Jack Henry has left the building

Time to go home!

Instead of goodbye, Jack Henry and his parents say "Until we see you again soon (over wine and dinner!)" to our wonderful NICU friends.

The feeding tube - in slow motion

Here are the pictures from the replacement of Jack Henry's feeding tube. As mentioned in the previous post, his tube was switched from the mouth to the nose. This is being done to help clear the pathway in the mouth for breastfeeding.

For the grandmas in the audience, Jack Henry was fine during this whole little process. He squinted his eyes and furrowed his brow just like you would if someone were to placing something in your nose. He didn't cry and as you can see, he was totally cool at the end and back to sleep.


First off, the nurse measures the length of the tube that needs to be inserted so it properly reaches his stomach. (Note the numbers on the tube.) Otherwise, the tube eithers ends in his esophagus (too short) or in his intestines (too long). Also, the nurse will check at the end to make sure the tube went into the stomach rather than in the lungs.


The measurement process is to stretch the tube across his face from the mouth to the ear and then from the ear along his chest to the stomach.


Then, thread the tube through the nose on down to the belly!


See - happy baby at the end!

An unobstructed view

Jack Henry was due to have his feeding tube replaced today. His orogastric tube is being replaced by a nasogastric tube. Translation: the tube that went through the mouth directly to the stomach is now being replaced with a tube that is threaded through the nose directly to the stomach. More pictures on that in a minute.

In the interim, here are some quicky shots of him without anything on his face so as to help you judge who he looks like.

After the head shave, I think he looks like former Houston Rocket / current TNT announcer, Jon Barry.

Day 24 and my escape plans have been foiled once again...

To all fellow babies in the NICU:

I have now been trapped in my clear cage now for 24 days. While my presidential campaign is off to a roaring start, the ladies in the smocks seem to mock me every three hours with their humiliating routine of stripping me naked to wipe my bare behind with a cold and wet cloth, sticking a cold probe that does God knows what in my arm pit, and then finally, they rotate me into a different positions even though I had been so comfortable before.

I would guess that the reason that these prison guards where clothes called smocks is because it actually is a shortened name for the practice of embarassing me in their creative manners - perhaps it stands for Shameless MOCKing.

They will rue the day when they started this game of torture! All I see out of them is laughter and I know that it's directed at me. Oh, the degradation!


Otherwise, my day in my cell has been the same as the other days in capitivity. First off, a warm plunge of some liquid substance is drained into my belly by the guards. I suspect that this is some sort of sleep serum as I always feel drowsy after imbibing it. Seemingly, they want me to sleep constantly as this drug is given to me every three hours. My only consolation is that I am able to strike some fear and revenge when my diaper is checked!

Today, although I had tried to escape through one of the hatches to my cage, it appears that the guards are on to my maneurs as they keep wedging me in to my bed with this dismembered arm.

Outside of the humiliation and torture that I have described above, I'm often visited by the same two familiar-looking people who don't seem to be part of the guard troops.

There is one who calls herself "Mommy" that looks really pretty and for some reason smells and sounds like I know her real well. I think that she may be the one that I escaped from over three weeks ago, but yet although she has returned in pursuit of me, I enjoy it immensely when she holds me and kisses my head. She must be playing mindtricks on me so that I will unknowingly trust her.

The other one is called "Daddy", but I'm never certain if that is actually him or not as he likes to hide behind his third eye. This is a clever disguise by him, but I will unmask him eventually. He shows up, but not as frequently as the woman aka "Mommy". He likes to smile at me in a mocking manner like the guards, but he appears mostly harmless. I am hopeful that he will seek mental attention by the guards as he seems quite goofy. In the least, I always feel relieved when the "Mommy" is with the "Daddy" since she makes me feel safe - again, the trickery!

Well, today was quite unusual. Instead of being released from my cage for being kangaroo'd, this "Mommy" held me differently. She still clenched me enough that I could not escape. Yet, this time, she held me in a comforting manner differently than before. When she brought me to rest on her skin, there was this pleasant tasting liquid there to sample. My suspicions were raised, but I was intoxicated by the experience and I was quite overwhelmed by all that was occuring. It seemed similar to the sleep serum that the prison guards have been thrusting upon me.

Occassionally, I would attempt to wiggle away, but I kept feeling compelled to return to the comfort, warmth and nourishment brought on only by this woman. It must be her soothing voice, or, no, some other wretched subliminal message that she coaxed into me while I slept in this womb of hers. Something, but I don't know quite what.

Eventually, I feel asleep... just as I thought that I can sneak away. Darn!

I'm just very thankful that this experience occurred with this "Mommy" creature rather than the "Daddy" fellow.

Allegedly, I hear rumors that these two along with some furry critters are my family.

I will relay another message soon after I achieve my escape!

Your comrade in arms,

Jack Henry

Unveiling of my campaign banner

Howdy, future constituents!

I appreciate the support that you have offered in my charge to be the nominee for president of the Rabbit A/B pod. With your support, I will lead our pod in defeating the Evil Doers.

Their reign of terrorist through partial head shavings and IV sticks in the middle of the night is too much to tolerate.

Remember - we did not choose to go to war against them ... they choose to strike first!

Only united as one will we win against in this War on Needles!


My opponent, Johilbar, thinks that this issue should be resolved through rounds of meetings as well as updates to policies and procedures manuals! My opponent will be soft on the nurs-istas! My opponent is only full of compromises (and pooh)!

Yet, I, fair citizens, will hunt down those who have an issued a fatwa against us babies! I will not stop until this mission is accomplished!

I have been butchered!

My opponent's presidential campaign has reached a new LOW!


Late last night, my opponent sent his henchmen into my residence (isolet) to deface me and my campaign.


That is correct! The blatant destruction of my beautiful hair at the hands of these barber-arians is the last straw. I have tried to remain civil, but no longer will I tolerate such thuggery!


My sharp, presidential looks have been replaced with a sidewall and a mullet.


Just remember that a vote for my opponent, Johilbar, is a vote for tyranny!

First haircut, first faux-hawk

Jack Henry's first haircut with the spike in the forehead lead to his first styling of hair.

Nurse Amy welcomed his haircut of the area between his eyebrows and hairline by saving his hair and incorporating it in the cute sign below. Yes, if you notice the description of where his hair was cut, essentially his forehead was shaved. I suppose this counts as a first haircut, but it does sound like a de-monkey-ifcation of my son. :)


As most of the nurses are multi-talented such as Nurse Amy's sign above or Nurse Kelli's sign, Nurse Ashley (one of the many nurses named Ashley) has a fall back job in the event that the whole nursing thing doesn't quite work out.


Yes, yes, Mr. Jack Henry got to use a little bit of product and he was styling. He was all rico sauve with his spikey hair as he could especially pull the look together when curled his lip.


And he's definitely singing for us like a rockstar with the new 'do!

We definitely know where to go to get future cuts!

They're sucking his brains out!

Exciting headlines grab attention, don't they?!?


In fact, what you are looking at is an IV site in the scalp. While Jack Henry still needs an IV to supplement his breastmilk feeds, the choice of IV sites rotates between the arms, legs and scalp.

Generally, a vein can be found in either of the arms or legs, but unfortuanately in preemies, these sites don't last very long (1 to 2 days) until a vein is blown. Additionally, these blown IV sites take a week or so to heal so then the Stick-team (i.e. the transport nurses who could thread spaghetti through a tick's teeth) is asked to come in to start looking for the sites around and under the hairline.

Although it looks like in the picture above that the IV is in his brain, it is right below the skin. (We may use this as an excuse later when Jack Henry acts like a goober as he gets older.)

The big trick in this IV site is that they have shave the site first. Fortunately, they only had to shave the area between his eyebrows and foreward so no reverse mohawk for him today. Ha!

Breaking down the walls of the two-party system

It's official!

Jack Henry has thrown his name into the presidential race by competing to win the Rabbit A/B pod party nomination.

Even though little Jack Henry is young to be Baby-in-Chief, he's never been one to accept the establishment's point-of-view. If elected, he will led the charge to change the minimum age for president as stated in Article 2, Section 1 of the US Constitution. His pledge is for solidarity amongst all the people of the U.S., especially in contrast to his opponents who are age-ists (age discrimination is discrimination just the same, no matter what your age may be).

Now, you too can help Jack Henry in his race for the White House. (Shhh, don't tell him that he will definitely make it to the White House when he gets released from the NICU, since our last name is... ya know. Nyuk! Nyuk!)

Look to the upper left side of this blog to find the latest poll. The opponents may be familiar, but don't underestimate their ability to manipulate the truth that Jack Henry is spreading.

Just remember: it's your constitutional responsibility to vote on your choice for El Presidente!

So as Dr. Tom says: Vote early and vote often!

Poop envy?

Don't worry - no pictures for this posting. :)

The Mrs and me are interested in seeing little Mr. Jack Henry to move them bowels. After having a slow-go on rebuilding his feed levels (3 ccs per feeding on Monday and Tuesday; 6 ccs per feeding today) due to his being NPO from the indomethacin, we are interested to see that input turn into an output.

Short of waiting for his first meconium, we are really anxious to see the, um, outputs to catch up to the inputs.

Yes, that means we have poop envy of the other outputting kids in the pod.

I'm Jack Henry and I approve this message

As your candidate for the presidential nomination for the Rabbit A/B pods, I promise to be your candidate for change. No longer can we tolerate the policies of my predecessors in this pod as we fight the tyranny of IV sticks and cold thermometers.

I have heard your cries at night!

I have smelled your poopy diapers of protest!

I too have had the bright lights of fear shined in my eyes!

No longer will you have to deal with these injustices. In my administration, every blanket will be warm, but not too hot. Your parents will listen to you and obey your commands. Furthermore, your diapers will be changed every 5 minutes regardless of whether you soiled them or not. And, if you happen to pee or poop on someone, they will like it!

Do not listen to my opponent in Rabbit B pod. She claims to have all of the answers and to provide free chocolate chip cookies to your parents. But I ask you, what do you receive? How do you benefit from said cookies, when all you want is milk!

So remember to vote for Jack Henry White!


I am the only candidate who has an American flag attached to my IV and the Rabbit logo tattoo to my behind.

I'm Jack Henry and I approve this message.

Breaking news: Boy doubles in age in one week!

Despite Elaine and I being his parents, Jack Henry has managed to make it to two weeks-old / 31 weeks-old (gestationally-speaking).

So only if Channel 2 News still had its "Big Story", I would totally be able to sell the headline above since its still sweeps month!


Or I would play the angle of "Why are certain Houston doctors telling the parents of this two week-old baby that he is in fact 31 weeks-old? Our investigative reporters go undercover to tell you the truth, tonight at 10PM on Channel 2."

Another really cool doctor

I'm pretty lucky to have a neonatologist who is immensely patient with my parents. :)


Dr. Ursula Nawab, who moved down to Houston during a real representative time of year weather-wise (October), always goes out of her way to answer the numerous, numerous, numerous questions that they have. Did I say numerous? And yes, Houston's summers are just like Philly / South Jersey from what my parents tell me.

Since she's cool to visit with, my parents have been talking her ears off on all things Houston - everything from the rodeo to the various outdoor activities around town to the various regional wineries. (Dr. Ursula - the previous links are for you since my parents probably overloaded you.)

Now, Dr. Ursula has promised that she's going to grab dinner and a glass of wine with them one day to tell them about all of the things they should have been scared about, but she has been nice enough not to tell them about yet.

Plus, after a bottle of wine, they can then try to talk her into babysitting me... it would be part of follow-up research, right?

~ * ~ * ~ * ~ * ~

Doc Ursula - since you're new to the area, my parents now have a good excuse to go get dosa at Bombay Sweets with you.

Oh, my Daddy says that he would have still written a nice post about you regardless of the outcome on the indomethacin treatment. Giggles!

Ductus appears to be closing

RELIEF!

According to the cardiologist's report, it appears that the ductus is closing. The results were shared with us by the neonatologist this morning. This means that the neonatologist will follow Jack Henry's heart murmur clinically (i.e. no current need for medicine or surgery to resolve the issue).

The finding of the ductus closing per the echocardiogram yesterday confirms Dr. Nawab's (Jack Henry's neonatologist) earlier assessment of the quieting of the heart murmur. Furthermore, the increased levels of creatinine and the reduction in urine output was indicative of the effectiveness of the drug. (Sometimes the indomethacin takes a few days to take effect.)

Elaine and I feel immense relief right now particularly since we were uncertain how the indomethacin would effect the ductus and other organ function. Now, we get to wait a bit while we see how Jack Henry's digestive track wakes up before he goes back on normal feeds (i.e. breast milk) and reduces his need for the IV.

Hurrying up to wait

We are currently in a holding pattern on Jack Henry's PDA.

That's right - we're hanging with the acronyms still like we work for the hospital. When reading our observations on various medical activities, please keep in mind that we're not doctors... we just play them on TV.

So to recap, Jack Henry's PDA is not this or that, but instead it's the heart murmur.

~ * ~ * ~ * ~ * ~

The present info on the heart murmur is that the doctor decided to end the treatment of indomethacin early after two of the three doses in the first round. This decision was due to watching Jack Henry's urine output decrease precipitously, but fortunately it did not stop all together. Additionally, his creatinine levels (related to the adrenal glands and kidney function) were in the elevated range of 1.5 to 1.8. The neonatalogists and nurses have been patiently watching these levels every 12 hours to see if there remained an opportunity to administer the final dosage of medicine in this first round, but it appears best to wait for his levels (urine and creatinine) to improve and normalize.

The next step is to have an updated echocardiogram to determine the size of the open ductus relative to the original ECG.

We're sitting on a balance of extremes. While the doctors have noticed that the murmur sounds quieter over the last day, this is not a clear predictor of success or failure as the lesser turbulence over the ductus could mean that it is more open or almost closed.

If the ductus remains open, the doctors may determine that the best course of action is "wait and see" on whether the ductus will close on its own rather than jumping right into surgery.

UPDATE: The ECG has taken place, but we are now waiting for a cardiologist to read the report. While the tech took multiple snapshots of the ductus, the cardiologist will need to review the entire session of scans as there are multiple measurement points related to blood flow through and around the ductus. (On the ECG, the ductus looks like it is flaring blood through it, but then again, I'm not certain what I'm reading.) This means that the doctor will also review a dynamic file on the scans rather than limited points in time.

Paying attention to and treatment for a heart murmur

Jack Henry has been diagnosed with a heart murmur. More specifically, he has a Patent Ductus Arteriosus (PDA). Although this is common with preemies, this is something that requires diligent monitoring and treatment by the doctors.

Jack Henry's PDA was first noted by the doctors and nurses by listening with a stethoscope during their daily check-ups. The diagnosis of a PDA was confirmed through an echocardiogram.


The ductus arteriosus exists in utero as a means to pass blood between the aorta and the pulmonary artery as the lungs are not used prior to the baby's birth. When a baby is born, often the baby lets out a good scream, followed by a deep breath, which in turn changes the air pressure in the lung. This air pressure change effectively constricts the ductus to be closed. In preemie babies, they may scream at birth like Jack Henry did, but the muscles that line the blood vessels are not strong enough to constrict or stay constricted permanently.

Due to the moderate-to-large size of Jack Henry's PDA, it was not previously detected as the sound to listen to with the stethoscope is the turbulence of the bloodflow passing over the ductus. As the ductus was large, very little to no turbulence (heart murmur) was able to be heard, until recently.

NOTE: I may not provide the most accurate description of this condition, so please click the links in this post.

~ * ~ * ~ * ~ * ~

Fortunately, Jack Henry has not shown any outward signs of the PDA, such as respiratory problems, inability to take his feedings, or an enlarged heart. The PDA needs to be treated though because the greater risk of congestive heart failure.

The treatment regiment will first consist of dosing Jack Henry with indomethacin. The first course of three doses given 12 hours apart will also require that he be taken off of his feeds (i.e. breastmilk or formula). The indomethacin works to inhibit the production of prostaglandins, which keep the ductus open. Yet, the indomethacin does not act only on the ductus as it also constricts blood flow to the adrenal glands and the kidneys as well as other places. Thus, the doctors will want Jack Henry on only IV fluids and nutrition, while they watch the extent that his urine output declines.

If the first course is unsuccessful or partially successful, the doctors will consider a second course of three doses depending on other factors (i.e. urine output, creatinine level) regarding his tolerance.

After each course of medication, the doctors will perform an echocardiogram to determine the effectiveness of the treatment. Other checks, such as listening with a stethoscope, will be made in between doses for each course.

Finally, if the indomethacin does not solve the issue, the doctors can make an evaluation relative to the size of the PDA. If Jack Henry is performing well, they can continue to monitor his health and the PDA with the hope that the ductus may close on its own or require a lesser invasive procedure when he is older, such as at six months of age. If the PDA requires more immediate attention due to the size and his health, a cardiologist would be brought in to perform a surgical ligation on the ductus (to effectively clamp it closed).

~ * ~ * ~ * ~ * ~

Lots and lots and lots of 'ifs'.

Elaine and I are praying for success with the medication, but also that this does not cause any other complications or dramatic side effects. While we know that the PDA is common with preemies and that, if surgery is considered necessary, ductus arteriosus ligation is one of the most common performed in the NICU, this is a very anxious time as we watch Jack Henry move through this treatment over the following couple of days.

1 week old, going on 30

Today was a big day for Jack Henry - he turned 1 week old!

As far as the NICU is concerned, while he is 1 week old, his gestational age is 30 weeks, which will be the dates that we file until he is able to execute on his planned escape.

Who is Billy Ruben and why do they dislike him so much?

You'd think that hospitals really dislike this guy named Billy Ruben considering their interest in getting rid of him.

Oh, wait ... that's right - it's the old bilirubin.

What? You don't know what this is?

Well, me neither until my son's skin was tinted orange! Yuck!

As noted below, bilirubin is common in all babies, but especially preemies. Yet, the phototherapy sessions can be very effective, even if the elevated bilirubin levels will return after the first round of treatment.

Here's a few pictures of the treatment process:

The first step is a small light focused mainly on his body, but this doesn't catch his extremities. Yet, he does wear a protective eye covering.




The next step is a brighter, more cover all phototherapy session with the stronger blue light.



And after the bigger blue light, the bili-blanket comes into play.

Proof that Orangeblood is toxic! ;)

Well, one thing has popped up on Jack Henry is that the doctors noticed that he was jaundiced. This is very common for all babies, but in particular with preemies, they have to shed their in utero red blood cells (bilirubin) to make room for their post natal red blood cells.

This means that Jack Henry looks a bit orange, which we all know is bad. :) So with a blue-tinted light for the next couple days to mimic the sun (hence the eye covers), he will get to be more maroon or normal colored.

Thank you, come again!

Thank you to each of the 700+ people who have visited the blog from over 20 countries. I am including the map above (which only reflects a rolling representation of 500 visits) as a reflection of the smallness of the world.

I really look forward to showing this blog posting to Jack Henry down the line so that he can truly understand the power of prayer and, while we are spread apart by thousands of miles, how there is an easy closeness in love and support.

~ * ~ * ~ * ~

Elaine and I are humbled by your compassion and encouraging messages. As those of you who have visited Jack Henry in the Level III NICU have noticed, there are many, many beautiful, yet sick or developing babies here at Memorial Hermann. This is true at other hospitals in the Texas Medical Center for babies that are in Level II or Level III NICUs. We ask that you continue to pray for Jack Henry as well as those other babies receiving care, their families that are full of anxiety and hope, and the medical professionals who are so diligent and professional in their loving care.