Achieving Goals

Archer had a busy week full of appointments and accomplishments. He has shown everyone just how far he has come since being born 17 weeks premature!
Tuesday: Archer saw a urologist for the first time. While he was in the NICU, Archer had a urinary tract infection and an ultrasound showed that he had a mild case of hydronephrosis of the kidneys. Since this ultrasound he has been on a daily dose of Amoxicillin to help prevent any future infections. For this latest appointment he had another ultrasound of the kidneys. The urologist said that the hydronephrosis was cleared and that he did not have any reason to see Archer at a later date or keep him on Amoxicillin.
Wednesday: Archer, along with Mom and Dad, stayed overnight in a hospital room for Archer's pneumogram study. They arrived at 4:00pm and stayed until 8:00am the next morning. Archer was hooked up to two pulse oximeters to measure his oxygen saturation levels. One was for recording and the other was to alert nurses if he needed assistance. These also measured his heart rate and respirations. Archer also had a cannula that measured his outgoing airflow. It was also capable of pumping oxygen if needed, though the study tested how well he would do without oxygen. Archer was content for the evening and played, slept, and ate as he would at home. His oxygenation levels stayed around 96 or 97 percent for the majority of the evening! He only dipped in the 80s when he choked a couple of times (once during a feeding and once while waking up and refluxing). His new pulmonologist and a respiratory therapist visited in the morning to see how Archer did. They were very impressed and gave Mom and Dad a call later in the day on Thursday with the results. The pulmonologist was comfortable with taking Archer off oxygen permanently, along with the apnea monitor! Mom and Dad opted to keep the apnea monitor for a few more weeks while they attempt to have Archer sleep in his crib, instead of a rock'n play, and use it as a safety net while Archer is in another room from Mom and Dad while sleeping. Mom, Dad, and Archer are all pretty excited to get rid of the cannulas and oxygen (except the cat, who enjoyed playing with the tubing)!
Thursday: Archer met with speech, physical, and occupational therapists again to help with developmental skills. Archer's milk intake has been slowly increasing and has been taking 2 1/2 to 3 ounces per feeding. The speech therapist recommended some teething toys to help him get used to textures for when he starts solid foods, and these will also help when he starts to teethe. The physical and occupational therapists were impressed with his muscle improvements as he holds his head high and steady and is using other muscles to help twist, turn, and explore. It shouldn't be long before he starts rolling over on his own.
Friday: Archer had a follow up appointment with the pediatric surgeon who performed the hernia operation and circumcision. Archer had his sutures removed from the incision. The surgeon was pleased with the results and he has cleared Archer from any future appointments.
Current Doctors and Medications: Since Archer has been able to stop seeing a couple of doctors and get rid of some medications, here is an updated list of doctors, medications, and other concerns:

• Archer sees a pediatrician on the same schedule as any other baby would for well check-ups and vaccinations.
• Archer sees a pulmonologist monthly, who is helping to take him off, or reduce, medications and to monitor any oxygen and respiratory needs.
• Archer will see a pediatric ophthalmologist again in 6 months to look for any concerns of eye issues that result from prematurity, though currently his eyes are "perfect."
• Archer has a follow up appointment with a neurologist. He will most likely be cleared from seeing this doctor for any future appointments.
• Archer is currently seeing speech, physical, and occupational therapists, which Mom and Dad hope to continue seeing through the winter months at home.
• Archer is taking a daily reflux medication, which was just reduced from 3 1/2 ml twice a day to 5 ml once day.
• Archer is taking a daily diuretic to help reduce fluid in his lungs.
• Archer is taking a daily breathing treatment to help his lungs mature.
• Archer will receive preventative RSV shots, once a month, when the season begins in the fall.

All in all, Archer is surprising many with the numerous accomplishments he has achieved since his premature birth and leaving the NICU, thanks to many doctors, nurses, family, friends, and prayers! 

Archer all hooked up during the pneumogram. That bundle of 

wires was pretty heavy and made diaper changes difficult!

Archer's head control during tummy time has greatly improved!

Home Again

Archer was able to come home this morning after having hernia surgery yesterday. He did well throughout the night and did not have any events to cause concern. Around 6:00 in the morning he started to perk up and he took a full bottle. Since being home he doesn't seem to be as sore as he was last night. He is still a little gassy and fussy. Mom and Dad have had Archer on 1/8 liter flow of oxygen at home to make sure he isn't tiring himself out by working too hard. Archer will have a follow up appointment with the surgeon in about one week.

On the way to the hospital!

So hungry I had to eat my thumb and paci!

Waiting to go to surgery.
 

Still waiting. This gown is huge!

Where are my toys? I'm ready to go home now!

Hernia Surgery

Archer woke up Mom and Dad this morning screaming, which is not his normal behavior, and it was difficult to calm him down. Dad looked at his hernia and it was the largest he had ever seen. He could not reduce it by hand as he normally would. Mom made a call to the pediatric surgeon whom Archer was going to see next week to discuss when to schedule the hernia surgery. Archer had already made the decision to have it today. The Kumfer family headed to the hospital to meet the surgeon and had him give a final look to see if Archer indeed needed surgery. The surgeon reduced the hernia though he admitted it was fairly large and said it would be wise to go ahead and perform the surgery, along with a circumcision, later in the afternoon. Mom and Dad met with a couple nurses and the anesthesiologist who explained the procedure. Archer was then taken to the operating room as Mom and Dad said their goodbyes. The surgery did not last more than one hour and the doctor said that everything went perfectly fine. He spoke more about the process of the circumcision than he did the hernia repair. Archer was put on a ventilator during the surgery and he was off it as soon as the surgery was complete. He was then put on 1/2 liter flow of oxygen through a cannula. He was very fussy when Mom and Dad met him in the recovery room. He was able to take some water as he did not eat anything for the majority of the day. The Kumfers then moved upstairs to a pediatrics floor where they will stay the night to let Archer recover and have nurses keep a close eye on him. He has been very fussy when he is awake. This is common as the anesthesia starts to wear off. He is also very gassy, which is an affect from the anesthesia, and the gas could be making it uncomfortable near his incision areas. He is allowed to take Tylenol every four hours to help ease the pain. If all goes well then Archer should be ready to go home in the morning. Mom and Dad have been told that babies tend to thrive better, as in eating more and having less reflux issues, after such a surgery. Archer's overnight pneumogram study has been postponed until next week.

Crystal Clear

Archer has been very busy the last few weeks. Along the way he has been laughing and learning new talents. He is constantly putting his hands in his mouth, along with other things. This is supposed to help him make new sounds as he learns about how his mouth works. Archer has also started seeing new occupational, physical, and speech therapists at a local hospital. They help him with exercises and feeding techniques to help get him caught up with other babies his age. They are all very impressed with his progress. Dad practices exercises with him everyday to help him do things like touch his toes, roll onto his sides, develop good trunk muscles, and sit up. When Archer plays on his own he mimics these movements quite well. He also talks to his toys and is getting better at propping himself up during tummy time. Archer also had his first experience in a large swimming pool. He is picky about the water temperature, just like his parents. He enjoyed kicking and splashing water at Grandpa Long as Dad held him. He has also significantly increased his milk intake and has finally hit the double-digits! Archer was 10 lbs. 6 oz. at his weigh-in today!
Archer had an overnight oximetry study at home a couple of weeks ago to see if he still required oxygen. Shortly after he had a follow up appointment with his pulmonologist. After this appointment, Mom and Dad decided they were uncomfortable with this particular doctor. A couple of days after this appointment Mom received a phone message to increase Archer's oxygen intake during sleep times because it might help him with weight gain. Mom and Dad were frustrated with not getting many answers regarding Archer's health and felt that his needs weren't being met. They quickly decided to change pulmonologists with the help of the pediatrician's office.
Today, Archer met his new pulmonologist, who had several good reviews and was also highly recommended by a case manager. The new doctor's initial thoughts were that Archer physically seemed very healthy. His lungs sounded very clear, and he did not react poorly to any quick tests by increasing respirations or work of breathing. He mentioned that Archer's vocal chords sounded very good after being on a ventilator for over 60 days in the NICU. The doctor was a little perplexed about some previous decisions that had been made regarding Archer's lungs and oxygen requirements. He reviewed the most recent overnight oximetry results but said there is not enough information to determine if the data is accurate and whether Archer can come off or requires a higher flow of oxygen. He then sent Archer to receive a chest x-ray as Archer has not had one since he left the NICU. After the x-ray the doctor seemed very pleased. He said that by the x-ray you would never be able to tell that Archer was a micro-preemie with Chronic Lung Disease. Archer's previous chest x-rays always looked hazy or fuzzy, but Mom and Dad observed that this x-ray was crystal clear! The pulmonologist spoke with Mom and Dad a little longer, along with a respiratory therapist. Mom and Dad agreed to a different type of overnight study that is more complex than just setting up a pulse oximeter at home. In two days they will stay overnight at a hospital with Archer while he undergoes a pneumogram from 4:00 pm until the next morning. Archer will go about his normal evening and nighttime routine with Mom and Dad. Without oxygen, he will be hooked up to a pulse oximeter and a monitor on his leg to see if his leg movements affect the oxygen reading on the pulse oximeter, as this can throw off actual numbers. His heart rate and respirations will be monitored to see if they correlate with drops in his oxygen saturation levels. He will also have a special cannula in his nose to measure the amount of air intake. If his saturation levels stay consistently above 88% without any major events, then there is a good chance that Archer can come off oxygen altogether. If it appears that he still requires oxygen, then his flow may have to be increased because as he and his nostrils get bigger there is more room for the oxygen to escape. If Archer were to come off oxygen, then he will still require an apnea monitor at home for at least another month to make sure that he is through with having any real events (he hasn't seemed to have any, almost all alarms during the night have appeared to be false, although Mom and Dad are still awaiting the results of an apnea monitor download). Then his medications will most likely be reevaluated and hopefully he will not require them, as this doctor prefers to wean babies off oxygen and medications quickly after being released from the NICU. Mom and Dad were very pleased with Archer's new pulmonologist and feel like a plan is now in place to meet Archer's needs.