The finish line is in sight

It has been a very exciting weekend for the Schlegel boys.  On Friday afternoon, the doctor called me to ask when our boys decided they knew how to eat.  They have made pretty amazing progress over the past few days.

Anderson is weighing in at 6lbs, almost 8oz.  His feeding tube was removed Friday afternoon and he has been taking all of his feedings by mouth and doing very well!  He has been drinking solely breast milk (no fortifier) and still gaining weight, so he will probably remain off the fortifier unless our pediatrician has a different plan.  For right now, the plan is for Anderson to continue taking all feeds by mouth on Sunday and then to have his 10 hour sleep study on Sunday night/Monday morning.  They will monitor him to ensure he continues to breathe, has no dips in heart rate, etc.  If he passes, then he will have his 1 hour car seat test on Monday morning.  If he passes that, Ty and I will come to the hospital on Monday night and room in with him!  The hospital has rooms that look fairly similar to a hotel room where we will be able to stay the night with Anderson.  Nurses will come in periodically to check on us, but for the most part, Ty and I will be on our own with him.  If all goes well, Anderson could be home by Tuesday afternoon.  We are ridiculously excited for this.

Carter is also doing really well.  He is up to 4lbs, 14oz.  The doctor transitioned him to a different fortifier, one that he can continue taking at home. He is taking 2 out of 3 feedings by mouth and is doing pretty well.  He certainly still gets tired and sometimes has to have the feeding finished through his tube.  But with each day he gets stronger, so we are seeing an increase in what he can take.  The doctor has scheduled his hernia surgery for Wednesday morning at 10am.  They do not perform surgeries on babies at the hospital we are at, so he will be transferred on Tuesday to a different hospital.  The doctor hopes Carter will be taking all feeds by mouth by the time of his surgery so that he can get the surgery, have a few days to recover in the hospital, and then be discharged home.  If he isn't doing as well on feedings, he will have to stay at the hospital until he can take all feedings by mouth consistently.  

We are praying Carter is able to complete his feedings before the surgery for many reasons.  It will be difficult for us to get used to a new nursing staff, a new doctor and a new hospital. The hospital is also downtown and therefore harder to get to as often as we would like.  Also, we believe we might have Anderson at home, so the logistics of feeding one baby in the hospital, and one baby who is home (and cannot come with me into the hospital) will be a little bit tricky.  Most importantly, we are hoping Carter can complete them because it means he is getting bigger and stronger and is ready to come home with us.  

We will keep you updated on their progress this weekend and early this week.  Hopefully I will have at least one baby home very soon!  

More feedings by mouth

Anderson moved up in his feeding plan.  He now receives 2 feedings in a row by mouth, and then one by tube.  He needs to do this consistently for a few days and then they will move him to taking all feedings by mouth.  This new plan started last night and he has taken all of the feedings thus far, so we are hopeful that he is close.

We had a bit of a scare with him a few nights ago.  He consistently had some blood in his diaper and the doctor became concerned about the cause, so he ordered an x-ray.  The x-ray looked okay, but not completely clear, so he ordered another x-ray for the following morning.  Luckily, the next morning it appeared that everything was  clear and the doctor was no longer concerned.  He removed the fortifier from his diet and believes this was likely the cause for the blood. Anderson has been on breast milk only for the past few days and they are hoping he will continue growing solely on breast milk and then they can keep him off of a fortifier.

Carter is still doing very well with getting his feeding by mouth every other time. He has not consistently taken all of it, so it might be a few days before they increase his feedings by mouth.  He definitely knows how to do it, but he just gets tired.  As he gets bigger and bigger, it seems to get easier for him to take down the feedings.

Their weights have remained pretty stable.  They both lost a bit over the past few days, so they're working on gaining that weight back.  Carter weighs 4lbs, 10.5oz and Anderson weighs 6lbs, 7.5oz.

Hopefully one of these days soon we'll be posting that the boys are taking all feedings by mouth and are headed home!

Pictures of the boys

Not too much new to report today.  The feedings are going well and we are hoping they will increase the amount of feedings by mouth in the next day or so.

Here are some pictures of the boys:

Anderson in his puppy hat from Aunt Cait

Grandma Jean holding both boys (the boys are staring at each other, probably wondering who the favorite grandchild is)

Carter and Grandma Jean hanging out (Carter is trying to remove his feeding tube)

Caught Anderson dancing in his crib

2 months old!!!

Carter, contemplating the mysteries of life, beginning with why he has a large orange pacifier that smells like vanilla in his mouth 

Yet another post about feeding...

There's really not much else to post about other than feeding and growing. Fortunately, both boys are making great movements in both of those areas.  Carter is weighing in at a whopping 4lbs, 11oz!  And not to be outdone by his older brother, Anderson is weighing in at 6lbs, 5oz!  Every time we start to think Carter is catching up, Anderson has a great day as well. It is really fun to watch them grow and begin to interact with us more and more. They can stay awake longer, lift their heads up and make extended eye contact with us.

Their feeding is steadily progressing as well.  Both boys are now receiving 4 feedings by mouth per day, or every other feeding.  They have both been consistently taking their whole bottles and breastfeeding well.  Carter has actually turned into a much better breast feeder than his brother, but we're hoping Anderson will come around someday soon. As long as they consistently finish their bottles, they will up them to 6 bottle feedings per day, and then take all feedings by mouth.  They need to do each of these steps for 48 hours, consistently finishing each feeding.  We are hoping they keep doing as well as they are and they could potentially be home in the next two weeks!  

They had their two month birthday on Friday, which means they received their 2 month shots this weekend. It was not a great day for them, but they already seem to be fairly well recovered.  Ty and I were planning to be there for it, but the pharmacy didn't have the shots ready, so the nurse gave them the shots at 2am on Saturday.  We can't decide if it was better we weren't there or not.  

Labs this week looked really good. Carter's bone growth and hematocrit continue to look good.  His direct billirubin increased, but only very slightly.  The doctor hopes this is an indication that the level is plateauing and will begin to decrease.  The doctor increased Carter's medicine for this once more, and still has more he can prescribe if Carter's level doesn't decrease.  We are hoping this won't be necessary, but we're glad it's an option.

Overall, both boys look great.  We are starting to get very excited about having them home.  The doctor said we couldn't quote him on this, but that Ty should certainly have them home with him to watch the first college football game of the season.  We'll just have to decide which team's apparel they will be wearing that day....... 

Slowly but surely learning to eat

The Schlegel boys reached a great milestone today.  Both boys finished their entire bottle this evening, 44ml for Carter and 50ml for Anderson.  They had a pretty big day today with baths and an eye exam, so it was even more incredible that they both finished their whole bottle. Anderson also finished his entire bottle this morning, so we are hopeful that he is really starting to get it and will begin finishing the bottle at each feeding.

Their eating is definitely helping them gain weight.  Anderson is now 6lbs!!!!  It's pretty amazing to hold him now and think about how tiny he once was.  Carter is still gaining as well, weighing 4lbs, 5oz.

Their eye exams went very well this morning. Both of them have progressed in their vision and the doctor believes they will not have any vision problems resulting from their prematurity.  The will likely have to get one more eye exam in the hospital and then will have a follow up appointment at 6 to 9 months post release.  We are very excited that both boys are now cleared for both their vision and hearing, two things the doctors worry about with tiny babies.

The doctor increased Carter's dosage of his liver medication. I spoke with him today about why Carter's direct billirubin has continued to increase. His level is at 3.8, but the doctor assured me they really start to get concerned when it is in the mid to upper teens, so Carter's level is not alarming yet. The doctor did increase the dosage to hopefully see some decrease in his labs this week.  We will keep you updated on how it goes!

Lab results for the week

The boys had their labs taken for the week yesterday.  Anderson's labs all looked great.  Carter's were almost all good.  His red blood cell production is up, so he no longer needs his shot to increase them.  His bone growth also increased significantly, so he is no longer receiving calcium and phosphorus.  The only result that was not good was his liver. His direct billirubin increased again. The doctor does not seem concerned about this. Carter has only been receiving the medicine for a week and it likely has not had time to work yet. Additionally, they have eliminated most of the major concerns for what could be causing this by doing ultrasounds.  They believe it is likely related to his small size at birth, or a buildup from some of the IV meds he received when he was first born.  For either of these scenarios, he just needs to get bigger and older.  They will continue to watch this.

Carter has his hearing exam done this week and passed in both ears!  Similar to his brother, we were fairly certain that he could hear, but it's always good to have it confirmed.

Feedings are going well this week.  Anderson is consistently taking the majority of his bottle.  Carter is having a little bit more trouble finishing his, but he is probably getting tired faster since he is out in an open crib.  This morning he did a great job, so we are hoping he is acclimating well to being out in an open crib.  His temperatures have been great, so he will likely be able to stay in the open crib for the rest of his stay at the hospital.

Both boys are doing great.  We are starting to get a little bit anxious to have them home, but we know its best for them to be at the hospital until they are eating well.  Their weights continue to increase though, so we're hoping the end of their hospital stay is coming in the next few weeks or so. Carter is weighing in at 4lbs, 2oz and Anderson is 5lbs, 14oz.

A cause for celebration!

The Schlegel boys have given their parents, friends and family plenty of reasons to celebrate this weekend.  To start with, on Friday afternoon, the doctor decided to try Carter out in an open crib.  He was not quite 4 lbs yet, but they thought he could do it.  Ty and I were there to give the boys a bath, and then helped put them in the crib together.  It was pretty incredible.  We laid them in there with their heads turned towards each other and they just kept staring at each other.  I guess they were wondering where the other one had been for so long.  Here is a picture of when we first put them in:

The trend seems to be that Carter is fascinated by Anderson, and Anderson is largely ambivalent.  

Carter had to keep his temperature up for 24 hours before they would be moved into a permanent open crib together.  He did great and they were moved into a larger crib together on Saturday evening.  They use cribs from pediatrics to put multiples together in order to have enough space to change diapers, check temperatures, etc.  Here is their new home:

The nurses are waiting on some tables or shelving to put near the crib to get all their stuff out of the way.  Luckily for now, two babies weighing just under 10lbs combined don't take up too much room.

The sign above Carter's head may have given away his other big news.  He successfully crossed the barrier and now weighs 4lbs!!!  This is great for a number of reasons.  1) Gaining weight is always good (for premature babies), 2) He can now be out in an open crib, 3) He now weighs enough to fit into a car seat, so he will be able to go home at this weight once he gets his other stuff figured out, and 4) 4lbs just sounds better than 3.

Anderson also gave us a great reason to celebrate.  He finished an entire bottle on Saturday night!!  He drank all 47ml fairly quickly.  What made this even more impressive was that he had breastfed immediately before this for 15 minutes and had a fairly good feeding just through that.  We are hoping he has had his light bulb moment and will begin taking down his entire bottle each time we feed him.

The boys are both on the following feeding plan: They can receive 3 feedings per day by mouth, 1 by bottle and either 2 breast feedings or 1 breast feeding and 1 bottle feeding.  If they breast feed for less than 10 minutes, they receive half of their feeding through their tube.  If they breast feed for 10 minutes or longer, they get a bottle to supplement if they are still hungry.  Both boys are actually great at breast feeding and haven't had to get a tube feeding in a week or so.  We are hoping the doctor will increase the amount of feedings they receive by mouth in the next few days as this will be a huge step towards them being able to come home.

Their feedings have increased due to their weight increases.  Carter gets 40ml per feeding and Anderson receives 47ml.  It's pretty amazing that Carter is taking in almost as much as his brother, who currently weighs 1lb and 13oz more than him.  We keep thinking Carter is closing the gap in weight, but Anderson keeps on packing on the pounds as well.  Anderson currently weighs 5lbs, 13oz.

As Carter puts on more and more weight, Ty and I are starting to think they may look alike.  Here are a few pictures that we think show some similarity:

Which baby am I?  

And which baby am I?

As I put these in, I'm not sure if the similarities show up as well in photos, but oh well.  The first one is Anderson and the second one is Carter.  Carter definitely looks similar to the photos of Anderson that we have when he was 4 pounds.

Here are a few more pictures of the boys:

Anderson getting a bath

Carter gets a bath

Anderson avoiding Daddy (but looking like he's thinking hard about when to turn)

Then he gives Daddy a little half smile (He learned this tactic from his Mom; just smile halfway and hope the camera  moves back away from your face)

Anderson is also working on eye contact.  He seems to have it down pretty well in this picture.

Carter takes getting a bath much better than his brother, even though he has much less fat to keep him warm

The sweet sign the nurses made for Carter today to celebrate his achievement

Carter practicing his wink at the nurse holding him

Getting taller and wider

The Schlegel boys are having a great week for growing already. Anderson weighs 5lbs, 7oz and Carter weighs 3lbs, 11oz.  The nurses measured the boys this weekend and both are getting taller as well.  Carter is now 15.75 inches tall and Anderson is 18 inches.  I looked back in their charts to see where they started and Carter was 12 inches tall when he was born and Anderson was 15.  The length is the least accurate measurement for the boys, but it's still great to see progress.  Their heads are also getting bigger. Carter's head is now 11.75 inches around (9.5 inches at birth) and Anderson 's head is 13 inches around (10.5 inches at birth).

Feeding is going really well for Carter. This morning he breastfed for quite awhile and then took 27ml from a bottle.  The doctor has increased the amount of feedings he gets from the bottle per day, so now he is getting 2 bottles and 1 breastfeed during the day and then one additional bottle feeding from the night nurse.  Anderson is doing okay.  He consistently takes from 15-25ml from the bottle, but he still had never taken half of his bottle.  any day now, the nurses believe the light bulb will just go on for him and he'll start gulping, so we are hopeful for that.

Their labs looked pretty good this week.  They took Anderson off of the caffeine because he had not had a cardiac or respiratory episode since June24th.  This is good progress because they need to take him off this and observe him for a few days before they would allow him to go home.  While he still isn't quite ready to go home, it's good to have this observation out of the way.  All of his other labs looked great as well.

Carter's red blood cell count is still rising which is great.  He is still receiving a shot three times a week to help his body produce more red blood cells. His bone growth was increasing this week according to the labs which is great. He will continue to receive calcium and phosphorus for a few weeks in order to continue this growth.  His direct billirubin count was higher again this week, so the doctor decided to give him a medication which will help his liver produce bile. He gets this medication once per day and then they check his labs every week to see how it's working.  This is a medication he could continue to receive at home, so it's nice that this will not be something holding him back from coming home.

Anderson had his hearing test this week and he passed in both ears.  We weren't too worried about this for him because he definitely seems to respond to our voices, but it was nice to have it confirmed that he is hearing well.  We are not sure when Carter's test will be done, but probably over the next few days.

Carter is still in his little isolette.  The doctor decided it was best to leave him in there until he is 4lbs in order to conserve energy.  The doctor increased his bottle feedings instead, because Carter learning to eat is more important at this point and he needs all of his energy to be able to do so.  Carter's temps have been great this whole time, so we don't think he should have any problem maintaining his temp once they let him out at 4 pounds.

We will try to take a few more pictures this week and post them soon!

Eating and Growing

Our boys are now classified as "feeders and growers" by their nurses and doctors.  They are just working on getting bigger and learning how to feed, and then they can come home.  They have been making some pretty great movement on both fronts.

Ty and I have been whispering in their ears to wait to poop until they are weighed for the day, just to give them a few extra ounces, and they clearly have been listening.  Tuesday was a big growing day for both of them.  Carter weighed in at 3lbs, 6oz and Anderson tipped the scales at 5lbs, 2oz.  Yesterday they both seemed to just be maintaining their weight since they had just grown so much the day before, but they clearly were working hard.  Carter weighed in at 3lbs, 8oz today.  3 and a half pounds!!!!  I was celebrating this big gain for him and thinking he was clearly closing the gap between him and his "little" brother.  But then I opened Anderson's chart and saw that he gained as well.  Anderson now weighs 5lbs, 9oz!  Just when we thought Carter was getting close, Anderson widened the gap to a 2lb, 1oz difference.

The doctor was pretty shocked by how much they both gained, so he warned us not to be discouraged if either of them actually loses weight tomorrow.  We are confident they will continue to follow our excellent parental advice to hold that poop in until they're weighed.  Perhaps not so great for their GI tract, but we can work on that later.

As evidenced by their weight gains, they both seem to be digesting their new fortifiers well.  Although you'd never know that Carter's has quite a few more calories in it than Anderson's.  Since they have gained, they are now getting more volume per feed as well.  Carter is getting 33ml (just over an ounce) and Anderson is getting 46ml (just over an ounce and a half).

They are making progress on the feeding front as well.  Carter has definitely taken the lead in figuring out how to eat and surprised us all by taking his full bottle on Tuesday afternoon!  He was being fed by the speech therapist and she couldn't believe it.  He took all 33ml down in under 30 minutes and then digested it all.  He was pretty tired afterwards.  Since then, he and Anderson have been taking around half of their bottles which is good progress.  We are hoping they will continue on this path and start taking the full bottle each time.

Feeding and growing are really our only updates from now on, unless something takes a turn for the worst.  Breathing and heart rates have been great, so no more episodes to report.  Once they get closer to coming home, this will be a bigger deal as each episode of bradycardia (low heart rate) and apnea (stoppage in breathing and low respiratory rate) buys them another 5 days in the NICU.  So if we were ready to head home and Anderson had a dip, we would have to wait another 5 days before he could leave.  It is great because this ensures we have very healthy babies to take home, but I can only imagine how frustrated Ty and I will be at the time if that happens.

A few more pictures:

Daddy giving some love to Carter

Anderson in his great new outfit!  Thanks Grandma Jean.  (In case you were wondering, those are the tiniest shorts in the world and are just as cute as you think they are)

Daddy and Carter again.  They give the boys pacifiers to help them learn how to suck and Carter has got it down.

Anderson in a big boy outfit.  Thanks so much Heather!

Our little firecrackers

Since we aren't allowed to have fireworks in Texas this year, we were counting on our boys to provide some entertainment over the holiday weekend.  We thought we had a reason to celebrate yesterday when they moved Carter to an open crib, right next to his brother.  But when we got to the hospital this morning, Carter was back in an isolette.  He got cold overnight and was not maintaining his own temperature, so he will be in the isolette for awhile.  In his defense, they typically wait until babies are at least 4 pounds before putting them in the isolette, so Carter still has a bit to go.  We actually believe he tried to make himself cold so he could go back in his quiet and dark isolette.  Right when he was taken out yesterday, our boys got a very noisy new neighbor.  A full term baby who just needed some breathing assistance was brought in and placed about 5 feet away from them (the NICU is over capacity right now).  Full term, full size babies can really make a whole lot of noise. So we think Carter just realized "Hey, why would I want to be out here where it's noisy and cold?"

While we are sad that they can't both be out in the same crib together, we know it's good for Carter to still be in an isolette.  This way he can use his energy for growth and practicing feeding, rather than trying to keep himself warm.  Turns out when you only weigh 3lbs, you don't have much fat to keep you warm.  Who knew? :)

The boys are still growing though.  Anderson is so close to the 5lb mark at 4lbs, 15oz.  Carter is 3lbs, 3oz.  Their feedings are going okay.  They have good days and bad days.  The nurse provided some comfort to us yesterday when she reminded us that all babies learn how to eat.  It's not a question of "if," it's a question of "when." They seem to get all of the mechanics, but sometimes are too tired to put it all together, or in Anderson's case, perhaps a little too lazy.  Right now, the doctor's orders are for them to breastfeed once per day.  If they breastfeed for less than 10 minutes, we give them a full feeding through their tube.  If they feed for over 10 minutes, then once they are done, we just offer a bottle to see if they are still hungry.  Anderson fed for quite awhile last night and wasn't interested in a bottle afterwards, so he may have taken his full feeding.

They have changed the fortifier that the boys are taking.  The fortifier they were on before was specifically made for preemies and is not something the boys could still be on when they leave the hospital.  They transitioned Anderson to a different supplement that is for transitional babies (e.g., from preemie to more newborn size).  Carter is getting a different supplement that has more calcium and phosphorus in it to promote bone growth.  Carter's supplement also has more calories, so hopefully it will help him to grow as well.  They are both taking in more food as well.  Anderson is up to 42ml per feeding and Carter is taking 31ml.

Carter's hemoglobin levels were back up to normal this week which is great. They will continue on his shots just to ensure that he can make enough red blood cells and then see how he does on his own.  His billirubin count was a bit higher, so the doctor is continuing to monitor that.  His liver appears to be functioning well, so the doctor is not too concerned and thinks he will grow out of this as he gets larger.

Here are some new pictures of the boys:

Anderson wearing his "Handsome like Daddy" shirt

Anderson taking a bottle

Anderson getting his temp taken (whichhe hates), but wearing his cool shirt from Grandma Jean (and you can't see the ridiculously cute plaid shorts that match it)

The boys getting a bath (Carter went first and Anderson is staring at Megan very concerned about the bath) 

Carter taking a bottle

Carter getting ready for a bath and taking it like a champ

Carter in his hipster hat

Gaining weight!

It was a big day for Carter yesterday. He gained 3 oz, bringing him over the 3lb barrier!!!  He is now 3lb, 2oz.  He is still doing pretty well at his feedings.  2 nights ago, he took in a personal best from the bottle, 23ml.  He is now getting 28 ml per feeding, so he's doing really well.  He needs to consistently take over half of his feeding from the bottle and then they will begin to increase how often he is fed through the bottle or breastfeeding.

Anderson is also growing.  He is up to 4lbs, 11oz.  He is not quite as good at feeding as Carter, but he's working on it.  His record is 17ml out of the bottle, but he gets 38ml per feeding, so he's not quite up to half.

No other updates today. Hopefully Carter will leave his isolette soon and join his brother. We'll let you know!