Week 7
4/5/04 - Toby had a great day.  He was quiet and happy all day, so his CPAP device
stayed on his face well and his oxygen requirement was nice and low.  At least when he
wasn't being handled.  He got a few drops of breastmilk in his mouth today, which is the
first time that I know of that he's tasted it.  He looked as if he was thinking 'what is this
new stuff?' and started smacking his lips and opening wide like a baby bird.
In other news, his hematocrit is beginning to rise, meaning he is making red cells on his
own and doesn't need a transfusion.  And as his crit increases, his oxygen
requirements and stability should improve.  Yea!
4/4/04 - Another big day for Toby - his first bath!  He just loved relaxing in the warm
water.  He didn't even mind being cleaned up all that much.  When bathtime was over, I
got to hold him to my shoulder and walk him back to his crib - that was the best!  Once
he was dry again he was mellow yellow.  For a while.
He is still doing well on CPAP.  At least when he isn't pushing it off his face.  His
morphine was weaned again today.  Otherwise no new developments.
4/3/04 - Toby is good today.  He doesn't exactly love the CPAP but he's putting up with
it.  We on the other hand really like it.  It's easier for us to be able to hold him from time
to time, and we get glimpses of his face without any attachments every once in a while.  
That is enough to keep us going back for more.  When you look at his oxgenation levels
on the pulse-ox, he does pretty well even when the pressure dips way below what it's
set to deliver.  We won't know exactly how well he's ventilating until Monday, though.  
We are optimistically predicting that he'll move off CPAP soon and on to regular, plain
old oxygen.
4/2/04 - Things are about the same.  Toby is still doing fine on CPAP.  He still has no
voice but his squeeks are louder.  His morphine was decreased again today and so he
was a little cranky.  He is pretty pale due to the low hematocrit.  It may be another week
before his red blood cell production starts to kick in.  But all in all he's hanging in there
just fine.  And he's enjoying rockin' out with the singing nurses today!
4/1/04 - Toby went home today!  (Ha ha April fool's)  Toby is happy to be rid of that tube,
and he's doing well with gas exchange.  However, this morning when they showed his
chest Xray in rounds, all the doctors kinda grimaced.  His lungs do not look too good.  
As long as he keeps oxygenating and ventilating well on the CPAP, he'll stay on it.  But
there is some chance that he will decline and need to be re-intubated for a little while.  
We hope that does not happen.  But if Toby needs a little more help for a while, then so
be it.  He is still getting used to CPAP, but already is squirming around a lot less than
when he was on the ventilator.  Good boy.
3/31/04 - Toby had his eye exam today.  The exam was to look for evidence of
retinopathy of prematurity (ROP), a disease of the retina that can lead to blindness.  The
disease is classified in stages 1-4, with 4 being the most severe case.  Toby is stage 1.  
This is *excellent* news, considering how premature Toby was and how much he has
been through.  I believe all stages are treatable, but stage one often goes away on it's
own.  The other amazing thing about the exam that while he didn't like it one but, he
didn't get too stressed out by it.  Once it was over he went back to sleeping.  Wow.

His rate is down to 18 bpm and his PEEP was turned down to 5 today.  He will get
caffeine today.  All of this is in preparation for extubation.  Dave is pushing for
extubation tonight but the docs believe tomorrow would be better.  We shall see ....

PM - Tonight they extubated him!  He was moved onto CPAP, a device that delivers air
through the nostrils, but in between the ventilator and the CPAP, we got to see his face
unencumbered.  He was doing fine when we left.  We sure hope he can stay off that
vent!
3/30/04 - Toby is down to a rate of 20 bpm!  He really wants to get off that ventilator!  He
is on a new (lower) morphine dose.  Someday he will be off that stuff.  He is still having
some trouble with vomiting.  From looking at him, it looks like the tube is gagging him
and that is causing the trouble.  He squirms a lot because he wants the tube out and
then that makes him gag, and then he quirms, etc.  It's a vicious cycle.  Poor baby.  He
just has to hold out another day or two and then they will consider taking it out.  Yea!  
Tonight his rate will be turned down to 18.  Power wean!