great news, some explanation of the vent, and a first bath!

We have excellent news! Thank you, Jesus!!! Carson's liver ultrasound came back completely normal. All the vessels in his liver are patent (open) and have no evidence of any clots. The size of the liver has also normalized and is no longer enlarged. YEAH!!!! We are so thankful for this news. The neonatologists believe Carson no longer needs his Lovenox (the shot he gets every day to prevent the clot from getting bigger). We are so thankful because it is hard to watch the little fella get a shot each day. There was some talk of continuing Lovenox for 6 months as a precaution, but as long as it is safe for Carson, we would love it for there to be no more shots. 

The kidney ultrasound was completely normal as well. His tumor markers have gone from 3,000 to 300 now, so this is also fantastic news indicating no recurrence of the tumor.

As mentioned his blood gas was very good on Friday. As of right now, Carson has a rate of 5 on his ventilator, PIP of 24, PEEP 6, and PEEP plus of 8. His oxygen is at 30 to 35%. 

Ignore this if you don't care or already understand, but I have had several questions about what all this means on the ventilator. The rate of 5 is the number of breaths the ventilator gives every minute and each breath the ventilator gives is a pressure of 24 (PIP). Carson is breathing between 60 to 70 times each minute, so only 5 of those are fully from the ventilator. The doctors are just weaning the rate and when it gets down to 0 then the PIP won't matter because he won't have any ventilator initiated breaths. The other breaths Carson initiates, but the ventilator still provides support through the PEEP and PEEP plus. The PEEP is the peak end expiratory pressure (pressure left in the lungs at the end of exhalation) and makes sure Carson maintains open alveoli (where oxygen and carbon dioxide exchange occurs in the lungs or little lung sacs). According to Dr. Yang, this should not be a problem for Carson, because Dr. Yang does not feel Carson will have any problems with the collapse of his alveoli. Therefore, we don't have to be as concerned with weaning the PEEP. The PEEP plus is the pressure the ventilator gives each time Carson initiates a breath (all but the 5 breaths the ventilator gives each minute). It just helps him get the necessary tidal volume in each breath, or in other words, a deep enough breath. Room air (what we all breathe is 21% Oxygen) will be the goal with Carson, but he is requiring 30-35% oxygen (not bad at all, considering), but they will keep weaning that as they are able.

The plan right now is to wean this afternoon to a rate of 4 and then tomorrow to a rate of 2. Then, the doctors will start weaning his PEEP plus again. This plan has changed multiple times, so we will see, but essentially the weaning process is focused mostly on the rate and PEEP plus. After they get to an appropriate level (not exactly sure where that is b/c it isn't set in stone, but more of an overall feeling that Carson is ready), they will either do CPAP trial or "sprinting". CPAP would be continuous positive airway pressure and can also have added oxygen. "Sprinting" is where they will do a trach collar (no airway support) for an hour at a time and then put him back on the ventilator at his weaned settings. Gradually as he tolerates it, they increase the amount of time on a trach collar and decrease the amount of time on the ventilator until you wean away from the ventilator entirely. I am unsure if you can add supplemental oxygen to a trach collar, but I would think you would be able to. Hopefully, that helps explain the weaning process a little better.

There will be another blood gas on Tuesday to see how he is doing (planned blood gases are on Tuesdays and Fridays). This could be a very big week for Carson if he continues to make the progress that he has the last couple weeks. We may get to try something other than the ventilator. We will just wait and see. Thank you from all of the Clarks and Bunches for all your prayers.

Kellen has his doctor's appointment tomorrow, Monday, at 2:30 PM to talk to Dr. Yang about a hernia repair. We will keep you posted.

Posted by Sarah

I'm not so sure about this bath thing here, Dad!
(Carson having his first bath)

great blood gas results!

Carson did fantastic on his blood gas!!! His carbon dioxide was 53!!! YEAH! Down to 8 on the rate. He has been such a champ.

His weight is 8 lbs 15.9 oz. Almost to 9 lbs for good...he was there but lost some extra fluid. They did his liver and kidney ultrasound but we do not have any results.

We are so proud of our little fella. Have a wonderful weekend everyone!

Posted by Sarah

Carson had a good night. This morning they turned his rate on his ventilator down to 10. They increased his feeds to 76 mL every 3 hours. And they increased his Prevacid, so hopefully that will help with his belly hurting. 

Tomorrow, he will have a big day. They have a blood gas, liver and kidney ultrasound, and additional blood work scheduled. We will see the results yield.

Thanks everyone for praying!

Posted by Sarah

Kellen got his Synagis shot (protects against RSV) today and was weighed b/c it is weight-based on the amount. He weighed 9 lbs 7 oz. Liz and I were laughing because at 2.5 months, he finally reached our birth weight. He did well with the shot and continues to be a delightful little guy. 

Carson had a good day. They weaned down to 8 on his PEEP plus. Next step will be working on weaning the rate more. He is at 12 now and they are going to try to get him to 5 or 6. He has a blood gas on Friday so we can pray it is excellent so they will keep weaning. He did lose weight, so we also need to pray he isn't working too hard to breathe. He continues to not do as well with the bottle, but for right now, we are focusing on ventilation. They increased his Prevacid, because they thought it might be reflux that is contributing to his poor eating. We will see what that does.

down more on the vent

Carson is down to 9 on his ventilator. Hip hip hooray! The doctors do not feel he has really increased in respiration per minute since we began weaning so this is a good sign. The doctor today said once the PEEP plus pressure is down to 6 to 8, he will begin weaning the rate again. It is at 12. We'll just wait and see what they are going to do and keep on praying for healing for his lungs. He continues to gain weight and appears to be doing well. 

That said, he has not been eating from a bottle as well as he has in the past. They believe it may be reflux, but have not figured it out yet. He is only taking 30-40 cc rather than closer to 60. We aren't too concerned with this, because there are so many other things.  So we'll just pray for that too.  :) 

Kellen has an appointment with Dr. Yang on Monday to evaluate his hernia and discuss surgery. Both boys got their Synagis shots today. 

I have to say the pictures from today are probably two of my favorite so far... how cute can they be!

Posted by Sarah

identical twins

I WAAAAAAANT................................MY BROTHER!!!!!!!!

Carson went down to 10 on his ventilator setting. He is doing fantastic!!! He also gained weight last night...about 5 ounces in one day...so he either had a slice of Preston's birthday cake and ice cream when no one was watching or he has a little extra fluid. :) He is over 9 lbs though so we are happy. They are going to be watching though because we don't want excess fluid. This Friday we should get a liver and kidney ultrasound to follow up on his clot in the liver and calcium in his urine.

Hope everyone is having a great start to your week!

Posted by Sarah