Thanks for following Josh!

Thank you everyone for following Josh's story while he was in the NICU. Now that he is home and doing well our days are full with feeding, changing, playing and sleeping. This will be our last post but we will try to send out pictures and post updates on Facebook.

Josh recently was checked out as the cardiologist and everything looked great with his heart. He is now concentrating on growing and gaining weight and we think most of his appointments from now on will be routine. Soon he will have an evaluation by a physical therapist, as part of the Colorado Early Intervention program, and they will assess whether or not he needs any additional therapy moving forward.

He is now 7 weeks adjusted and weighs 10 pounds and is 22 inches long. All in all he is a happy little boy.

Figuring out a schedule

In the last week Josh has gotten better at sleeping at night but has shifted his time of fussiness to the day, but at least he is sleeping a little more at night. Right now he wakes up like clockwork every 3 to 3 1/2 hours and is ready to eat. We have discovered that we need to burp Josh completely or his fussiness increases at night. This also happens if he has extra gas so we have tried gas drops intermittently. This can be quite a challenge because sometimes it can take 30-45 minutes to get a burp. We have also been using a great swaddle called the "Miracle Blanket" which is basically a straight jacket for babies.

After his last doctor's appointment it was determined that he still needs some extra calories to gain weight so he is getting a mix of 24 calories hypoallergenic formula and breast milk. We hope this will help him gain weight and keep him around the 50th percentile line. He is a very active boy but doesn't like to eat a lot so it's hard for him to maintain his weight gains.  Because of his time at the NICU working with physical therapy he already can hold up his head about 80% of the time, he can push up on his arms when doing tummy time and has even rolled himself over after being placed on his small tummy time bolster.

This last weekend we had a visit from Grandma and Grandpa Jorgensen and spent some time going on walks and hanging out with everyone at Grandma and Grandpa Yeager's house.

Sleepless Nights

Josh is still having a lot of trouble at night, in fact, he rarely sleeps at all which of course puts a lot of pressure on us. After midnight he turns into a different baby who won't sleep for more than 10 minutes at a time, screams, and flails around. No amount of swaddling or shushing can calm him down. Needless to say this is hard on us because one of us has to be up with him all night and the second we lay down to rest is when he starts crying again. Our best guess is that he has reflux and gas but we'll have to discuss it with the doctor again. If anyone has any advice as to how to deal with an extremely fussy baby it would be appreciated.

Otherwise Josh is doing well and we are coping with the lack of sleep.

First Week at Home/Four Months old

Josh has had an interesting first week at home with some ups and downs. He has mostly adjusted to the new environment and to being with mom and dad all the time. He still has some trouble sleeping, especially at night when he gets colicky and can't relax. This is mostly hard on us because we don't like to see him in discomfort.

On Tuesday Josh had some bloody stools and we had to take him to urgent care in the middle of the night to get him checked out. The doctor seemed to think that this was a reaction to the formula and he has been placed back on a hypoallergenic formula which should be easier for him to digest.

Today he got checked out by the pediatrician and he has gained 6 ozs in the last week, weighing in at 8 lbs 11 ozs. Next week he will get his four month checkup and his next round of vaccines.

Josh's first days at home

Welcome Home Josh

Josh was discharged yesterday afternoon from the hospital and is adjusting well to life at home. It's a little different environment with less light, noise, and people so it will take him a little while to get settled but so far so good. We are also all adjusting to having him home and learning his sleeping/eating patterns. Right now he is waking up every 2-3 hours and then eating smaller amounts. We are shooting for a goal of 270 mls every 12 hours. Caleigh (our cat) is cautious around Josh but mostly treats him as a non-entity.

Today Josh went to the pediatrician office and got a clean bill of health. He will continue to see the pediatrician once a week for the next month. At the end of October we will take Josh to see the cardiologist in Denver to look more into his ASD vs. PFO.

Trying new things

Josh is still a "feeder/grower" and working on taking full feeds and we are trying new things to get him home soon. Because he is full-term they are now letting him sleep up to four hours at a time and then hoping he'll eat more when he is awake. Unfortunately he hasn't taken extra amounts yet to meet the prescribed volume, but we are hoping that if we try this for a few days he'll start to take larger volumes when he is awake.

Tonight we are trying what they call "rooming in" where Josh will be hooked to a portable monitor and will stay with us in the family room where we will care for him overnight. We want to see if Josh will eat as well for us overnight as he eats for the nurses.  The nurses will still prepare his milk for us and be available for an emergency but in general we will be on our own.

Patience Required

Now is the time when our patience is truly being tested as we have to let Josh proceed at his own pace. It has been a day by day challenge to get Josh to nipple his feeds and some days he does really well (90%) and then the next day he'll be tired and do less (50%). It is a day by day process but we know that he will get there soon.

Josh has recently been switched to a new formula, Good Start Nourish, which is better nutritionally for him than the Alimentum. We are still monitoring him carefully to make sure that he doesn't have any bloody stools but it appears that he is tolerating this new formula. We are sticking with the plan of alternating bottles of plain breast milk and Nourish and it is helping him gain weight and get the right nutrients while still getting the benefits of breast milk.

In good news Josh now weighs 8 pounds and today he passed his hearing test.

Micro-management

Hi everyone,

It was a tough weekend while we tried to puzzle out Josh's eating habits.  As you may or may not know, he's been struggling with various types of milk fortifications/formulas and one of the main things we need him to do to come home is take all his feedings without the need for a gavage (nose feeding tube).  Sunday we met with the staff (doctor, NNP, nurse and OT/PT) in a "Care Conference" to talk about our options and outline a more consistent feeding plan for the next few days.  We were fortunate also to get more of the NNP's time to watch us feed Josh and witness first hand the issues we (and many of the nurses) have experienced.  This of course led to immediate changes to our "consistent" plan, but changes that Becky and I think will help Josh handle both breast milk and the Alimentum formula.  After setting the new plan in motion yesterday evening, we're pleased to hear this morning that Josh has already taken four full feedings and one partial which is a real step in the right direction.  It may be too soon to celebrate, but we have to take little wins when we can.

Side note: I'm sure parents of newborns go home for the first time and never get this kind of practice with feeding a baby, so while it is frustrating to watch him struggle at the hospital, we have to look at the positive in that we're getting a lot of support and guidance that most parents would not necessarily receive from a trained staff.

On another bright note, Sue Cooch visited this weekend and got to meet Josh in person.  Sue is one of Josh's loyal blog readers and a long time family friend.  We've been friends ever since she fed me individual curds of cottage cheese as a baby.  Thanks for taking us out to dinner on Saturday between feedings!

I also noticed that we have over 10,000 page views, so I will ask that my mom please stop refreshing the page every two seconds :)

Anyways, thanks everyone for sticking with us and thanks for all the love and support.  Here's a recent photo that I like:


-Evan

100 Days Old

Today Josh is 100 days old or just over 14 weeks. His due date is this upcoming Saturday which is hard to wrap our minds around. He is still a "feeder and grower" and is working on taking full feeds from a bottle. He is tolerating the elecare, that is used to fortify his milk, and is now getting 24 calorie milk. Today he was switched to a multivitamin and an extra dose of iron which is what he will get when he goes home. He is still having some incidents of bradycardia which will have to stop before they will let him go home. Yesterday he had a tough day, but he seems to have recovered well, when he was circumcised. All in all he is doing well, and we are hopefully approaching the time when he will go home.

Is Time Slowing down?

As each day passes it seems to go slower. Maybe this is because we are anxious to have Josh at home and tired of driving to Denver every day. We are nearing day 100, and his due date, with no indication yet of when Josh will be ready to come home. Today they will try to fortify his milk again with a hypoallergenic formula called Elecare. Although he is growing on plain breast milk he needs the extra fortification because he missed out on a lot of essential vitamins and minerals that he would have gotten in utero. Other than this there are no real changes. He still is not able to take a full bottle every three hours but he is getting better. He weighs 7 lbs 2 ozs and has graduated to size 1 diapers. All of his growth curves are following the 50th percentile line which is right where we want them to be.

Josh is resigned to practicing "tummy time"

Three Months Old

Josh is now three months old or 38 weeks gestation. We hoped he would reach the 7 lb mark but he fell just shy coming in at 6 lbs 15.8 oz :). To make sure that his weight gain continues the doctors have upped the volume of milk he receives at each feeding. The other option would be to fortify his milk with a hypoallergenic formula to give him extra calories. Josh is still under close watch to make sure the blood in his stool does not return but we hope he is past this and moving forward. Yesterday he took four full bottles and three partial bottles before sleeping through the one feeding that we were there for. He continues to have a few brady's a day, sometimes associated with reflux and sometimes not associated with reflux. The goal is to still have him ready to go home by his due date, September 15th, but we will go with whatever schedule Josh chooses.

More ups and downs

Ups- Josh is no longer on oxygen and has been breathing room air. He is closing in on 7 lbs and almost three months old.


Downs- Josh has had more bloody stools even on plain breastmilk. Right now they at continuing full feeds and watching him. We hope it will pass and that he doesn't have an infection or a milk allergy. If the bloody stools continue they may try him on a hypoallergenic formula. Josh has also had increased Brady's some of which have required vigorous stimulation to get his heart rate back up.

Finding the right Formula

After Josh's troubles last weekend he was placed on plain breastmilk for a few days with no fortifications. This was done to help his digestive tract rest a little bit. Unfortunately, because he is a preemie, he needs extra minerals and fortifications to help him with proper growth due to missing out on these minerals in utero. Wednesday they tried adding back in some formula to his milk and once again had some blood in his stool. They immediately put him back on plain breast milk and he recovered and had several normal stools. Today they are going to try him on a brand new formula to see if he can tolerate that. If not we will have to go back to the drawing board.

Today is also a sad day for Josh as his primary day nurse Teena is retiring. She has taken care of Josh 2-4 times a week since his birth. We will miss her but we want to wish her good luck and we hope she enjoys retirement.

Josh loves to pull his arms out of his swaddle

Twelve Weeks Old

We have now spent 84 days in the NICU or 12 weeks. Josh is back up to full feedings and they will begin to add in some extra calories. Even without the extra calories he has been gaining weight so we hope they don't have to go back up to the super high calorie formula he has been on in the past. His reflux also is less on plain breast milk we hope that adding back in extra calories won't make his reflux worse. He now weighs 6 lbs. 10 oz and he has outgrown all of his preemie clothes. We have no entered a frustrating stage of being at the NICU where he seems ready to go home if not for the reflux (and accompanying brady's) and being able to consistently take full feedings from the bottle. One thing we are trying is to hold him upright for 30-60 minutes after his feedings or to put him in his car seat which keeps him at a better angle.

Josh with Frog Take Three

Josh with Frog- Four days old

Josh with Frog- Forty-Four days old

Josh with Frog- Eighty-Four days old

Tummy Troubles Part Two

This weekend was a stressful one as Josh exhibited signs of being sick, thankfully everything appears to be okay but he is being monitored closely.

Thursday afternoon Josh had blood in his stool which is a warning sign of a possible infection. This is not taken lightly so immediately he was given an x-ray and all additives were taken out of his milk. The x-ray did not show signs of an infection but also did not look normal. That evening his nurse thought he was acting a little strange and he still had some blood in his stools. The doctor decided to make him NPO (nothing per mouth) which means that all of his feeds were stopped and he was given IV fluids only. This is done to rest the digestive tract. At the same time he had labs sent out to test for inflammation and infection.

On Friday he had a repeat x-ray and again things looked unusual but there was no visible sign of infection. He was still acting normal (just hungry after having no food in his stomach) and his labs came back normal. His x-ray showed dilation in his intestines and the radiologist was concerned so he was put on antibiotics.

Saturday morning he had one more x-ray and although his intestines were still slightly dilated it looked better than the day before. The doctor decided to start him back on feeds of plain milk and to slowly build him back up to full feeds. He is still being monitored closely but he acts like he feels fine. Today he should get his IV out (which is in his head) and be back on full feeds. If he shows any signs of distress or there is more blood in his stools he will go back onto NPO status with just an IV.

Josh also continues to have reflux problems which in turn causes him to have apnea and bradycardia episodes. Right now these episodes are bad but not severe enough to warrant giving him medicine for reflux. The hope is that as he gets older and more mature these problems will decrease.

Josh with a funny IV "hat"

Tummy Troubles

"Tummy Troubles" is probably not the best description of what Josh is going through but it sounds better than acid reflux. Because of Josh's prematurity the valve at the base of his esophagus is still developing and thus, he gets acid reflux when he eats. The reflux causes him to be uncomfortable and to sometimes choke which in turn leads to apnea and brady's. We are trying to help him by sitting him up when he eats and afterwards and not pushing him to eat too much from the bottle. The hope is that as he gets bigger he will outgrow some of these issues. If the reflux continues he may need medicine to help bring it under control. The reflux is scary because Josh rarely cries, even when he spits up he is silent so often our only indication of a problem is that the monitors go off. 

The results of Josh's echo on Tuesday came back inconclusive. This means that the cardiologist was unable to see if he had a hole between the atrium. At this point the NICU doctor's are unsure of what they will recommend. He may have another echo before he comes home, or we may be referred to a pediatric cardiologist.

Josh wearing "big boy cargo" pants

Six Pounds

Today is day 77 (or 11 weeks) since Josh was born and it'a amazing to see the changes.
Josh has been growing in leaps and bounds and now weighs just over six pounds. He has outgrown his preemie diapers and clothes and is just starting to fit into the newborn sizes. His weight is right around the 50% percentile while his head circumference and length are hovering between the 25% and 50%. His head should round out more now that he does not have to wear the restrictive c-pap hat.

Yesterday he had an ultrasound on his brain and everything is developing normally. He had some extra fluid on the right side but the doctor's felt that it was normal and nothing to be concerned about.

Josh is still learning to wake up for his care times and take a bottle but he is getting better at this. A good way to get him to eat more his to lean down towards his face and go "nom, nom, nom" :).

36 Weeks Gestation

Josh has finally hit 36 weeks gestation which is means he will have a busy week. He is closing in on six pounds and his about 17 inches long.

Friday he had his third eye exam which showed the same results, immature eyes but no ROP. He will continue to have eye exams every two weeks, even after he comes home, to monitor the growth of his eyes.

Saturday he had what they call a Hood Oxygenation Test. They took out his nasal cannula and placed him under a plastic hood which had oxygen pumped into it. They were then able to observe how much oxygen he would need to breathe in a regular environment. His results came back at 23% oxygen which means that he has no signs of chronic lung disease. This was great news and everyone was shocked because he did not get any steroids before he was born. If we lived at a lower elevation he would probably not need extra oxygen at all.

Today he will have an ultrasound on his head to evaluate how his brain is growing and tomorrow he will have an echo-cardiogram. The echo is for the research study he is part of but it will also look to see if he has a hole between the left and right atrium. This was observed back in June but the doctor's weren't sure at the time if this was a hole that would close on it's own or if it's a heart defect.

This weekend Josh also got to meet his Uncle Andy and his cousin Jeremy. The rest of his time was just spent sleeping, eating, and growing.

Family Photo

                                               New Family Photo before Josh's bath :)

Why did you wake me up?

This is the look we get from Josh when we wake him up to do his afternoon exercises...

Big Weekend

Big things happened this weekend which could speed up the timetable for Josh coming home.

On Friday he received his last dose of caffeine, one week earlier than we expected. He is now in the seven day period where the caffeine leaves his bloodstream. He is still having 1-2 brady's a day but the doctor's say most babies begin to outgrow these around 36 weeks gestation.

Yesterday he took his first full feeding from a bottle. Although he is not ready yet to take all feedings this way it is a big step. He also tends to wake up around his care times (every three hours) which is a good sign that he is getting hungry around the time when we want him to eat.

He was also moved to low-flow oxygen on Sunday after only one week on the high-flow. This is just straight oxygen with no extra pressure for his lungs. They started him at 40% oxygen yesterday morning and he was already down to 30% oxygen by mid-afternoon.

The next big things are another eye exam on Friday, and a brain scan next week to make sure everything is developing properly. We are also going to work with him on strengthening his neck and legs with different exercises.

Steps to coming home

We get asked all the time when Josh will be ready to come home and the answer is that we really don't know. Initially we were told that we could expect him to be in the hospital until around his due date (September 15) but it could be sooner or it could be later. These are the steps he needs to take to be ready to come home.

1. Maintain his body temperature- This was the first milestone reached when he hit the 4 lb mark.

2. Take full feedings for all meals from the bottle- In the last few days Josh has shown interest in the bottle and has taken anywhere from 15-20 mls from the bottle at about a third of his feedings. Right now a full feeding for him is 45 mls.

3. Go from the high flow nasal cannula to a low flow nasal cannula. Currently he is on a flow of 2 liters and this will need to decrease to 1/8 of a liter and then they will put him on low flow oxygen.

4. Be off his caffeine and have no incidents of bradycardia for five days. When he is about 36 weeks gestation (one week from now) they will try taking him off the caffeine and seeing how he does. The caffeine remains in his bloodstream for a week and then after that time the five day countdown will begin. If he drops his heart rate any time during this five day countdown they start over with a new five day countdown.

5. Smaller things- pass his eye exam, hearing test, car seat test, sleep without extra support around his head or feet, etc.


And now, a new picture :)

Staying off the c-pap

Josh has been doing really well off the c-pap so far. Hopefully we have made it past the critical point and he will be able to remain on the high flow nasal cannula. Right now he is on a flow of 2 liters and they will eventually wean him down to 1/16 of a liter. Then he will go home on oxygen with a low flow (no extra pressure). They have also moved his feeding tube to his nose which means he will be ready to try bottle-feeding soon.

Josh has lost a little weight due to the Lasix which is good because he is less puffy. He will probably have to go home on a diuretic to help him with the common problem of edema.

Trying it off the c-pap part three

Third time's the charm, or so we hope. For his two month birthday Josh is trying it on the high flow nasal cannula again. We hope that this will be the time when he is able to stay off of the c-pap for good. They will wait to change his feeding tube to his nose until they are sure he has adjusted well to the high flow.

I'm two months old!

This weekend he also had his second eye exam which came back with good news, he still have immature eyes but no signs of ROP (Retinopathy of prematurity). This is good news and he gets to go another two weeks without another eye exam. Josh also had his first set of immunizations on Saturday and got through them with no side effects.

Earlier this weekend we thought Josh might need another blood transfusion as his hematocrit levels (red blood cell count) was low, but after testing it again it came back in the low range but not dangerously low. The doctors did another test and found that he is producing his own red blood cells now so we hope he won't have any more major problems with anemia.

Baby of the week

Every week the NICU chooses a baby to highlight as "baby of the week". This week is Josh's turn and he gets his picture on the board at the front of the NICU. It says his age, weight, what he wants to be when he grows up (a concert pianist and pro golfer) and his favorite thing to do (pull on his tubes).

Trying it off the c-pap part two

A week has passed since the last attempt off of the c-pap so they are trying Josh again on the high flow nasal cannula. We hope that this time he will do well enough to stay off the c-pap but if he has a lot of bradycardia they will put him back on the c-pap for another week.

Josh just hit the five pound mark and is growing well. He's still puffy so they are trying to give him the right amount of calories without too much extra fluid.  But, his growth remains on the 50th percentile line which is right where they want to keep him.

Update: Josh is back on the Cpap. After trying to change his gavage to his nose he got upset and was no longer tolerating the high flow.

Exciting Weekend

An exciting weekend was had by all;
 Josh was moved to a crib since he is now able to maintain his body temperature. He is closing in on 5 lbs, clocking in at 4 lbs 13.8 oz yesterday. This week they will try him off the c-pap again and see if he does better this time. He will also get his two month vaccinations at the end of the week.

About to get weighed

Yesterday we learned how to give Josh a bath and did that with some nurse supervision. Although he regularly gets a bath we have just missed all previous bath times. The technique they use at the NICU is a swaddled bath. So we wrap him in a blanket inside the bath tub and just wash one extremity at a time. This helps keep him calm and from flailing around but it is definitely a two person job to keep him wrapped up and bathe him at the same time.

The Saturday nurse had an exciting day as Josh had two diaper blowouts in his bed, requiring new sheets twice and a thorough scrubbing of the wall next to the crib.

Josh's new digs

Two Kilos

Josh is getting big and has surpassed the two kilo mark weighing it at a whopping four pounds and eight ounces. He is able to maintain is body temperature fairly well and will be ready to move to a regular bassinet as soon as he is able to permanently transition off of the c-pap. He was able to stay off the c-pap for 14 hours on Monday before struggling with bradycardia episodes. They will leave him on the c-pap until at least next Monday before trying him on the high-flow nasal cannula again.

Evan, Josh, and I have now spent 52 days in the NICU (just over seven weeks). You know you are a regular visitor to the hospital when most of the valet workers recognize us and our cars and comment on how we drive two blue Toyotas :).

Trying it off the c-pap

Much to our surprise the doctor decided to try Josh off the c-pap yesterday and he was doing pretty well. They will continue to try him on the high flow nasal cannula but keep the c-pap machine handy just in case he gets too tired or has problems. He really likes being off the c-pap and having the ability to move his head around. He showed us how strong he was by turning his head from the left to the right while on his tummy. If he tolerates the nasal cannula they will give him a new feeding tube, one that goes through his nose, and is supposedly easier for him to handle. Update:Josh was able to stay off the c-pap for 14 hours. They will try it again in a few days.

First Eye Exam

Last Friday Josh had his first eye exam and the results were good. The doctors found that he has immature eyes (to be expected) but currently no signs of ROP (Retinopathy of Prematurity). ROP occurs in about 50% of premature babies, especially those with a low birth weight. It is caused by the disorganized growth of blood vessels and can lead to scarring or retinal detachment. Because his eyes are still developing they will do another eye exam in two week, but the news is good for now.

Josh is continuing his strong growth rate pattern and now weighs 1900 grams or 4 lbs 3 ozs. He is still getting extra calories, protein, iron, and minerals added to his milk to help him continue to grow and mature. For now he will remain on the c-pap which he still needs to help him breathe. The next step will be to transition him to a high-flow nasal cannula which provides extra oxygen and some air flow to help keep his lungs open.

We have also been trying to get him interested in his pacifier and in turn feeding from a bottle. So far he has shown zero interest in the pacifier. After trying to give it to him yesterday he just stared at us like we were crazy and then passed out for a long nap.

Josh's clothes are just a "little" too big still.

Josh with Frog Take Two

Josh at Four Days Old

Josh at Forty-Four days old

Closing in on Four Pounds

Will today be the day Josh hits the elusive four pound mark? He currently weighs 1760 grams or 3 lbs 14 ozs. In the last few days he has gained an average of 40 grams a day but some days he only gains 10 while others he gains 75! Yesterday his cpap was turned down to a lower setting again and the doctors seem to think he may be off the cpap in the next week if he does well. He's been going through the same problem as last week of having larger aspirates after they feed him so his feeds have been decreased slightly. Once he is off his cpap he should have less air in his belly and more room for his food. Part of the problem is every few days he has difficulty stooling and needs a glycerin enema, and even though he might not like the enema it does help him.

Last night we had our first experience with dressing him inside the isolette. This is definitely a two person job because we have to reach through the armholes and then maneuver around all the tubes. The one help is that he is still swimming in his clothes which makes it easier to snap around him when he is being a squirmy monkey.

Growing Fast

It's amazing that just a week ago Josh broke the three pound mark because he is quickly closing in on four pounds. Yesterday he weighed 3 lbs 11 oz. In the last few days he has gotten to wear his first set of clothes which fit length wise but are still a little big in some areas. They just increased his calorie intake to 24.5 calories per ounce and they have started adding protein to his milk. The protein will also help him with his water retention as he has become a little puffy. His c-pap was turned down slightly yesterday so hopefully they can begin weaning him off it and get it removed in the next few weeks.

Much to the nurses chagrin he has also had two major diaper blowouts in the last two days. Luckily for mom and dad we weren't changing his diaper at that time :)

                                                                                            Getting a new c-pap mask.

Hello Everyone :)

5 Weeks in the NICU

It's hard to believe but Josh has now been in the NICU for five weeks. In some ways it's flown by but in some ways it has seemed like forever. Hopefully the large aspirate problem has been solved by adjusting his feeding schedule, he now gets his food over 2 hours and they found that if they wait to "vent" his tube for 30 minutes it allows time for him to digest the food and yesterday he was only have aspirates of 1-2 ml. Today his feeding amounts will go up to 28 ml every 3 hours and his milk will be fortified to 24 calories. Hopefully Josh will start eating more and we'll start going through the ~100 bags of milk we have frozen at the NICU and at home.

The doctor's are still watching Josh closely to make sure he is eating and stooling properly but everything seems to be going well. He is getting glycerin enemas once in awhile and he has "c-pap tummy" which means his tummy is distended with air, but it is still soft and he has good bowel sound movement.

He has done better with tolerating being out of the isolette and we are trying to increase the time we hold him everyday as long as he remains stable and happy.

Three Pounds

Who would have thought a month ago that we would be having regular conversations about aspirates, stools, and reflux? But, here we are and these seem to be normal conversations these days. Yesterday Josh hit the 3 pound mark which means he has gained more than half his birth weight in a month. We learned that in order to move into a regular bed he will need to reach a weight of at least 1800 grams. Right now he is about 1375 grams so we've got a ways to go but he's on his way.

Unfortunately he is now having trouble digesting his milk and is having large aspirates (food left in his stomach after a feeding). The doctor thinks he is not stooling properly and they have given him some enemas to help flush his system. They are thinking about giving him some contrast dye and watching how it goes through his digestive system. Supposedly this can help clear things out and it will also let them know if he has any blockages or narrowing in his intestines. To help his aspirates and reflux his bed is now at a large incline and they are giving him his food more slowly, over two hours.

Yesterday we learned "infant massage" which is something we will try to do every day when we visit. It consists of light strokes on his head, back, legs, shoulders, and arms. He seems to really enjoy it and it helps him to relax.