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I realized he was smiling after I took the picture!  He loves his great-grandma!







Oh how I have longed to write this...it's time to go home.  On Monday we were moved into a room with Josh.  This is our preparation for going home.  We have been taking care of him ourselves.  The nurses are available if we need them.  We are happy for this time to transition. 

Joshua had a sleep study on Sunday night.  It was a follow-up from his study four weeks ago.  They said that he had improvement from his last study but he still had periods of apnea.  Therefore, they are sending him home on a monitor.  He'll have to wear it while he's sleeping.  A loud alarm will go off anytime he stops breathing for a certain period of time. 



His new splint!





 

Also, he has a splint that he will be wearing at different intervals throughout the day.  Since his right foot is slightly deformed, the splint will be used to loosen the muscles and help reposition his foot. 



We must say, we will miss the people here.  It was bittersweet leaving the NICU to go to our room.  It means progress and finally being together as a family.  With that being said, we will miss our new friends.  Joshua has gotten wonderful care and the staff is absolutely amazing.  It has been hard to leave Joshua every night and periodically throughout the day but knowing he was getting exceptional care helped us sleep at night. 





We're excited to be going home tomorrow.  It seems surreal.  After being here for 48 days, it's time.  Today was our first full day with him.  We spend a majority of it holding him and playing with him.  We're making up for lost time!  We'll be coming back next week for a follow-up appointment in which they will do another ultrasound to check his ventricles.  Joshua will continue to have peiodic appointments throughout this upcoming year.  Please continue to check our blog.  Joshua's story is not done yet!

--Kim, Matt, and Josh (finally!!!)









This wasn't a small victory, it was huge!

Stress is what started this day.  We were already stressed thinking about the upcoming ultrasound.  The nurses had stopped feeding Josh at 4am in case he had to go to the operating room for a shunt.  When we walked into the NICU, we could hear him crying from the door.  He was miserable.  To further complicate his misery, the central line, which is what they implanted in his chest to substitute for an IV line, came loose during the course of the night.  They noticed that his entire blanket was wet after his IV fluids (for the possible surgery) were started.  His chest looked swollen and sore.  The surgeon from the operating room had to come up to pull the line.  However, he needed to have an x-ray to make sure it was really out of place.  After the x-ray, the surgeon pulled the line.  Then finally the ultrasound technician came up to do the ultrasound.  The little guy hadn’t eaten for seven hours, was given a bedside x-ray, and had a tube pulled out of his chest.  Keeping him still for the ultrasound seemed like it would be harder than it actually was.  After the ultrasound tech finally left, it was a waiting game.

About an hour later, Matt and I were changing Joshua’s diaper when I looked up and our nurse was on the phone.  She came over to us with a smile on her face and tears in her eyes. She heard from neurosurgery and they told her that the ultrasound showed that his ventricles were normal and that they were going to begin transitioning us to go home.  We were overjoyed and can’t believe we’ll be going home shortly.  On Sunday they will do a sleep study on Joshua since his last sleep study showed that had some apnea.  On Monday he will do another ultrasound to make sure everything is okay before letting us leave.  We will spend the night with him in a room at the hospital and probably end up leaving on Tuesday or Wednesday.  We’ll be going back to the doctor every Monday so that they can do an ultrasound to check his ventricles.  There are many reasons that we don’t want Joshua to have a shunt but here are the cold hard facts: 80 – 90% of kids with spina bifida get a shunt.  After getting a shunt, it usually will fail or become infected within the first 6 months.  On average, they need to be modified 2 to 3 times before a child is 18 years old.  Typically if a child needs a shunt, it will show in the first 7 days.  After that it’s most likely to occur within the first month.  If you make it out of the first month, the chances reduce drastically again.  If you make it out of the first year, the chances are much smaller yet. 

Today was a huge victory!  I can’t believe our time has finally come.  We felt like we were perpetually “2 weeks away” but finally the end is in sight.  It felt hopeless towards the middle of the process.  I think back to when the CSF was leaking out of his incision 11 days after the initial closure.  The doctor felt at that point that he needed to put the shunt in, but in the operating room the CSF was slightly cloudy so he wanted to send it to the lab to make sure it wasn’t infected. That’s when the neurosurgeon put the first catheter in his head.  A few days later, they figured out that the two ventricles weren’t communicating so they added an additional drain.  All of these things prevented the shunt from going in right away.  We know that God is and has been doing something spectacular.  We needed to persevere.  It’s not to say that Joshua won’t need a shunt, but we have high hopes. 

Big day!

We rush around every morning hoping to get to the hospital as soon as the NICU opens.  Of course when we're there on time, Josh's neurosurgeon doesn't come until 11am.  When we're 15 minutes late, he has already stopped by!  We waited for a while for the ultrasound tech to get there and do the ultrasound on Joshua's head.  As soon as she finished, she brought the results to neurosurgery.  As you can imagine, we were on pins and needles waiting to hear what his doctor had to say!  He finally got there at about noon and said that everything looked great!  It brings tears to my eyes as I recall his words.  Joshua's ventricles were slightly enlarged but still looked normal!  They are going to check them again early on Friday morning.  The great news is that if they still look the same size, they will probably send us home this weekend!

On Thursday, we will have been here for 6 weeks.  It seems like a lifetime ago since I delivered.  Never would I have guessed that we would still be here.  We can hardly wait for Joshua to hear the sounds of a car, see the room we've created for him, and many other things.  We are thrilled with the idea that we could be going home soon.  It's been a long journey but we're almost there! 

More changes

Two days ago when I was holding Joshua, I felt a drip on my hand.  Matt at the same time noticed that his dressing on his head was wet.  The nurse paged neurosurgery to come and take a look.  The nurse practitioner from neurosurgery came up.  She took the dressing off of his head.  She poked and prodded around the area where the catheter comes out and wasn’t able to find anything dripping.  Her opinion was that it was fine.  Matt and I left shortly after that because the NICU was closing.  When we got back to the Ronald McDonald House, Joshua’s nurse called to tell us that they had noticed that no fluid was dripping from the catheter into the drain.  Therefore they took him down for a CT scan.  When neurosurgery looked at the CT scan they found that the just the tip of the catheter was still in his ventricle, but it had pulled out 2 centimeters.  They just wanted to watch for any other changes. 

The next two shifts only collected 5 mL and 7 mL.  In one shift they usually collect 20 mL.  When Joshua’s neurosurgeon came the next day, he told us that he wanted to take the catheter out.  He didn’t feel like it was doing anything for him anymore and his white blood count had spiked for the second time in 3 days.  At this point, the catheter had more risk than reward.  Another doctor pulled the catheter and stitched up the opening.  This is a little sooner than our doctor originally had wanted unfortunately.  During these next 24 – 48 hours we’re going to be watching to see if CSF is leaking from either his incision on his back or from the area on his head that was stitched. 

We need some extra prayer while we wait and see what happens.  We’re continuing to be positive and hopeful!

One month old!

Not much has changed this past week, which is great!  Since Joshua’s surgery, the doctor has been monitoring his back for any changes.  We’re hoping that the wound continues to slowly fill in.  The doctor is taking it one day at a time, which means that we still don’t know when we’ll be going home.  He wants to be very conservative which we are in favor of also.

It’s been fun to see Joshua growing.  It’s so crazy to watch how much he is changing.  Since he has been on his stomach for 5 weeks now, he has got so much neck control.  He definitely favors laying on his right side.  Anytime we move it to the left, he almost immediately moves it back on the right side again.

Fortunately we were able to go home last weekend for a military formal and Matt’s graduation.  He will not have to worry about school for a while, at least until it starts again in July!  Let’s hope that we’re not still here!

You know what they say....third time's a charm!

Thankfully, surgery went well.  This was his fifth surgery but third closure for his back. Joshua was supposed to go down to the operating room at 10:00am but they didn’t get him down until about 11:30am.  The time difference isn’t huge unless you’re dealing with a baby who’s hungry!  He’s allowed to eat until four hours before surgery.  Therefore his last feed was at 6:00am.  He’s eating like a piggy these days…about 4 ounces at every feed.  Usually he’ll tolerate not eating for about five hours (It’s sad that he’s had so many surgeries that we can tell you how he typically tolerates not eating before surgery!).  After five hours IT’S ON!  He’s hungry and he’s not afraid to tell us.  It’s probably the hardest part about this entire situation.  We can’t hold him and comfort him, which is naturally the thing that you want to do the most when you have a baby.  When we’re able to hold him, it’s on several pillows while he lies on his tummy.  We still love it but you and I both know it’s not the same. So when he’s crying and wants to eat and there’s nothing we can do to console him, it makes my heart ache.  Fortunately he likes his little car ride in the cart down to the operating room.  He usually will quiet down during the trip. 

The doctor came to let us know that everything went well during the surgery.  Rather than stitching up the area that was leaking, he stitched both the top and the bottom.  In the opening in the middle, he left it open wanting it to granulate in.  Basically skin and tissue will fill in as the wound heals.  He expects the entire healing process to last about two to three weeks.  It’s possible that we could be going home before then.  We would just leave with a treatment plan.  We’re not ruling anything out at this point though!   The doctor reminded us again today that we’re used to living our lives in hours and minutes but the human body heals in days and weeks.  I’m just so thankful that babies are so resilient!  

Thank-you to everyone for loving us through this.  God has used all of you to bless us in a way that we have needed more than we can explain.

Good news, bad news

On Memorial Day, we noticed fluid leaking from Joshua’s back.  The good news is that it didn’t look like CSF.  However, anything leaking is bad news.  The day after his surgery for the second closure I asked the neurosurgeon about this area that was in the middle of the incision that looked white.  The last time Josh had something leaking from his back, it started with a white area that slowly broke down and CSF leaked out.  The doctor said that we needed to watch that area to make sure nothing came of it but as I’ve told you, something started leaking out.  It looked like pus of some sort.  The nurse paged neurosurgery and they told us to stop his feeds at 4am in case they felt that he needed to go to surgery to do another closure.  We got to the NICU early on Tuesday morning hoping that we wouldn’t miss the doctor doing his rounds.  He hadn’t been by yet so we waited and waited.  It turned out that he was in surgery and wasn’t able to do rounds in the morning.  Of course he came in the afternoon while we were gone.  He said that he wanted to continue to watch it but would talk to us in the morning.  Again we got to the NICU right away this morning.  We got there just before the neurosurgeon did his rounds.  He looked at it again and decided that he needed to put some extra stitches in the incision because the stitches that are there are starting to stretch and open.  Therefore, tomorrow Joshua is scheduled to go down for surgery again.  Rather than opening the entire incision or cutting any of the current stitches, he will just put additional stitches in the area that is starting to stretch.  After that they will continue to put gauze on the incision in hopes to remove any dead cells.  When the surgery is finished, the neurosurgeon said that he wanted to watch it for about 10 days or so. 

Continue to pray for us.  It’s difficult not to get discouraged while we’re constantly thinking we’re 2 weeks away from going home.