Second appointment at the pediatrician's!

Our little guy is 7 pounds, 0 ounces today.

First appointment at the pediatrician's!

Today was Alexander's first visit to the pediatrician's after discharge and it came after a night with some seizures. So up goes the phenobarbital a bit (which is better than the offer of a readmission that was given earlier).

Our little guy is 6 pounds, 12 ounces today.

Mommy and Alexander came home today!

Five days after being born and both Mommy and Alexander are coming home today! Hooray...no more hospitals for us! (consider that this is being written on 16 Mar 2005...ha ha! -- Ed.)

Springing him from WakeMed was a little more exciting than we planned... and there was more than a little hurry up and wait. So after an hour or so after we're notified that he's getting booted out the door and the paperwork is done, we're ready to go.

Except that his circumcision required him to actually take a pee before they'd let him go. Aaaaaggggggghhhhhh...this is so darned excruciating... we are so ready to blow this joint!

So Mommy does the only logical thing to do...she orders Alexander to take a pee and be quick about it. Not one minute after the nurse who dropped the youse gotta pee requirement went elsewhere, he obeys the orders in Bristol fashion. All over Mommy, in fact! But that's enough to satisfy the nurse and Alexander is on his way home. He looked so tiny in that car seat (so did Nicholas but he was two pounds lighter at birth!).

But yeah, he's a keeper. :)

Seizure cause found!

Alexander had his MRI today and it revealed that he had a small bleed in the right frontal lobe of his brain approximately two or three days ago (based on the observation that the blood that was found was old blood which indicates that whatever vessel popped, it's already been repaired which was a good sign. The age of the blood indicates that it happened either right before delivery or during the delivery. The good news (if you can imagine it) is that it was definitely a small bleed and not a stroke...if you have something like this going on, you definitely want the former.

They're not really sure what caused this...theories include abnormal vessels in the brain that popped due to the pressure of pregancy as the most likely. But they are saying that if you're going to have a complication such as this, his age and the location of the bleed combine to make it so that a child up to three years old has a much better chance of recovering from an injury such as this than an adult would.

Unfortunately, the brain doesn't take kindly to blood just sitting on it, blood is irritating to the brain and thus you tend to see seizure activity.

But now that we know what caused his seizures and that it's pretty much repaired itself, the question is now what can we expect and the answer is a pretty big we don't know as of yet. If there is going to be any long-term problems from the bleed in that particular area, it's expected to manifest itself as difficulties with attention, focus, and and behavior. There aren't any expectations that actual cognition / intelligence will be affected. Another MRI will be taken probably in about two or three months once the swelling has gone down in his brain and that'll shed a lot more light on what we can expect going forward. And there is a fair chance that Alexander might not suffer any ill effects at all. But he will be watched very closely to see if there are any additional seizures (which is complicated by the fact that the manifestation may well change over time from what he was doing as new pathways are formed). He'll probably be on the phenobarb for four to six months and then be allowed to outgrow it or if there are additional difficulties, he will be switched to some other medication if necessary (as it was explained to us, phenobarb is wonderful for little ones up to six months...after that, it tends to mess with cognition).

To sum up: for a sucky situation, this was the best possible news we could hope for!

He's getting excellent care from some of the best pediatric neurologists in the business and now that we know what to watch for, whatever follow-on effects come of this are treatable with available therapies so there is no reason Alexander can't have a happy and healthy life. We'll just be better prepared to watch for and correct any problems that we see with his development and that's not necessarily a bad thing.

Unfortunately, this means that like his older brother, we won't be bringing him home when Mommy comes home. But it's better to make sure that we've really passed the acute phase so that he doesn't have to make a U-turn right back into NICU even though emotionally, we'd rather have him come home straightaway.

Thanks for the continued good wishes for his well-being...they were very much appreciated, particularly for the last 48 hours! :)

Alexander visits the Intensive Care Unit

Just when you thought you might finally have something go normally without complications, of course that's the time that you get the news of complications.

He was irritable yesterday evening (if I had just gotten shoved out of a small birth canal into a bright and cold world, I'd be a bit irritable as well. Unfortunately, Mommy noticed that it had progressed from irritable and prickly (which you'd expect after the day he had!) into actual seizures.

Those aren't normal, guys!

It took a fair amount of pushing by Mommy to finally get them to realize that she knew what she was seeing (you'd think she'd get a pass on that as she works pediatrics ED at the WakeMed facility and probably sees enough of this!). But thanks to her being persistent and keeping her cool under very trying and emotional circumstances, Alexander followed his older brother over to the redesigned NICU unit for more intense scrutiny to discern the cause. Several labs were drawn to check for infection but those were very quickly ruled out. They wired a bunch of leads to his head (it almost looked like something from an old B-grade science fiction movie when the mad scientist hooks up the poor victim to a really bad machine to suck out their brains or something). These leads were for the EEG which did confirm the seizures (some of which were pretty obvious to the eye when you knew what to look for and how it would manifest).

Next up is an MRI to see if they can pinpoint what's going on and that's likely going tomorrow (it seems to be localized on the right side of the brain). In the mean time, he's responded well to phenobarbital or phenobarb for short. This is billed as a wonder drug, particularly for very young babies and it certainly has helped cut down on the seizures as well as whacked him out for a while!

Until then, we can only hope for the best and be prepared for what news comes our way.

Gram made a trip up from Fayetteville to get an Alexander fix this evening...I think it's safe to say that she's on the he's awfully cute bandwagon!).

BTW, a big shout-out to our new friends over at A4 where Daddy works who were kind enough to send an awfully beautiful flower arrangement which arrived at precisely the right time (read: when we were getting the initial reports and wondering just how this was going to go with Alexander). What a beautiful and thoughtful gift and it was very much appreciated.

Nicholas has a little brother!

The story starts innocently enough with Mommy and Daddy playing games upstairs last night and the universe has a sublime sense of humor when you consider that the games were Payday and Aggravation. You just don't tend to get enough of the former but a surplus of the latter, particularly when you've got little ones running amok! Anywho, Mommy started feeling a bit out of sorts but considering that Nicholas wasn't really a normal pregnancy, we didn't really put two-and-two together because she hadn't really felt what the onset of contractions naturally felt like. (Mommy was rather brutal in trouncing Daddy in the games. I'd say it was luck but in Aggravation, she particularly laid the smack down!)

Well, by 0100, she felt something was up and by 0600, they were spacing about five minutes apart. That's get yo bags together and start making plans to drive time, people! Of course, getting up and about meant that the contractions actually started spacing out to ten minutes apart...of course after we've made calls, started the Escape to warm her up, and sent EMAILs saying that a certain Alexander was on the way.

Our friendly consultant Dr Bass suggested Mommy rule out false labor by chilling out for a two hours. But there were a couple of indicators that suggested that it wasn't false labor at all.

As we're getting stuff ready for the trip to hospital (again!), I want to comment on Mommy's toughness. Anyone who says that she's not a tough lady is going to get punched in the puss (and I'd probably have to get in queue to do it!). You want to know what tough is? Tough is standing up when a nasty contraction hits and remaining on your feet the entire time. I dare you to show me a recruiting poster Marine or infantry soldier who could do that! Throughout the whole experience, I got more of an appreciation of something I've already known...Mommy has a serious pain tolerance (a lot more than I do, let me tell you...I'd be SOOOOO on the floor curled up in a fetal position) and more guts than you'll ever imagine.

Well, we were convinced she wasn't faking it so at 1030, the Escape's engine was spooled up again and now we're on our way to WakeMed. What made this a more interesting journey was that we had freezing rain the day before so the roads were potentially treacherous. Fortunately, the roads were pretty clear with small patches of ice on the shoulders (unlike last Wednesday when the Raleigh-Durham area made the national news for being completely inept in managing a snow event causing massive gridlock in the area). Along the way, the contractions started getting more frequent...4 minutes 9 seconds, 3 minutes 34 seconds, 2 minutes 38 seconds.

A bit of an aside, apparently Grammy were tuning in on the same smart-aleck wavelength. Somewhere along Timber Drive, I remarked to Mommy that what is it about her doing this labor and delivery thing on Sundays? Nicholas was born on Mother's Day on a Sunday in 2003 and now it looked like Alexander was going to repeat the feat. Grammy had apparently told her the same thing as she was preparing to drive in from Zebulon to meet us! Not that I mind Sunday births...you know, Sunday's child is full of grace...that sure beats Daddy's Wednesday's child is full of woe schtick. Just saying, you know... :)

We get to WakeMed and breeze through patient registration at 1105. That's a pretty easy feat when you've got someone obviously pregnant and in labor! Don't worry, they find ways to get the piles of paperwork to you later on. A quick trip through labor and delivery triage told us what we already knew...Mommy is having a baby and there isn't anything stopping her today! Surprisingly, no one was manning the triage area when we arrived on station but they showed up soon enough. We did get a bit of a laugh that Dr Bass had taken Julia off the list... "she's not coming today". All we can say is that's what you think, buddy!

Now things really start moving, folks. Grammy arrives on the scene at 1200 and I'm off to take Nicholas to Jamie and Andrea's place where he gets to have fun staying with them and their two sons. Hopefully, Grey and Forest ran him ragged so he'd sleep through the night! (Thanks so much for taking care of him, guys...we appreciate that more than you'll know...it makes it much easier to concentrate on the task at hand when you don't have to worry about your other little one!).

Whilst I'm away getting Nicholas taken care of, Mommy's water is broken and she's assigned her room. I get back round 1500 hours to find out that we were likely to have a baby by 1730 hours. Imagine a classic cartoon double-take. That's what I did for Dr Bass (and he really loved it...he apparently doesn't get to surprise parents that completely very often!). Last I had heard, we were looking at a much longer labor because Alexander was bigger and further along than Nicholas.

Of course, the best laid plans often don't survive contact with the enemy which was the case with Mommy's hoped-for epidural. She had been hoping so much for one but unfortunately, it was not to be. The rest of the labor up to delivery is pretty much a blur but what was really clear was that Mommy was blasting through the stages very quickly. A turn here, a turn there, a check of progress and this was Mommy's shining moment. She was tough...she didn't scream even though the pain was quite intense (she got one dose of drugs to take the edge off the pain and that was it). When she finally got to the pushing stage, it was seven minutes from the time she started pushing to the time Alexander came out. That is a pretty amazing feat, folks! It was also 46 minutes earlier than was predicted...give Mommy a hand for this one. She was truly a trooper and literally blew through the stages like a Category 5 hurricane. That takes some serious tough and she did an amazing job.

Alexander was so beautiful if you discount all of the white cheese looking stuff (I'm not the clinician here, give me a break, eh!) and the purple color. Daddy even got to cut the cord which was a bit like using scissors on a rubber hose from the feel of it...but it was cool nonetheless and all appendages of other persons were still intact afterwards! But there was no doubt about the set of pipes on the boy and he did really well on his APGARs. After the delivery was completed and all of the required checks were done, the scene got a little surreal, at least for us because we didn't have the entourage from ICU that we had the last time.

You see, with Nicholas, we never really had an opportunity to appreciate the really cool parts of having a baby. You know, the holding him thing and taking pictures and whatnot. Nicholas literally flew over to the ICU people (he gave them a golden shower!), we got him back long enough for each of us to hold him for about a minute, and then he was on his way to ICU. I didn't get to see him until two hours later and Mommy didn't see him until twelve hours after delivery. So a lot of those cool things we just didn't get with him and we didn't get a chance to get pictures after the birth. You know, we understand the necessity and only wished for the best for his welfare but at the same time, we didn't get to do the really cool things you normally get to do. We're not bitter about that but you might understand why we wanted to make up for lost time with Alexander and really enjoy what passes for a normal birth with us.

We had him for a good hour or so just to cuddle up and take pictures and generally enjoy the time with him. He's definitely the talker and he looks very much different from his big brother. Where Nicholas had the super-long eyelashes and dark eyebrows, Alexander's eyelashes are much shorter and the eyebrows are a near invisible blonde. He also has far more of a blonde tint in that mass of hair on his head and the longest fingers and toes I think I've ever seen in a newborn. This is a good thing...I think it'll be better if Alexander is different from Nicholas.

Unfortunately, it was time for Missy (our nurse who had assisted Dr Bass on delivery and did a stellar job for someone newly commissioned!) to take Alexander to nursery for his first bath and the length / head circumference measurements and the initial treatments all newborns receive (they don't do those in the room...you get length and time of birth there!).

First bath was at 1927 and he really didn't seem to like that all to much. He certainly does prickly mode with the best of them! First diaper was at 1936 (oh, the indignity of being in a bassinet in front of the glass windows all naked and stuff!). The first shots were at 1945, one in each thigh. Talk about a really unhappy camper at that point...

By 2000, he was back in the room with us for his first feeding and the boy is a quick learner but then he came out at 37 weeks and 1 day which was two weeks beyond Nicholas. We had him pretty much the rest of the evening and into the next morning until he was wheeled away to nursery at 0200. That was SOOOOO awesome...just being able to hold him and cuddle him and he's quite the talker. He's also got a serious stubborn streak...he just wasn't interested in settling down and sleeping until much later in the evening. I'd imagine after nine months in a warm dark place with no one to talk to, he probably has plenty to say. Along the way, we continued the tradition of Mommy's first meal after delivery coming from Outback Steakhouse. Compared to what was offered from Dietary...um, yes...going to get some fair dinkum tucker from Down Under! :)

All in all, it was an exhausting experience but a joyful one. Mommy and Alexander are doing just fine and barring any complications, discharge is expected for both of them on Tuesday. That's an even weirder feeling, not waiting eight days for Alexander to come home.

We're OK with that. :)