginning of her life. However, saving the Norwood for later would make it difficult on us down the road. So there are advantages and disadvantages to both ways. He did say though that even if they decide to do the Norwood at birth, it will be an easier surgery as compared to other babies with HLHS that have a more severe case.

     Overall, this was such a positive visit. I felt so much peace after we left that God would continue to improve Breckin's heart and brain. Prayer has been so powerful throughout this pregnancy, and I know that it will continue to be as Breckin grows. God is so faithful and truly does work in awesome ways!

Here is our sweet one who cooperated so well at this visit!

My God is Big

     Several people have asked about all my recent doctor's appointments, so I thought I would just put one big update on the blog. I have had four doctor's appointments in the past week and half, but it's not as bad as it sounds. The first appointment I had was the glucose test to rule out maternal diabetes. Good news: no diabetes! I passed with flying colors! I was so relieved that I didn't have to give up my carbs. :) I also learned that I'm a little anemic so I have to take an iron supplement now.
     As I last mentioned, I've been on light activity because of my increased amniotic fluid. Last Friday, I worked a 10-hour day, and had so many strong contractions that afternoon. I didn't think too much of it because lately at work, I've been having more contractions. Well, over the weekend, they seemed to be constant and stronger than they had previously been. So, I called the doctor Monday and they wanted me to come in and be evaluated.
     Tuesday, I saw the nurse practitioner where she hooked me up to a monitor to check my contractions. She said I was definitely contracting and she kept saying my uterus was "irritable." However, she said it did not look like a pattern of labor. She checked my cervix and there was no dilation, and after an ultrasound, they learned that my cervical length was great. These things all mean that I am not in pre-term labor. The nurse practitioner decided to put me on bed rest for the next 48 hours and have me be reevaluated with my OB on Thursday.
     So for two days, I watched a lot of HGTV, finished a book, and knitted two pair of baby booties. My family and friends have been so great this week! They have helped with Harper, brought meals, cleaned my house, and just given me some company. I am so blessed to be surrounded by amazing friends and family who will literally do anything to help us out. I also want to give a special thanks to my husband who has been waiting on me hand and foot. He's also been doing extra little things around the house that I usually do, but can't right now. I am really a very lucky woman!!
     Thursday's visit was sort of uneventful. My doctor let me go back to work for a half day to see how the contractions go, and then to come back that afternoon for an ultrasound. My employers have been so awesome to let me work shorter days and do mostly seated work. I had some contractions at work when I would get up and just walk down the hall, or get up to see a patient. But, I made it through my half-day and on to the doctor for the third time this week!
     The first thing they did was get an ultrasound. My cervical length was great again, and to my delight, my fluid level had returned to normal! I learned that at Dr. BK's office only a week and a half before, my fluid level was 30 cm. Anywhere above 25 is considered abnormal. This day it was 17cm! Another relief! My OB decided to keep letting me work a few half-days at work and then to really rest and take it easy the rest of the time.
     It has been a crazy stressful week, but there have been so many blessings! God has just continued to remind me this week that he is so much bigger than me and my circumstances. It's like He's constantly saying, "Trust me." Throughout this whole pregnancy, when I have thought the worst, every situation has turned out so much better than I imagined it would be. I just continue to give Him praise everyday!

Love,
Brooke

A Short Update

     I don't have much to report today, but there are a few small updates from our two doctor's visits this week. Tuesday, we saw Dr. BK (the maternal-fetal specialist), and had another ultrasound. It's been four weeks since we had one, so I was missing seeing our little girl. I had almost forgotten that she had any kind of heart or brain abnormality. However, I was quickly reminded of that when they started the ultrasound. The good news is that everything is stable. The left side of the heart is still smaller, and the brain still has a fluid-filled cyst; but, nothing is getting worse. The ultrasound tech measured the ventricles in Breckin's brain and they are normal and not dilated. She said this was a good sign, because it means the cyst is not getting worse. 

     The tech then began doing measurements after she had checked her heart and brain. Breckin is measuring exactly where she should be. She is growing and developing right on track, and for this we are very thankful! However, I have too much amniotic fluid. I first thought, oh well this is good because too little is bad right? Well too much can be bad also. It puts me at a higher risk of pre-term labor causing early contractions or the amniotic sac could rupture which would also cause premature delivery of the baby. These are two things we definitely do not want to happen! So, I have been put on modified activity meaning no heavy housework, no long walks, and no big grocery trips! The nurse practitioner I saw also said this extra fluid could be a sign of gestational diabetes :(

     My visit today was with my regular OB and she did my glucose test. I won't know if I passed until sometime next week. I am really hoping I do not have gestational diabetes. I'd hate to have to give up my beloved sweets for three months! She also measured me today and my belly is measuring at 28 weeks instead of the 25 weeks that I am. She said this is due to all the extra fluid I have. This explains why I've been feeling so uncomfortable lately!

     I am grateful that Breckin is doing well and everything is stable with her. For all those prayer warriors out there, please continue to pray for continued healing and improvement in her little body. Also pray for me that the fluid will decrease to a normal level, and there will be no hint of any preterm labor. This week at Bible Study, I was reminded of this verse from Matthew: "Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own." (Matt. 6:34) I have to remember this daily; to take each day at a time, and not worry about what the future holds.

Love,

Brooke