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