that's my blanket!

Times must be tough in the NICU, because earlier this week, the Twinsler's were removed from their separate incubators and placed together into an open crib. They call this co-bedding and its something that they do for most preemie twins as it is suppose to help them develop. Although they are both still fluctuating w/ their oxygen needs, both twins continue to grow and develop. Last night was actually the first time that I realized a substantial change in their appearance - they have chubby chins! More to come soon...

-tinny out

On a roll?

The end of last week was pretty rough, but our girls had a pretty good weekend and Monday. Ava is in a new, open crib, waiting for Ella to get done w/ her antibiotics to "co-bed". It's a sleepover! Both babies are over 3lbs and growing. They are both still on the nasal canulas w/ varying levels of breathing assistance. Last night Rachel and I got to help give them baths, but because this is a pg-13 blog, no pics, sorry! but to tide you all over, here are a few recent snaps. Above, Ava and I are kangarroing, below, you see Ella wide awake & alert.And here is Ava sleeping w/ her mouth open... Thanks for all your support...

-tinny out

Visitors

The girls really enjoy visitors. Here are some pictures of their recent guests. Grandma got to hold Ava during a feeding on Wednesday (I am sure that Grandma from North Carolina is very jealous).
Nate and Whitney have visited several times...
Who's that behind you, Ella!?!?
-tinny out

Ups and Downs

What a crazy couple of days. Rachel and I are headed to a baby shower for the Twinsler's that we are really looking forward to, so I need to keep this brief. Ella is doing pretty well. She is breathing room air, w/ some extra flow through her nasal canula. She has 3 more days of antibiotics, she is almost ready for an open air crib, and is taking her feeds well, and last night she hit 3 lbs!Ava has now become our little stinker. She has had an uncharacteristically rough couple days, and the doctors think that she may have a blood infection. They started her on antibiotics and are taking blood cultures from her daily (just like w/ Ella earlier this week). Overall they are both healthy, and the nurses keep telling us that this is just what preemies do, ups and downs.
Thanks for all your love and support!

-tinny out

Thursday Update

The girls had a pretty good days today. They both continue on oxygen and surprisingly Ava is requiring more than Ella. They both continue to have episodes of heart rate drops and at times have trouble keeping their oxygen saturation up, but this is mostly right after eating or if they are stimulated too much. Because of this step backwards a lot of tests were done today to make sure there isn't anything else going on. So far, they haven't found anything else going on. The plan is to wean the oxygen as tolerated. We will keep you updated.

About the infection....I'm not exactly sure where to start. One of the cultures drawn about 5 days ago ended up growing staph, which may again be a contaminate, but because this is the second culture that grew staph they decided to change the antibiotic. This new antibiotic will take care of the staph and enterococcus. They also pulled out the PICC line just in case that was causing the infection. The doctors as well as Nick and I are very confused and frustrated with this changing infection. I just hope they are treating the right thing.

Nick promised to post more pictures this weekend.

-Rachel

Thursday AM

I went in this AM to see both my girls back on nasal canulas. The nurse said that both twins did a lot better overnight once they had the breathing assistance in place. Yesterday was quite a day w/ a lot of commotion, so let's hope that was the case. Nurse says that this is totally normal w/ babies of this age ~31-32 weeks, they are just being "preemies."

-tinny out

Rough Night...

The NICU is kinda strange. It has its own energy and it ebbs and flows in no predictable way. Sometimes its calm and soothing, other times its loud and chaotic.

We've had a pretty good run for the past week or so. Ella was taken off oxygen this past weekend, and both girls have been more or less taking their feeds and growing (Ava is now 3lbs 2 oz. and Ella is 2lb 12 .) They both seemed to be having less episodes and self-stims. This morning they "popped the top" of Ava's crib. This is what they call it when they open up the incubator's top, essentially making it a normal open air crib. I think she wanted to feel the wind in her hair.

I'll let Rachel blog about the blood infection, but I'll just say that we had a solid 8 hours of "yeah, we're good" until the story changed again... Ugh!

So tonight, Rachel and I headed to the hospital for one of the more difficult visits that we've had yet. In short, the NICU was flowing in a really bad way; lots of alarms and noise, lots of babies crying, and an overall very eerie vibe. The twins started out OK, but started to have episode after episode for no apparent reason. None of the usual tricks that the nurses use were working. Ella is back on a nasal cannula (room air w/ added flow), and Ava's color looked too dark to me. It was really painful to be there, I felt helpless, and it was even more painful to leave... Lots of tears tonight.

-tinny out

We'd like to introduce...

...our new cousin, Jocelyn Marie. We kinda stole her thunder as she was supposed to be born right about now and have a month or two to enjoy the limelight as the youngest grandchild, but we sure showed her! Here is the proud momma and Grace and Grant. I don't know what they are feeding her, but we need to get us some of that!
-Ava and Ella

Infection Update

Sorry for the lack of updates...We had computer troubles this weekend.

The infection saga continues....The blood culture that we thought was growing step turned out to be growing enterococcus, which for the doctors was a little more alarming. It was for sure not a contaminate, which meant that little Ella did have an infection in her blood, and definitely needed the lumbar puncture to make sure she didn't have spinal meningitis. The lumbar puncture was done on Saturday and the awesome resident and nurse were able to get enough fluid on the first try, so we don't think Ella suffered too much. That culture was sent to the lab and we found out today that it was clear, so the infection is only in her blood. Praise God!! The plan is to treat her with antibiotics for 10 days, but the doctors are still questioning how she picked up this infection. It could have been from me (Rachel) or the PICC line that was placed days ago. To make sure that it is not the PICC line they drew another blood culture today and if it grows the same bacteria then they are going to pull the PICC line out and find another way to give her the antibiotics. Sorry for the lengthy update, I hope it all makes sense.

-Rachel

Strep

Well unfortunately it looks like Ella does have an infection. Yesterday we found out that the culture grew something that resembles strep, which is not that surprising since I tested positive for strep B 30 minutes before the C-section. She was started on antibiotics yesterday and the course of treatment will be determined once the culture is identified. We are praying that it is not strep because if it is she will need a lumbar puncture (like a spinal tap) to make sure the infection is not in the fluid around the brain. Poor Ella. We will keep you updated on this as soon as we find out more information.

Other than the infection, Ella seems to be doing well with less oxygen requirement everyday. We are hoping by next weekend she will be on "room air".

-Rachel

Now we wait...

On Wednesday morning, Rachel and I learned that Ella may have an infection. Ella Rae was having a few more-than-normal (even for her) episodes of apnea and brady cardia (where she either forgets to breath or beat her heart). The doctors drew some blood and found that she had a high white blood cell count. This could be a sign that Ella is fighting an infection, but not necessarily. So, they put the blood in a culture for observation and administered an initial round of antibiotics. They said not to worry, as it probably would not be an infection, and that these were precautionary steps. It gets a little funny after this because as we head back to talk to our nurse, and she thinks that Ella just needs her caffeine upped. Ugh-should I worry or should I not?!?

Last night, both Ella and Ava had great nights. The night nurse said that they were angels and that she did not have to log a single episode between them, which is a first. So, everything's great, right?

Then late this afternoon (Thursday), the doctor informs us that they did find an infection-like structure in Ella's blood culture, but they have a suspicion that the culture was contaminated. Ella is doing really well, so they decided to draw a second culture to either confirm/deny the presence of an infection. So, I guess that we now pray that there is not any infection.

Keep little Ella Rae in your prayers.

-tinny out

Drama Queen

I think that Ella Rae may turn out to be our very own little drama queen. below are a few pictures that show some of the sides of Miss Ella.-tinny out

Wednesday Update

I came into the NICU before work to find Ava looking like this...
Earlier this week, Rachel was able to Kangaroo both girls at once.... lucky! I tried later that day and it didn't work out so well. I was a little nervous, and I think that the twins felt that energy and were extra fussy.
Here is Ella through here porthole.-tinny out

Tuesday Update

The girls continue to be moving in the right direction.

Ava was taken off her oxygen today and seems to be doing well without it. Yesterday she reached her feeding goal rate (20 mls every three hours) and tonight she will start on fortified breast milk, which will help her gain weight. She continues to not need an IV, which means that she is only hooked up to leads (which monitor her heart rate) and the feeding tube, which is now going through her nose. They tell me that having the feeding tube feed through the nose is more comfortable and allows her to work on sucking with the pacy. The only concerning thing with Ava is that her brain scan showed tiny cysts around her brain. The doctors didn't seem that concerned about it and plan to scan her again in about 6 weeks. We are going to get more information on this tomorrow.

Ella continues on oxygen and they tried to wean her down to 1 liter, but that only lasted 6 minutes before they needed to bump her up again. I think they are going to try weaning her again tomorrow. She is going to receive 15mls of breast milk every three hours and hopefully reach her goal rate tomorrow (20 mls.) The TPN was stopped and they may be able to take out the PICC this weekend. Ella's brain scan came out normal.

I have been going to the hospial every morning and for the past two days they have let me kangaroo both of them together. Yesterday was the first time the girls were able to be next to each other since delivery. Ava is really funny when she is kangagooing with her sister, because buy the end she tries to move as far away from Ella as she can. I think she is tired of her sister already.

I just wanted to thank everyone for their continued support and prayers. Daddy and I would not be able to survive this season in our lives without you.

-Rachel

Here are a few pics from the weekend. Here Ella looking all content and cozy...
And here is Ava being ambushed by the nurse "What's going on, stop that your hands are cold!" Right after this picture was taken, she slapped the nurse hard! :)
-tinny out

Happy Birthday!

Yesterday, Monday, was Ava and Ella's first (week) birthday. For some reason, they wouldn't let me bring in a cake w/ candles into the NICU (neonatal intensive care unit) to celebrate. They said something about pure oxygen being pumped through the walls and that flames are a bad idea (blah, blah, blah :) . So, daddy had to improvise. I purchased a couple small frames and made them each their own birthday cards.

Whatever you all are doing, whether its praying, thinking of or meditating, please keep doing it, b/c the girls have had 3 good nights and 3 good days in a row.

Sunday night, Rachel's parents returned from vacation and met the twinsler's for the first time.
-tinny out

Good Stuff

We've had 3 good nights and 2 good days in a row, so these little girls are coming along. Both are breathing "room air" (no supplemented oxygen), but both still have some extra "flow". I'll try and post more tonight, but here are a few pics from the weekend. Rachel Kangarooing and a sprawling Ava.
-tinny out

Some More Pictures

Rachel and Ella Kangarooing, still w/ her Cpap on.
Ava through the port hole
Rachel changing Ella's diaper
-tinny out

Here come the Grandparents!

My parents traveled in on Saturday for the weekend to meet the girls. They arrived in the late afternoon and we went up to the hospital in time for their 6:00pm feeding. Rachel and I were able to change the girls diapers and help w/ their feeding time rituals. Overall, the girls are doing well. Tonight, Rachel's parents get home from Florida. The girls said that they were sorry for causing such a ruckus during their vacation... oops!

Here is Ella saying hello to Grandma and Grandpa Tinsler...
Ava saying what up!

-tinny out

C-pap

This is a picture of Ella. As you can see, she is off the c-pap. I think she is a lot cuter this way. The bruise on her forehead is from the c-pap mask.

-Rachel

feeding update

Ava and Ella seem to be doing better with their feeds. Ella is currently getting 5mls of breast milk every 3 hours and continues on TPN for the rest of her calorie needs. Ava is currently getting 15 mls of breast milk every 3 hours and if she tolerates the increase tomorrow she will likely come off TPN, which means the IV can come out. I'm sure she will be very happy about that.

These pictures are of the girls during their 6 o'clock feeding tonight. If you look closely you will see a syringe of milk, held by the nurse and a pacifier in their mouths. The pacifier is used to associate sucking with their belly getting full. This will hopefully make the transition from tube feeding to a nipple easier. Ava likes her pacy better that Ella.

-Rachel

Ava says Hello!

Friday AM Ava said hello to daddy and said "Why don't you get some pics of me up on the Blog already, Ella is not the only one that can open her eyes."
Bright light, bright light!
-tinny out

Friday Update

Friday, the girls had good days heading into the weekend. I'll hopefully post in a little more depth later, but here are the high points. Both were taking their feeds w/ little to no aspirate (left over food in stomach when its time for the next feeding) , Ava was taken off her photo therapy lights. Ella gained 10 grams, and Ava opened her eyes, for daddy. Nick changed his first diaper. We were discharged on Friday, and that went OK. We headed home at 3:00 (to a clean house, thanks Jenn & Sally!), and settle in for a few hours before heading back for a visit in the evening. This will be a big weekend as the Twinsler's will get to meet all of their grandparents for the first time.

For now, I'll leave you w/ some pics of the diapers that that the girls are wearing. That is a standard blackberry Pearl phone for reference. They are pampers, for all the P&G folks in the house. These diapers look so big on our girls b/c they don't really have any butts yet, but they promise that they'll come! The best factoid about these is that they are not even the smallest size that they make, yikes!

Ella opened her eyes

I went down late last eve, after our hardest day thus far to say good night to the girls, and Ella was squirming all over the place. After a few minutes she opened her eyes! I about melted and struggled to get the camera out to capture the moment.

Today, they plan to take Ella off Cpap, Ava off the lights, and we are really hoping to get to Kangaroo w/ them...

-tinny out

Feeding

Feeding and IV's have been a problem the past couple of days. Both of the girls are currently on TPN (nutrition through the blood) with the hopes of transitioning to breast milk as soon as possible. An NG tube (a tube going through the nose and into the stomach) was placed on Tuesday and both girls were started on 3 mls of breast milk every three hours. Before each feed they attach a syringe to the NG tube and suck out what is left in their stomach, to make sure they are tolerating it. If what they pull out is the color of milk and less than 40% of the feed then they are likely tolerating the feed and can be given more. Ava has been tolerating the milk more than Ella. Ella's feeding has been stopped several times and continues to only get 3 mls every three hours, with the majority of her nutrition coming from TPN. Because of this she was given a more permanent IV called a PICC line. Ava on the other hand is up to 9mls of milk every three hours, with the hopes of d/cing the TPN soon. We have a wonderful dietitian named Suzanne monitoring them closely, so mommy is trying to be a mom and not the dietitian.

-Rachel

Day 4, A dose of reality

Today was rough. Everything to this point has been generally trending upwards, but today was discouraging. Ava was put under the lights for jaundice (but thankfully, Ella no longer needed the lights), so we were not able to Kangaroo w/ her today. Ava was generally steady but was really up and down w/ her feedings. I think Rachel may blog about that later. Ella is our little stinker. She already knows how to get to her mom and dad. She had a lot of bradycardia today (brady's for short). In layman's terms, this is when the heart rate get's dangerously low, and the baby needs to remind itself to keep breathing. They call this a self-stimulation or self stim. Basically an alarm goes off, and a nurse watches the baby to see if they bring their own heart rate back up. If needed they'll jump in and help stimulate the baby by moving and gently poking the child. They'd rather the child self stim because you don't want them to "learn" that someone else is always going to handle them.

There were a lot of these episodes today, each one lasting only a few seconds, but they are so hard to watch! Each one really takes its toll.

Here is Ava holding daddy's hand for the first time.


-tinny out

The Girls' Room

Here are a few pics of the girls’ room. Now you can see why we chose the colors that we did for this blog. I am pretty happy w/ the room, but I drove myself crazy in the process. I did most of the work right after we learned that we're having girls, finishing during the holidays. I really enjoy these kinda painting projects and would love to help out other people or do this on the side, but who am I kidding, I don't think I'm going to have much time for a second job :). We have since added bright pink curtains (thanks Grandma Tinsler!). I bought white mini-blinds for the room on Saturday, thinking that I’d get to install them soon. I guess the joke is on me!

We also have one of our cribs (thanks, Rybolt family). I assembled it last week and it looks great, perfectly matching the changing table/dresser that I painted.

Who's this schmuck?
-tinny out

Those are centimeters...

...not inches. :)

Day 3

Here are a few pics from yesterday. Ava was removed from the Cpap devise and put onto a nasal canula, basically supplemental oxygen like an elderly person could use. We think she looks a lot cuter w/ out her mask. She is taking her feeds and is passing bowel movements (both very improtant if she is to build stregth and grow. Here is Ava before the removal of the Cpap.

Here is Ava right after the removed the Cpap before they put on the nasal canular.Here is Ella. She takes after her mom and likes to sunbathe, already. She has jaundice, so they had her soaking up the rays under a special light. Has anyone seen my Oakley's? Ella is slowly starting to have bowel movements, and is accepting about 1/2 of her feeds, so they took a break on day 3, and will start them again on day 4.

Day 2 update

After a very blurry initial delivery day (Monday), Rachel and I got to hold our babies for the first time today. We were able to touch them yesterday, but it was pretty overwhelming approaching these little girls. They look so small and fragile, we didn't want to break them :) We held them during a process called "Kangarooing." This is a process where the babies are placed on your bare chest, and the you're both bundled up together. It is pretty much one of the coolest things that I have ever experienced. Here are pictures or Rachel w/ Ava and Ella in my "pouch". I think that I look 17 in the picture.