Thursday, March 25, 2010

Still Working on the Wean


So tomorrow will be the end of week 2 of our wean schedule. Everything seems to be going well. She has tolerated 1/2 liter for the last two weeks just fine. I am not totally convinced that a dropping down to 1/4 liter is going to go as well. The only way to find out is to try it.

We have also met our goal with the TPN schedule. When we first brought Juliana home we only had three hours off a day from the TPN pump. So she was infusing for 21 hours a day. Now just over a year later we are down to 12 hours a day. Now that she is older this is especially important. She is able to move around a bit more without having an extra pump to drag around. It also decreases the amount of times per day that I have to access her line. We hook both the TPN and the omegaven up at night before bed time and instead of disconnecting the omegaven first and then the TPN hours later, we can disconnect all at once. I try to schedule our in home labs to coincide with our disconnect time in the morning. The risk of infection increases each time the line is accessed.

Feeding therapy is coming along very slowly but we are noticing some progress. She continues to fight off anyone or anything that comes near her face. Recently she hasn't been fight as much as before. It is very small progress but definitely an improvement. She allows finger play in the mouth more than she will with spoons or the NUK brush. I have stopped focusing on the amount of food we can get into her orally. If we can get her to at least tolerate any type of mouth stimulation we know that this will help her more in the future. The stimulation will aid in her speech progression and help her to learn how to control the food. She still does a lot of gagging when it comes to actually swallow food. Part of this in my opinion is due to the NG-tube (Nasal Gastric tube runs up the nose and then down to the stomach for feeding). At this point we have no other choice. The only way to get rid of it is to have the surgery for the reanostomosis and at that point the surgeon will put in a G-tube. The G-tube is a gastric tube used for feeding that is inserted through an incision direct to the stomach.

As the days go on I get more and more anxious. I just want to have the surgery in the past. I am more than ready to start moving forward towards getting Juliana off the TPN. Whether or not she will actually get off TPN is not a guarantee, but we could at least explore this possibility. What I dream of even more is to exit the ostomy world. Everyday the challenge of caring for Juliana's ostomies is increased. She is much more active and keeping bags on her for more than a day is near impossible. Couple this with the fact that we are only allowed enough supplies for one bag change a day and we find ourselves in a very stressful situation.

So as much as I dread having to go back to living in a hospital, I know that this upcoming surgery means some very big changes in our lives and for the better. For now we just continue to work on weaning down the oxygen to get her ready for surgery. Praying for no surprises in the upcoming months.



Finally a tooth shot!!!! The first one is not the greatest but I did the best that I could. She has four on the top and another four on the bottom.

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Juliana Maria was born on July 12, 2008. She is a micro preemie born at 1lb 2oz. 11-1/2 in 23 weeks and 4 days gestational age.