Beruflich Dokumente
Kultur Dokumente
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Contents
Dedication 1
Sofia 4
My Pages 114
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Sofia 1
10.31.07 - 20 weeks today! Today was our first appointment with the perinatologist. My
Mom drove up last night for moral support and came along for the appointment to help re-
lay info to my Dad and be an extra set of ears for us. The perinate confirmed our dia-
gnosis by ultrasound, the baby has left-sided CDH (LCDH) also sometimes known as a
Bochdalek hernia, which makes up 80-90% of all CDH cases. The stomach and some of
the intestines are in the chest cavity, causing the heart to be displaced to the right side of
the chest. This is called a mediastinal shift. It was unclear if the liver was in the chest or
not. Cases where the liver is also in the chest have a decreased chance of survival than
ones that do not. Our baby has been given about 50-60% chance of survival.
We did get a bit of good news. The baby has a healthy brain, 2 kidneys, and the heart ap-
pears to be normal too. A defect with the heart, brain, or kidneys sometimes suggests an
associated chromosomal abnormality, which could be confirmed through chromosomal
testing. We opted to have an amniocentesis as well. This is done by inserting a long
needle through the abdomen and into the uterus to draw out a sample (10-20cc) of amni-
otic fluid for chromosomal testing. (Not nearly as painful as it sounds.) I was afraid Kenny
might pass out for this, but he was right next to me watching the whole thing!
We then met with the genetic counselor to review our family medical histories, both of
which are unremarkable. As of now, no one knows the cause of isolated CDH, meaning
individuals that have CDH but appear to have no other chromosomal abnormalities or
4 malformations. It's believed that the cause of isolated CDH is multifactorial, meaning it
may be caused by multiple genetic and environmental factors. The genetic counselor told
us we could expect preliminary results from the amniocentesis, also called FISH test res-
ults in 1-2 days and full results in about 2 weeks. The FISH test looks specifically at chro-
mosomes 13, 18, 21, X, and Y. Abnormalities of these five chromosomes account for
nearly 95% of all chromosomal abnormalities.
11.2.07 - Today we met with Dr. W. for our regularly scheduled OB appointment. Our
FISH test results were normal! This was definitely good news, since CDH has a high as-
sociation with other genetic/chromosomal abnormalities and syndromes. Full amnio res-
ults should be back in about 2 weeks. This was a very hard week for us, because Dr. W.
also discussed with us, as did the perinatologist, the possibility of terminating the preg-
nancy. Since CDH has such high mortality and morbidity rates, around 20% of patients
opt not to continue the pregnancy. This was a horrible decision to have to face when con-
sidering all our baby will have to face after birth and the months/years to follow, but we
decided to continue with the hope that our baby will be a survivor.
Prior to our CDH diagnosis, we had planned to deliver at the hospital where I work, which
has a Level II NICU. But since the baby has greater needs than a normal, routine deliv-
ery usually does, we will need to deliver at a Level III facility. Occasionally, Level III
NICU's have ECMO machines, but this isn't the case for any of the hospitals in our area.
The only Level IV facility (which has ECMO) is Children's Mercy Hospital, which doesn't
care for adults - including labor/delivery. This means a transfer will be necessary. Trans-
ferring a seriously ill baby is always something that you try to avoid, since it's very dan-
gerous for the baby. But since we have no other local options, we chose to deliver at a
Level III and transfer the baby to Children's Mercy as soon as he or she is stabilized after
birth. This usually takes place within the first few hours after delivery. We chose Over-
land Park Regional Medical Center for our delivery. This hospital has been considered
the "sister" hospital to the one where I work. We share some staff members, including the
Neonatologists and some Neonatal Nurse Practitioners. So it gives me great comfort that
people who know us will be the ones caring for our baby. Also, a nurse I work with, who
also has worked at Overland Park (OP), has so graciously volunteered to be my person-
al labor nurse!! I'm sure this will bring me great comfort during what will be such a
nervous time for Kenny and I. I'm very grateful for the support people have shown us and
their willingness to help or just to say they're thinking of us.
11.5.07 - Today we met with one of the neonatologists in the group that will be caring for
our baby at the delivery and for a short time afterward until the transfer to Children's
Mercy. Dr. S. is one of the neonatologists that practices at my hospital, so I had met her
on several occasions before. She is a great Dr. and also a very caring person. She took a
great deal of time explaining to Kenny and I what to expect with CDH.
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The primary problem with CDH babies is that because there are organs in the chest that
aren't supposed to be there, the lungs aren't able to develop adequately. How much and
how well the lungs develop will determine if the baby survives after birth. Unfortunately
there is not currently a very accurate way to determine how well the lungs are develop-
ing in utero in a way that accurately predicts the baby's chance of survival. This is defin-
itely the hardest part of waiting because you just don't know until the baby is born if the
lungs will be able to supply enough oxygen to the body to survive. With cases that
present like ours, with the heart shifted to the right, the right lung is usually the primary
lung that develops. How big it is able to grow depends on how much room it has around it
between the heart and the chest wall. The left lung often is severely restricted in growth
because it is compressed by the herniated organs, and may only be a lung bud.
However, as long as there is enough lung to sustain life initially, the lungs can continue to
develop until around 6-7 years of age.
Dr. S. explained what we could expect to happen at delivery and shortly afterward. There
will be a large team from the NICU at the delivery to care for the baby. From other par-
ents' experiences this team is usually anywhere from 10-20 doctors, neonatal nurse prac-
titioners, nurses and respiratory therapists. The baby will immediately be intubated allow-
ing oxygen to be delivered directly into the lungs. The baby probably will not be able to
cry when it is born. Also a tube will be placed into the stomach to keep air from accumu-
lating in the stomach and intestines. If they were to fill with air, this would keep the lungs
from expanding even more. Medications to help with breathing will be given and the baby
will be taken to the NICU to be placed on a ventilator and have IV's started. More de-
tailed info with great pictures and explanations about what to expect can be found under
the CDH Links section on the left. Go to "What to Expect After Delivery."
After the baby is considered stable enough to be transferred, a transport team will place
the baby in an isolette with all the monitors, lines and equipment attached. The isolette
becomes a mobile NICU bed for the baby to travel in the ambulance. They will bring the
baby to our room so we can see him or her for a few minutes, and then they will travel to
Children's Mercy. Kenny will be able to follow behind the ambulance and should be able
to see the baby fairly soon once they arrive at Children's. Babies that are seriously ill
need to be in a dark, quiet, calm environment, so visitors will likely be limited at this point.
While at the neonatologist's office, we also met with a social worker from OP. She gave
us a quick tour of the birthing unit and NICU at OP. While at OP and also at Children's
Mercy, we will be assigned a social worker to help us with a variety of things.
11.13.07 - Today we had our second appointment with the perinatologist. They will be
seeing us monthly for ultrasounds to monitor the baby's well-being, growth, and level of
amniotic fluid. CDH babies frequently have portions of the bowel that have herniated into
the chest, just as our baby does. This sometimes causes too much amniotic fluid to accu-
mulate around the baby in the uterus, also called polyhydramnios, which could cause
preterm labor and other complications. The measure of amniotic fluid is called the Amni-
otic Fluid Index (AFI). They expect it to be roughly between 10-20. Levels above 22-25
would cause concern. Today our AFI was 13.25, so very good. The baby also weighs
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about 1 lb now and is still in the breech position. Anatomy in the chest basically looks the
same with stomach and bowel herniated, and heart shifted to the right. Still waiting on the
full amnio results. The bad news today is that it appears part of the liver is also present in
the chest.
11.30.07 - 24 2/7 weeks. Today we had our first appointment with our new OB Dr. Dr. E.
came highly recommended to me from the nurses I know that work with her at OP. She
will be consulting with the perinatologists about our plan of care throughout the preg-
nancy. Basically all we can do is monitor the baby closely and stay pregnant as long as
possible. Babies with CDH born before 37 weeks typically do very poorly compared with
babies born closer to full term at 40 weeks. Because lung development is our primary is-
sue, being born early would only add to that problem.
Also, we will plan for a natural delivery, rather than a c-section. The stress of labor is
good for babies and stimulates lung function. Also the mechanics involved in a natural
delivery would benefit the baby's lungs by helping to squeeze out excess amniotic fluid.
12.3.07 - Today we had our meeting at Children's Mercy with the neonatology/surgical
team. They met with us for a little over 2 hours to give us some idea of what to expect
after transfer, for surgery and the plan of care to follow. We had lots of questions, and
they took the time to answer everything we could possibly ask in detail. The answers they
gave us coincided with all the research that we had done, and we really feel like our baby
will get great care at Children's Mercy. They really made us a priority while we were there
and we were very impressed with them. They see about 18 cases of CDH per year of
varying severity. Of the more severe cases that present similar to ours, they see about 2-
3 per year.
They told us that based on what we've seen so far on ultrasound, we should expect that
our baby may need ECMO, which is heart/lung bypass. Any baby that goes on ECMO
has a 50% chance of survival. There are a lot of complications associated with ECMO,
and we hope to avoid it if all possible. However, ECMO has saved babies that otherwise
may not have survived, so as a last resort it can certainly be life saving. If the baby
doesn't need ECMO, the optimal time for the hernia repair surgery is after the baby is
stable, possibly 3-4 days after birth. If the baby does need ECMO, they usually stay on it
for 2-3 weeks. The surgeons prefer not to attempt the repair surgery while the baby is on
ECMO, because it is too dangerous, but will do it if they have to.
The repair surgery involves removing the herniated organs from the chest and then pla-
cing them into the abdomen where they belong. If the part of the diaphragm that is miss-
ing is small, say like the size of a golf ball, they may be able to sew the hole closed. This
is the best case scenario. If a larger part is missing, they will have to use a synthetic
patch to close the hole. Using a patch increases the risk later that the baby may reherni-
ate through the patch and have to have additional surgery to repair the reherniation. Also,
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since the patch isn't real tissue, it will not grow as the baby grows, so it will likely need to
be replaced at some point, hopefully not more than once, but every case is different.
Sometimes the abdomen isn't large enough to hold all the organs, since it's basically
been empty up until this point. If that is the case, they have to leave the abdomen open
for some time to allow it to stretch and accommodate everything, then they would per-
form another surgery later to close it. Once the diaphragm has been closed or patched
and the abdominal organs put into the proper place, the heart will slowly shift on its own
back to the middle of the chest and the lungs will finally have the room they need to ex-
pand and continue to grow a little.
After we get past all that, the next big issue is feeding. CDH babies typically have seri-
ous long term problems with feeding and growth. Since the bowel has been malrotated
during development and manipulated so much during surgery, it will be a while before the
baby is able to take any nutrition by mouth and digest it. From birth until the intestines are
working, the baby will be fed through IV's by TPN (Total Parenteral Nutrition). Once the
baby is able to digest food, a feeding tube will be placed either through the mouth (OG)
or nose (NG) that goes directly into the stomach. Feeding and growth will be something
we work on for a long time, and the baby will most likely go home with a feeding tube in
place. We were told to expect that the baby may possibly be able to go home around the
time he or she is 3 months old, but this can vary a lot depending on how the baby is pro-
gressing.
The baby may also go home with some oxygen that is given through the nose by a nasal
cannula, a monitor, and some medications. For this reason, we will not be able to use
daycare and are currently trying to work out our schedules so we can continue working
and also be able to stay home with the baby. We both need to work full time and contin-
ue to carry our insurance to pay all the medical bills that we'll have. I am hoping to work
on the weekends, so I can be home with the baby during the week. But as of now, I'm not
sure that will work out.
After our meeting, we were given a tour of the NICU at Children's by one of the Neonatal
Nurse Practitioners. She showed us the special ECMO room where ECMO babies are
cared for. They can have 2 babies in there at a time if they need to, but usually have just
one. The operating room is attached to the ECMO room, so the baby won't even have to
leave the unit for surgery. We also got to see a CDH baby that was getting ready to go
home. She was about 3 months old and had a very severe diaphragmatic hernia. They
thought several times that she would not survive, but she did and appears to be doing
well and is going home. That was good for us to see, but also very emotional, as it's hard
to see these very sick babies and know that ours is going to be there too.
12.11.07 - 25 6/7 weeks. Today we had another appointment with the perinatologist. The
baby has turned and is now in the vertex position (head down), so that is good. The baby
is measuring 2 lbs. and is about 1 week large for the gestational age. This is good be-
cause the bigger the baby is at birth, the better, because surgery is easier on big babies
than on small ones. Our AFI was also good at 13.61 today. It wasn't clear if the liver was
up or down today, but the best news of all was that we saw the right lung! Up until this
point, we hadn't seen any lung tissue, so this was big news. It looked to be a little bigger
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than the size of the heart, and we found this to be very encouraging. So overall, we had a
great appointment today.
12.21.07 - 27 2/7 weeks. We had another appointment with Dr. E. today. I had my 1 hour
glucose tolerance test, where they give you a really nasty, sugary drink to drink in 5
minutes. Then they wait an hour and draw your blood to see what your blood sugar is.
They said the results should be back in about a week or less. This is the initial screening
for gestational diabetes. I have been a little nervous for this because my fasting blood
sugars run a little on the high side of normal, diabetes runs in my family, and my mom
was gestational diabetic when she was pregnant with me. Although I'm not really at a
higher risk because of those things, I was still nervous for the test. Gestational diabetes is
a concern in pregnancy for several reasons, but the most important one to us is that it
negatively affects lung development. And while a baby of a gestational diabetic mother
may be born at full term and be very large, it may have underdeveloped lungs. It our
case, this is NOT something we need stacked against us even more.
12.26.07 - Dr. E.'s office called today to tell me that I failed my 1 hour glucose test. The
blood sugar level is supposed to be under 130 and mine was 154. What a Christmas
bummer. No sweets for me just in case!! I will need to have a follow up test done to de-
termine whether I have gestational diabetes or not.
12.28.07 - Today was my 3 hour glucose test. I had to fast for at least 8 hours before
coming in, so I hadn't eaten anything since 9pm the night before and my test started at
8:45am. First they draw your blood to check your fasting sugar level. Then I got another
nasty sweet drink to gulp down in 5 minutes. After that you wait in the lobby for an hour,
they draw your blood, you wait another hour, they draw your blood, you wait another
hour, then they draw your blood again and you are done! I finished at 12:00, 3 hours and
4 blood draws later, and went straight to the nearest restaurant.
12.31.07 - Happy New Year! My 3 hour glucose test came back normal!!
1.10.08 - 30 1/7 weeks. We had another appointment with the perinatologist today. They
estimated the baby's weight at 2 1/2 lbs., but said this was probably an underestimate
due to the way the baby is laying today. They suspect the baby is actually closer to 3 lbs.,
which is right on track for the gestational age. The head is measuring at 30 weeks and
the abdomen is measuring at 28 weeks. Since the abdomen doesn't contain the usual or-
gans that have migrated to the chest instead, this is not surprising.
The Dr. also checked an S/D ratio today, which is a measure of the blood pressure in the
umbilical cord. It tells how well the placenta is perfusing with blood and how well the
blood/oxygen/nutrients are being delivered to the baby. An elevated S/D ratio can be as-
sociated with several things, including polyhydramnios and low birth weight infants. The
S/D ratio was normal at 2.4. Normal levels are usually considered to be less than 4.0 at
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20 weeks, less than 3.0 at 30 weeks, and less than 2.0 at full term.
We also had a Biophysical Profile test (BPP). This measures the baby's well-being by
checking 4 things: the baby's breathing movements, muscle tone, body movements, and
level of amniotic fluid. Each of the 4 areas scores either 2 for passing or 0 for failing. 8/8
is normal, 6/8 means we need to repeat the test in 12-24 hours. A score of 4 or less
means the baby is having problems and further testing is needed. We will be having
BPPs regularly in addition to Non Stress Tests (NSTs) until the baby is born. Today the
baby scored 8/8 on the BPP and the AFI was still normal at 13.4. But the biggest news of
all was that we saw the LEFT lung today!! It was almost at big as the heart, so more than
just a lung bud, and it was showing breathing movements. This was great news!!
1.14.08 - We had another appointment with Dr. E. today. Everything was still right on
track. We discussed the option of doing either weekly BPPs by ultrasound or biweekly
NSTs instead. An NST is done my placing an external fetal monitor on me to monitor the
baby's heart rate and any contractions I may be having. She said that I could do bi-
weekly NSTs while I'm at work, which would be great, so we won't have quite so many
Dr.'s appointments to drive to. We will still have BPPs when we see the perinatologist.
1.16.08 - 31 weeks today! I had my first NST at work today. The baby passed with flying
colors. What an overachiever! We will do NSTs twice a week until delivery, and I should
be able to do most of them at work, which helps a lot. It was definitely weird being a pa-
tient instead of the nurse though. It's hard not to watch the monitor and just be a good
little patient ;-)
1.25.08 - 32 2/7 weeks. Today we had our OB appointment. We are going every 2 weeks
now, instead of once a month. We saw a midwife in the group today, because Dr. E. is on
a medical mission trip in Africa for a couple of weeks. Everything is still going well.
...Wow, I know that was a lot of information, but now everyone should be caught up. I
didn't realize how much had happened since the end of October, or I would have started
this earlier. Our next OB appointment is scheduled for Monday, Feb. 11th. We'll see the
perinatologist again on Feb. 12th. I'll post when anything new comes up. If anyone has
questions, please don't be afraid to ask!! You can either post a comment on the blog, or if
you'd rather ask us privately, email me directly at jtmku@yahoo.com
Posted by Kenny and Jennifer Miller at 09:40PM (-06:00)
34 5/7 weeeks - First let me say, we have been so overwhelmed (in a good way) by all
the support we have received from everyone! We've gotten so many emails sending
thoughts and prayers and it really means a lot to know you all are thinking of us. We had
an appointment with our OB today, but had a scheduling conflict, so I actually saw one of
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the midwives instead. I've been having contractions on and off since around 20 weeks or
a little before, but didn't think much of it. Lately they have gotten more regular, so I asked
her to check to make sure I wasn't dilating any, because we definitely don't want to deliv-
er preterm. Unfortunately I am already dilated to 3-4cm/90% effaced/and -1 station. At
this point in the pregnancy I really shouldn't be dilated or effaced much at all, so that was
not good news. So now I am on bedrest and trying to make it to at least 37 weeks. We
have another appointment tomorrow morning with the perinatologist, so I will try to up-
date after that with any new info. Please keep us in your prayers and hope for a March
birthday for Baby Miller!
Posted by Kenny and Jennifer Miller at 09:05PM (-06:00)
We had our appointment with the perinatologist this morning. All good news to report as
far as growth on the ultrasound. The baby is measuring just a little over 35 weeks, so we
are right on track. They estimated the baby's weight at 4lb 14oz. We are really trying to
get to a point where the baby will be a little bigger for surgery. Also there is a weight min-
imum to even be a candidate for ECMO. I think it is around 4 1/2 lbs, so we'd like to be
bigger so we have that as an option if we need it. The amniotic fluid level was normal,
right in the middle range at 14.5, so that was also good news. Baby passed the biophys-
ical profile with 8/8 and it looked like the liver was down today, so that was also very good
news. I had thought that at our previous visits, they had never been able to fully visualize
all the major vessels of the heart, so I asked about having a fetal echocardiogram. Appar-
ently they did a fetal echo at one our previous appointments (this was never discussed
with us), and it was normal. 70-80% of heart problems can be ruled out with a normal
echo, so that was more good news. We were able to see all the major vessels of the
heart coming from their appropriate places today, and even though this doesn't rule out a
heart defect completely, it strongly indicates that everything is ok with the heart and ves-
sels. So for now I am just resting (aka being really, really bored) and trying to stay preg-
nant as long as possible.
Posted by Kenny and Jennifer Miller at 11:34AM (-06:00)
35 5/7 weeks - Well, we made it another week! After last Monday, I wasn't sure we would,
but we've had a pretty uneventful week on bedrest (imagine that), but that's the goal - to
be as boring as possible. Friday night and Saturday I had a lot of contractions, but they
eventually got better by Saturday afternoon. Thanks, Melissa, for coming over to be my
personal nurse! We had another OB appointment this morning. I'm dilated just a little bit
more than last Monday, but not a lot, so that's good. She said 4+cm/almost 100% ef-
faced. Hopefully we can get at least another week or two in. After our OB appointment,
we went to the perinatologist's office for another BPP ( biophysical profile) and passed
with 8/8. AFI (amniotic fluid level) was normal again at 15.86, so those are all very good
things. Other than that we have all our bags packed and ready to go. My mom came up
on Thursday to help me do some things around the house and run some errands, which
helped out a lot!! And both my parents came on Saturday to check in and my dad fin- 11
ished our tax returns for us - yeah for tax refunds to help buy baby furniture!!! Kenny's
mom and dad are coming up on Tuesday to visit and bringing lots of good home cooked
food for us. I can't wait for the turkey and noodles! Well, back to my couch for now, hop-
ing for another boring week. :-)
Posted by Kenny and Jennifer Miller at 12:39PM (-06:00)
We're almost to 37 weeks! This will be a huge milestone for us, because delivering pre-
term would have meant even more complications. Still, we want to get as many more
days or weeks in as possible for maximum lung development and weight gain. This has
been a pretty easy week, so hopefully we can go one or two more. The baby should
weigh almost 6 lbs now if growth is still average. We most likely will not have another es-
timated fetal weight measurement done before delivery, so it's really anyone's guess as
to how much the baby will weigh when he/she is born. We've started talking about order-
ing some furniture for the nursery this week, since it takes about 6 weeks to get it in. This
is really the first thing we've done to prepare for the baby's arrival. We decided not to get
a nursery ready or have any baby showers until after the baby is born, so I'm excited to fi-
nally get to do some of these things! We have another BPP at the perinate's office and
then another OB appointment to follow tomorrow morning, so I'll post the update as soon
as I get home.
Posted by Kenny and Jennifer Miller at 11:18PM (-06:00)
36 5/7 weeks - Not much new this week, but that's a good thing. We had our BPP before
the OB appointment and passed after Baby Miller finally decided to wake up from a little
nap. The AFI was 14.46 this week, still doing well. Nothing new at our OB appointment.
Dr. E. said I really wasn't dilated much more that last week if any at all. Then she sent me
over to OP Labor & Delivery to have some labs drawn, so they will already have those
results when I come in to deliver.
Dr. E. has taken a lot of time over the last week to take charge of the situation and per-
sonally make sure everyone is prepared for us when we arrive, so that is really reassur-
ing. It's nice to know that when we go in to deliver, the staff will have some idea about
what's going on, since it might be a relatively fast delivery.
We've been enjoying some great food this week that Kenny's Mom and Dad brought up
for us. Thanks Cheryl, it's all really good - best turkey and noodles I've ever had!! Not that
Kenny doesn't make a mean frozen pizza, but I do appreciate the home cooked meals!
My Mom and Dad also came up this weekend and helped around the house again, which
really helps us out a lot too - thanks guys! We got our second guest bedroom pretty much
set up here at Hotel Miller and the new office is mostly up and running too. The baby's
room is a disaster area, but we have some time to get it ready.
12 I set it up for my Dad and my friend, Kristi, to post updates on the blog for us when we
are in the hospital, so they can keep everyone updated and post some cute baby pic-
tures as soon as we get them! Well, that's about it for now. I'll update if anything new
happens. Also, Happy Birthday to Uncle Kris today!!!
Posted by Kenny and Jennifer Miller at 03:03PM (-06:00)
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Special Prayer Request
This is a special prayer request for a family from my hometown in Kansas. LeAnn and
Travis are expecting their baby this Wednesday and their baby has been diagnosed with
a rare and serious condition called Caudal Dysplasia Sequence. Please keep them in
your prayers this week and in the weeks to come.
Posted by Kenny and Jennifer Miller at 05:26PM (-06:00)
The Board of Directors of Breath of Hope launched an awareness campaign for CDH last
July. Since then, several more members have become active in this campaign by re-
questing their governors and mayors proclaim March 31st as CDH Awareness Day.
Since then, 21 states have signed proclamations and several more are pending. Breath
of Hope has become an international support group with members in Europe, Australia,
and Mexico. One member in Mexico has even gotten President Calderon to sign a na-
tional proclamation, making Mexico the first country to recognize March 31st as CDH
Awareness Day. BOH member, Jeanie Toney (Mom to Ryan - CDH & ECMO survivor
1987, a college sophomore, now 20!), has been working closely with the Deputy Chief of
Staff for President Bush and is close to getting President Bush to sign a national proclam-
ation for CDH Awareness Day.
While national recognition is the ultimate goal, each state that signs helps to increase
awareness. In addition, 7 cities have also signed proclamations. As a member of Breath
of Hope, I have joined this campaign for awareness by mailing requests to Governor
Blunt in Missouri and to Mayor Funkhouser in Kansas City. My parents, along with BOH
member Tanya Gottschalk (who lost her daughter, Naudya Jo, in May 2007), also mailed
letters to Governor Sebelius in Kansas. Thanks to the hard work of BOH committee
member, Jean Ashner (who lost her son, Luke, June 2007), Missouri has signed the pro-
clamation! My official copy of the Missouri proclamation came in the mail today from Gov-
ernor Blunt's office. See picture below. Currently, Kansas is denying the proclamation be-
cause they don't consider CDH Awareness Day to be of " local or regional interest". But
we are still working to get that changed.
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After contacting the Mayor's office here in
Kansas City, my work has paid off. This
week, Mayor Mark Funkhouser signed
the proclamation, making Kansas City the
7 th city in the U.S. to declare March 31st
CDH Awareness Day! Since I'm stuck at
home, my best friend Kristi, went in my
place to pick up the official proclamation
from the Mayor's office yesterday. See
the picture below!
I really want to thank all my coworkers at Menorah for their overwhelming generosity.
They have prepared meals for us and delivered them to the house, sent cards and gifts,
made phone calls to check in and done whatever they can to help us in any way we need
it. We really couldn't make it without the help of such good friends. Your prayers and
good wishes have really touched me, and I sincerely thank you.
Jennifer
Posted by Kenny and Jennifer Miller at 09:28PM (-06:00)
37 5/7 weeks - Well, we've officially made it to full-term status! We'll be 38 weeks on
Wednesday, and we've reached the point now where the benefits of having a planned
and better controlled delivery may outweigh the benefits of getting another week in. So
with that being said...Baby Miller has an induction date, and we hope he/she cooperates
and doesn't decide to jump ship before then! While waiting for the Luck of the Irish on the
17th would have been nice, we felt like we might be pressing our luck by waiting that
long, so we scheduled the induction for next Monday, the 10th. If all goes well, Baby
Miller will be making the big debut in just 7 days!
14
Our OB appointment went well today with no other exciting news to report. We saw the
perinatologist for the last time today as well. The AFI was still normal at 13, which is
really encouraging because many CDH babies have trouble swallowing toward the end of
the pregnancy and end up having lots of excess amniotic fluid. The BPP was again 8/8
and growth seems to still be on track. It's a little harder to have accurate measurements
with the abdomen being so much smaller because the organs are in the chest, but the
perinatologist thought the baby weighs somewhere around 6 lbs.
I also wanted to update on the family I mentioned from Iola last week. LeAnn and Travis
welcomed Baby Theo on February 27th. He was transferred to Children's Mercy that
evening and has been holding steady. They are waiting on numerous test results, includ-
ing an MRI today to look at the brain and spinal cord. Please continue to keep them all in
your thoughts and prayers.
Posted by Kenny and Jennifer Miller at 05:34PM (-06:00)
Most people aren't aware of this, but CDH babies often need multiple blood transfusions
during the course of their treatment. Donating blood is a way that people can help. Even
if your donation doesn't go directly to someone affected with CDH, it is still able to help up
to 3 people in need of blood or blood products. With the help of friends, I've been able to
work with Menorah Medical Center in organizing a blood drive that not only raises aware-
ness for CDH, but helps dozens of people in need of lifesaving blood. The blood drive will
be held on Monday, March 24th at Menorah Medical Center. To donate, you may sign up
online by visiting http://www.esavealifenow.org/ Click on "Find a Drive". Enter sponsor
code: menorahmedctr Select a time and sign up. It's that simple, and just a few moments
of your day may help to save 3 lives!
If you have never donated blood before and have questions, check out this info from the
Community Blood Center. Kenny and I encourage you to become a blood donor in honor
of Baby Miller. Kenny's Dad has already set the bar high - he has donated 7 1/2 gallons
of blood!!
Another victory in the CDH Awareness campaign came this weekend. Initially Kansas
denied the proclamation for CDH Awareness Day, because the Governor's office determ-
ined that it was not of "local or regional interest." After 2 letters to Governor Sebelius, my
parents took another route and contacted Senator Schmidt. The work paid off and Gov-
ernor Sebelius signed the proclamation declaring March CDH Awareness Month! See the
official proclamation below!
15
Posted by Kenny and Jennifer Miller at 10:20PM (-05:00)
41-46
The Countdown has Begun
Just a few hours left to go until we head in to the hospital - 7 hours to be exact! Baby
Miller will be here by this time tomorrow and will finally have a name other than Baby
Miller!!! We are excited to meet this little one and see what the next phase of this journey
brings. We are so blessed to have a great team of people working tomorrow to take great
care of our baby and lots of friends and family to support us. Thank you to everyone for
your thoughts and prayers, phone calls, emails, and cards. We really appreciate
everything. We'll post an update just as soon as we can with all the big news and hope-
fully some baby pictures!
Posted by Kenny and Jennifer Miller at 10:32PM (-05:00)
It is an honor, as my first duty as a Grandpa, to announce that Sofia Rose Miller arrived
at 11:43 a.m. this morning. She was 19 inches and weighed 6 lbs. 4 1/2 oz.
Jennifer is doing well, as is Kenny. The NICU is preparing Sofia for transport to Children's
Mercy Hospital in Kansas City, MO. Early reports of Sofia's condition sound positive. Jen-
nifer will be providing updates regarding Sofia's progress in the days to come.
On behalf of Kenny's parents (Grandma Cheryl and Grandpa Kenny) and Jennifer's par-
ents (Grandma Linda and Grandpa Steve), we want to thank all you that have helped
Jennifer and Kenny in so many ways. A special thank you for all of the prayers for Sofia.
Please continue to pray for miracles in the days and weeks to come.
Posted by Steve at 01:10PM (-05:00)
69-88
Pictures of Sofia
Sofia is doing well so far! I'm pretty exhausted and not thinking very clearly so this post
may not make much sense. She was transferred to Children's Mercy around 4:00 and did
well during the transfer. After being settled in at Children's, they placed a chest tube and
central line. She is pretty sedated now, but holding steady with oxygen saturation 90's -
16
100% (doesn't get any better than that!) She's on the oscillating vent and getting inhaled
nitric oxide, which helps with pulmonary hypertension. Kenny is staying at her bedside at
Children's and I should be able to be discharged tomorrow so I can join them. Here is a
quick slideshow with some of Sofia's first pictures!
It was a busy day yesterday. We are sorry about slacking on the update. I tend to ramble
a bit so forgive me if this isn't as good as what you are used to getting from Jennifer.
I want to start by thanking everybody for their thoughts and prayers. Whatever you are
doing keep it up because our little girl is as good as we can hope for at this point. She is
such a strong little girl.
Mom got released late yesterday morning from the hospital so she was able to spend a
lot of time with Sofie yesterday. She probably overdid it because she was in a lot of pain
last night. Thankfully they have Ronald McDonald Family Rooms here at the hospital so
she was able to lay down last night and get some much needed rest.
Well I better get to the star of the show. While I don't think they could find room for anoth-
er wire or tube on her little body and she has enough drugs going in her to make every-
body on Celebrity Rehab very jealous, she is doing really good. The main problem right
now is there is air leaking from her right lung that they are trying to get under control.
They put a chest tube in not too long after she got here to help relieve the pressure. After
several rounds of Xrays throughout the day they thought it wasn't in the best location to
be getting everything so they put in another tube last night and her blood pressure num-
bers are the best they have been since we got here. The doctors have even said that if
continues to progress at this rate that they're optimistic that we will be able to make to
surgery without having to go on ECMO. Which may be the best news yet.
I think I should start leaving her alone more often because everytime I went in to see her
last night they were lowering her settings on the ventilator. The Doctors told us we are on
the low end of the range of settings, but it's still good to see everytime they go even
lower.
The surgens were in to check on her this morning, which is good becuase the doctors
told me when we got here we wouldn't see them too much untill her vitals got into a range
that is safer for surgery. They told me we aren't quite there but we are getting closer.
Some of her doctors have begun a study that is trying to help babies that have to take a
lot a pain killers. With babies that are on pain killers for a long period of time they begin to
develop a tolerance which means the drugs levels have to continue to increase. This also
means they have a harder time with withdrawls when they start to come off the drugs. So
her doctors want to try a drug that has been used on adults and has been effective but
17
hasn't been studied on babies yet to try and limit the the need to increase her pain medic-
ation levels. Our little girl is the study's first participant. So the doctors say if this works
she will be legendary to a lot of babies in the future.
Well while it seems like I have been writing forever I sure I am leaving out so much. I
need to go down and get Mom so I will sign off for now. Keep those prayers coming.
More updates later. Hopfully from Jennifer who is better at this stuff.
Sofie's Dad.
_______________________________________________________________________
_____________
Never miss a thing. Make Yahoo your home page.
http://www.yahoo.com/r/hs
We started off the day with Dr. H (neonatologist) removing that first chest tube because it
was no longer functioning and didn't need to be there. She was still stable with no further
problems. Her team made morning rounds around 1030. It was the first time I had been
there to hear what they all had to say and ask questions. Sofie seemed to do really well
through the night after the 2nd chest tube was placed, and the team was pleased with her
progress. Her labs from the night before were all reassuring and her vitals still stable this
morning. Her primary problem is pulmonary hypertension ( PPHN) and it seems as
though her PPHN is mild to moderate with the mean pressure hanging in the low to mid
40's. That seems to be where she keeps her O2 sats the best (95-100%) and her heart
rate steady in the 120's. Dr. S (neonatologist) told us a couple of the surgeons would be
by to see her soon and they are saying possible repair surgery in 1-2 days. We were very
encouraged to hear this! However around noon she had her first of several setbacks. She
spontaneously dropped her blood pressure to the 30's and her heartrate went up. During
the morning she had slowly been rising her b/p to the mid 50's in order to keep her sats
and hr stable. So this was a pretty significant drop. They were concerned maybe her
chest tube wasn't working properly so they took another chest xray. It showed no
changes which was good. They gave her a fluid bolus to help her recover which worked
quickly. They drew an ABG (arterial blood gas) which was excellent, so they actually de-
cided to wean her vent settings even more from 33 to 31. This was her biggest jump
down, so we were very excited. Not long after that, Dr. S told us her repair surgery was
scheduled for 1pm tomorrow (Thursday). We were thrilled but also very nervous.
Around midafternoon, she had another spell like she did in the morning. They gave an-
18
other NS fluid bolus and also gave 3 of hydrocortisone to try and help her blood pressure,
which has settled in the 50's, making her PPHN a little worse overall. Through the after-
noon her b/p's were labile and then around 4:45 pm she dropped her sats to the upper
80's and had another spell. Her ABG was not as good and her PPHN was worsening. So
she probably won't be having her surgery Thursday, which is okay with us because we
want her to be more stable when she goes in. After that last spell, they increased her
dopamine and dobutamine and jumped way up on her vent settings from 31 to 36. Since
she doesn't have much further to go on the vent or with her blood pressure medicines
and her PPHN is getting worse, they are now considering putting her on ECMO. So after
starting the day at the highest of good news, we were ending with some of the worst
news.
We went down to rest in our sleep room and pray that Sofie stabilizes and doesn't need
ECMO. It's now around 3:15am and Kenny just went to check on her and said since her
last spell around 5:00 pm she has been pretty stable with sats 95-96%, b/p steady in the
50's and hr steady in the 120's. No further spells, her ABG's have been good, and her
vent settings were weaned again down to 34 from 36. Her 1:00am chest xray showed her
pneumothorax was slightly worse and her urine output is down a little. They are okay with
her urine being less because she had been putting out tons, which means her kidneys
are being perfused and working well. So that is where we stand heading into Thursday. I
pray that we can get back on the right track and avoid ECMO and that her PPHN im-
proves. Please pray extra hard for Sofie today, she really needs it!
Posted by Kenny and Jennifer Miller at 02:10AM (-05:00)
102-114
Prayers are Working!
Sofia had a good night overall last night and seemed to get better as the night pro-
gressed. She only had one spell where she needed a fluid bolus during the night, where
she needed 5 boluses during the day yesterday. When we visited her at 4:15am she was
moving her arms and feet quite a bit. However she was tolerating it really well and her vi-
tals remained very good. Her b/p has resettled in the mid to upper 40's and her hr and O2
sats remain very good. Her blood gases (ABG's) were better during the night and con-
tinuing to improve this morning. They were able to wean her back down a bit on the vent
to 33.
This morning during rounds the team was very encouraged by how much she had im-
proved and feel today or tomorrow may be a good time to do her surgery while she re-
mains in this stable window. We are waiting for the surgeons to come by and see her
now and there is talk that they may actually do it today. The goal is to get it done while
she is as stable as possible to avoid having to go on ECMO before the surgery, because
doing the surgery on ECMO is much more risky. There is still a chance even if she did
have her surgery today that she might need ECMO afterward.
After her 9:00am ABG her levels were so good they weaned her vent again down to 32.
Yeah Sofie! You can do it! Her 11:00 ABG was also rock solid so they did another echo
to check her pulmonary pressures more accurately. This is kind of the final criteria that
needs to be good for surgery to happen. Will update again when we hear anything about
surgery. Please continue to pray for Sofie to stay strong and stable!!
19
Sofia's Mommy
Posted by Kenny and Jennifer Miller at 11:14AM (-05:00)
We started out yesterday on such a high note. We thought we'd be through with the re-
pair surgery by now and on the road to recovery. They decided to move her to the OR
suite which is attached to her room at 1:00 pm yesterday to see how she tolerated it. The
move took 30 minutes and 9 people. I think Kenny and I held our breath the entire time. It
was very stressful to watch!! She tolerated the move very well and continued to be stable.
So around 3:00, they scheduled her surgery to be today starting between 10:00am-
12:00pm.
That was the plan until about 5:30, when her O2 sats suddenly dropped to the 80's. Her
heartrate started climbing and she began to be more and more unstable. At 6:30 her sats
were hanging at 67% and the doctors started discussing ECMO with us. She had quite a
team of people assembled to take care of her. Her doctors and nurses have been fantast-
ic here! They are taking such good care of her, and we are always reassured that she's in
good hands. Finally at 10:00 pm, the decision was made to place her on ECMO. In the
hour before they made the decision to do ECMO, she was trying so hard to fight. She
raised her sats up to 77% very slowly, with her Daddy cheering her on. This wasn't the
scenario we were hoping for, but it was clear that she was getting tired and really strug-
gling. Being on ECMO will give her a chance to rest a little and regain her strength so
she'll be stronger for surgery.
They started her ECMO procedure to place the cannulas around 10:30 pm and finished
around midnight. Then they slowly changed all of her settings over to accomodate her
being on ECMO. They took her off the high frequency oscillator vent and placed her on a
conventional vent. They will not need to oxygenate her with the vent as much since she
will be oxygenated by the ECMO circuit. This will allow her lungs and heart to rest.
20
We finally got back in to see her around 1:00 am. She tolerated the procedure very well
and immediately brought her O2 sats and blood gases back up to a normal range. She is
so strong!!
Today was a much more stable and restful day for everyone. We can see that she is rest-
ing easier and not struggling as much, so that's good. She also doesn't have to be quite
as sedated now, so once in a while she'll move her toes and feet and move her little
hands. She is pretty swollen from all the fluids and blood products she has gotten so she
can't open her eyes because her eyelids are swollen. Since the ECMO circuit keeps her
stable, she isn't stressed as much by lights or noise or being touched, so we have been
able to touch her a little bit today and talk to her. She even got her first bath early this
morning! Her hair is strawberry blond and it's wild!!
I'm sure we'll sleep better tonight too, and we may even go home a little tomorrow if we
can tear ourselves away from our sweet baby!
Sofia did well last night, she has remained stable, so we are thankful for that. We are
waiting for the team to make rounds this morning and see what the plan is for today.
Hopefully we are in for an uneventful weekend, so Sofie can rest a little. They may start
to wean her off the ECMO machine early next week if she continues to do well. We're
hoping she'll come off strong and ready for surgery. I'm hoping to post some more pic-
tures later today. She was the littlest KU fan last night with her KU bear next to her dur-
ing the game! Sofie says, "GO HAWKS!!!!"
Sofia's Mommy
Posted by Kenny and Jennifer Miller at 10:31AM (-05:00)
130-134
The 5 Day Plan
The team finished making rounds around noon. Overall they are very pleased with how
Sofia is doing. The plan is to continue to rest her on ECMO for a few more days and then
possibly try to start weaning her off ECMO Tuesday or Wednesday of next week. If she is
able to wean off ECMO, they would probably do her repair surgery 2-3 says later. If she
isn't able to wean off, they'll wait 2-3 days and try to wean her off again. They will usually
try to wean off 2-3 times before they would consider doing the surgery on ECMO.
However, they are very optimistic that she'll be able to come off before her surgery, since
she did pretty well for so many days before going on. They said she never had any really
bad episodes and her PPHN never got really bad. Her pressures only got up to mid 50's
at their worst and they say 65 is pretty bad and 45 would have been really really good.
On Tuesday or Wednesday of this week, they put a catheter in because she hadn't had a 21
wet diaper for almost 8 hours. Once they put it in, she emptied tons of urine, so it was just
the morphine she's on that was making her retain urine. They took her catheter out yes-
terday to see if she would go again on her own. The last couple of days her urine output
has decreased a little, but is still adequate. They think the reason for this is she might
have too much sodium in her TPN, so they are reducing that to see if she'll have more
wet diapers to get rid of some of her fluid. This may help some with her swelling. They
also check often to see how thin her blood is, since she has to be on a lot of heparin with
the ECMO machine to keep the blood from clotting while it's running through the circuit
and back to her. Her levels were all good last night and she didn't need any blood
products at all last night.
This morning while we were waiting for the team to make rounds, her nurse helped us get
footprints and handprints for her baby book. See how cute!!!
22
Posted by Kenny and Jennifer Miller at 12:01PM (-
05:00)
The nurses also say they really think the Narcan drip
(from the study she is pioneering) is really helping
her. Her morphine and versed dosages have not
needed to be increased since she arrived. Her dosages are 40 of morphine and 30 of
23
versed. Some babies that are on narcot-
ics for a very long time get up to dosages
of 300 of morphine and 200 of versed. So
she is on a very low level and still scoring
0-1 on her pain levels. She is a little more
active and sometimes wakes up, but she
doesn't seem to be in any pain and she
tolerates the increased activity very well
with no change in vital signs. They are
hopeful when she finally comes off of the
narcotics, her withdrawal symptoms may
not be as severe since she had the Narcan drip. We hope so too!!
Her sodium levels decreased after they changed her TPN yesterday and she started hav-
ing lots more wet diapers, which is great. She is a lot less swollen today and her urine
output is very good.
Yesterday was the first time she woke up and opened her eyes since right after she was
born. I'm so glad we were there at her side to see it! We took a few pictures too (for a
child that sure doesn't do much, we have 500 pictures of her already). She also was
sporting her CDH Awareness Bow yesterday, courtesy of Grandma Linda.
My first hairdo
24
Posted by Kenny and Jennifer Miller at
11:59PM (-05:00)
Sofia had another good night last night. She got another blood transfusion and another
platelet transfusion and had to have a small amount of pain medication so she could rest
a little better. Her oxygen challenge test this morning was great! Her level was in the mid
200's today, up from 151 yesterday so that's really good. Yeah Sofie!!!
She got to have a few visitors over the weekend, while she is a little more stable. We'd
love for more people to be able to come see her, but she is still too critical for much activ-
ity and her risk for infection will continue to be an issue for many months to a year. The
risk for infection is why we won't be able to take her out in public places or to daycare for
a very long time, and she can't be exposed to other children during that time either. But
Sofie thanks you all for your wonderful prayers and good wishes!!!! Please continue to
pray for Sofie to rest and regain her strength to fight her next fight. They plan to try to
wean her off ECMO early this week and that will be a very critical time for her. After that,
the next major hurdle will be her repair surgery, possibly at the end of this week or begin-
ning of next week. She is such a strong baby, and your prayers have helped to carry her
through some very rough times!
Sofia's Mommy
Posted by Kenny and Jennifer Miller at 12:33PM (-05:00)
141-145
Happy St. Patrick's Day!!
Wearin' My Green!
25
146
THANK YOU!!!!!!!
While we have a chance, Jennifer, myself and especially Sofie would like to thank every-
body who has gone out of their way to help us get through this difficult time. We have re-
ceived so many cards and gifts, many of which come from people who we have never
met, that we have just been blown away. It is truly amazing how kind people can be and
words cannot express just how grateful we are. Just knowing that there are so many
people out there pulling for our little girl is so comforting and gives us even more hope
that we are going to make it through this.
To our parents who have kept watch in the sometimes crazy waiting room and to Kristi for
all the things you have done to keep Jennifer sane, we appreciate it.
I would also like to thank everyone at my job for everything they have done to help me
out personally. I knew before this that I worked at a pretty great place, but this has really
solidified it. The gifts you have given and all that you are doing to try and raise aware-
ness have been amazing. But to have people giving up their personal vacation time to me
so that I will be able to spend more time focusing on Sofie may be may be the best gift I
could have received. I know you are probably expecting me to say this, but you have
done too much. If you are trying to make a lifer out of me you may have sealed the deal.
To our friends Amandrew, we will never be able to repay you for all that you have done.
I wish I could mention everyone by name but I don't want to leave anyone out. Just know
that we are keeping a list and when she is up to it Sofie will be hand delivering thank you
notes.
Sofie's Dad
Posted by Kenny and Jennifer Miller at 06:28PM (-05:00)
147-151
Sofia's Big Week
This will be a big week for Sofia. The team made rounds late in the afternoon today. They
say she is doing very well on ECMO and they are confident she'll be able to wean off for
surgery. There are risks and benefits for doing the surgery on ECMO and off ECMO, but
the least risky seems to be to do it off ECMO as long as she is stable enough to handle it.
Once they take her off, they cannot put her back on, so she'll be on her own from that
26
point. ECMO is a one-time thing for the most part. So the risk with taking her off is that if
she becomes unstable again after the surgery, they can't put her back on again. There is
a chance that if that were to happen, they could attempt VV ECMO, which is a little differ-
ent and not quite as beneficial as it doesn't allow the heart to rest. She is currently on the
most common type of ECMO, which is VA ECMO. VA means it involves both an artery
and a vein. VV ECMO only involves the vein. But that is a last resort, and they don't think
she'll need it. If they did the surgery on ECMO, she'd have the "safety net" of it still being
there for her afterward. However, the risks of bleeding would be enormous and outweigh
that "safety net" benefit.
The main factor in how she will tolerate coming off ECMO is her lung function. If her
PPHN is resolving, there is little risk that she would rebound to the point she was at be-
fore going on ECMO. They will do an echocardiogram in the morning to check her pro-
gress on this.
If all looks well in the morning, the plan is to start weaning her off ECMO sometime to-
morrow afternoon. They'll do this over a period of 12 hours or so and then trial her off the
ECMO circuit by clamping the tubes for around 2 hours to see how she would tolerate be-
ing completely off. If that all goes well, they will remove the ECMO tubes (cannulas) on
Wednesday. If she remains stable, her repair surgery could be done on Thursday or Fri-
day of this week.
The doctors say she may be very critical coming off ECMO and then again for the first
24-48 hours after surgery. After that point, everything will hopefully be much smoother for
her and she'll be on the road to recovery!!! She has been amazingly strong all along, so
we have faith that she'll do really well with all of this. She needs lots of prayers this week
to get her through the rough patches that await!
Kenny and I finally went home for the first time on Saturday night since Sofia was born. It
was so hard to leave her here!! But we knew these last few days would be her most
stable for a while, so we needed to rest while we could. Tonight will be our last night at
home for a while and then we'll be living at the hospital for a few days again. It's so nice
that there are sleep rooms and a shower for us downstairs in the Ronald McDonald Fam-
ily Room. We stayed there all last week and it was great knowing she was just a few
steps away and we could visit her during the night. Everyone has been so great here to
help us with anything we need. We are also really happy that Dr. H will be on all night to-
morrow night, during Sofia's weaning process to watch over her. She has been taking
care of Sofia since her arrival here at Children's and she is fantastic!! Sofia is receiving
excellent care here from all of her doctors, nurses, and RT's. Thank you to all of them!
Sofia's Mommy
Posted by Kenny and Jennifer Miller at 08:53PM (-05:00)
Sofia had a restful night last night. She is continuing to do well and we are so thankful for
that. She did very well on her oxygen challenge test this morning, with her oxygen level
27
reaching 314, up from 246 yesterday. Yeah for Super Sofie!! We are still waiting for her to
have her echocardiogram sometime this morning. That will give us a better idea as to
how her PPHN is resolving. She only needed 1 unit of platelets last night and no blood,
but it's been about 24 hours since her last transfusion, so she'll probably need some
blood sometime this morning or this afternoon. She looks great, so pink and so cute!!! I'll
update again after the doctors make rounds and let everyone know when she may start-
ing weaning off ECMO today. Go Sofie!!!!!
Sofia's Mommy
Posted by Kenny and Jennifer Miller at 10:49AM (-05:00)
155-158
Weaning Off ECMO Tonight!!
Even though we hit a small snag this afternoon, the plan is still to try to wean Sofia off
ECMO tonight. This afternoon she had an echocardiogram to see how her PPHN is do-
ing. We expected it to be better than it was before ECMO, showing signs that it was be-
ginning to resolve a little bit. Her last echo pressure before ECMO was 55, and today it
was 78, so quite a bit higher. That was discouraging, but the plan is still to attempt to
wean her off. Some CDH babies continue to have PPHN for weeks or months, even after
their repair surgery. Some even go home with pressures around 60 and take medication
for a while, so we'll forge ahead and hope she shows us her tremendous strength again
in the coming days.
The plan is to begin weaning her ECMO settings at 9:00 pm tonight. The process will
take several hours. They hope to be down on a very low flow of ECMO by 6:00 tomorrow
morning and then leave her on that setting for a couple of hours to see how well she tol-
erates it. If she does okay with that, they will clamp her ECMO cannulas for 3-4 hours.
This is called "trialing off ECMO", and it's a preview of how she'll do when she is taken
completely off ECMO. If she does well with the trial, they are scheduled to remove the
ECMO cannulas sometime between 12:00 and 2:00 pm tomorrow. From that point, they
want to give her 36 hours to stabilize herself before proceeding with the repair surgery. If
all goes well, her surgery will be around noon on Friday. So that is the plan as of now.
These next few days may be pretty rough for Sofia, so please pray extra hard for her !!
If she doesn't tolerate the wean tonight, they will turn her ECMO settings back up and let
her rest a couple more days before trying to wean again. There is also a good possibility
that because of her PPHN, she may need to go back on the high frequency ventilator to-
night and receive INO therapy (inhaled nitric oxide to dilate the blood vessels in the
lungs) again to help with better oxygen exchange. Dr. H is also starting her on a new
blood pressure medication tonight called milrinone to help with the PPHN. Dr. H is a great
doctor and she'll here will Sofia all night tonight during the weaning process. We are so
thankful for that!!
Kenny and I are staying here at the hospital again tonight and probably for the next sev-
eral nights, until Sofie gets through this part of her recovery. We tried to power nap this
afternoon for the all-nighter tonight. I'm sure we'll have no problem staying awake!
Sofia's Mommy
Posted by Kenny and Jennifer Miller at 08:42PM (-05:00)
28
159-162
A Long Night
We are underway with the weaning. She got off to a bit of a rocky start. Before they even
started the weaning process, her night nurses were assessing her and noticed a leak
around her chest tube sight and she had been laying in about 22cc of serous drainage
from it. They cleaned her up and repositioned her towards her right side, which she's
really never been on. Her pressures went down pretty quickly from 70 to 45 and her sats
dropped to about 88% for a while. After about 30 minutes, they moved her more to her
back and turned up her vent settings a little. Her sats are low 90's and her pressure is 45-
50. They are turning her ECMO flow down every hour and drawing ABG's every 2 hours
on the evens, so the next one will be at 2:00 am. We are in for a long night I think. I'm
working on photo slideshows to try to keep from looking at the monitor every 2 seconds.
It's not working!!
In trying to keep myself distracted, I put together a slideshow of the day Sofia was born. I
also wanted to thank everyone at OPR for the wonderful care that Sofia and I received
while we were there. Thank you to Dr. E for a great delivery, to Dr. H and the rest of the
NICU team for getting our sweet little girl off to a good start, and to Julia and Melissa for
taking extra special care of me. All things considered, we had a wonderful experience,
and I couldn't have asked for an easier delivery.
As you all know, we didn't find out whether Sofia was a boy or girl while I was pregnant.
We wanted to be surprised at her delivery, so through all the ultrasounds and the amnio-
centesis, we made it to our induction date without finding out her gender. Early in the day,
some of the NICU nurses came in to set up a few things for delivery. They had been told
the baby's gender and had prepared some gender specific things for the baby in the
NICU, but they had also been told that we didn't know and not to tell us. When they came
in to set up, one of the nurses accidentally looked over and said to us, "so, you're having
a boy?!" We thought the surprise had been ruined. We called our family in and told them
all, "it's a boy!" We also told them his name would be Liam, and wrote Happy Birthday
Liam on the board in the room. You can imagine our surprise when Liam came out - a
girl!! Turns out we were even more surprised to meet Sofia! The nurse felt so bad for
spilling the beans, but it turned out she was mistaken and it made for a good story that
we'll laugh about for a long time!
It was a long night, but our tough little girl made it through with no problem. I think she
was much more comfortable than her parents. The doctors just got finished rounding on
her and are very pleased with how she responded to the weaning last night. Her blood
pressures and oxygen levels are great and she is doing it without any meds for help and
her vent is only at 50%. Her lung is expanded nicely and she isn't showing any signs of
the earlier air leak. Dr. H said if there is such a thing as a perfect ECMO run she did it.
So the plan is to clamp her off the ECMO in a little while and see how she responds to 29
doing all the work on her own for a couple hours. If that goes well she will have the sur-
gery to remove the canulas from her neck with the thought being to do her repair surgery
on Friday.
The doctors say that since she has done so well without much additional help that we still
have a lot of tools in the bag if she should need it. But let's just pray we don't need them.
These next few days will be a little rocky, but when we know more Jennifer or myself will
try to update.
Sofia's Dad
169-176
Not Quite Ready
Well we tried and little Sofia just wasn't quite ready to come off the
ECMO today. Everything was going pretty good, but she just wasn't able
to keep her CO2 levels down in a good range once they clamped her off.
The doctors said there were drugs they could have tried to help her
out, but they felt that since we were getting close to our time limit
for being clamped off that it was best to just turn it back on and
give her a few more days to rest.
They replaced her breathing tube with a larger one to help with her
with her air leak during the time they were trying to clamp her off.
So while she doesn't sound like a duck anymore Dr. H thought
this might have been a little more than she could handle during that
time and she just didn't have enough time to recover before they had
to make the decision.
Sofie's Dad
30 Sofia had to move out of her big OR suite and back to her old spot in the ECMO room
this afternoon. She doesn't tolerate
moves very well and her sats are down a
bit after the move, but overall she is hold-
ing steady. The plan will be to move her
back to the OR suite sometime on Sat-
urday. They will attempt to wean her off
ECMO again Saturday night into Sunday
morning, with possible cannula removal
Sunday and then repair surgery Monday
or Tuesday. She is still on the convention-
al vent without nitric oxide, so that leaves
somewhere to go if she needs it at a later time. She also never needed to go back on any
blood pressure medications, since she initially went on ECMO, so she'll have those to
add on if she needs them too. We are still very hopeful she'll be able to come off ECMO
for her surgery.
31
Friday, March 21, 2008
180
Day 8 of ECMO - Not a Fan of Thursdays
Well, little Sofia just doesn't seem to like Thursdays very much. Last Thursday was when
she had to go on ECMO, and last night she had a pretty rough night again. Her oxygen
levels weren't as good, and she was having problems getting rid of her CO2. Her sats
were all over from 77%-97%, and they had to increase her flow on ECMO to 390 where
she had been running 280-290 last week. The increased flow has caused her blood pres-
sure to be a little higher, but not so high that she needs medication yet. They repeated
her echocardiogram this morning to see if her PPHN is getting worse again, which could
be the cause of her problems.
This morning she only got 88 on her oxygen challenge test after performing like a rock-
star yesterday and getting 383. Her chest xray this morning showed some more fluid col-
lection in that right lung again, so they have adjusted her vent settings to try to help that.
She also mistakenly received more IV fluids last night than she was supposed to. Her
TPN ran in too quickly, so she is a bit more swollen today and getting some lasix to help
her get rid of that extra fluid. Thankfully her blood sugar and electrolyte levels weren't af-
fected by this. She really seems to have handled it pretty well.
Despite all that she is doing better today. Her O2 sats have been 96%-100% today and
she has been awake looking around for us, stretching her legs, and looking pretty con-
tent to be awake snuggling her Sugarbear even though we tell her to go to sleep and
rest. She is stubborn!! Wonder where she gets that from? We got some cute video today
of her looking around at us that I'm sure is only amusing to us, but I will post it to the blog
for everyone's enjoyment just in case. She is such a cutie!!! I can't wait to be able to hold
her!
Sofia's Mommy
Posted by Kenny and Jennifer Miller at 02:36PM (-05:00)
181-194
Setbacks
We are on the CDH roller coaster, that's for sure. Sofia's echo came back this afternoon
showing her pulmonary hypertension ( PPHN) is getting worse again. Her pressures are
now the highest they have been at 89-90, so that is really discouraging. They are starting
her on Milrinone, a drug to help lower her blood pressure. They are continuing to in-
crease her vent settings just a little bit to help that right lung expand a little better. She got
a second dose of Lasix this afternoon to help her get rid of more of her fluid to see if that
helps as well. She's also been very alert and awake most of the day today, so they are in-
creasing her sedation for the first time since she got here. Her Morphine and Versed
have been at 40 and 30 and are going up to 50 and 40 now. She doesn't seem to be in
any pain, but the increased sedation will help her rest a little better, and the Morphine will
also help to lower her blood pressure a little bit.
The plans for weaning off ECMO have changed again, as you might imagine. Every time
we make a plan, little Miss Sofia decides to change it for us! The plan was to try to wean
again tomorrow night and into Sunday morning, possibly removing her cannulas on
32 Sunday and surgery on Monday or Tuesday. Now we will let her rest over the weekend.
They'll reevaluate her on Sunday and possibly try to wean again Sunday or Monday if
she is stable enough. If not, or if the wean isn't successful, we'll discuss going ahead with
the repair surgery on ECMO.
Repairing on ECMO has many risks, but mainly bleeding is the biggest risk. Her blood
has to be so thinned while on ECMO to prevent clots from forming that she's at a very
high risk for hemorrhage during surgery, particularly for bleeding in the brain as well. Both
of these risks are very scary, but if she's not stable enough to come off ECMO that will be
our only option.
Please continue to pray that her PPHN resolves, so she can truly be stable enough to
come off and stay off ECMO!!
Sofie's Mommy
Posted by Kenny and Jennifer Miller at 06:17PM (-05:00)
Day 9 of ECMO has been a little better. Sofia is responding really well to the Milrinone for
her blood pressure. Her blood pressure came down last night shortly after they started
the medication from 70-75 to 58 and today it's been upper 40's-mid 50's all day. Much
better Sofie! She is keeping her O2 sats around 97%-100% too. Her oxygen challenge
test was a lot better this morning. Yesterday she only got 88 and today she got 297!!
Yeah, overachiever! Her ABG's are also stable and looking good today with great CO2
levels in the 40's. Her chest xray was also better today, showing less fluid on that right
lung and better expansion. Her urine output after the 2 doses of Lasix was very good, so
she's back on track fluid-wise. She slept more last night and today with the increased
dosages of Morphine and Versed. No new plans as of now. They are just letting her rest
and hoping her PPHN resolves some before attempting to wean off ECMO again.
And as promised, here is Sofie's first movie! This was from yesterday when she was so
alert and awake. She's so cute!
203-205
Photos From Sofia's 1st Week
206-208
Day 10 of ECMO
Sofia is holding steady and had a pretty good night. Her oxygen challenge test was 276
this morning, and everything else has been stable. They are going to try to wean the flow
down on the ECMO circuit from 450 to about 300 over the rest of today and tonight and
let her sit at 300 all day tomorrow to see how she tolerates it. Depending on how she
does with that, they will talk about possibly weaning again on Tuesday. If she doesn't tol-
erate it, they will talk about going ahead with the repair surgery on ECMO. One way or
another, she will most likely have her repair surgery sometime this week. We're still hop-
ing she can come off ECMO before surgery, but if not we're ready to get the surgery be-
hind us and try to move forward.
She has been sleeping well since we got here this morning, so she doesn't have her
"Easter outfit" on yet. Never fear, there will be pictures later today!!
Sofia's Mommy
Posted by Kenny and Jennifer Miller at 12:11PM (-05:00)
209-213
Happy Easter!
Just a reminder that tomorrow is the CDH Awareness Blood Drive at Menorah Medical
Center in honor of Sofia Rose! Menorah Medical Center is located at 5721 W. 119th St.
in Overland Park, which is at the corner of 119th and Nall. (See map below) The blood
drive is in Conference Room 1 off the main lobby at "A" Entrance from 11:00am-3:00pm.
You can make an appointment to donate here. Click on "Find a Drive", then enter spon-
sor code menorahmedctr. There are still appointment times available between 1:15 and
2:45. I know many of you have expressed interest in donating, but are unable to make it
to the blood drive tomorrow. If you want to donate and can't make it, you may contact the
Community Blood Center by calling 1.888.647.4040. For those that already donated at
another location in Sofia's name, thank you for saving a life!! Little Sofia is getting 2-3
platelet transfusions per day, in addition to blood transfusions, that save her life. Your
donation makes a difference!!
I also want to thank my friends, Julia & Melissa, for helping to prepare so much for the
blood drive, for coordinating with Menorah for me, and for being there tomorrow. You
guys are such a huge help, there's no way I could have done this without you!!
Rock Chalk!
220-224
Sofia Passed Her Clamp Test!
Well the original plan today was to challenge Sofie by weaning her to a low setting and let
her sit there overnight. And then depending on how she did, wean her completely tomor-
row. Once they weaned her down completely tomorrow, they would attempt to clamp her
off ECMO for a couple hours to see how she does without it and then take out her cannu-
las and be completely off if she does ok clamped.
The plan changed a little this afternoon. She did so well with her challenge today, that
they decided around 4:45 this afternoon to go ahead and try the clamp test. She did ok
clamped for 2 hours, so they've decided that she will be stable enough to come off ECMO
for her surgery! Her decannulation surgery is set for tomorrow. We are still unsure of the
exact time, but she will be officially off ECMO sometime tomorrow. After the clamp test
this afternoon, they unclamped her and turned her flow back up to maintain her through
the night. They don't want to do the decannulation surgery during the night, so they will
hold tight and wait until tomorrow when the full crew is here. This is really exciting, but at
the same time very scary. We just hope she is truly stable enough to withstand
everything off ECMO, because there's no going back once it's gone. On the other hand,
surgery is much less risky off ECMO, so it's good that it looks like we're proceeding in
that direction. They also repeated her echo this morning and her PPHN is better. Her
pressure was 49, much better than the last echo on Friday which was 89-90!
35
If all continues to go as planned, her repair surgery will be sometime around noon on
Wednesday. So hopefully Sofia will cooperate and stick to the plan this time!! It's going to
be rocky for the next few days, so Sofia really needs some extra prayers to get through it.
Please pray that Sofie continues to be stable off ECMO, through her surgery, and in the
days afterward.
We just talked to one of Sofia's surgeons (Dr. Pablo), and her decannulation surgery is
set for between 3:00 and 4:00 this afternoon. We'll be glad to see the cannulas and the
ECMO machine gone, but at the same time it's so scary. We hope she can do it on her
own! Please pray hard for her today that she'll have the strength to fight even harder and
get those lungs functioning better!
Sofie's Mommy
Posted by Kenny and Jennifer Miller at 09:10AM (-05:00)
232-235
So far so Good!!
We haven't got to go back and see her yet, but the Doctors just came and told us that
she is off the ECMO and is doing good. If she continues to be a little superstar through
the night they will most likely do her repair tomorrow afternoon. Thanks for all the pray-
ers and good vibes. I think she is hearing them. We will update later when we know
more.
Sofie's Dad
236-245
Sofie Continues to Rock
Sofia is continuing to do really well off ECMO! She didn't need to go back to the high fre-
quency ventilator. She's still on her conventional vent with a little nitric oxide. They restar-
ted the nitric today at noon at half of what she'd been on before ECMO just to optimize
her lung function. Her vent settings have weaned way down in the last hour and her
ABG's have been really good. Her B/P is holding steady in the low 40's with O2 sats 97-
99%. What a rockstar!! As of now, her repair surgery is scheduled for tomorrow, possibly
sometime around 2:00 or 3:00. We will know more tomorrow morning. Here are some
pictures of before and after ECMO decannulation.
36
Wednesday, March 26, 2008
246-251
Knock on wood
Sofie and I have had a pretty boring first night off ECMO. She has been keeping her sats
in the upper 90's and her BP in the mid to upper 40's. She just got her latest blood gases
and her CO2 level was 49, which means her lungs are doing a pretty good job keeping
up. Her only real issue tonight has been that her heart rate and temperature are running
a little high. But we have been told that the higher temp is pretty common with babies just
coming off ECMO. And one of Sofie's favorite nurses Sara, who is taking care of her to-
night, thinks the higher HR may be linked to the high temp. So she has been getting
doses of Morphine to relax her and keep her HR down and it seems to be working.
I think she is trying to tell everyone she is ready to get all fixed up today. So let's just
hope she continues to behave and the Doctors agree. When we hear a more definite time
for surgery we will let everyone know.
Sofie's Dad
252-266
Surgery Not Happening Today
Sofia gave us a bit of a scare this afternoon while we have been waiting to hear from the
surgeons. Around 1:00pm she started to get more acidotic, and her CO2 started rising
again. This has been the trend when she has taken bad turns in the past, so we were
very scared since she's off EMCO now. She continued to oxygenate well, but was just
having problems blowing off her CO2 again. She has a fairly large air leak around her ET
tube still, and they think that's what was causing this change. So they switched her back
to the high frequency vent at 100% oxygen, and her numbers improved very quickly.
They gave her more sedation and increased her morphine and versed drips to 70 and 60.
Her blood pressure was creeping back up to the high 50's with the dopamine at 10, so
they dropped down to 9 on it.
37
She seems to be doing much better now, but we are very nervous we will miss her very
narrow window of stability for her repair surgery. The most upsetting news this afternoon
is that the surgeons will not have time to do her surgery today. We feel such a sense of
urgency to get it done while she's doing ok, so this has been really upsetting. As of now,
her surgery is scheduled for around noon tomorrow. Please pray that Sofia continues to
hold steady throughout the rest of today and tonight while she is waiting for her surgery to
be done tomorrow.
Sofia's Mommy
Posted by Kenny and Jennifer Miller at 02:56PM (-05:00)
267
CDH Blood Drive Success!
Thank you to all who donated at the CDH Awareness Blood Drive yesterday at Menorah,
including Grandma Cheryl. They were expecting 20 units and ended up getting 31 units
of blood! Way to go everyone! I also know of a few others who had donated recently and
were just a few days shy of being able to donate again, so they are planning to donate
next week in Sofia's honor. Several others were unable to make it to Menorah to donate,
so they donated at other sites, so thank you to you as well! Every unit donated makes a
big difference!
The first annual CDH Awareness Day is Monday, March 31st. Be sure to wear your tur-
quoise in support of all CDH babies, including little Sofia! If you're looking for official CDH
Awareness Day gear, click here. If you would like to order CDH silicone bracelets, you
can find them here. Or click on the pictures below. Also, if you wear turquoise on
Monday, send me your photo at jtmku@yahoo.com and I'll put you on the blog next
week!
Thank you so much to everyone for your support and prayers, it really lifts us up during
these rough times. We are so lucky to have such a strong support system. Sofia even got
an email from her friend, Garrett, who can't wait to meet her when she's all better. Gar-
rett is my friend Melissa's sweet little boy, and he had his Mommy write a special email
from him to Sofie. Here it is...
278-281
Surgery Update #1
We have kissed her goodbye and told here to behave for the surgeons before they kicked
us out. They should be starting anytime now. Dr. H is going to stay with her through the
surgery so she can come and give us updates. So when we get some news we will try
and let everyone know.
Sofie's Dad
282-285
Surgery Update #2
Dr. H just came in and told us Sofia is doing really well. The surgery actually started right
around 1:30pm, so they are about 45 minutes into it. Her O2 sats have been 95-100%
during surgery. Dr. H said all of her intestines have been moved down into her abdomen,
and the surgeons have said that her defect appears to be pretty large. That's all we know
for now. They will come and talk with us in more detail when the surgery is finished, but I
wanted to let everyone know that Sofia is doing well.
Sofia's Mommy
Posted by Kenny and Jennifer Miller at 02:15PM (-05:00)
286-294
Surgery Update #3
We just got another good update from Dr. H. Sofie is continuing to do really well during
surgery. They are just about 2 hours and 15 minutes into it. Her patch is in, and they are
just making sure it's all secure. They also took out her appendix while they were in there
just to avoid having to possibly take it out later if there were other complications. They
turned up her oxygen at the beginning of her surgery to 100% to provide extra support
with all the stress of surgery. But her O2 sats have been 100%, so they started weaning
down her oxygen on the ventilator. It's now at about 60%, which is really good. That
leaves somewhere for her to go afterward when things get a little rocky. Things are going
really well so far, and they are getting closer to being done. Hopefully the next update we
get will be that they are finished, and we can see her soon!
39
Sofia's Mommy
Posted by Kenny and Jennifer Miller at 03:19PM (-05:00)
295-318
Surgery Went Great!!
Sofia's repair surgery went as well as the doctors could have hoped. We got in to see her
just a few minutes after they finished. They finished around 4:45 pm, so the surgery las-
ted about 3 hours and 15 minutes. She really did great, and her first blood gas after the
surgery was very good. She just had another gas done that was also very good. She
looks very swollen, and her color is not as pink, but that is very normal after surgery, es-
pecially a surgery as major as the one she had. Her incision is pretty large and looks
pretty painful, but Dr. H and her nurse, Dot, are keeping her sedated and comfortable.
We'll post more details later about the surgery. Just wanted to let everyone know she is
doing well, and came through her surgery with flying colors thanks to the skills of her doc-
tors, nurses, and RTs. And especially because of all your extra prayers. Thank you!!
Sofia's Mommy
Posted by Kenny and Jennifer Miller at 05:15PM (-05:00)
319-323
Surgery Details
At 17 days old, after 12 days of ECMO, and 2 days off ECMO, Sofia had her hernia re-
pair surgery. The surgery lasted about 3 hours and 15 minutes. 90% of the left side of her
diaphragm was missing. She had just a small anterior rim of diaphragm, and her stom-
ach, intestines, spleen, and part of her liver had herniated. Her right lung is a normal size,
and the surgeons did say they could see some lung tissue on the left side, but it will be a
few days before we know how much is there.
She did amazingly well during her surgery and continues to be stable this evening. She
didn't need to receive any blood or blood products during her surgery. She received one
unit of blood after surgery, mostly as a precaution, but her blood loss was minimal con-
sidering how invasive her surgery was. Her abdomen is pretty swollen after surgery and
will likely be much more swollen over the next couple of days. After being removed from
her chest, her herniated organs were placed outside of her body while the surgeons
placed a large patch over the area where her diaphragm was missing. Her organs were
then placed in her abdomen once the surgeons made sure the patch was secured. Be-
cause of how much those organs were handled, particularly her intestines, they will swell
after surgery. This is normal and will resolve in a few days. We are expecting the next 24-
48 hours to be pretty rocky and have a few setbacks, but she should pull through it just
fine and really begin her healing process.
Because her defect was so large, she does have a patch. Her patch is an AlloDerm
patch, which is made from donated human skin tissue. It provides a biological matrix for
her own tissue to grow through. The original patch material eventually dissolves, leaving
her new tissue behind. This type of patch will hopefully lessen the chance for reherni-
ation later. However, reherniation is always a possibility, especially with the size of her
defect.
Before the surgery, her heart and lungs were shifted significantly to the right side of her
40 chest. Now that the herniated organs are in their proper place and there is room in the left
side of her chest, her heart and lungs will slowly shift back into the proper position. The
body doesn't like to have an empty space, so the space where the organs were in the
chest is filled with air and fluid right now. For this reason, they placed a second chest
tube on her left side to help remove a small amount of that air. They don't want to quickly
or completely drain the fluid off that space, because it could cause the heart and lungs to
shift drastically over too far to the left. By leaving that fluid in there, it allows a gradual
shift that is less traumatic, and the fluid will slowly reabsorb into the body on its own.
Her incision is large, about 6 inches in length, and goes about 2/3 of the way across her
abdomen. As her Daddy says, that's one big owie! Her skin is closed with sutures in the
layers beneath the surface of the skin. These are called subcutaneous sutures and will
dissolve. The part of the incision on the surface of the skin is closed with a type of clear
gel called DuoDerm that's kind of like superglue.
We are so glad to have this big hurdle behind us, so Sofia can start to heal and get ready
to come home with us. We still have a long road ahead, but this is one major step we
have finally been able to get past. We pray for her continued strength and healing, that
she is comfortable, and feels her Mommy & Daddy are here with her. It's so hard to see
your little baby laying all by herself on an OR table in a big room with a big incision that
looks so painful, and not be able to pick her up and hold her and make her feel better.
Hopefully it won't be long until she is better, and we can finally hold her. Here are some
pictures from her big day and her battle wound. Just a warning, if you have sensitive
eyes, you may not want to look! Thank you, everyone, for your amazing prayers today.
God has been with Sofia protecting her before she was even born, and she is truly a mir-
acle baby.
Sofia's Mommy
41
Seriously, Sugarbear, a fauxhawk?
42
The Big Owie! (Don't worry, it'll get better)
While it is still early and things could change at any time this is one proud poppa. It is al-
most 12 hours after her insides were on the outside and her numbers look great consid-
ering everything she went through. I stand over her and would trade places in a minute,
but I don't think I would be 1/2 as tough as she is. It's almost like she is telling me "don't
worry dad, I got this under control." We still got a long way to go but I think she will be
able to handle anything in front of her. Keep the good vibes coming her way to get her
smoothly through these tricky hours after surgery.
Sofia's Dad
Posted by Kenny and Jennifer Miller at 03:40AM (-05:00)
334-342
Rock Chalk Sofia!
Sofia is doing great today, even better than expected! Her blood gases have all been
really good throughout the night and today. She is on low settings on the high frequency
ventilator, and she still has her nitric oxide, but she is close to being able to go back to
the conventional vent soon. She is only needing 46% oxygen right now on her vent, and
is keeping her O2 sats between 95-99%. She is keeping her CO2 levels way down today
and seems to be ventilating much better. They have increased her pain medication over
the night and some more today to keep her comfortable. Her morphine is now at 100 and
her versed is at 70. She gets extra doses of morphine, versed, and fentanyl when she
needs them. She is less swollen today than she was yesterday, and her incision is
already starting to look better. She hadn't had a wet diaper in a few hours last night,
which they weren't too surprised about since she was so heavily sedated. So she got her
foley catheter back and her urine output is ok. Overall she is doing fantastic and has
been very stable since her surgery. We couldn't ask for more!
Sofia is just resting and healing and getting ready for the big Jayhawks game tonight.
Rock Chalk!
Sofie's Mommy 43
Make a postcard - it's easy!
Posted by Kenny and Jennifer Miller at 04:03PM (-05:00)
Sofie's Mommy
Before Surgery
After Surgery
359-364
Superstar!
I was so excited about the chest xray earlier, I just realized I forgot to post an update
about last night and today. Last night Sofia's heartrate was a little high, and she seemed
more agitated and in more pain. Last night her little fists were clenched so tight. I could
tell she was in pain. Her nurse was giving her pain meds, but they just weren't quite
enough to catch up with her. Over the night and this morning, her morphine and versed
drips were also increased a few times to help manage her pain better. Her morphine is
now at 140 and her versed is at 110. She seems to be more comfortable and relaxed
today.
44 Her blood gases continued to look good all night until around 5:30 this morning, when her
pH was a little acidotic, and her CO2 had
risen from the 40's to mid 60's. Her
heartrate got up to the 190's, and her
blood pressure was in the 30's. To help
raise her blood pressure, they increased
her dopamine drip to 12. They did a chest
xray and found that she had a large air
leak on the left side, and her chest tube
on that side needed to be repositioned as
well. They air leak had caused her heart
to shift back over to the right, compress-
ing her good lung, which is what caused the change in her blood gases. They inserted a
needle into her chest to withdraw a large amount of air and fluid and then adjusted her
chest tube, and she quickly got better. Her gases all day have continued to be very good
and stable. Because she lost quite a bit of fluid from her chest last night, they needed to
replace that volume, so she is getting a unit of blood right now.
Her temperature was a little unstable overnight and today, and she had some green
drainage on the dressing around her chest tube site on the right side. They changed the
dressing, and her skin wasn't reddened at all around the area. The site itself didn't really
seem to have any green drainage, so that was good. As the day went on, her heartrate
remained elevated in the 180's, and her blood pressure was running a little lower in the
upper 30's - lower 40's. Her white count was also elevating, so they sent some cultures to
see if she might have an infection. It will be 24 hours before the culture results are back
to know for sure, but they went ahead and started her on some antibiotics - gentamicin
and vancomycin. They will repeat her labs in the morning, and hopefully she will start get-
ting better after about 24 hours. Sofia's Mommy
Posted by Kenny and Jennifer Miller at 09:24PM (-05:00)
Sofia had a better night last night. Today she has been stable. Her blood pressure is still
a little on the low side, and her pulse is still high, but her blood gases have all been very
good. She's still on the high frequency vent with her oxygen setting at 65%. They reposi-
tioned her chest tube on the left side around noon to try to get some more of the air and
fluid around that left lung to come out. She just had a chest xray at 4:00 pm, and it
showed a little bit of an improvement in getting that left lung reexpanded after that big air
leak yesterday morning.
She seems very comfortable today and looks like she has good pain control. They seem
to have found a good level for now with her morphine and versed drips, so they haven't
changed them from yesterday. Her morphine is still at 140, and her versed is still at 110.
She hasn't needed as many extra doses of pain medicine today.
Her incision is a lot less red, and her white count has gone down since yesterday with the
antibiotics on board. She has a low grade temperature again this afternoon. It's still early,
but her cultures so far have shown no growth of bacteria, so that's good news. We won't
know for sure on those for another day probably.
45
Her chest and head are still very swollen. They are replacing the fluid volume that drains
out of her chest tubes. She gets 1/2 cc of albumin (albumin is a large protein found in the
blood) for every 1 cc of fluid that drains from her chest tubes. She's also getting 2-3 addi-
tional boluses of albumin per day to help draw some of the fluid that's causing her swell-
ing back into her vascular system, so she can pee it off. This should help not only her
swelling, but also her blood pressure and heartrate.
Yesterday afternoon they removed the dressing and drain from her ECMO cannula in-
cision site. The incision is about an inch long on the right side of her neck, and it's already
healing so well! I think you'll barely be able to see where it was once it is all healed. She
already has 5 major battle wounds, so hopefully they will all heal as well as that one.
We actually ventured out of the hospital yesterday afternoon for a couple of hours to try
to find Sofia some furniture, so she has a place to rest her cute little head when we take
her home. We didn't find anything we liked yesterday, so we're still looking, but Daddy did
pick out some little socks to keep her feet warm. And of course I had to make a little
scrapbook of her first socks :-) . . .
366-367
Turning The Corner
Sofia is continuing to improve this afternoon and tonight. We all haven't decided what did
it for sure. Dr. J repositioned her chest tube around noon today. Then around 4:00 pm or
so, her nurse Sunny turned her to her back and within a half hour, 16cc of fluid had
drained from that left chest tube. Then Dr. H came by for a visit, and Sofie must have
thought she better shape up for Dr. H. But I really think Sofie just finally breathed a sigh
of relief when Davidson missed their final shot at the buzzer! Whatever it was, she defin-
itely turned a corner this afternoon and has improved a lot.
They were able to wean her oxygen setting on her vent down to 34% late this afternoon.
Her blood pressure has improved and is back up to 45-50, right where they want it to be.
Her heartrate has come down from the 170's where it's been the last couple of days to
the 150's. And her O2 sats are 97-100%. She has been doing so well, Dr. J was finally
able to start weaning her high frequency settings a little tonight. Her MAP (mean airway
pressure) was able to come down to a setting of 14 from 16. This just means she is need-
ing less support from the high frequency ventilator. Her oxygen only had to be increased
to 44% with this change to keep her sats in the upper 90's. If she continues at this rate,
she may be ready for the conventional vent in a day or two! Go Sofie!! She wants to be
off high frequency so she doesn't have to be so sedated for the Final Four next weekend.
Sofia's Mommy
Sofia is doing pretty well today. They weaned her MAP (mean airway pressure) down
again on her vent to 13 and are planning to try her on the conventional vent today! She
has always had a big air leak around her ET tube, even though it's an appropriate size.
They even changed her to a 4.0 when she was on ECMO and it still leaks. So it appears
she has the world's largest airway. This is one reason she likes the high frequency vent
better, because it reduces her air leak, so we'll see how she tolerates the conventional.
She is getting her post-op echo today to see if her PPHN is better so they can hopefully
d/c the milrinone and start weaning the nitric oxide.
Her blood pressures and heartrate are better today now that she's had 24 hours of antibi-
otics, and she is peeing more since her albumin replacements. She'll get a dose of Lasix
today to help her get rid of some more fluid too. Her chest and head are still so swollen!
She had a positive culture (she has an infection) already last night, so I'm sure that had a
lot to do with her low b/p's and high hr's the last couple of days. Turning her yesterday af-
ternoon released a bunch of fluid from that left side of the chest, and she immediately
started doing better with everything, so it's kind of a combination of things that's really
helped her.
At any rate, it looks like she's trying to turn the corner. She's still really sensitive to posi-
tion changes and desats to 70's-80's occasionally when she's on her right side. On her
chest xray this morning, there is more fluid accumulation and less air around the left lung,
so hopefully that air leak is resolving, and now some of of the fluid will start to reabsorb
and that will get better.
She also had an ultrasound of her superior vena cava (SVC - large vein that carries
deoxygenated blood back to the heart from the upper body) this morning to rule out the
possiblity that an obstruction of her SVC could be causing all the swelling in her chest
47
and head. This is a scary condition that could be caused by a number of things. We may
have results back late this evening or tomorrow. I'll post more if anything develops with
that, but we'll hope this isn't the case.
I'm so excited because in rounds today, they started talking about when to do her post-op
MRI. She's never had one because she's been so "hooked up" her whole life, so she
couldn't make the transport down to radiology to go through the machine with all of it.
They want to do it when she is about ready to come off the conventional vent, so they
can sedate her more easily while she is still intubated. Then after they do her MRI, she
might be extubated. Dr. S threw out possible MRI on Thursday today, so that would mean
they think she might possibly be ready to be extubated as early as Thursday or Friday of
this week!!!! We might get to hold her in a few days!! I'm so excited. She's 3 weeks old
today, and she's never been held. It makes me so sad for her. Hopefully she'll continue to
behave and take big strides toward being tube free!!
Sofia's Mommy
Posted by Kenny and Jennifer Miller at 11:16AM (-05:00)
373-377
Celebrating CDH Awareness Day On The Conventional Vent!
Little Sofia decided the best way to celebrate CDH Awareness Day was to switch to a
conventional vent. Yeah Sofia!! She's been on the conventional vent for about an hour
now and is doing well on only 50% oxygen.
Results from her echo at noon came back really good. Her pressure is now at 41 down
from 49 on the last echo, so her pulmonary hypertension is getting better. They will stop
her milrinone today, so that's one less med. They are still weaning down her dopamine.
It's at 8 now and her pressures are stable around 50. Her hr has been in the 140's today,
so much better than 170's!
The swelling in her face is a little better than it was this morning. She could actually get
her eyes open a little. Her poor little ears are still so swollen, they look like they are al-
most swollen shut. The preliminary reports from her SVC ultrasound this morning all look
good too, so that is a big relief. Dr. H thinks now that she is back on the conventional vent
and she can move around more, her swelling will continue to get better. She also got a
dose of Lasix and is peeing up a storm right now, so that will help a lot too.
So now she needs to continue to do well on the conventional vent. Then they can start to
wean her nitric oxide in the next day or so. Hopefully she'll get rid of the dopamine soon,
and that will be another med gone. That would just leave her maintenance fluid, TPN, lip-
ids, vancomicin, gentamycin, morphine, and versed.
She'll continue the antibiotics for a few days to be sure her infection is gone. She did
have one positive blood culture in addition to the positive culture from her right chest tube
site. They are repeating her blood culture today and also sending a trach culture from her
ET tube.
Once she no longer needs her chest tubes (hopefully in the next few days), they can be
removed and we could hold her while she's on the conventional vent. We can't wait!!!
48
By the way, keep the turquoise pictures coming, they are great!! I also got an email from
our friend, Megan, in Lawrence. She took 4 coworkers (all wearing turquoise), and they
all donated blood today in Sofia's honor! Several of Kenny's coworkers have also gone to
the Community Blood Center and donated blood in Sofia's honor as well. Thanks guys for
spreading CDH Awareness and for donating blood - you guys are awesome!!
Sofia's Mommy
Posted by Kenny and Jennifer Miller at 02:36PM (-05:00)
49
Sofia: Comments
Dawn
President, CHERUBS
http://www.cdhsupport.org
You truly are two wonderful people, and while I can't imagine what you
two must be going through, I also can't imagine any baby luckier than to
have the two of you as parents. Thanks for sharing this, and know that
you have the support and love of friends, family and co-workers. Let
Steven and I know if we can help in any way.
Kenny & Jennifer - I've gotten to know you through your site through
Elaine Larson (one of her Deb group friends). You both and baby are on
my prayer list and praying for miracles to happen. Praying for
50
peace,comfort and patience as you are on this journey. God has allowed
you to experience this awesome journey and He is able to do mighty
things.
In Him - Bev H.
Once they arrive - shock and awe - they love to do that to the doctors and
nurses (as you know).
51
We are praying for you! Enjoy your rest, it's a lot harder when they're
outside than it is when they're inside. :)
I think of your family often and have passed your story on to my church.
We are all in united prayer for healing, health and peace for your family.
We will pray that baby Miller stays in and "cooks" so more.
Sorry you are on bed rest. There is certainly nothing to watch on tv.
Maybe you can get caught up on all the DVDs out there. You certainly
won't have any time for that after the baby is born. We think of you both
often and continue to keep you in our prayers...all 3 of you. Take care
Millers
You are in our thoughts!!! Bed rest yuck but is the best thing for you right
now. I was on partial bedrest with Bryden it is boring but I miss the rest
now since things will be so busy after the baby comes but wonderful.
Thanks for the updates this blog is so wonderful, keep us posted and
52
your feet up and head high!! Christal Casey & Bryden Crane
Jen,
The 3 of you are still in my prayers. I know that bed rest can be a bore,
53
but every day that Baby Miller has to get stronger is a blessing. If you
need a different selection of books or videos, please call me or have
Kenny tell Steve and we'll send something over to you.
Lee
I know you are getting close to that due date. Make sure some one give
us a call or email. I will be in New York during your due date, but Roger
will be waiting to hear.
All is going well here, I dislocated my elbow at the end of Jan. and that
has changed my life a bit , but now I am doing physical therapy and
heading the right direction.
Take good care of yourself and know you are in our prayers and in our
thoughts.
Lori
I am so glad you took the time to create this blog. What an insperation
you are. Baby Miller, you and Kenny are in my thoughts and prayers.
Stay in bed! Best of luck in the weeks to come.
Staci
54
23. Re: CDH Awareness Day in Kansas City!
by:Kristi L. February 29, 2008 at 11:00 PM CST
YEA!! I am so glad that you got the official Proclamation from Missouri!
We'll keep hounding Sebilius' office for CDH. We won't settle for less than
3 for 3.
LeAnn Church
56
Wow, only 7 more days! Better start nesting if you haven't already ;-)
My thoughts and prayers are with you and your baby. I will be watching
your blog for updates next week.
Cindy
mom to Claire, LCDH, 6/7/07
Cindy
mom to Claire, 6/7/07 LCDH
Gina
(Wyatt's mom)
You and your Parents should be very proud of yourselves for all you have
accomplished in bringing CDH awareness to Missouri and Kansas. If I
ever need to get something accomplished I will know who to contact. You
guys are just amazing!!!!!!!!!!!!
57
Love Gail
Jenn Miller
Remember that the 3 of you and your medical teams will be prayed for
many times today.
I'm keeping you in my thoughts and prayers today. I can't wait to learn
about he or she! It is an amazing, up and down journey and know that
we are all here to support you through all of it.
Amy
58
Liviana's Mom
Tracy Pierron
(Amanda and Andrew's friend and fellow KU fan!)
59
52. Re: It's a Girl!!
by:anonymous March 10, 2008 at 12:00 AM CDT
Congrats on your precious baby girl. We will continue to pray for you all.
Amandrew
Andrea
Deb Raney
(a friend of Kristy Larson ?'s mom - sorry, Kristy, I don't know your
married name!)
Congrats guys. I am so glad that things are well! I love the name. I look
61
forward to seeing her. I will keep Sofia in my prayers.
Janet and Dale
63
Congratulations,
Bobbie
What a precious baby girl God has blessed you with. She looks just like
her daddy. Jennifer take care of yourself and enjoy your little girl. We will
be praying and thinking of you guys. May God put his healing hand on
Sofia.
Congrats
Rachel Burkholder
What a gorgeous little girl. Her beautiful name fits her. Congrats. Jenn
make sure you are taking care of yourself too. Always in my thoughts and
64
prayers
Andrea
Take care,
Sherrie Thompson
Rebecca
mom to Hannah, LCDH 11-14-06
The two of you are so blessed. Remember to take care of yourself and
each other.
Again congratulations!
Your Cousin, April Kroenke
65
Congratulations on the new baby! She is a beautiful girl. I hope
everything goes well with all that is going on. You're in my thoughts.
Your cousin,
Joel
Sounds like your little Jayhawk is a strong one! Keep the good news
coming!
[You should win some sort of Supder Dad award for typing all of that on
your iPhone!]
66
~ Megan and Family
We look forward to more updates, but please take care of yourselves first.
Way to go Sofe! Kenny, that was a great update. It sounds like things are
going well around there. We'll keep praying for more miracles and further
improvement. And, like the Cottrell's said, you should get a super huge
67
award for doing all of that on your iPhone! Keep taking care of
yourselves! Love, Ryan & Kristi
Ryane
Jenn Miller
Sharon
68
We just found out about the birth of your sweet baby Sofia.
Congratulations!! We have you in our prayers. Hang in there! Wish we
were closer so we could help if needed.
Gina
Wyatt's Mom
Hello!!
As a fellow CDH mommy, hang in there and take care of yourselves as
much a possible (I know easier said than done) but be healthy for when
Sofie needs you. Stay strong Sofia, we will be praying for you.
Hugs,
Ana and Marco Luis
You are welcome to check his carepage: marcoluis
I just did a blog- pena family
70
LCDH 3.2.07 Our happy and Healthy miracle!!
What an absolutely beautiful little girl Sophia is! We are thinking of you
and wish you the very best!
It must be difficult to be where you are, but try to stay strong. Take peace
in know that you have hundreds of people praying for you and your
family.
--Erin
The jump to ECMO always causes our hearts to jump BUT sometimes it
is what these little ones need to recover. (I know you know this! Just
trying to reassure you!)
72
Sophia is beautiful - and has a fan club!
We're happy she's getting some rest by being on the machine. Count this
as another plea for more pictures.
LeAnn Church
Vicki
mom to Jack
It sounds like you guys had a pretty good day today. We'll continue to
pray for you all. My church group meets regularly to pray for little Sophia
and your family. They'll be happy to hear good news tomorrow!
--Erin
What a smile your little girl has, I'm sending all the prayers I can her way.
75
Love Gail
What a precious little girl, I love the picture of her smiling. We are praying
for Sofie hard and my Sunday School Class is also praying. Sounds like
you have a real fighter. Keep it up Sofie
God Bless
Rachel B
Amandrew
76
149. Re: Sofia's Big Week
by:stacitalkington March 18, 2008 at 12:00 AM CDT
Jennifer and Kenny:
What a beautiful little girl Sofia is. She has such a pretty smile that I'm
sure just lights up your face. My thoughts and prayers are with you.
Keep the faith.
Staci
Peace,
Elizabeth
77
155. Re: Weaning Off ECMO Tonight!!
by:Gail k. March 18, 2008 at 12:00 AM CDT
Let's see Super Sofia again, stay strong little one. One day at a time.
Love Gail
I hope that the process of turning down the ECMO went well last night.
Prayers are coming to you from the Pitt. I'm not surprised that Sofie is a
tough little gal. She has a lot of fiesty blood in her.
Go Sofie--You Rock!
Janette M
79
167. Re: Doing Good
by:Megan D. March 19, 2008 at 12:00 AM CDT
She is truly amazing. Good wishes are continually being sent your
way!..and your supporters are growing! I have my entire office on Sofia's
team now! Some of us plan to donate blood on March 31 in her honor.
Keep on fighting little Jayhawk!
~ Megan
My wife and I are friends of the Turleys and just wanted you to know that
we are praying for Sofia.
My wife is also a labor and delivery nurse, and my sister in law is a NICU
nurse.
We are praying that God will continue to make Sofia strong in the
transition off the ECMO, and that he will give the two of comfort and
endurance in the process.
Blessings,
Hang in there guys. She'll let you know when she's ready. You're all in
80
my prayers!
Vicki
mom to Jack
LeAnn Church
82
We are saying many prayers for Sophie and for mommy and daddy.
You're always in our thoughts! Love you- Kristi & Ryan
Jen
Kim Murry
Jen--
We are continuing to pray for Sofia. I can't imagine how difficult it must be
for you and Kenny. You have such a precious little girl. We'll continue to
pray that she becomes stronger and that she will be able to tolerate the
84
surgery and will be on the road to recovery soon!
Best,
Libby Cohen
Mama to Makena, LCDH 9/30/06
www.caringbridge.org/visit/makena
(who had TWO surgeries on ECMO!)
Keep up the good fight Sophie and Mom and Dad try to get some rest
when needed - take care of one another - it is hard.
Andrew
She has a loyal following here in Colorado of people who are praying for
her and checking on her daily!
--Erin
Jen
(If this message comes up as "the Mom said", it because that's how I am
listed on Joel's blog. I don't know how to change it right now...not quite
the computer expert.)
Lori
Happy Easter Sofia! I love your bunny booties, so cute! I can't wait to
87
come visit you. Keep on fighting, you are a tough baby girl.
Erin
I have been thinking of you all - and love the picures and videos! Sophie
88
is a diva! ;-)
LeAnn
That's great news. We will continue to pray for the 3 of you plus you
89
medical team. Thanks for the updates.
Amber
-Amy :)
91
Sabrina's gma.
I'm so sorry that you guys are on this crazy rollercoaster ride. We will pray
that she can go ahead and have her repair surgery tomorrow as
plannned.
93
Andrew
Janette
KELLY HIGH
Melanie
Sabrina's gma
Andrea
--Erin
I've been lurking on your page for quite some time, but needed to post
something since today is such a big day. All of our positive thoughts and
prayers are with you all.
98
As we sit glued to the computer awaiting an update, please know our
hearts and prayers are with you!!
Love,
Jason and Kira
That was smart to go ahead and take out her appendix. Claire's surgeon
told us her appendix is probably not on her right side like everyone else's
since they had to just stuff everything down. I hope she never gets
appendicitis because they might have a hard time finding it!
JM
~Kira
99
Praise the Lord! We will continue to pray that the remainder of the
surgery goes well. Thanks for the updates! Go Sofie!
--Erin
Camilla
Janette
Best wishes.
You are in our thoughts daily. We are so glad to hear that the surgery
went well. We continue to keep you in our prayers. She is such a
beautiful baby :)
101
Tim & Sara Ellis
Janelle M.
Amanda
That is wonderful news! Those must have been the longest moments in
103
your entire life waiting to hear from the doctors. Please know that we will
continue to send prayers each and everyday for all 3 of you and
especially for little Sofie to continue to grow stronger and healthier every
day. I hope you get to hold your sweet baby girl in your arms very soon.
We just wanted to let you know that we are following your blog daily on
little Sofie!!! She's a doll. We will continue to keep Sofie in our prayers
as well as the new Mommy & Daddy!!!
Our energy, strength, love and healing prayers is always going your way!
Much Love,
Christine and Shaylin
Jen--
I didn't really understand all of the details when you first sent me your
blog, but now I have a much better understanding after reading the
surgery details you've written. Thank you for writing in 'layman' terms.
WOW! This kind of surgery is amazing. I think you have many angels
looking out for all of you, both on this side and on the other side.
104
Janette
Excellent news! You were the first thing I thought of this morning, darling
105
Sofie! Rest and heal sweet baby. You too Kenny and Jennifer!
Take care,
LeAnn
Staci
While I can't bring myself to say Rock Chalk too loud (and I may not admit
that I said them later). :)We are praising the Lord that things are going
well and we will continue to pray for Sofie's recovery! Keep it up super
107
Sofie!
--Erin
Janette
--Erin
110
sofia is so amazing!! almost 3 weeks old already!! thanks for all the
updates!! i find myself checking the blog when i wake and before i go to
bed to make sure sweet sofia is doing good!! you are all three
superstars!! and of course go hawks...i am sure sofia will be cheering
them on again today!! take care,
carrie p.
It's so good to hear that her numbers are going it the right direction. We'll
111
be praying that they continue in that direction. I hope you both are
breathing a little easier, too. And congratulations on the win last night!
113
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