Week 6
3/29/04 - All is well again today.  Last night Toby must have just been overstimulated
or something.  He is back to his normal routine of squirming and swinging.  His
hematocrit is geting low, and they don't want to expose him to another blood donor,
so he will be getting a drug to stimulate his own red cell production.  I'm not sure
how many days until we know whether that will work.  His blood gasses were good
this morning, so his rate was weaned again, to 22 bpm.  (A wean of 4 bpm - woo
hoo!)  He is breathing a lot on his own over the ventilator, so the wean didn't faze
him.  There is talk of taking him off the ventilator this week!!!  Wow.
3/28/04 - When we went in this morning, Toby was having a pretty good day.  Or at
least a normal day.  He is still fussy and swings a bit, but nothing too bad.  They
decreased his rate to 26 bpm and he didn't flinch.   Tonight when we got there,
everything was going along as normal.  But after his 5:00 feed he spent about 2
hours crying and vomiting.  He was inconsolable.  By 7:30 he was calmer and he
was keeping down his 8:00 feed when we left.  It seems like he got upset and
worked himself up into a fit, rather than anything being really wrong with him.  We
will have to see how he does the rest of the night.
3/27/04 - Today they are decreasing the rate on Toby's vent to 28 and also weaning
his morphine dose.  Since they switched from iv to oral morphine I lost track of the
dose, but whatever it is, it will be lower today.  He seems to be handling the
ventilator weans reasonably so they will continue until he's off or he is no longer
able to take it.  If he gets to that point they will give him a short course of steroids to
help his lungs along.  Either way, looks like the days of being on the ventilator are
going to come to an end in the near future.  Yea!
3/26/04 - Not as exciting a day as yesterday but still very nice.  Toby is holding his
body temperature well and doesn't seem stressed by all the noise of the room.  So it
looks like the crib is a 'go'.  He had his vent rate turned down to 30 bpm.  You could
tell he was working a little harder, but that's the idea.  He is still eating well.  It was
fun to go visit him in his crib.  We can hear the little noises he makes when he's
sucking on his tube and it's so much easier to see his face.
3/25/04 - Today was a very exciting day for Toby.  They decided to turn off all his iv
fluids!  So he gets all his food, vitamins, and drug orally now.  This will allow him to
eat more food.  He's up to 27 ml feeds - yea!  In terms of the ventilator, he is getting
another day of rest to get used to the settings he's on.

Plus, Daddy got to hold him for the first time!

AND, he moved out of his isolette and into a real crib!  We dressed him in some
clothes and wrapped him in one of his blankets and everything.  
3/24/04 - Toby broke 4 pounds today!  He is growing well.  His weight is waaay up
and he hasn't peed much lately so they gave him lasix again to get some of the
fluids out.  It did the trick - his output was 73 ml  in the ~4 hours after the lasix dose.  
He is stuck at 25 ml feeds today because the 25 ml plus the iv fluids and the
morphine is the maximum volume he can have right now.  There was talk of
stopping iv fluids, in which case he can increase his food intake.  We will see
whether that happens tomorrow or the next day.  They also decreased the PEEP on
his vent from 7 to 6.  I don't know how to explain what PEEP is, but decreasing it is
good.  I think the goal PEEP setting is 5 before taking him off the vent. Otherwise
they left him alone today.  He seemed a little agitated and his blood CO2 was
starting to creep up, so he mostly got a day of rest.
3/23/04 - There were lots of changes for the good today.  Let's see if I can remember
them.  Toby did great with the lower vent setting of 32 bpm, so they decided to
decrease his inspiratory pressure to 20 from 22 mmHg.  His morphine was reduced
today to 40 ug/kg/hr, down from 45.  He's doing well with feedings and is up to 22 ml.  
And his weight is up to 1790g - maybe he'll break the 4 pound mark tomorrow!