4 Weeks Old and 4 lbs!

Today marks Calvin's 4th week and he celebrated by making it to 4 lbs. He's filling out and we are loving his chubby cheeks. He is also more active and when we arrived at the hospital tonight, he had squirmed his way over to the incubator door. We think he is implementing the escape plan that Grandpa Rick laid out for him.

Cal is now on the CPAP for 5 hours and off for 7 hours so progress is being made on the breathing front. He is also showing signs that he will do well with breastfeeding. Tomorrow he gets an eye exam to check for retinopathy of prematurity (ROP) and we're hoping for the best.

All in all, Cal seems to be doing better and better every day. It makes his parents very happy.

He's got more grams than a gram convention

Calvin weighed in at 1795 grams this morning. As most of you have probably immediately calculated in your head, that's just shy of 4 pounds. That's a lot in proportion to his original weight of 3 pounds, and we all thought that he looked bigger today than even yesterday. He's getting to look a little more like what you think of when you think 'baby'. This is a little weird- after getting used to seeing nothing but preterm babies, full term ones look like ungainly giants, and it's been interesting watching him fill out. He's moved on to feeding every three hours instead of hourly, too.

From the nurse's perspective he was kind of misbehaving today, pulling out his feeding tube several times. This meant that he was free of tubes when Sam held him, which was nice to see:
Those pictures are very calm looking compared to what he was actually like today. Anyway, today was pretty fun on the Calvin front. To celebrate, here's a Weekend Fun Edition of Calvin, by the numbers!

425: net weight gain in grams.
33: mL of milk every three hours to sustain that growth.
4.7: average number of times per day I rifle through his nursing chart, looking for more data. Must have data.
2: Tablespoons of extra virgin olive oil that's been rubbed into his skin so far.
1.8: average hours per day spent outside the incubator (estimated).
1: number of times the word 'explosive' has been written in his nursing chart.

The Cardiologist's Assessment

Nick and I patiently waited most of the day for the visiting cardiologist to stop by and take a look at Calvin and he finally made it near the end of the day. He did an echocardiogram (or ECHO) of Cal's heart and found that Calvin does have an open duct. However, he said that it is not a big opening and that this is what he would expect to see in a preterm baby. Cal's doctors told us that this indicates we should give him time to work on his breathing and hopefully the duct will close on it's own in the next 2 weeks. If he is still having trouble in a couple of weeks, then we may be hearing from the doctors about the other options (medicine or surgery). We'll keep you posted.

In the meantime, Calvin has put on more weight (3 lb 12 oz total!) and he is making a name for himself in the nappy changing for the nurses. As one nurse put it the other day, "he pooed for Britain." Wait to go Cal.

I'll leave you with an adorable pose Cal struck while I held him today.

Some pictures from Mother's Day

Sunday was Mother's Day in the UK, and Calvin came out for a two hour cuddle.

Blip on the radar

So, Calvin is starting to ease into the 'long time' tail of the distribution for getting off the CPAP. It sounds like it will take another week or two of him still relying on it before people start to think this is a real problem, but at the moment his breathing sticks out as one area where he's not really sprinting out of the blocks. I was never much of a sprinter, so I blame myself.

What they now suspect he has, and might be contributing to his slow move towards breathing on his own, is a patent ductus areteriosus (PDA). You can google it for details if you're into that sort of thing, but basically the ductus areteriosus is a structure involved in letting blood bypass the lungs while a baby is still in the womb (and hence not doing much breathing). It's supposed to close up shortly after birth, but in preterm babies it can sometimes remain open (patent), sending too much blood to the lungs and overburdening the heart.

Calvin isn't totally symptomatic of this, but they hear a heart murmur and are going to have a cardiologist take a look on Wednesday to get a better idea of what's going on. If he does have one but it's small and probably not the cause of his breathing issues, they're not exactly eager to rush in and aggressively treat this. The plan is still to give him more time to grow and mature with the CPAP support, and see what happens. After asking two doctors variations of the same question as many times as I felt that I could, our understanding is that this isn't yet a pressing concern, but something to be aware of. We'll know more on Wednesday, I suppose.

We heard about this last night, and night is a bad time it turns out to find out not-so-sunny news. After more reading, pestering the doctors, and in the light of day, this seems ok for now though, so I hope this post isn't alarming.

I'd like to post a picture to lighten the mood, but all the pictures from today are on Rick and Rose's camera. Imagine Calvin chomping and slurping away at a miniature pacifier- that's how we left him tonight, and that's cute.

PS- magic of the internets, Rick just emailed me a picture. No imagination required!

Another sunny day in the NICU

We've been having some really sunny days here in Dundee which makes our visits to the NICU a little cheerier. Sometimes Calvin gets hit directly by the sun and the nurses have to put a blanket over his incubator so he doesn't overheat. After all, he isn't supposed to be experiencing the sun yet.

Calvin is still doing well today. There isn't much to report except that he is gaining more weight (3 lb 6 oz total) and they continue to cycle his CPAP on for 8 hours and off for 4 hours. I (this is Sam writing this blog by the way) got to cuddle with him twice today, which always makes me happy.

In case you wanted to visualize where we're spending all of our time, here is a picture of me in Calvin's corner. See the monitor by the incubator? Imagine trying to ignore all the flashing lights and alarms that emit from there. I think I'm getting used to it now. Rose suggested we make a recording of all the alarms since Cal seems to be able to sleep through them and maybe he'll need them later in order to fall asleep. I sincerely hope not.

A glimpse of a routine

I tried out my 'go see Calvin, then go to work' schedule today for the first time. My plan is to do this three days a week, and work from home the other two. They kick us out of the NICU from 9 to 11 so that the doctors can freely talk about the babies, so if I can get to the hospital at 8 or so then I can do his morning cleaning, feed him and then get on the bus to work by 9. Then Sam can head in after 11 and spend the early afternoon with him. Sounds good in theory, anyway.

He's continuing to gain weight, cycle on and off the CPAP, and devise new ways to make changing him an adventure. Here's a picture of Grandma Rose holding him for a few minutes. This prompted the nurse to say that 'Granny was over the moon'. Kind of funny, the word 'granny' applied to Rose.

A boy and his tiger

Calvin packed on 40 grams over the last day, it went straight to his hips. Nothing else new really, he continues to be weaned off of the CPAP and we're getting better at changing him. He doesn't attract a lot of attention from the doctors during their rounds, which means they're not worried and are just giving him time to develop.
He learned today that grandparents come bearing gifts. No points for guessing the name of his new friend.

Slow and steady

The last two days have been very similar for Calvin- on the CPAP for six hours, off for six hours, get changed at the transitions. Come out for some bonding time in the afternoon, get stared at and poked by us. Incremental improvements and growth don't make for the most thrilling updates, but it's a relatively comfortable situation to be in.
The CPAP hat, when not actually holding the tubes and other apparatus in place, makes it look like Calvin's dressed up as a gnome.

Grandpa Rick arrived today. Pop-pop, as I think I'll insist he get called, had a suitcase full of gifts and some interesting theories about speaking different languages at him.

Feeling tired

We're feeling the lingering effects of not sleeping much last week. Wow, I'm tired right now, and Sam is asleep. Calvin might be tired, but you wouldn't know it from the way he continues to pee all over as soon as the opportunity presents itself. He was on and off the CPAP today in 3 to 6 hour blocks, and we saw him for quite a while this afternoon free of all that stuff. Got him out for a cuddle, fed him a few times, changed him... all in all a pretty good day. He's been gaining back some of the weight he lost right away and is just 10 grams short of his birth weight now. His cheeks are starting to fill out a bit, and he makes little smacking motions with his lips when you hold him sometimes. Cute.

Taking a breather

Calvin went back on the CPAP last night. After three days off of it he seemed to be working pretty hard and not fully exchanging gasses like you want to, so he's getting a bit of assistance. He wasn't quite ready to jump right into independent breathing, and after a break it'll be time to ease off of the machine again. It's hard to walk in and see what looks like a step backwards though, no matter how many people tell you (and how many times you tell yourself) that this is going to be an up and down experience.

However- the nurses didn't seem concerned about this blip, saying that it's normal and nothing to be alarmed about. Taking our cue from them, let's call this a sidle to the left rather than a step back. In any case, the journey out of the NICU and into a basket in our flat isn't going to be accomplished in a day, and as long as the overall trend is toward the door, we'll be happy. Still anxious, but happy.

Here's Grandma Rose from the other day, getting a first look at him:

Straight, no chaser

Caffeine! Calvin is getting some caffeine as we speak. Today felt like a half step backward, at least for two anxious parents. He kept having the heart rate drops (bradycardia, if you want to google it) that have been occurring each day, but more frequently, and his oxygen saturation was maybe a bit low. His respiration continues to be rapid- in the afternoon a blood test showed that his CO2 levels have been creeping up over the last 24 hours, and the nurses taking care of him said that he looked like he was working pretty hard on his breathing.

Sounds scary, but one thing (of several things) I've come to accept over the last week is that I need to recalibrate my definition of 'scary'. There are alarms going off constantly in the NICU, and most of them seem to be in the 'expected for preterm babies' category. So, in the absence of any real sense of alarm from the healthcare folk, we feel ok. Having him come out for some skin-to-skin bonding helped the mood.
Back to the caffeine: it's supposed to help him out with the bradycardia and maybe get the breathing a little more under control. The coffee in the hospital coffee shop (The Metropole) oscillates between tolerable and revolting- hopefully the pure caffeine is of higher quality.

On the good side of things: he's off his IV, he didn't pee all over the place when I changed him this time, and the nurse watching over him today was awesome.

Sam is Home

Hi everyone. It's Sam, signing back onto the world wide web. It's been one heck of a week and I am so grateful for all the emails, texts, and messages of love, support, and prayers. They helped me get through an extremely difficult week and I can't thank you enough for all the words of encouragement.

I was discharged from the hospital today and I will forever be grateful to the midwives and nurses of Ninewells Hospital for letting me stay close to Calvin for 6 nights. It was extremely difficult for me to leave him tonight but I know he is in great hands and I will see him tomorrow morning. I can't wait.

Oh, and Calvin says "Hi".

Neonatal nerdiness

Within about five seconds of me telling my parents that they were grandparents, my dad pointed out that Calvin's birthday, 3/3/09, is a square root day. I was reminded of this in an email from an engineering friend today. Also, I had somehow failed to notice until today that hanging in the lobby of the NICU is a certificate noting that a star in Scorpius has been named 'Neonatal Unit Ninewells'. This is fantastically nerdy.

Calvin is breathing on his own now. His respiration is kind of rapid, and he continues to have one or two of those moments where his heart rate plummets each day ('wee drops', the nurse called them), but he still seems to be heading in the right direction. Other happenings today: we changed him on our own and he peed all over the place, Sam learned to feed him with the feeding tube, and he came out for a little bonding. I got to hold him for the first time- we bonded so well he kind of stuck to me a little bit.
I don't usually wander the wards with my shirt undone, that was to keep him warm. Also, Sam is coming home tomorrow! Baby steps toward normalcy...

Busy day in the NICU

There was a lot of activity last night in the intensive care unit. Sam was visiting Calvin when they (the staff, not Sam) were told to get ready for two new arrivals. She said it was interesting to see what it must have been like when they were preparing for Calvin -- and the three other early babies that were born that day. It's almost a full house in there now.

Today went well- they took Calvin off the CPAP machine while changing him, and left it off for a while to see how he'd get on. This let us have a look at his face without tubing in his nose. Blood tests seemed to show that he was doing fine without it, and when I left he'd been breathing on his own for six hours or so. They're guessing that he'll get tired or otherwise need to go back on it later, but he's started the process of taking care of breathing independently.

He hates getting his nappy changed (we'll probably call them nappies just to fit in with the healthcare people, but I don't like the word), kicking and screaming to the point of the nurses warning each other. It's not an effective tactic since he has about half a pound of muscle, but it leaves him agitated. Fact I did not know last week: you can apparently calm down preterm babies with great success via a hand on the head and a hand on the rump, and a hand on the head works with Calvin:
Also, his hands are still small, though the signs are pointing toward him following the Nick tradition of long, graceful, almost aristocratic fingers:

An uneventful day

After his fitful day yesterday, Calvin was able come out and be held by Sam for a while when she wandered over in the middle of the night to see how he was doing. He's handling his introduction to milk with no problem, and there's been no sign of infection, so he can stop getting the antibiotics. He remains on the CPAP for now, and right before I left for the day he had a moment where his heart rate and oxygen saturation dropped. They gave him some time to see what he would do, and he got back up to speed without being prodded this time. The doctors and nurses have all been patiently explaining what they're doing and showing us all the data they're collecting. In fact, everyone that we've encountered at the hospital over this last week has been very helpful and understanding, notably the shifts of midwives who were (and are) taking care of Sam. Ninewells hospital would get our official seal of approval if we had one.

The plan is for Calvin to be a champion mountain bike racer. Here's Paul thinking about his training regimen:

Day two

Today was a pretty decent day for Calvin. We went and saw him quite a few times, and Grandpa Paul arrived around noon and was pleased with what he saw. Quote of the day: "once you get past the fact that he's small, he's really quite cute".

Calvin is doing alright. He was fed his first drops of milk today (by fed, I mean pushing the plunger on a syringe), so that's good. He had a few episodes during the night and day when his heart rate slowed and oxygen saturation dropped- most of the time he was back in the swing of things after a bit of prodding, but a couple times they had to boost the oxygen in the air he's being given. Because of these blips it was decided not to have him out of the incubator for a repeat of yesterday's bonding time. So we didn't get to hold him today, but I held him up in the incubator while he was having his sheets changed, which was the first time I've done more than kind of hold onto his hand:
and here are two pictures after he was changed. He looked pretty comfortable after that, which was nice to see.


One of my long-standing disappointments about myself is that I'm a tremendous wimp when I see blood drawn. Cuts I'm fine with, but show me a vial filling up in a controlled medical setting and I get queasy. Today I discovered that filling a tiny vial from a prick on a baby's heel brings up the same reaction. Sad.

Sam says hi to everyone- while she doesn't have any internet access yet, I've loaded up your emails from the last few days on my laptop to show her in the morning, and they've really helped cheer her up in some gloomier moments.

Calvin Ajax Moeckel!

Whew. Neither of us got much sleep last night, Sam lying awake in the hospital and me kind of lying there in bed with startling images flashing before my eyes. This morning we were told that Sam would probably get a chance to hold Calvin for the first time in the afternoon, which was a pretty huge boost. The initial shock of seeing all the tubes and wires had worn off a little, but it was a pretty a helpless feeling only really being able to stick you hand in the incubator to touch him. Here are a few pictures of Team Moeckel the Next Generation from the afternoon.

First real mother-son contact:

A family self-portrait of exhaustion:


Mid-squawk, being put back in the incubator:


As you can see, he's got some filling out to do, and it's not really a whole lot of fun with the tubes and wires all over the place. It's going to be stressful going for the next while, but it was really great to see him resting with Sam for those few minutes. Hopefully, in the end, this episode will just make the first chapters of his biographies a little more interesting, and make his future world-dominating exploits all the more impressive.

For the next few months, our life is going to be pretty focused on Calvin. I think our plan is to use this blog as a place for people who are interested to check in and see how things are going. So, whenever you're curious, pop in and check it out.

At the moment: his first 24 hours went by pretty uneventfully. He's getting some help with his breathing (CPAP), has an IV, a feeding tube ready to go but not in use yet, is being given some antibiotics as a precaution, and is getting some blue-light phototherapy.