REUNITED and it feels so good!

As you might have noticed, I typically try to update the blog on Sunday evenings. Unfortunately, I missed last Sunday's update, mainly because I was pretty tired. However, I am happy to report that the reason for my exhaustion is that Vicki and I have been busy taking care of both Shepherd and Jackson. That's right, both our boys are home. On Friday December 4, a week and two days after his brother was sent home, Vic and I were given the word that Shepherd was ready for pickup.

The last time I spent this many nights awake until 4:30 A.M. I was at a bachelor party in Vegas. In fact taking care of new born babies is not all that different from a trip to Vegas with the boys. During both events you are running on very little sleep, someone is drinking from a bottle at all hours of the night, you often have to carry that person to their bed, and boobs are matter of great importance.

Jackson had a great first week at home. Aside from getting settled in his new room, he made two trips to the pediatrician's office (standard procedure for a premie), saw a home health nurse, and spent many nights up late with his mom and dad (he likes to watch Conan). The pediatrician continues to monitor him closely, but has been very happy with his progress and weight gain while at Casa de Britton.

Not to be outdone, Shep quickly picked up his pace in the NICU and was able to join his brother at home. Over the past few weeks, Shep has been on a medication called Lasix. The medication is a diuretic that is used to eliminate excess water from the body. Less fluid in the body means less fluid for the heart and lungs to process, which ultimately reduces the strain on these organs. The Lasix has helped lowered Shep's breathing rate and allowed him to spend less energy on breathing and more energy on eating. Over the past few days, Shep has been to the pediatrician and cardiologist (again, standard procedure). Both doctors are pleased with Shep's progress and want us remain focused on helping him gain weight in preparation for surgery.

The Britton boys have clearly had a good couple of weeks and this last week marked another amazing first - the boys were able to meet their Grandmothers. I am not sure if I mentioned it, but the NICU visitation policy is extremely strict and only parents are allowed in to visit their children. As a result, no one has been able to see the boys except for Vic, me and the NICU medical team. The past two weeks were more than just a homecoming, they were an introduction to friends and family. In addition to their Grandmother, the boys have been able to meet their Aunt Heather and a number of our friends.

Shepherd and Jackson are looking forward to the holidays and spending more time with family and friends. Words fall short in expressing how happy Vicki and I are to have our boys home. We will keep the updates coming.

Much Love,

-The Brittons

Kodak Slideshow of Shep's Homecoming

Your Baby is Ready for Pickup

As I have mentioned in previous updates, it has been difficult to determine exactly when Shepherd and Jackson would be coming home. Before the boys can leave the NICU, they must be able to maintain their body temperature, pass a multitude of exams (hearing, eye, car seat challenge), and most importantly drink their entire bottle in less than a half an hour / 8 times a day. Only when these benchmarks are consistently met do parents get to bring their children home.

On Wednesday (11/25/09), after almost six weeks, Vicki received a call from one of the neonatologists informing her that Jack was ready to go home. This incredibly important call, which we have been anxiously awaiting, was surprisingly similar to the call you would get from your local dry cleaner or bakery, letting you know that your order was ready for pickup. We knew Jack was getting closer to going home, but we had no idea it was going to be on Thanksgiving.

So on Thursday (11/26/09), Vicki and I headed to the hospital to celebrate Thanksgiving with the boys and then bring Jackson home. Needless to say, Vicki and I have had an amazing and somewhat exhausting Thanksgiving weekend. Jackson is adjusting incredibly well to his new home. He has already called dibs on a crib and is hanging posters on his side of the room.

At the moment, we are still unsure about when Shepherd will make his trip home. We think of ourselves as being on the baby installment plan. It's basically like those sketchy late night infomercials - we will try Jackson at home for a week and if we like him, we will receive another baby just a few days later. The doctors and nurses continue to be impressed with Shep's progress and believe he will not be in the NICU much longer.

Though they are in two different locations, both boys continue to do well (both boys are over five and a half pounds) and get stronger. Jack's homecoming was definitely a great way to kick off the holiday season and to remind us of all we have to be thankful for. I hope everyone had a great Turkey Day! Please know that Vicki, Shep, Jack and I are thankful for the love and support we continue to receive.

-The Brittons

Kodak Slideshow of Jack's Homecoming

Don't Drink and Drive

Shepherd and Jackson are five weeks old. The boys are now the sage elders of the NICU, sharing their wisdom and life experience with the young kids who come into the unit. The Britton Boys continue to improve on a daily basis and at some point during the last week both boys crossed the five pound mark (Jack is 5 lbs 4 oz and Shep is catching up at 5 lbs 1 oz). Shep and Jack's feeding schedules are like a frat boy's during rush week. They grab a bottle, drink until they pass out and then wake up three hours later and do it all over again. And the similarities don't end there, they also occasionally throw-up on themselves.

Jack has been doing so well with his feedings that he was able to take the Car Seat Challenge (CSC). I find it funny that the quicker you can down a bottle, the faster you get to go in a car, but that's for another time. Now, earlier I talked about the onesie challenge, which is a contest that doesn't really exist, but that I made up to help improve my baby dressing skills (I can now dress the boys in just under two hours). The Car Seat Challenge is a real test that the boys must pass before they can leave the NICU. To complete the CSC a child must remain securely fastened in their car seat with their leads attached for 90 minutes. During the 90 minutes the child must maintain their heart, breathing, and pulse-ox rates without any significant decreases. I am happy to report that Jackson dominated the CSC and passed without any problems (There are pictures below). After watching his brother Shep is anxious to show us his skills and will hopefully take the CSC at some point this week.

In addition to the CSC, the boys have had eye-tests (that came back normal) and Jackson had a hearing test (that also came back normal). We are still unsure of the boys homecoming timeline, but the CSC is one of the last NICU hurdles. The doctors and nurses have told us to be ready and that the boys could be coming home at any moment. It is possible that Jackson may come home before Shepherd, but for the moment we are in a holding pattern.

Another great week in the books. Vicki is doing very well and we are both trying to get the apartment ready for the homecoming celebration. Thank you all for keeping us in your thoughts. New photos are below.

Kodak Slideshow of Shep and Jack Week 5

Video Slideshow

Much Love,

-The Brittons

Some Like it Hot!

Shepherd and Jackson like it hot. In fact the boys like the warm weather so much they have been spending the last four weeks inside enclosed boxes, called isolettes, that help regulate the air temperature around them. To describe the environment inside the isolette, imagine putting on a flannel shirt and sweatpants, wrapping yourself in a blanket, and then going on a summertime camping trip to the Amazon Rainforest. This box of heat and humidity is not my idea of a super cozy environment, but the boys really seem to enjoy it. However, over the past few weeks, the nurses have been slowly lowering the temperatures in the isolettes and allowing the boys to regulate and maintain their own body temperatures. I am happy to report that this weekend the boys took another major step and moved out of their isolette and into an open air crib. Shep and Jack were able to take this step because they have been able to maintain their body temperatures while at the same time maintaining their feeding levels (two things that require a tremendous amount of energy).

Speaking of feeding levels, the Britton boys are still poppin bottles and packing on the ounces. The boys continue to do well with their bottle feeding and Jack is weighing in at 4 lbs 13 oz, and Shep is still close behind at 4 lbs 7 oz. Jack has done so well with his feeding that the doctors have removed his feeding tube and he now takes all his feeds through bottle. Shep's heart issues make it a bit more difficult for him to feed, but he is still doing very well and takes the majority of his feeds by bottle.

The boys have had a great couple of weeks and are continuing to make huge improvements. We are looking forward to the week ahead and hopefully my next update will contain details about the boys homecoming timeline.

-Hugs and Love from the Brittons!

Jack in his new crib

Shep in his new crib

Baths, Baby Clothes, and Bottle Service

Yesterday marked Shep and Jack's three week birthday. A great deal has changed over the last few weeks and the boys have had lots to celebrate. The biggest news is that both boys were moved to a less critical room in the NICU and for the first time since their birth, they are neighbors. Something I have failed to mention in previous updates is that when the boys were first brought into the NICU they were placed in separate rooms, which is standard procedure in the hospital (separating twins helps reduced commotion and confusion in the NICU). However, as the boys improved the nurses told us that Shep and Jack would eventually be placed in the same room. Vicki and I were ecstatic when we received the call from the hospital letting us know that not only were the boys being placed in the same room, but they would be moving to one of the Step Down (less critical) rooms.
A stay in the Step Down rooms is vastly different and far better than the more critical care rooms. Both are loud and filled with sounds, but Step Down is filled with the sounds of babies crying, not with machines and alarms beeping. The Step Down rooms are focused on preparing the babies, and more importantly the parents, for the transition from hospital to home. Shepherd and Jackson's new home is awesome because it is basically a Parenting 101 class for Vicki and I. Over the past week or so, Vicki and I have received instruction and been able to practice bottle feeding, bathing, and something I like to call the onesie challenge.
We will start with bottle service. The NICU is basically a club for babies (lots of flashing lights, blaring sounds, and everyone wants a bottle) and the doctors, nurses, and parents are the wait staff. Premie babies typically don't have the coordination required for feeding until about 34 to 36 weeks (Shep and Jack are 33), but doctors and nurses like to start the babies as soon as possible. Shep and Jack still receive most of their feeds through a tube (when you look at the pictures it's the tube in their nose); however, Vicki and I have both been able to feed the boys and they are improving every day. Both Shep and Jack are doing very well and have taken entire bottles in one feeding. Though Shep's heart issues make it a bit more difficult for him to feed, he doesn't let it show and is doing just as well as his brother. The feeding is definitely paying off as both boys continue to gain weight. Jack is 4 lbs 3 oz and Shep is close behind at about 3 lbs 15 oz.
Anpther first for Vic and I was bath time. The boys get sponge baths every two or three days. Bath time is not their favorite time of the day (we have to replace their leads, which means pulling off stickers), but they take after their mother in that they both love getting their hair washed. There is lots of squirming involved during bath time and it takes Vicki and I quite a while to just wash one, so we have decided that to save time when the boys come home we are only going to give them a bath once every six months, whether they need it or not. Of course we are kidding, but we are very thankful the NICU is giving us the opportunity to practice. By the time the guys get home we will be as efficient as a NASCAR pit crew!
Last but certainly not least is the onesie challenge. For those that are wondering, there is no such thing as a onesie challenge, but the boys are now allowed to wear clothes (no more IVs!) and that means we have to dress them. I have recently come to find out that putting a baby into a onesie is like trying to put a angry sumo wrestler into mazda miata...it's difficult, and I am not very good at it. Vicki is great with the clothes, but if it was left up to me the boys would be naked all the time or I would need 6 hours of lead time before I had to get them anywhere. Needless to say, I will be working on my onesie skills over the next few weeks.
If you couldn't tell from the tone of this message, things have been great! Vicki, the boys, and I are all doing well. Vicki is feeling great and even started back to work this week. The doctors and nurses are very pleased with everyone's progress and we are still looking at late November or early December as a potential homecoming.
To parents who are reading this, I hope you are enjoying yourselves as you laugh at me. As always, thank you all for thinking about us and sending your love, positive thoughts, and good vibes. There are pictures posted below.

PS Through all the craziness of the last month I failed to mention that Vicki passed her medical boards (she took the exam back in August) and is officially a board certified physician!!! I am a very proud father and husband!

Kodak Slideshow of Shep and Jack Week 3

Video Slideshow

-The Britton Clan

Bring Me the Finest Diapers and Breast Milk in All the Land

Hey Gang,
So Shep and Jack are officially a week old. The Britton Boys celebrated this milestone by having the NICU nurses bring them the finest diapers and breast milk in all the land. Though their first few days were a bit rocky, I am happy to report that Shep and Jack are doing extremely well as they move into their second week of life. The biggest news is that Jack's PDA closed on its own! With no lingering heart issues, the doctors have increased his feeds and fluid levels and Jack has gained about 5 oz since birth. The doctors are very pleased with Jack's progress and they are looking forward to his continued growth in the coming weeks.
Shep also is enjoying week two. Shepherd has not shown any symptoms related to his VSD or pulmonic stenosis and will likely remain asymptomatic for the next 5 or 6 weeks. The doctors are monitoring him closely and have increased his feedings and caloric intake to help him beef up in preparation for his surgery. Shep has gained 1 oz since birth and will be gaining many more in the coming weeks.
The good news doesn't end there, I am happy to report that both boys are a hit with the NICU nurses. As a result of their easy going nature and incredible good looks, both Shep and Jack have the nurses competing with each other to try to include the boys on their service. What can I say...they're Rock Stars! But in all seriousness, words cannot express the level of care and compassion our guys are receiving from the amazing medical professionals at the hospital. We are truly blessed to have so many wonderful individuals caring for our boys.
Lastly, today marked another big moment for Vicki and I. Today was the first day we were able to hold Jackson, and tomorrow we will likely be able to hold Shepherd. Over this past week we have been able to take temperatures and change diapers, but the IV lines have prevented us from being able to remove the boys from their boxes. With the start of the second week comes a changing of IV locations and our ability to hold the little guys. To say we were super-excited would be an understatement.
As always, Vicki and I are forever thankful for your love and support. Below you will find a link to photos from their first week. Have great Mondays!!!

-Ryan, Vicki, Shep, and Jack.

Photo Slideshow of Shepherd and Jackson:

Never a Dull Moment

The Whole Gang,
Vicki and I want to keep everyone posted about our beautiful boys Shep and Jack, and by the time this is all over I may consider a career in blogging. First off, Vicki is continuing to recover well from the C-section she had on Saturday. She has been up walking around, moving quite well and we are hoping to be home by Wednesday. Now let's talk about the boys. Shepherd and Jackson have been enjoying their stay in the Neonatal ICU. The boys are receiving excellent care and have an amazing team of doctors and nurses looking after them around the clock.
While most of the news we have gotten about the boys has been amazing (great body weights, breathing on their own, and very active), we unfortunately got a bit of bad news on Monday. While doing a routine examination on Monday morning the doctors heard a heart murmur on both Jack and Shep. The doctors ordered an echocardiogram for both boys to explore the cause of the murmur.
We'll start with Jack. Jack's murmur was caused by something called a PDA (Patent Ductus Arteriosus). Basically this is a condition where the connecting blood vessel between the pulmonary artery and the aorta, called the ductus arteriosus, stays open in a newborn baby. When a baby is in utero the mom does the work of breathing and this vessel stays open and directs most of the blood away from the lungs. When a baby is born this vessel is supposed to close, but often in premies this vessel stays open and causes a murmur. The good news is a PDA is very common and often they resolve themselves in a few days. If the PDA doesn't naturally resolve itself, it can be treated with medication or a small procedure that can be done at the bedside. None of the doctors are really concerned about Jackson's PDA and hopefully in a few days his murmur will be gone and his heart will be beating normally.
Shepherd's echocardiogram returned a more complicated situation. The good news is that Shep does not have a PDA and that his vessel naturally closed. However, Shep has two other issues that a currently effecting his circulatory system. What's interesting about Shep's problems are that individually they are both serious and would create a situation that would need to be corrected immediately. However, due to the unique set of circumstances I will describe below, the problems are actually working to counteract one another and balance his system. Thus, allowing us to postpone the correction temporarily and let Shep and his immune system grow and mature.
Shep's first issue is called a VSD (Ventricular Septal Deffect). This is a hole in the membrane that separates the heart's right and left ventricles (lower chambers). These lower chambers of the heart pump deoxygenated blood up to the lungs and pump the returned oxygenated blood out to the rest of the body. The hole between these 2 chambers is allowing blood that has already been oxygenated to flow back up to the lungs. The hole and its subsequent return flow is causing to much blood to be sent to the lungs and will ultimately result in an over saturation of the lungs.
Shep's second issue is called subpulmonic stenosis. This condition is a tightening of the valve that allows blood to flow into the lungs. By itself, this condition restricts the amount of blood flow to the lungs, preventing the blood and the body from receiving the necessary amount of oxygen. However, in Shep's case the VSD is causing too much blood flow to the lungs and now the pulmonary stenosis is helping to restrict that excess flow.
So what does this all mean. These two issues are serious and they need to be corrected. The good news is that though these problems are not common, they are not unprecedented and can be fixed. The hope is that the VSD and pulmonary stinosis will continue balancing each other for the next few months, allowing Shep's immune system to mature. Around 4 or 6 months Shepherd will undergo open heart surgery to repair these two issues simultaneously. The doctors will actually sew a membrane patch over the hole and then shave off the excess valve muscle causing the stenosis. The good news is that they can both be repaired and that Shepherd will make a full recovery. Though no parent wants their child to have to undergo major heart surgery, there are great doctors here, who have preformed these procedures many times before. Not to mention, that once these problems are resolved, they will likely be fixed for good and Shepherd will grow up with a fully functioning circulatory system, able to live an active lifestyle with no restrictions.
So for now things don't change much. The boys will still be staying in the NICU for the next 6 or 7 weeks to continue to grow and develop, and barring any unforeseen circumstances they will still be coming home with us at the end of that time. However, at some point within the first year, Shep will have to make a return trip to the hospital for his surgery.
While I understand that this is not the happiest email that I have ever sent, please know that Vicki and I and our doctors are all incredibly optimistic and expecting only great things for both our boys. Remember, the Britton Boys have no idea anything is wrong with them and neither of them have any real symptoms yet. They are just hanging out in their little NICU boxes chillin and moving around, they are having a good time and getting lots of attention. Vicki and I have been blessed with these two wonderful guys and though our road seems a bit rocky at the moment, I can only think that this experience is helping to prepare us for the amazing journey that lies ahead.

PS To all the doctors on this list, I apologize for this email and my layman-ology.

PS To everyone else, I apologize for this impromptu biology lesson and discussion of our circulatory system.

PS Thank you to all for your support throughout this amazing experience.

PS One last thing. This list has continued to grow and my emails have been inconsistent so below I am including all of the emails I have sent describing the last two weeks of our lives. Most of you have already seen them, but just incase you haven't you can follow the timeline.

With much thanks and happiness,
-Ryan & Vicki - New pictures of the boys are attached.

Two Beautiful Britton Boys

Hi gang!!
Sorry for the mass email, but I am writing to let you all know that Vicki and I became parents Saturday afternoon at 4:45 and then again at 4:46. On Saturday morning Vicki woke up to some pretty significant back pain. By Saturday afternoon the back pain began to coincide with contractions. After placing Vic on the monitors, it was barely an hour before we were leaving the High Risk Pregnancy floor and headed down to Labor and Delivery. Vicki likely began to develop and infection and the doctors knew this would be her body's natural reaction to it. Everyone was very pleased with Vic's progress over the last 2 weeks and the doctors were ready to go in a get the babies, if a situation like this arose.
The C-section went very well and the NICU doctors are extremely happy with the Britton Boys. The babies are both 3 lbs 5 oz and 16.5 and 16 inches respectively. They are breathing on their own and their color is great. The boys will probably be spending the next 7 to 8 weeks in the NICU, but the doctors are expecting great outcomes and full maturity. The attached pictures show the babies with some tubes and lines attached to them, but don't be alarmed. Their vital signs are being monitored regularly, they have oxygen going into their noses and IVs for food and fluids. All normal stuff, just baby sized. And the boys aren't the only ones doing well. Vicki has been amazing through all of this and she is now in her room resting and recovering. She is going to have to spend the next few days at the hospital, but she is feeling good and has already been out of bed and had a short walk.

Thank you all for the thoughts, prayers and warm wishes over the past two weeks, we are extremely fortunate to have such an amazing support system. As always I will keep you posted. Have great Sundays and thanks again!!!

Love,
Ryan & Vicki

A Little Excitement in Our Lives

For those of you I have talked to this is a followup and for those I haven't talked to yet I apologize for what will likely be a long email. To get to the important things first, Vicki and the babies (which are still in her belly) are all doing well.
This email is coming to you from Fairfax Hospital in northern VA. This is where Vicki and I had originally planned to have the twins just in case a situation like this arose. This hospital has a huge labor in delivery area and one of the best neonatal intensive care units in the area. Having a high risk pregnancy like twins means we were looking for both of these things. Needless to say they are well prepared to handle whatever happens.
The situation is that on Sunday night one of the twins' amniotic sacs ruptured (Vicki's water broke). Luckily we had lots of family in town and they took Vic to the ER to get her checked out. Early Monday morning, as I returned from Detroit (I was headed to Wisconsin for work), they brought Vic from the ER to the labor and delivery floor to be prepared in case she went into labor. They have been monitoring her constantly and she has not gone into labor and the twins' heart rates remain strong. At present Vic is 29 weeks pregnant, which is more than far enough along to have a good outcome for both babies. Even if they came today, the babies would be fine, they would just have to spend a couple months in neonatal icu. However, as you would expect the drs would prefer they did not come today and that they remain in Vic for as long as possible and continue to develop. Obviously, the longer they stay in Vic the less time they spend in the icu after birth.
Vicki has been stabilized and the drs no longer believe that labor and birth are imminent. We are scheduled for an ultrasound today and if everything is okay we will be moving upstairs to the high risk pregnancy floor. Though the name sounds ominous, it is a good thing. Vicki will have to remain in the hospital until the babies come, but again that is a good thing and the hope is that she can stay here for another 2, 3, or 4 weeks. A baby can survive in a ruptured sac as long as the leaking is minimized and there is enough fluid surrounding the baby. If Vic can make it through the week and the babies can stave off infection (which more difficult because of the ruptured sac) there is a strong possibility the babies will not be delivered for another couple weeks.
Either way, the babies are in great hands and will most likely have no issues what so ever. We are focused now on keeping Vic stable and minimizing contractions and keeping the babies healthy (they are giving Vic steroids and antibiotics to boost their development and reduce the risk of infection).
Everyone is in good spirits and the staff here has been amazing. The first 72 hours are the most critical and we are already halfway through that. Fingers crossed we continue in this direction. My next email will hopefully not be a book but rather a short quick update.
Expecting only great outcomes,

-Ryan