Luke Guerrero – Page 2

42 Days Old: Daily Update

June 4, 2016 9 Comments

Good morning. Olivia had a great night with one of her favorite nurses. She awoke early for a jog from 5:30 to 7:30 AM.

Medical updates:

Bilirubin is down to 5.1. We’re loving the continuous slide here with 6.1 & 7.0 in the prior two readings. Her goal is sub-2.0. Based on Dad’s very fancy (10th grade) math skills, he’s projecting she’ll get there by June 16th.

The team continues to push her on respiratory. Her sprints are ordered to increase to 3 hours, 3x/day. She’ll start that this morning.
Feeds remain constant. Her weight is up another 50 grams.

Ms. Olivia will be entertaining guests today and asked to be dressed for the occasion. Mom helped her out with the selection. Charise and Lindsay (Maccie) arrive from Connecticut and Massachusetts, respectively, this morning. Olivia (and Mom) are very excited.

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41 Days Old: Daily Update

June 3, 2016 4 Comments

Good morning! Olivia slept soundly last night. She was exhausted from a multiple hour play session with Mom yesterday.

No lab updates for today. Sprinting continues on the respiratory front. We ran for 2 hours to start the day. Feeding remains the same. We’re not starting bolus-style feeding, as mentioned yesterday, instead focusing breathing and OT progress.

Dad went with the blue whales today.

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40 Days Old: Daily Update

June 2, 2016 4 Comments

Olivia had a great night and a fun morning with Dad. While sprinting we jammed out to Yanni, then wrapped up with Rumpelstiltskin and The Little Engine That Could. I put her in pink flamingos for the festivities, check ’em out below.

Medical updates:

Respiratory. Sprinting sessions are ordered to increase to 2 hours, based on stellar performance thus far. We hope to make some assessments on the ventilator next week.
Feeds. Holding steady here – 19 MLs/hr, +1.5 teaspoons of pregestimil, +6 MLs of liquid protein. Tomorrow we may trial bolus-style feeding. Right now she’s on a continuous feed where milk drips into her stomach at 19 MLs/hr. Bolus-style feeding simulates her feeding naturally, giving her 76 MLs (4-hours worth) all at once.
Billy. Direct Bilirubin continues its slide down to 6.1 from yesterday’s 7.0. This is fantabulous. Sub-2 is the goal.

Note, the hose is pulling on her face in this photo. That’s why her right eye looks a little funky.

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39 Days Old: Daily Update

June 1, 2016 5 Comments

Good morning. Olivia had a quiet night and morning. When we came in this morning, she handed us a card she wrote for her aunt Lauren.

No major medical updates today. She continues sprinting and feeding. They are adding 1/2 teaspoon of protein to her feeds to keep her growing.

Playtime (stretching and sprinting) are in store for her today.

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38 Days Old: Daily Update

May 31, 2016 8 Comments

Good morning. Olivia had a peaceful evening.

Medical updates:

Respiratory continues on the same trajectory – continuous workouts.
- She’s now ordered for 3-4 sprints per day. This is up from 2 sessions/day.
- She “ran” for an hour this morning in Dad’s arms. They had a transcutaneous CO2 monitor hooked up during the exercise to measure her CO2 levels (grey and purple gizmo attached to her tube in the image below). Rates consistently held in the 40s-50s, which is great for her.
- Note: overnight she had a significant desat event, however, it was deemed to be related to the tube “tenting” against the wall of her lung due to movement. They’re going to adjust its position (depth) and re-tape her today.
Feeds remain consistent at 19 MLs/hr. She had a residual of 19 overnight, well under the limit. These are now checked every 12 hours.
Direct bilirubin measured at 7.0. Last measured on Thursday at 9.7, this is fantastic! Since the number has previously jumped around on us (8.6-9.7), they await Thursday’s reading to assess any measurement error (e.g., was today’s 7.0 or the 9.7 a false reading).
Other regularly scheduled labs came in as normal (hems, etc.).

After her morning sprints, Olivia requested to start the literary classics curriculum. Dad read her Cinderella, Jack and the Beanstalk, the Tortoise and the Hare, and a few others.

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37 Days Old: Daily Update

May 30, 2016 6 Comments

Good morning and happy Memorial Day. Olivia had a peaceful night.

Medical updates:

Feeds are going up to 19 MLs/hr to add calories and keep her growing.
Respiratory rates and settings remain the same. She is scheduled for two sprints today, with one going on at the time of writing. So far, she’s doing well with these exercises. They are expected to continue throughout the week.

Mom will post more pics of Olivia this afternoon.

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36 Days Old: Daily Update

May 29, 2016 9 Comments

Good morning.

Medical updates

Respiratory. Today we’re starting a “sprinting” regiment. Her rate support will be completely shutoff for 30 minutes so that she has to breathe completely on her own. She’ll still get pressure support as she’s breathing through a little air tube. She’ll do this 2x a day to gain strength and demonstrate whether she can be off the vent. Here’s a picture of her sprinting!
Feeds. Olivia continues to leave large residuals that flirt with the limit (36 MLs). We’re adjusting her Reglan dosage up slightly, corresponding to her weight increases.

Olivia will get to see her Guerrero Grandparents and Aunt today before they head back home. She dressed in her bees for the occasions.

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34 Days Old: Daily Update

May 27, 2016 4 Comments

Olivia had a good night, and is getting some holding time with Mom and Dad this morning.

She’s on a “lab holiday” today, meaning her usual tests/exams will be put on hold until tomorrow to give her a break. She’ll be getting her work up again in the early hours tomorrow following her Tuesday, Thursday, & Saturday schedule.

Medical updates:

Feeds are going strong. She had small residuals most of the night (3-10), which means she’s processing all of her feeds well. We’re at 18 MLs/hr with 1.5 teaspoons of pregestimil/100 MLs. Note: I previously reported pregestimil as per kg, which is how they size other drugs; it’s actually per 100 MLs of fluid. Whoops!
Her supplements will be switched to vitamin D only for the weekend, as she’s been spitting up the other vitamins. They will reassess on Monday.
Respiratory was stable overnight. No planned changes for today.

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33 Days Old: Daily Update

May 26, 2016 6 Comments

Good morning. Here are today’s medical updates:

Feeds went up to 16 MLs/hr overnight. She had a great residual this morning, 3 MLs at 8 AM. We were in the 20s & 30s yesterday. She will increase to 17 MLs/hr today and go to 18 tonight. Olivia has lost weight in the switch from ND, so the supplements of pregestimil remain.
Direct Bilirubin is back up to 9.7 from 8.6 on Tuesday. No immediate concern, as the reading fits within the (slope of her) trend line.
Respiratory will remain the same today. Her blood gas was higher overnight and she’s had several desat events. This area started acting up towards the end of the day yesterday, despite a strong day on Tuesday.

Dr. C & team stopped by today to round. They were impressed with her OT performance. They expect results from genetics tests in mid-June.

Below are some photos from Mom’s morning holding session. We brought in a boppy today.

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32 Days Old: Daily Update

May 25, 2016 5 Comments

Good morning. Olivia had a great night. We found her changed into new gear overnight, after pooping all over her outfit from yesterday, so today it’s hot air balloons.

Overnight Olivia did great with her new NG tube (see our update from yesterday on the ND->NG change). She had residuals (undigested milk in her stomach)) of 22, 17, 15, & 24 MLs, measured on the four-hour mark. She’s currently on 15 ML/hr regiment, so she’s digested over 200 MLs via her stomach already. Note: it dropped from 18 when switching to NG feeding, as 18 MLs was a lot for her little stomach to handle at once from a cold start.

In all the fun transitioning from ND->NG yesterday, she missed a bit of feeding and lost 40 grams overnight. They are increasing her pregestimil to 1 & 1/2 teaspoons per kg (up from 1/2) to give her more calories. She will remain at 15 MLs/hr rate during the day. It will increase 1 ML/hr every 12 hours starting at 1 AM EST.

Although she had one of her best blood gases this morning, there are no changes to her ventilator settings today. Her main goal is progressing on NG feeding, so no distractions necessary.

She’s been in Mom and Dad’s arms since 8 AM.