Tomorrow! tomorrow!

If that subject line didn't make you think of "Annie" and get that song in your head... I'll have to try again later. (Ask me what song my kids kept singing to Jeremy's Mom, Dottie all week... that's a pretty good one for sticking in your head, too) We are heading home tomorrow. God has been so good in using this last week. I have had the opportunity to bless my roommate (she's going home today and is single Mom, from Montana, with some financial hardship) through the body of Christ. What a gift to see His love poured out in and through His people. Thank you, Ruth, Anastacia, Mom, and Jeremy specifically. She has been MUCH more open and talkative this week, so I thank the Lord that he kept both of us here. I really enjoyed staying overnight with Kara last night. I am getting the feel for her schedule She has her days/nights straight... at least at the hospital, all you Moms and Dads remember how you have a completely different baby once you get home, right? So we'll see! She took 47 mL by bottle last feeding (her new world record). Her record nursing is approx 28 mL. We learned how to operate her feeding tube yesterday. I had to place her NG tube this morning (she pulled it out). I was unsuccessful Tuesday, but today was able to do it first time with a minimum of screaming (poor Kara!) Kara is getting filmed today (I think I posted that on facebook) to show her eating progression. Jeremy & I got filmed for something completely different earlier in our stay. Our little Kara sure does like to attract attention, right? Lord willing we can channel that, and He will change her heart so she will use it for His glory in the future! We may speak at a fundraising event in May as well - crazy, right? Please be praying that we use it for God's glory and not just the "greater good". We have our post discharge Pediatritician, PT, surgery, dietician, and OT/PT outpatient appointments set up. The person in charge of our outpatient OT/PT in North Bend is a former co-worker at Starbucks. Someone I regard highly and enjoy working with. It's been SO GREAT to see God continue to give us the best people to work with. *sigh* We are so blessed. Well, if it's a while 'till we post, you'll know why! Please do feel free to call or e-mail, we LOVE hearing from our friends and family.

Eating Update

We met with our Physical Therapist (PT) again yesterday, and I opted to try nursing (instead of working on holding Kara in a "normal" bottle feeding position instead of on her side). Kara did AWESOME! For all my nursing Mom friends, feel free to ask details if you like, but in short, she nursed without a semi-poor latch and at not the best time but still got almost an ounce in 10 minutes. I am now allowed to nurse her twice per day for up to 10 minutes. Discharge is (Lord willing) this week. We are hoping for Friday as it would be a great transition into the weekend for Jeremy's work and it would work out well insurance-wise. So this week will be soaking up all we can from PT, learning about her feeding tube, staying overnight at the hospital and doing as much of her care as we can, and getting some things ready at home that we've not done since we didn't know when she'd be home (oh yeah, I guess we should get our swing out and get girl clothes - probably 0 to 3 instead of newborn out =) Woo hoo!

Kara - better and better!

We just finished rounds with Kara's doctors and such. Here's the scoop: *Kara's potassium levels are still above normal, but no longer dangerously high (the diuretic and such worked). We are still hoping it was a result of some stomach meds she was on. Those meds were switched so we're hoping her potassium levels will go down over the next few days. *Kara was difficult (o.k... impossible) to wake for her 9 a.m. bottle. We have been feeding her a bottle since Friday, up to 3 x per day for a max of 10 min. Then she gets the rest of her feed via nose tube. Things have changed a bit each day. She slept through eating all 30 mL in 5 minutes and was extremely comfortable at 9 a.m. (wow... just like a "normal" baby. =) So the Drs. said we can now bottle feed her up to 40 mL (max of 10 minutes) every time. That is every 3 hrs. We will do it as often as we're here and probably have nursing staff do it starting Mon/Tue. *Random fact - she has had a pretty yucky rash since the NICU. We are trying different stuff and are hoping something works! So hard to see a little bottom so 'ouchy' (yes, I am a Mom of little ones and use the word 'ouchy') *I asked if we can reasonably hope to be discharged this week, and the surgeon said "yes". Due to some insurance stuff, we are praying for Friday. I think that if Friday comes and we're not ready, we can then just know it's an "April Fool's" ;) We have loved looking back at God's timing for things: *Jeremy's Dad & Sue were here for the surgery and most of the first week where Jeremy & I wanted to be at the hospital (together)every day and to do housework so I could recover from delivery. *My parents have been here constantly and have made time away from us special times with Grandparents. My Mom has graciously helped keep our house clean! *Jeremy's Mom came into town this week when we have needed to be at the hospital quite a bit more to feed Kara 3 times per day. She is also catching up and getting ahead on our laundry (towels, etc.) *Next week is Spring break, so I have NO GUILT in taking a week off of tutoring to adjust to (Lord willing) Kara being home. *If we discharge Friday, Jeremy will have Sat/Sun to be home for the transition. Jeremy's work has been gracious in allowing him all the time off he needs, but his vacation was used up within the first week. We have seen God's provision in so many areas that we are very comfortable with Jeremy working as much as is good for our family. We know who owns the cattle ont eh 1000 hills (or is it the 1000 cattle on the hills?) That brings me to another point, I continue to forget my Bible at home and am THIRSTY for the Word. I'm praying that I find/buy a Bible today. it's taken me far too long to get here, but I know the feeling of the psalmist with panting after the Lord and His Word. Sorry no pics, I think jeremy has our camera with him today, or it's at home. Trust me (and all our nurses) that she is just adorable! Sending love and gratitude from all the Putmans, Meg

Milk... Mmm, good!

Well, Kara continues to create excitement and interest wherever she goes (or even when she's just in on place!)

*Yesterday and today she's had high blood potassium levels. This is pretty rare. She had 3 blood draws to "double check" that this was real. A lot of times, the draw itself creates a false reading of high potassium levels. The 3rd verified that for sure, it was real. In the meanwhile they were able to get those levels down (diuretic with a saline IV to compensate... bummer, thought we were past the I.V.s!) It is just above the high side of normal right now. Hopefully today we can figure out why her potassium levels are high. Apparently high potassium messes with the electrical circuits in the heart (hers is currently doing fine, known thanks to the EKG).
*Kara was not very pacified with sugar-water when she was being poked (at least 3 tried... =( for her I.V. Milk in my finger, however? "YUM! Thanks, Mom!"
*Today PT and I started her on a bottle. She took 25 mL in 5 minutes (not bad with a tiny premie niple and for her first try). We are going to try again, with PT, again today to get some guidance for the weekend. Just this past Tuesday she was having a hard time swallowing even drops. Thank you, God, for her amazing progress!
*She is getting more milk to try to up her calories (her weight was down the past 2 days in a row). Her doctors were originally going to just add more calories (i.e. powdered formula) but agreed to do more volume and see how she does. What a blessing to be part of the decision-making process.
*Jeremy & I have had the pleasure of being interviewed, with Kara to be highlighted in a video to help raise money for NICU expansion. It was a blessing to be able to share our experiences and recommendations (like maybe a nearby potty for postpartum women!!) for the NICU.

Looking forward to the weekend!

Kara - looking forward

It's been a while since an update. We've had internet down and it's been busier at the hospital (a good busy). Let's see, my thoughts are a bit random, so here's an update in bullet format.

*Kara is OFF morphine =)
*Kara had her PICC (long term IV) line removed so she now has a "bare" right hand =)
*OT/PT thinks it may take Kara weeks (as opposed to days or a week) to get to a bottle, so we discussed our discharge/transfer options yesterday. Looks like we may stay another week and then discharge with "home hospital" support and feeding support from an Issaquah entity.
*Our nurse yesterday said we had the BEST surgeons (she thinks 3 are the best and 2 are taking care of Kara). She wants her Mom to be operated on by these surgeons instead of adult surgeons. Thanks, God! Again, we have gotten the BEST healthcare this whole process.
*I have finally figured the traffic out. Leave at 6:45 or 8:30 (but not in between!)
*Yesterday at noon, Kara did an excellent job on her "binkie trainer". So to get her sucking/swallowing, we are doing 2 things
1) finger/pacifier in mouth, dropping drops on top and letting them roll into her mouth so she has to swallow tiny amounts at a time and gets used to sucking with swallowing
2) binkie trainer which is a pacifier with a tiny tube going through the hole, connected with a syringe filled with milk. If she sucks well, she will get small amounts of milk each suck. I can "hold back" the syringe if it's too much for her to swallow, or advance a little milk from the syringe to get her started. Yesterday she powered through 2, 5mL syringes without choking or coughing and wanted more (but we are starting slowly). Hooray! Good job, Kara.

We are thankful for the support of our family and friends. Connor & Katie continue to do well (said 'goodbye' to both of us this morning with smiles). God has been giving them lots of grace, no wonder when we know how many of you are praying for us. Thank you.

Sorry no pictures, apparently I can't use the USB ports at the Chidlren's computer and our internet has been down at home.

Kara Update - Monday

Hello all,

Mom & I went in to see Kara today (Monday). She is now off of morphine. Well, she's off the drip. She did need a bolus at 1 p.m., but no more as of 5 p.m. and hopefully will not need any tomorrow.

I got to talk to the chief surgeon and a few things were clarified. It sounds like he is in NO rush to send us home (not even discussed) and certainly does not want to send us to another hospital. The increased the amount of calories they are adding (they call it fortification, I chuckle and call it "additives") to my milk to compensate for Kara's high respiratory rate. This will most likely be needed for a long while. (It's adding powdered formula to the milk, but we're still at a 5:1 milk to formula ratio, so that's good).

I also got to watch Kara get an "echo" (ECG) and her pulmonary hypertension looks like it's resolved.

The Occupational Therapist (OT) came to work with us on watching Kara suck and start to give her little drops of milk to help her learn to swallow. We are seeing that we need to be at the hospital more to work with Kara during her awake times. With this, we would appreciate prayer for wisdom in how to balance time with C&K, work, and time at the hospital. We know we can't do it all and that's where we need wisdom in choosing what is "best" vs. what is "good" (for all of us).

We're thrilled Jeremy's Mom is coming into town on Wednesday for a week. Yay for Grandma Dot!

Kara Update - Sunday

Boy, do I love the Lord's Day. We were blessed with a wonderful day today. I'll summarize bullet-style.

*Waffles for breakfast
*Church
*Lunch (provided by Mindy - delicious!) at Children's
*Taking turns holding Kara, kissing Kara, wheeling Connor & Katie around in a Red Wagon (they are scarce but one was at the entrance when we arrived at the hospital)
*Kara doing some active sucking on my finger (hooray! She's learning!)
*Kara fussing toward the end of our visit, and we actually knew what was wrong and that this was not normal and asked the nurse if it was time for Tylenol (and it was!!). Can words even express the joy of feeling like we know our baby (and not just this baby, but for any baby, right? Even a newborn that's been at home that you can finally distinguish one cry from another).

As far as medical updates. Kara was lowered to 5 mccg (from 10) of morphine yesterday. She had one bolus yesterday evening at 5 p.m. and nothing since then and is doing great. She's so close to being weaned from morphine! We had thought that Kara would need to be bottle feeding before discharge. Apparently that is not a "must" but we could be sent home on a feeding tube. This just makes us rearrange our thinking. I (Meg) am planning to sit in on rounds and strongly request that we be moved back to Evergreen for more support with feeding and possibly Evergreen would not discharge until bottle feeding is mastered (but that is an unknown). In any case, it will be nice to be in on "the plan" because we are hearing different things from different sources.

Friday and Saturday

From Meg:
I do not have new pictures to add because they are with Jeremy, and it is way past my bedtime! However, we went in to see Kara as a family yesterday. We had 10 glorious minutes in our room before Kara was moved to a double occupancy room. We are working on thinking on what is true in this situation instead of mourning the loss of what "was". We are thankful that our roommate is a newborn (which means we can still use the potty and shower if we want). And we are thankful that even the "taste" of a single room was by God's design and will be used for his purposes.

Kara rested WELL in our arms yesterday and today. Apparently when we're not there she's quite a bit more fussy. Hooray! She loves Mommy and Daddy. She also loves clean diapers =) She is down to 5 mccg of morphine, but they will probably need to supplement with bolus (single doses) as needed since that's a drastic change from the 10. She is also all done with her "gatorade" (not really gatorade, but the supplemental nutrition in her IV that looked just like gatorade) which means all her calories will come from my milk + the extra calories they add to the milk. She will most likely need to have extra calories (i.e. powder formula) added to her milk for a long time due to her higher breathing rate.

We are rejoicing that we are all doing well. Continuing to ask God to transfer us to Evergreen (if that's His will), thanking God that Connor & Katie are doing well and for my parents who watch them, for the time He's given our family together and Jeremy & I on our own thanks to our gracious brothers & sisters in Christ who have been providing meals. That has been freeing up a lot of time, worry and stress. Thank you! We are also thankful for a gorgeous day today. Thank you, God!

Wednesay and Thursdays

I've been lax in updating and there is good news to report!

Wednesday morning Meg and I went to the hospital for the morning. Kara was doing very well and the doctors decided to extubate her. While a very easy thing to do it did leave Kara a little uncomfortable for the morning. It was good to hear her cry again, albeit raspy from the tube. The kept Kara's IV and morphine levels the same for the day





Thursday Meg and the kids went in to see Kara along with Mimi. The doctors were very pleased with how Kara was progressing and indicated she could be moved from the NICU to the 'floor.' Which is the term they use for general surgery recovery. At first to me it was like moving Kara from isolation to the general population. But I had to remind myself this isn't a prison and the only reason I'm anxious is because it is unknown (nurses, room, etc). Something to confess before the Lord.

She was moved another section of the hospital with a larger room. She is in a single room for now. There is a possibility she will be moved into a shared room. The room is a huge improvement over the NICU. We can eat in it. There's a restroom and shower. There's a bed so we can sleep there if we wish. I (Jeremy) will probably take advantage of that.


Taken Thursday night

Here next steps:
- Continue to ween off morphine (she's down to 10 micrograms)
- managing her discomfort with oral medication like Tylenol
- Start working on her feeding skills (almost as important as nun chuck skills ;)
- They will start giving her oral doses of milk soon

Praises:
- God is greatly to be praised because He is worthy
- for God's grace to us in Kara's recovery, she is progressing so well
- Meg and I can hold her now whenever we want. We just have to mind the cords ;)
- for the great care Kara has received.
- for the community of believers who have supported us through this

Prayer requests:
- Continued wisdom for the doctors and nurses in treating Kara
- for us to be content if God has us stay at Children's or go back to Evergreen
- Connor and Katie would be content as we balance time at home and hospital
- for Kara's continued recovery and adjustment to life after surgery

Katie Running Dialogue

While I was on my bed the other day, Katie came in, got a step (to start to climb on the bed). While she was doing this, and as Jeremy came in and got on the bed, here is what she said (verbatim... we wrote it down to put in her journal, but I figured I should share as well):

*I will pick it up (the step)
*I am carrying it
*I'm a strong Katie
*I will turn it like (yike) this
*My finger is stuck!
(after on the bed):
*Mommy, where are your legs? (yegs - they were under the covers if you're wondering)
*Be careful of the edge, Daddy!
*I will come over to see Daddy.

Later, as I tried to tickle her feet, she said:
*Oh, no I don't, I'm focusing on my toes.

Tuesday a.m. update

We are going in to see Kara this evening, but called to get an update. Here is the latest:

*looking to extubate in the next 48 hours (wow!)
*breaths per minute is down to 30 (yesterday 35)
*morphine is down to 18 (yesterday 20)
*Kara had her most awake/alert period thusfar
*milk consumption (still through tube) is up to 10mL/hr (from 8)

And now - naptime for Mommy!

Shampooed and Styled

I (Meg) got to go in to see Kara for a few hours this morning and wanted to share the latest updates. In short - she is still steadily moving forward and improving.

* She had a hair wash (yippee!!). Her hair was getting a bit nasty, especially after the I.V. that was in it.

Before:

After:

* I got to lotion her - I put lotion on her almost every day. She currently has nothing in her left hand (as in no I.V.s or bandaids or anything)
* Her morphine drop is down to 20 Mccg (as of 10 a.m.) and she is doing well on that
* Her ventilator breaths per minute is down to 35 (they will go down approx. 5 per day down to a level of 20 before extubation)
* Her chest tube was removed this morning and because it was removed...
* I got to actually hold her (without a pillow underneath her). Hooray, hooray! She definitely likes to be held tight and did NOT like to be held vertically... guess that'll take some getting used to on her part.


We're thanking the Lord that Connor and Katie seem to be adjusted to the normalcy of Mommy or Daddy leaving to go to the hospital. Jeremy went back to work today. Right now the plan is for him to take Wednesdays off, and we'll go into the hospital together for a longer time Wed. morning. He will go in on his own a few different times (morning/evening) during the week. He had a good first day back.

Random blessing note: Children's volunteers provide free haircuts and massages for parents, so I am taking advantage of both (I am terrible about getting regular haircuts) on Wednesday. As we say around our house often (usually for sunshine), "Thank you, God!"

Good Lord's Day

We had a wonderful family day today. Waffles with peanut butter and syrup (Sunday tradition), church, then time at the hospital with Kara. Our expectations and planning have gotten better. Whereas last week it was very stressful to have Connor & Katie at the hospital, this week was great. The kids "gelled in and out" well, patted Kara's head, and played on the floor in her room for a while. (The difficulty is that all the "fun" things are outside of Kara's room). We also found a quieter location to eat snack (NICU waiting room is very loud and hectic). Jeremy really cared for the kids so I could have more time with Kara and then we 3 headed home and Jeremy is still at the hospital.

Changes - Kara is down from 30 to 25 McCg of morphine. Woo hoo! Does a parent's heart good to see that. Her chest tube has been water sealed (did we mention she has a large chest tube to drain post-surgery?). If she does o.k. with it sealed - they will check via x-ray -, then they will remove the tube. That will be one less thing between us and Kara when we hold her!

Kara is up to 6 mL per hour of Mommy's milk, she's digesting quite well. We anticipate chest tube out soon, extubation in the next few days, and continued weaning off morphine for the next week or so.

Kara Update - Saturday Evening

Jeremy & I got to go in to see Kara together for a few hours today. It was her BEST day yet. What a blessing! Jeremy got to hold Kara. She was still laying on a pillow and had all her cords everywhere... but still, Jeremy was so happy to get his baby girl in his arms.

While she was in his arms, it was the first time we've seen her completely relaxed and asleep. (Or at least a natural sleep where her mouth was totally relaxed and open).

Then, later she had some other "firsts" - those of you who've had newborns will relate, if you haven't - sorry if it's a bit "T.M.I."
* First hiccups (since in utero... she had tons in utero ;)
* First time with eyes open (about 25 minutes. WOW! And her respiratory rate remained stable. Until now any "awake" meant distress)
* First bowel movement with Mommy's milk - yay, Kara! That means you can have more milk and less I.V. feeding. She is being fed through a tube in her nose. Once her breathing is more stable, they will start to work on getting her to coordinate sucking and breathing.
* First 12 hours without extra morphine. Since this is the case, they can now lower her continuous morphine drip. She is at 30 mcCg right now, and the max they lower per day is 5. She needs to be off the ventilator and morphine before we are transferred out of Children's NICU, so we estimate at least another week.
* Oxygen is now at 21 (room oxygen! No supplemental). So the ventilator pressure and supplemental oxygen are both at the lowest level, now the breaths per minute just needs to be lowered until the Drs. think it's low enough before extubation.

Please join us in thanking God for the blessing of holding our baby and seeing her beautiful BLUE eyes (we weren't quite sure until today). We are so thankful for the support of our family and friends. We are a bit strained and feel like we have to think through every hour of our time, but we are not more tired than any other family with a 10 day old. When one of you tells us you are praying for us, we are reminded that it is God's strength that is holding us up and we no longer "wonder" at how we're doing so well, we just thank God for His sufficient grace.

Kara Update - Friday

We have nothing but good news. Praise the Lord! After meeting with the surgeons yesterday, they told us that the CCAM was only in the lower lobe of the left lung.
*Her x-rays this morning looked good (the right lung was much more oxygenated)
*She did not need any more morphine overnight than she had before surgery
*Blood gas (CO2 and O2 levels) have looked good since surgery and every good "gas" allows them to lower the pressure on the ventilator
*Estimated 2 to 3 days until extubation (removing ventilator)
*After ventilator is removed and Kara remains stable, we will be transferred from Children's NICU. Either to "the floor" (normal room) in Children's or back to Evergreen NICU. We're praying for the latter. We have close friends that live near Evergreen, and we adore the hospital staff there.
*Anticipated feeding tube placement (so she can start digesting Mommy's milk and get her intestines going) this afternoon or tomorrow morning.
*We might be allowed to hold her tomorrow (HOORAY!!!)

Still to come:
*re-learning the sucking reflex
*breathing without oxygen support (after the ventilator is removed she will most likely still need oxygen)
*more weeks of being "split" between our children. Connor & Katie are holding up well, but Mommy & Daddy could use prayer for patience as we're sleep deprived and the kids are a bit more "needy" than usual.

We are just in awe and thanking the Lord!

Surgery Outcome

Kara is now out of surgery. The nurses are getting her situated before we are allowed to go back. It went as well as possible. Her lower left lung (the left lung has 2 lobes) was removed - the CCAM was within the lobe and basically was the whole lobe. The upper lobe, amazingly enough, looked good size and well developed (it had been squished teh entire pregnancy so this is a huge praise. Also a HUGE praise that the CCAM was not within the upper lobe. It is not good developmentally - for growth - for an entire lung to be removed). Lots to be thankful for. Her vital signs looked good throughout the procedure. She will have a rough next few days with higher ventilator settings and more sedation (due to pain) but after that we anticipate improvement.

We are setting our minds for a 1 month hospital stay from here, so we'll see if that's what God has in mind for us, as well. Thank you for your continued support and prayers.

Starting Surgery

Kara was just wheeled back into the O.R. (12 p.m. PST). The nurse told us to plan for about 6 hrs total with anesthesia, ventilation, etc, before we see her again. We are anticipating her to "get worse" (recovery from major surgery) before she gets better.

We are SO thankful in the Lord's timing of this surgery and can clearly see His wisdom in enabling her stability going into it. Our hope is in the LORD!

Procedure tomorrow

"Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort, who comforts us in all our affliction so that we will be able to comfort those who are in any affliction with the comfort with which we ourselves are comforted by God." - 2 Cor 1:3-4

Kara had a great day! The doctors turned her ventilator down even lower today and her blood gas was excellent. They are very confident that she is at the best place to handle a procedure. They have scheduled the surgery for 10/10:30am. The surgeons will be removing the mass. Again we appreciate your petition on our behalf before the Sovereign Lord.



- Pray for Kara's physical strength.
- Pray for the Surgeon's ability to properly identify the limits of the mass.
- Pray for the Surgeon's clarity of thought during the procedure.
- Pray for Kara's stability during her recovery, which will be several weeks.



Connor and Katie have really enjoyed the animals at Children's Hospital. Anytime Katie hears us speak of the hospital she says, with hands outstretched, "We are going to SEE THE ELEPHANTS!!" The trip is not complete until she pats, hugs, and kisses the elephants at the entrance.




We will have more time to update tomorrow during the surgery. We love you all. It is a joy to know we have so many praying for Kara, the doctors, and us.

Kickstarting Kara's Kurrent Kuality Kareplan

We arrived at the hospital this morning we were able to confirm what we heard on the phone earlier:

- Kara has been breathing well, so well they lowered the ventilator breathing rate and oxygen level.
- Kara has been able to be on her back for a couple hours at a time. (She's been on her left side mostly to allow her right lung to work better)
- Her blood gas levels (oxygen/CO2) have been very good.

We were able to speak with the surgeon when we came in. (Which is a blessing they are very busy and it is unknown when they will be able to stop by). He is very pleased with Kara's progress and current state. However, he and the care team think it is in Kara's best interest to do surgery now. The doctors think it is important for her to start developing her ability to feed and digest. They are confident in Kara's strength and ability to handle the procedure. One thing they are going to observe is Kara's ability to be on her right side over the next 24 hours. Which is the side she will be on during the procedure.

They have set Wednesday for the surgery to remove the CCAM. We will go over more of the particulars with them tomorrow.

We thank you very much for your prayers and would ask for more of your time before God's throne of grace.

- Praise Him for the progress Kara has made. (oxygen levels, resting in different positions.)
- Praise Him for the grace and strength He has supplied for Meg and I.
- Praise for Grandma and Grandpa Putman coming to help us
- For continued grace and contentment for Connor and Katie.
- For Kara's physical strength
- For the surgeons' wisdom, clarity, and steady hand

The Lord is a stronghold for the oppressed, and a stronghold in times of trouble. And those who know Your name put their trust in You, for You, O Lord, have not forsaken those who seek You. - Ps 9:9-10

Kara Update - Sunday

The Putmans, in general, had a full day today. We went to 2nd church service (enjoyed a more leisurely morning at home), then to Children's and then home again. Well, that doesn't sound like a lot when I type it out, but we're pretty tired. The stress of being split between our children is starting to wear on us a bit. Understandably, Children's is not a great place for Connor and Katie to be. They have quite a few things they REALLY like there (like the elephant statue and some toys) but there are plenty of screaming kids in the waiting room, and our kids don't like to be in Kara's room for very long. All that to say, we are working through whether or not to bring them back (and if so, when, how often, for how long, etc.) Thanks for prayers on that!

As far as Kara, she had a quiet day. Hooray! The first quiet day of her short little life. Yesterday she had been increased in her levels of: morphine, breaths per minute on ventilator, and %oxygen she was receiving in the ventilator. She was very touchy but did stabilize by the end of the day. Today they were able to bring the % of oxygen down from 60 to 45 and also were able to lower the pressure of the ventilator. The surgeon is extremely happy with her progress and his goal is to extubate (which means take out the ventilator or intubation tube in the next several days. To work toward that they will continue to lower the ventilator pressure and % oxygen levels.

On the ventilator monitor, we can tell which breaths are ventilator initiated vs. which ones are Kara initiated. Most of the breaths are Kara-initiated which is a good sign. Because of her pulmonary hypertension (too much pressure in her lungs) she gets quite worked up with any stimulation and really has labored breathing - which is why she is kept sedated.

Thank you for your continued prayers. We continue to trust that God has all these circumstances in His control, that He makes NO mistakes and formed our little girl EXACTLY how He wants her to be. We believe that as we look at her and weep and "cast all our cares on Him who cares for us." We are reminding ourselves that the surgeons know how well newborns do (and do NOT do) in surgery and that the path they are taking is for our good (Rom. 8:28).

Saturday Afternoon

Things we are thankful for:

- Prayers of our family and friends.
- Great care for our Children. Thank you Roger and Gail!
- That Kara has care close to home so we can have a good night sleep.
- The meals and snacks our friends have brought
- Burgermaster peanut butter shakes
- Knowing that God does not make mistakes

Things we are praying for:

- Patience and contentment as we wait and see whether she will improve or need surgery.
- Full rest when we are home to sleep.
- Clarity of thought and wisdom for the surgeons (they are the doctors attending Kara).
- Extra grace for Connor and Katie to be content as we are away more. Wisdom for us to balance our time.

Thank you for your continued prayers.

Kara's Birthday Party!

Yesterday afternoon Roger and Gail brought the children by for their first visit with Kara. We brought them in to the room to see Kara. They were both very sweet and wanted to hold her. When Connor saw Kara he pointed to Meg's belly and asked, "Do you have another baby?" We had a good laugh.

Because there is not much room with Kara we went out to the lobby and had a birthday party for Kara. The kids ate birthday cookies, that Meg and Connor made last week. Connor and Katie also opened birthday presents from Kara. Connor got a little John Deere dump truck and Katie received a puzzle. Meg is amazing for planning that! I have obtained great favor from the Lord (Pr 18:22).







Happy Birthday Kara! We are excited to get you home!

Kara Update Friday afternoon.

First, thank you everyone for your prayers and kind words! We are very blessed and encouraged to know so many are praying for Kara and us.

Second, I wanted to give an update on Kara's situation. (Picture from last night)



Kara is comfortable and stable. Her blood oxygen levels were low this morning and she needed intubation. The doctors installed a breathing tube with a respirator. The mass had inflated and was creating pressure on her right lung which reduced the amount of oxygen she was getting. She is breathing well and getting the oxygen she needs now. She does need some sedation. She is fighting the breathing tubes and heal pricks. Our little fighter!

Now we wait. The doctors are hoping the mass will stabilize and reduce in size. The main concern is the mass, if enlarged, will create too much pressure on the right lung (good lung) and the heart.

Please continue to pray for the doctor's wisdom and that we would be content with the circumstances God has brought us to. "Our hope is in the Lord, who gave Himself for Me, and paid the price for all my sins on Calvary"

Kara Elizabeth Putman is here!

Kara is here. We are thrilled - She is 7 lb, 20 inches long
We have been absolutely in awe of God's goodness and His choosing to give "good gifts" to us, His children, this last 24 hours.

I will upload photos when my Dad brings the camera cord (currently just have the SIM which doesn't work in the laptop, oops!), but for now here are some of the blessings we're thanking God for:

LABOR:
* Going into labor on my own. (2 a.m.)
* Already had a perinatologist appointment (next door to the hospital) to go to at 11 a.m. so we didn't have to worry about going to the hospital too early or too late.
* Jeremy was home for us to get the car packed and house ready, Mom was home to take Katie and Connor (ear infections) to the pediatritician's just before we headed into the hospital. Dad was still home to stay home from work with the kids.
* Our perinatologist let us admit from her office.
* The same nurse was with us the whole time. She was outstanding and stayed 4 hours past her shift to see us through delivery.
* Our perinatologist (O.B. also) switched "calls" to be here for us. She said her other alternative was to just be here and not get "credit". Wow!
* The perfect epidural (I had a not so perfect one last time and only now do I appreciate the difference!)

DELIVERY/RECOVERY:
* Great staff on hand - 3+ for baby, 4+ for me, Mom and Jeremy
* Delivered at 10:30 p.m. Close enough to midnight so I can stay an extra day if I want (Kara will be staying so this gives me an option of a more comfy bed).
* Awesome nurse just after delivery. Very kind and considerate, took me up to see Kara when I was ready to go (about 90 min after delivery, WOW. Talk about different from c-sec).
* Able to get some sleep afterward because of the time of the delivery - not so many nurse interruptions after 1 a.m., and also because I was not a c-section.
* I am recoverying VERY well. Was able to take care of what I needed to do, in the midde of the night, on my own. I have VERY little pain (and I'm a bit past due for my tylenol and ibuprofen).

KARA:
* Apgar of 8/9 (deductions for color only), cried at delivery, and was able to breath so we were allowed to hold her. This is all WAY above what we anticipated or could have expected.
* Extremely kind, caring, and skilled staff working with Kara.

Kara Update - Last night (and continuing to this morning) the neonatologist and staff continue to problem solve. She is (as we have known all along) quite unique in her circumstances. The shunt remained in place during delivery (it goes from the cyst in the mass in her lung to her back). So they had to clamp it to prevent airleakage. After a chest x-ray, they saw that Kara had oxygen inside the cysts in the mass as well as oxygen between the lungs and the chest wall. They closed up the skin outside the shunt with stitches and steri-strips to see if that would prevent the leakage outside the lungs. Kara is under an oxygen hood and her vitals are usually within normal, respiration rate is a bit high but not worrisome. She will continue to get x-rays every few hours.

Prayers/thoughts - My anticipation is that, with the shunt capped off, the cysts are going to reaccumulate fluid which will make the mass larger. They can open the shunt clamp to release this but don't know what the solution would be long-term (as long as Kara has the shunt in, we're staying in NICU). My prayer is that if Kara needs surgery now (in the next few weeks) that it would be evident sooner rather than later so we can move forward. Otherwise, healing and stability so we can hold off on surgery until 4 months would be amazing.

Please join us in thanking God for His provision. He truly has done above and beyond all that we could ask or imagine, and we are humbled by His grace. God has been so gracious to unfold His plan to us one step at a time. I'm thankful we had to (and still have to) walk through uncertainty and trust in Him, knowing He gives grace sufficient for our weakness and that His mercies are new (and enough) every morning.