labwork and sono and doc appointments, Oh My!

Its been a busy couple weeks for us. As I mentioned, we have had some issues with Caleb and his weight. It started I guess about 3 weeks ago. He started spitting up after eating, more like projectile vomiting large amounts after most of his feedings. He never acted sick, always had a good appetite, kept having wet and dirty diapers, etc. Nothing seemed too off. I didn't think too much about it, figured he wasn't burping good, and this was something I did as a baby. It gets to be close to 2 weeks I guess, and over a weekend (our furnace was out at the time, but that's another story) Husband mentioned that Caleb had been pretty fussy, not wanting to sleep. Come Tuesday am, he mentions he was making odd noises when he was breathing, like he was sighing after each breath but it only lasted a couple minutes. I went to feed him at daycare after I got off work that morning, and he seemed to be his usual self, he did vomit all over me but seemed fairly happy. When I picked him up that afternoon, he seemed pretty sleepy. He usually gets very excited to see me but he went right back to sleep after I loaded him up in the car seat. My mommy-intuition kicked in and I decided that I would take him to the after hours clinic, just to make sure he didn't have something like RSV. I get there and the first thing they do is weigh him - only 11lbs 8 oz. I immediately start to panic because I swore that was what he weighed at 4 months. The NP saw him, said he had an ear infection, but lungs were good but the real issue became his weight. The next day, we went to Hospital for a pyloric sonogram to rule out pyloric stenosis. Caleb hated it, but it was fine. He also had some blood drawn and a urine sample done. All the labs were fine except his albumin was low. So that bought us a trip to the Children's Hospital in Bigger City for a sweat test to rule out cystic fibrosis. Now even though I knew it was impossible for him to have it since I am not a carrier, I still was a bit anxious about it. It of course came back negative. By now, it's Friday and he had stopped vomiting. We've started solids and try to supplement with a bottle of formula a day. But in true style of my children, he refuses the formula, will take bmilk out of a bottle just fine, and doesn't really like the solids. I would just supplement with bmilk, but I don't really have enough stored. I'm down to six 5 oz bottles in the freezer. I took him back for a weight check on Wednesday and in a week, he was up to 11lb 10 oz. I actually think he gained more because the initial weight of 11-8 was in a diaper, and this one was without. But the fact that he's 6 months and still hasn't doubled his birth weight and is gaining so slowly is concerning. We saw a pediatric GI doc yesterday and she was actually very encouraging. She said a 2oz weight gain in a week was great. She also thinks he may have reflux, which could explain why he hates solids like he does, so we now have zantac for the little guy. She also thinks that this whole thing stemmed from the ear infection/virus he had, and he dropped weight from the vomiting. The low albumin she said wasn't really a good indication for his current nutritional level, so she wanted to have a pre albumin done, along with repeat CMP and urinalysis. She was very pro-breastfeeding and wants me to try to get him to take 6 oz at a feeding (a no go so far) and if I don't have enough bmilk to supplement, she wants us to give a high fat formula (which I still need to pick up from the pharmacy) and try to get about 4 oz of that in him a day. We will have weight checks every week for 4 weeks and we'll follow up with her then. If he doesn't put on much weight, then she'll give us the high calorie version of this formula. But she was fairly confident he'd be fine. I did have my moment on my way to work last night because the diagnoses for him are GERD and Failure to Thrive. I remember learning about failure to thrive in nursing school and the way they presented it, it made it sound like the parents were doing something wrong. That isn't the case, but there's a sense of dread over that diagnosis. Plus it just makes me sad that once again my body is "failing" me and not providing for him like I want to, and should be able to. And even though I know that really isn't the case, all you mommies out there know what I mean - no matter what, there is still that part of all of us as moms that makes us feel guilty. So last night on my way to work, I let myself cry about the whole failure to thrive diagnosis. But, he is a happy boy, meeting his milestones like he should and hopefully we can plump him up.

And as a bonus, here's my cute little bubs:

Let's talk about Stress, baby

I never plan on being so neglectful...it just happens.

But in my defense, it's been crazy. Almost 2 weeks ago, our furnace stopped working and it took 5 days to get it straightened out. It was fixed last Tuesday and let me tell you, 50 degrees is WAY too cold in the house! At the same time the furnace man came, I was at the doctor's office with Caleb, just to be sure he was fine because he'd been throwing up after eating. Still pooping and peeing no problem, eating regulary, happy and content, but not sleeping as well at night. And he wasn't spitting up, but projectile-almost-emptying-his-stomach throwing up. He hadn't been too fussy and was still happy, so it was about 2 weeks this went on. I decided last Tuesday to take him in because Husband said he had a short period of time where it seemed like he was struggling with breathing - sounded to me from Husbands description that he was grunting, like a newborn who's lungs aren't quite mature and they start to tire. Caleb seemed fine in the a.m. when I fed him before going home to bed, but he wasn't his usual self when I picked him up. Mother's intuition said to take him in, just in case he's got RSV since my Fabulous new insurance refused to pay for the Synagis vaccines he was getting to prevent it. I really thought it'd be a pat on the shoulder, and an "He's just fine Mommy, quit worrying" kind of appointment since he wasn't really acting too sick. Nope. At almost 6 months, he's only 11lb 8 oz - the same as he was at his 4 month appt. That made Mommy completely freak out and bought us a pyloric sonogram, blood work and a urine sample. I also now know how they do a sweat test. And we get to see a pediatric GI doctor in a week. Yep, it's been, shall we say, a wee bit stressful here. I'd update more, but my bed is calling me after a long stressful night at work that included one true emergency.

Mass Chaos

Time is apparently getting away from me...I don't think I've ever been such a slacker about posting! Work has continued to be chaotic. We are short staffed, we have mandatory call, and even with the call schedule, we are still short staffed. One night a couple weeks ago, we had 3 labor nurses on...and started the night with just a couple laboring patients. Then the gates opened and everyone, and I mean everyone, came in in transition! I think we had 6 admissions, all wither 7 or 8 cm. About the time I was unplugging the bed to take one of my patients to the OR for a c-section for failure to progress, another mom came in, 33 weeks, complete and breech. So mine got bumped and we had to rush to get her prepped. By the end of the am, no one really had assigned patients - we just went to each room, doing what needed to be done. "Ok, she needs an IV, this woman is waiting for an epidural, this room needs an exam to check for dilation. It was unsafe, but the charge nurse on that night did everything she could to get us help. But no one answers their phone at night, except one day shift nurse who came to help, but we needed about 2 more nurses with what we had going on. I can't remember the total number of admissions/deliveries/patients that night, but it was unsafe patient loads. At one point, the anesthesiologist that was doing the c-sections/epidurals we had going on was just standing at the desk, waiting for them to get our second OR up for my c/s that was bumped for the breech 33 weeker, and it was getting crazy, with patients needing things right now. So I handed him the lidocaine I had pulled for an IV start in one room and said "Here, help me, start her IV in room 6". He said "You can't get it?", to which I said "Well, I have to go into room 3 because she is going to deliver right now, and that patient needs her IV and wants an epidural, plus my patient who was bumped needs to go to the OR once they get it ready. If I could clone myself to do it, I would, and I don't think you want to go be the labor nurse & nursery nurse for the patient who is delivering. Please help". So he did. Patient delivered, baby was skin to skin with mom (love it! we're trying to do that more and more), give quick report to a post-partum nurse who was back to help with the recoveries, and out the door I go to help with the epidural for the patient I sent anesthesia to see to start her IV on. Epidural in, charge nurse comes in to monitor patient for 20 minutes after the epiural and I head back to the OR with my patient. It was crazy. The house supervisor had come up and was trying to help, but unless you work in OB, there's not much you can do but start IV's, and answer call lights. If one more thing would have come in, I think we all would have crapped. But we survived the night, patients delivered healthy babies, they didn't have great nursing care, but we really did the best we could do and tried our best not to look too harried! All my charting from midnight on was done after passing off to the dayshift...I didn't get home and to bed until about 10am. We need more nurses, but no one seems to be able to pull any out of their arse. Hopefully management will figure something out, but unless we get some experienced labor nurses in and fast, I have a feeling this will continue. February is statistically a SLOW month for us, has been the slowest since I worked there, so who knows what the rest of the year will bring!

Quote of the day

Said by a scrub tech when she explained why she decided to get a nursing degree instead of a business degree:

"I decided to go ahead and do nursing because I can make more money as a nurse than I can if I get a business degree and go work for Big Insurance Co. in town."

All us nurses who were in hearing range stopped, looked at her, and then laughed hysterically to ourselves. Money isn't the reason any of my coworkers or I went into nursing, it was for patient care. If we were looking for a big salary as an RN, we'd be sorely disappointed.

Dear Lovely Twin Ladies,

I apologize for last night. Work was super busy and I didn't have time to empty your compartments of the liquid gold you so diligently make for my child. It is much appreciated and I didn't make time for you last night, and I know how much you look forward to the emptying with either the pump or baby, and I am truly sorry. And I do understand your confusion when you hear crying babies and you aren't being taken care of. But is it necessary to make yourselves so firm that everytime I turned the wrong way, it felt like a boulder, or a tight water balloon, ready to pop? Mrs. Bladder was also ignored, but perhaps she is used to the neglect because she didn't cause any leakage and really didn't bother me until the end of the night, when I realized I hadn't peed all night, but then again, I ignored Thirst and Hunger, so there really wasn't too much to irritate her to begin with. I understand you are a bit more hormonal than she is, but really? Did you need to leak that liquid gold clear through my scrub top? I know that first time dad, who's wife was laboring and planned to breastfeed, sure enjoyed the show you put on. I can still see the mortification on his face when he realized what had caused the headlight style design on my scrubs. I know my caring coworkers sure enjoyed seeing that display of your abilities (I can still hear them laughing...) Message was received, I will not ignore you again for a full 12 hours.

Humbly Yours,
Nurse Lochia

You know you're a mother when..

When you go to a health screening and it's not until you get home that you realize that you have breastmilk spit-up on your shoulder and one side of your nursing bra is unsnapped.

Or when you start making lunch and your 3 year old comes down the stairs, sans pants, asking you to wipe his butt. You grab the wipes and realize he's covered in poo. A bath is necessary so you take him upstairs to the tub and you find his poopy underwear in his room, poop smears on the hardwood floor, on his freshly laundered comforter, on a towel and smeared all. over. the. toilet.

Or when you are rushed out of the shower because the baby is hungry and it's not until the next morning that you realize in your haste to get dressed, you put your underwear on inside-out.

Gimmee a Pee!

Something wonderful has been happening in our house... Isaiah is potty trained!!! YAY!! We decided with Isaiah to do things a little different this time around. Part of it, I'll admit, is because I'm lazy. I just didn't want to spend hours upon hours sitting in the bathroom, or forcing fluids down him, or getting him to sit on a potty chair while watching tv. Jacob and Clara were both 3 before they were potty trained and I don't think anything we could have done would have made them use the toilet any sooner. Yeah, some kids are completely potty trained before they are two. A nurse I work with was one of those lucky mothers, both her boys were out of diapers before they were 2, and I hate her for it. Ok, so I don't really, I'm just insanely jealous. I just don't think my kids were willing to give up the diaper until they were 3. With Isaiah, we never bought pull-ups. Maybe they work for some kids, but I think they were a hindrance for mine. We used them with the older 2, but really, I think they are just glorified diapers that still allowed them to poop or pee in their pants with little consequence. I figured I'd just go straight to underwear, and that way he would be really wet/dirty, not like how it feels and be more motivated to use the toilet. I bought underwear for him about a month ago and we'd put the underwear on over his diaper, and encourage him to use the potty. About 2 weeks ago, after changing a monster, nasty poopy diaper one morning, I decided I'd had enough. He would go on the potty sometimes, and he knew when he needed to go - he just wouldn't always want to do it. So I put him in underwear. Said today was as good as any to jump right in. He fought me for a bit, but eventually he decided that it was pretty cool to not have diapers on, plus I told him how happy I was, how happy his teachers at school would be, etc. I loaded his backpack up with plenty of underwear and pants/socks, shirts, etc and sent him off to school after lunch. His teachers are more than willing to help with the whole potty training thing, and I had told them my plan a week or so earlier. He came back in the same clothes, and we've been good since. He did have a couple accidents. The first one, he completely emptied his bladder, the next was just a dribble, and we only had one poop in the underwear but other than that, he's done fabulous! Those accidents helped him to realize that it doesn't feel good to go in his pants. He hasn't had an accident for a week, and while we still do diapers at night, he is completely daytime potty trained! I did promise to buy him a toy once he was using the toilet so I took him to the store and let him pick out a toy...that was a 30 minute ordeal, but it was fun. Over this last month, we've really seen major changes in Isaiah - he's talking more, he no longer demands a drink for bed, he sleeps all night (HUGE!!!) and now he's out of diapers! It sure feels good!