Just another medical procedure...

Snuggles with Mom.

Zoë went in for her swallow study yesterday in the radiology department at Valley Medical Center.  Just in case you don't remember (I referenced it way back here), the feeding specialist was concerned that she might be aspirating part of her feeds (meaning part of it was going into her airway instead of straight to her esophagus) and wanted to rule it out, because it can be really uncomfortable and, more frightening, unsafe if that were to be the case.

Sleeping on Dad.

We arrived at the hospital and decided we should visit the NICU, since we were nearly next door.  It was the best feeling to have the nurses come running when they saw us standing at the entranceway.  Zoë received a lot of hugs and snuggles and "oh she's getting so big!"s.  I felt like we were visiting family we hadn't seen in over two months, they were fantastic.  They told me what a fabulous job I'm doing and said they missed us.  Wow, when I'm having a bad day I'm just going to go back there for a little pick-me-up.





When it was time for our radiology appointment, we went and met with Amy, the therapist we met with while Zoë was in the hospital, and found out she was going to do the study for us.  We went back to a room and plopped Zoë into an upright chair (after Amy got her own snuggles in) and all of us donned the really fashionable lead aprons (except for Zoë...hmmm, don't you think they could have a really small one to drape over her body?  I guess not.).  The first thing we fed her was a thin mixture of Barium (barium is what shows up on the x-ray!) and they took x-ray video of Zoë eating.  Amy could see immediately that she was partially aspirating the barium, so the next step was to try a more viscous barium mixture (after a palate cleanser of regular formula).  This time, Zoë didn't aspirate anything at all.  The difference was amazing.

After the study, Amy went back through the video with me and described everything we were seeing.  First of all, x-ray videos are awesome.  It was REALLY cool to see Zoë eating (AND I could see her reflux, too...cool).  Secondly, I feel like I learned way more medical terms about how we eat and swallow and why Zoë's been having problems. Her diagnosis is pharyngeal phase dysphagia which means that she had "deep penetration into the laryngeal vestibule on thin liquids".  In other words, part of her feed is going into her airway.  Amy said it wasn't REALLY deep (although, deep penetration describes otherwise, in my head), but she suspects that if we kept feeding her the thin liquid it would have gotten worse as Zoë got more fatigued.  Apparently this is a not so out of the ordinary considering her prematurity.  We've got a prescription for an artificial thickener to add to her formula to mimic the thicker Barium test.  I can already tell the difference from three feeds today.

Zoë should grow out of this issue as her jaw and esophagus matures.  The only concern is that maybe she might have a laryngeal cleft (similar to a cleft palate...something didn't fuse completely) and we'll have to determine if that's the case when we go back for another x-ray after a while to monitor her progress.  Amy was pretty certain she's cleft-free, though, so we'll hope that's the case.

In other news, she's now into her 3 month clothes, although they are a little big on her.  She definitely outgrew the newborn ones though.  I do her laundry every 2-3 days and it seemed like from one laundry day to the next she had outgrown them.  And I'm not talking, "Oh, they're a little bit too snug this time" I'm talking "girl, you're going to pop those buttons right off" tight.  I thought I would be excited to put her newborn clothes away and dive into the new wardrobe but I found myself getting a little teary-eyed as I was folding her clothes and putting them away.  :(

Zoë loves her black and white books.

Captive audience for story-time.

We've started to have daily story-time and she seems really engaged when we're reading.  It's fun to have her sit up and look at the pictures (her favorites are still the black and white books).  We're still working on tummy time.  Chris propped her up on the Boppy today which lead to a few minutes of good tummy time, we'll have to see if it lengthens as she gets older.

Tummy Time with Dad

We now have a week and a half break until her next doctor's appointment where she'll get her 4 month vaccinations.  Four months already!  Sheesh!  Shouldn't she be walking by now?  ;)

Happy Mother's Day!

As a very special treat to Chris and myself, Zoë has now slept for SEVEN hours the last two nights straight.  WHAT?!  From about ten until five am she's been a total sleeping angel (even in the heat that we've had...maybe that's helped?).  Chris is convinced we can't let her sleep that long and swore he would wake her up earlier than that this morning...uh, no he didn't.  :)  Which is just fine!  I weighed her last night before her bath and she weighs 9 pounds 4 ounces by our scale.  Which means she's gained 0.8 pounds in a week.  That's great weight gain and helps us feel better about letting her sleep.  She started her reflux medicine this week and it's a freaking miracle.  She doesn't grunt or groan while eating and hasn't projectile vomited ONCE since she started (she was doing it once a day before).  She seems a lot more comfortable while eating and is eating more regularly and more volume.  She has her swallow study x-ray on Thursday, so we'll see what that tells us.  And the home visiting nurse is coming Friday, so we'll get an official weight then.

Yummy Mother's Day breakfast!

This morning Chris made a delicious breakfast of stuffed French Toast (uh, it was amazing), let me sleep until 8!, and treated me like a queen.  :)  I told him he has set a high standard for future Mother's Days...bummer for him and Zoë.  :)

That's all for now!  Oh, and this:

Eating, sleeping and smiling, oh my!

We are getting regular smiles now!  Zoë has to be in the right mindset, but she will definitely give you a big smile or two when you talk to her or make faces at her, and they're becoming more regular, too.  My favorite place to get good face time in is when she's on her changing table.  For some reason, she's usually in a good mood (after the diaper gets changed, of course).  She's also making a lot more sounds, cooing, etc.  It's adorable and heart-melting and makes the toughest days better.

Changing table fun

Mom, I hate shots!

I have reflux and eating hurts!

We're still struggling in the eating department.  We went to the pediatrician's office on Friday for her last synagis shot (until the fall, that is) and talked about how her reflux doesn't seem to be getting any better.  We tried the rice cereal as recommended by the doctor, which seemed like it worked at first but then she started seeming just as uncomfortable while she was eating as she was initially.  She suggested we add even more rice cereal to see if it helped, but then if it doesn't get better in a week we can call back and get a prescription filled for some medicine.  This weekend hasn'tbeen easy...she eats about 40-50 ml (for her weight-8 pounds 6 ounces- she should be eating 77ml eight times a day) and then won't eat anymore.  The doctor mentioned that she might not eat AS much because there are more calories she's getting with the rice cereal (we're up to 27 calories per feed now!), but that seems like it's not enough.  The formula is SO thick with the supplement and we think it's harder for Zoë to get it out of the bottle (she's still using the preemie nipple, as demanded by the feeding specialist).  We think with the combination of more calories and the amount of effort she's putting into thefeeding that she's just not eating enough.  We gave her a bottle of straight formula last night and she guzzled it happily (and noisily, because despite the rice cereal being more difficult to eat, it does seem to help with the reflux).  And then promptly threw it ALL up on Chris (seriously, it was pooling in his t-shirt) ten minutes later.  :)


Clearly, we have an infant who is having no problem gaining weight, but does seem to be uncomfortable while eating, which we don't want to turn into an eating aversion in the future.  I'll be calling the doctor's office on Friday to fill that prescription, I think...

She looks a little like Scarlett O'Hara...

In the sleeping department, she's doing pretty well at night.  We were not given the go-ahead by the doctor to let her sleep as long as she can...she'd still like us to feed her every three hours, even through the night.  Uh, I'm done with that.  I'm pretty sure with as well as she's gaining weight (and especially with more calories in her diet), we can let her sleep as long as she will (sometimes she'll sleep for FOUR hours straight, like she did last night!).  I'm ok with going off-book for this one.  Since I'm no longer pumping (Halle-frickin-lujah!) this past weekend was the first weekend I slept through the night since January.  Chris took all of the feeding shifts and it. was. glorious.  So, I'm definitely going to let Zoë drive the bus at night.  If she gets up every three hours to eat, fine for now.  But if she wants to sleep an extra hour or two?  Even better.

Walks are good for EVERYONE.

Chris and I had a date night this past weekend and went to Thai food and rode The Great Wheel in Seattle (all his idea!).  It was really fun, really really fun!  We celebrated my birthday all week (maybe dropping it down from a month to a week is more reasonable, after all...) and hey, Mother's Day is coming right up!  :)

Love date night!

Naptime with Dad is always good.

Swallow Study

Mom and Zoë

Outside enjoying the new umbrella and sunshine!

Zoë gets more pictures taken!  Except this time they're going to take xrays of her swallowing.  I am learning more and more weird medical stuff the longer this child is alive.  ;)  We went into Children's Therapy today to have the feeding specialist watch her eat from a bottle.  The specialist is concerned with how hard she is breathing and also about some grunting and groaning she does as she eats (which we think is absolutely adorable just like every other sounds she makes, but could actually be caused by reflux).

So, in a few weeks she'll have an xray taken and we'll also talk to her pediatrician about getting on some medication for the apparent reflux.  It may or may not be the problem, but apparently as soon as she starts on the meds if it IS reflux it'll reduce the grunting right away.  The therapist also mentioned that she thinks the xray may be overkill, but she'd rather be safe than sorry and rule out bigger eating issues (like milk making its way into her airway) early.  Overall, Zoë IS gaining weight (seven pounds twelve ounces today!) and is healthy, so we're not too concerned, just some blips that made the therapist pause today while she was watching baby girl eat.

Our little gangster.

On another note, I was EXTREMELY defensive of Zoë and her eating today with the therapist, when I look back on it.  I have a little more empathy for my students' parents now.  It is CRAZY how immediately I was on the defense and down playing some of the things that Zoë does when she eats (the grunting and groaning, for example) to make it sound like it wasn't that bad.  It's a good thing Chris was there to help balance out my crazy and help the therapist get an accurate read on Zoë's habits.  Sheesh.  Apparently my hormones aren't back to normal.  Or is this how it's always going to be?

I asked Chris to tell Zoë a story and in true Chris fashion it was: "A train leaves the station going west at 9am. A second train leaves another station going east at 8am.  How long before they crash?  Oh, of course you need to know how fast they were going..."

Zoë is mesmerized by these curtains.  Perfect colors and pattern for her little eyes.

Three Months!

This is a typical conversation with strangers out in public when they see Zoë (who continues to be a people magnet, by the way):

Stranger:  Oh, how precious!  A newborn!  How old is she?
Me:  She's three months old.
*long pause*
Me:  But she was ten weeks early.
Stranger:  I was wondering why she was so small.  Such a miracle baby!  Where does that hair come from?

I love answering the questions, but sure wish she had some characteristic that looked like me!  Her red hair is beautiful, but it doesn't belong to me, so it's hard when that's what people ask about every time.  She sure does look like her dad, though.  Take a look at these three month pics, isn't it crazy how much she looks like Chris?  She's definitely his mini-me.

We went to the doctor on Friday for a weight check and she was JUST over 7.5 pounds and at the 50th percentile (for her adjusted age).  YAYAYAYAYAYAYAYAYAYAYAYAY!!!  So today three days later, she's surely at about ten pounds, wouldn't you think?  ;)  We've noticed that she's ready for the next size up of diapers (but we don't think she's ready for her FuzziBuns yet...it kills us every time we have to buy disposable diapers) and that her newborn clothes are fitting her pretty perfectly.  Soon she'll be in a whole new wardrobe, how fun!

Her iron count is still low, but that's really the only blip on her health radar.  She's just got a new prescription for a higher dose of iron in a multivitamin to take care of that.  She will get one more synagis shot at the end of April to protect her tiny lungs.  Thanks to those of you who kindly  take a rain check when you are sick and had planned on coming and visiting.  :)

Her new tricks are holding her head up REALLY high when she's on her tummy and holding it up and looking around while you're holding her.  She's a lot more alert and loves to look around.  She can follow Chris and my voices when one or the other is holding her and I'm pretty sure her range of vision is farther than it was because she can follow us around the room by moving her head.  I SWEAR she smiled at me today...twice.  I don't think it was gas.  It hasn't happened again yet, so I'll keep you posted.

Head up!  And hellooooo there.

Angela was here last weekend, which was so much fun for me.  She had lots of Zoë and Teta time and I missed her the moment she drove away.  :(

Chris and I have kept very busy, especially this past week.  He'll be starting a new job with the Seattle Fire Department as a fire protection engineer (yay Chris!) on Wednesday, so he took this week to spend at home with us and getting some projects done.  We've been on several dates thanks to some very generous grandparents and have been working in the yard like crazy.  We're looking forward to the next week of amazing weather so we can get even more done and get the yard in ship shape for some regular BBQs and fire pit fun this summer.  You're invited!

Oh, and a VERY happy third birthday to our first princess, Fiona, tomorrow.  :)  We still love you Fiona, even though you have to share our attention now!

Stress and feelings of inadequacy

I'm pretty sure, in all of the "get sleep while you can while you're pregnant because you're never going to sleep again" and "motherhood is the hardest thing ever" advice people have given me (which, by the way, is the worst thing you can say to a pregnant lady OR someone with a newborn, so knock it off) there was never once a warning about how stressful getting Zoë to eat would be.  Actually, she's doing a fine job eating, but if I'm not feeding her then I'm pumping, and if I'm not pumping I'm thinking about and stressing about the amount of milk I'm producing and whether or not it will be enough.  There's been a serious lull in production lately, and I think it's because I'm getting more and more stressed out about it.  We finally broke into the HUGE frozen stash we have but it has a really terrible (metallic) smell to it-which apparently is pretty normal because of the lipase in the milk- and Zoë won't eat it.  :(  So, what I once thought was a great insurance policy is really just several gallons of un-usable milk in the freezer.

What really spurred on this recent spiral of stress and feelings of inadequacy was our trip to Children's Therapy this week where they told me that while she was gaining weight, it still wasn't enough.  AND they observed her breast feeding and there were all kinds of things wrong, and what I thought was really 30-40 minutes of good feeding is actually probably more like 5-10.   Her adjusted age is 1.5 weeks, so really, if a typical mom takes 4-6 weeks to get the hang of breast feeding, then we have another month to stick it out.  But we've already BEEN doing this for 6 weeks, which is maddening.

I HATE the pressure to breast feed.  I HATE doing it.  I could care less about cuddling or bonding (I can do that stress free at other times).  I hate it.  I know the milk is best for Zoë so I will pump for as long as I possibly can, but I feel like there are so many things stacked against us with her actually breast feeding and I'm exhausted.  I'm not sure who gave me the advice, but I love it, "You have to do whatever you can until it makes you crazy, Emily.  And then you have to find balance.  It's ok...".

Today I gave her a bottle of formula after being counseled over the phone by Jenny (she should really charge me for her time...).  Zoë drank it and is sleeping peacefully.  Next time, I'm going to try to do half formula and half of the frozen breast milk, to see if she'll eat it when it's cut with formula.  I'm still pumping, so I'll give her fresh milk, too, but I've got to figure out if all of that milk in the freezer is lost...

If this continues to make me crazy, I'm going to be making some adjustments and continue to keep in mind the following supports that people have given me that make me feel better:

Chris:  You've done SO much already.  Think about all of the milk she HAS gotten.
Mom and Dad:  This is not easy, we love you and it's ok.
Jenny:  She'll be FINE!  Read this funny book and call me back.

***I hope the four of you know I got more out of our conversations together, but this is the short version. :)

But hey, let's get to the good stuff.  Zoë's holding her head up even MORE and for longer periods of time.  She's also awake for longer periods of time, too, which is really fun!  The last couple of days she's been a sleeping rockstar (knock on wood) and been sleeping for 2-3 hours in a row before we have to wake her up to eat again.  Angela's coming to visit this weekend which I am REALLY looking forward to, and I know she's excited to get her hands on her niece, too.

A very merry unbirthday, to our original April fool.

Today is Zoë's original due date, which is exciting for several reasons.  We've known her a whole ten weeks early, how special is that?  We know her faces, her cries, that her lip quiver means she's about to cry, that she loves bath time but hates getting out of the water, which outfits fit her best and which ones we can put on quickly to avoid the screaming that comes with her being naked.

What's most exciting is that now that we've reached her original due date (ODD), we can start checking off milestones.  To follow her progress, we'll use her adjusted age (her age from her ODD) to make sure she's on track.  If she's supposed to smile at us by two months, for example, we'll expect her to hit that milestone by the end of May, rather than, well, right now (because she's two+ months now).  This will be tough when we're explaining to strangers how old she is, but will be a more accurate gauge of her development.  So, speaking of development...

At her last doctor's appointment (last Thursday), Zoë measured 5 pounds 15.5 ounces (SO close to 6 pounds!) and she gained 24 grams per day on average.  This is right on target and Dr. Lee was pleased with her improvement in the weight gaining category.  She'll have another appointment in a week and a half for another weight check.  At six pounds, she's actually outgrown a hat and a few clothes.  Wow!  She's supposed to get another synagis shot this week but we haven't gotten the promised phone call from the pharmacy yet to see when and where to go get it.

"What do you MEAN I'm half an ounce away from six pounds?!"

I can't say that we've come very far in the sleeping department.  Zoë still prefers to be held day and night.  We'll worry about putting her down later.  I AM planning on heading to the library this week to see if I can snag a copy of the Happiest Baby on the Block to do some research.  :)  It's tough when the doctor told us that we can't let her cry it out...but then how in the heck do we get her to sleep in her crib?  Argh!

This week she can hold her head up when she's on our chests (It's amazing!  She holds it right up and looks at me!), looks us straight in the eye when we talk to her, and has been awake for two or so hours at a time once or twice a day to play and socialize.  These few precious hours are pretty fun and I feel like she's developing a personality!  We've been doing a lot of tummy time, both on her play mat and on our chests, and a lot of singing, reading, and playing with her toys.  She is starting to track objects when you move them in front of her, but she's not very consistent with that trick yet.  My favorite moments are when she and Chris are in a different room and I can hear him talking to her.  It's heart melting and I love it.

On Friday, Zoë, Fiona, and I went to the dog park.  Sheesh.  Our dog is crazy and found the ONLY mud puddle in the entire park and rolled in it repeatedly.  She was no longer a white dog ten minutes into our visit.  I didn't know whether or not I should laugh or cry, and almost had Chris come to the park on his way home to pick up Fiona, since she was absolutely trashed and I wasn't ready to deal with an infant AND a muddy, dirty dog on our first major outing.  We ended up getting home ok and poor Fiona had to have two baths (one inside and one outside).  Zoë did ok at the park, she was pretty much zonked out the entire time.

We went to a church in Des Moines for Easter service yesterday.  I would love to find a church family close by that I love as much as the church I grew up in, though I think it's going to be hard to do.  There is nothing like making a few quick friends as soon as you walk in with a baby in your arms.  I'm telling you, people flocked to us.  It might even rival walking in the park with a puppy.  :)  Zoë was very well behaved and was given a lot of attention, plus she looked amazing in her Easter dress and sweater and hat made by her two-Teta.

That's our update!  We got our pictures back, too, from our photo session a couple of weeks ago, and are in love with them.  Here are just a few that are pretty darn amazing.  There will be more hanging in our house soon, too, so come on by to see them.