November 30, 2007

Today was an early morning for our family. Anna and I took Tom to work this morning, so he could catch the train to the airport after work. Anna wanted to see her brother on the way home, so we headed to the NICU with Anna in he pajamas. I was so glad we did, because he was wide awake and watching and listening to everything we said. Anna really enjoyed this visit because most of the time when we go at night, he is asleep. I returned for his 11 am feeding and he slept through most of it. He managed to melt my heart in his sleep though. When I was leaving, I kissed his cheek and he smiled. This morning he weighed in at 4 lbs 5.7 oz (1977 grams) ...up an ounce from yesterday! He is still trying to get the hang of oral feeding but he is making progress. The nurses keep telling me that one day it will click for him. Right now he knows what to do but it wears him out.

Please continue to pray for Tom's weekend in Memphis. He will get to visit with some of our closest friends and eat some really good barbeque, so it's not bad that he has to go, just bad timing.

In the past, I have always been a worrier. Over the last 30 days, I have been able to give my worries to God very easily. I have tried so many times before to do this and failed every time. The Lord has taken this burden from me and that is why I chose Matthew 6:34 tonight. God has better plans for us than we can comprehend, so there is no reason for our worries. He loves us.

Thanks for checking on Noah today!!!!

Please pray for the following:
Noah, and his big sister Anna, that they would come to know the Lord at a young age
God's continued working in the lives of our friends and family
My mom (Susan) for continued comforting and encouragement after her surgery for a detached retina
Noah's neonatologists and nurses
Opportunities to be salt and light to others

Please thank God for (at least) the following:
His love, grace, faithfulness, and provision
His strengthening of our family
His working in the lives of all those who have played such an important part in Noah's life already: those who have and continue to pray for him

"Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own."
Matthew 6:34

November 29th

Noah reached 4 lbs 4.7 oz (1948 grams) today. That guy is just growing like a weed now. There was some concern tonight about the frequency of his pooping. It seems he is going quite a bit. I mentioned to the nurse that a likely culprit could be the fortifier that they have been adding to his bottle. She gave a curt "oh, okay," and went on about Miss needing to drink less milk. Some people just don't get it... I don't say these things to hear my head rattle. I say them because I've actually given them some thought and think it could help the situation. I don't know how many times these same sorts of scenarios have to unfold during Noah's hospitalization before some of these folks listen.

The little man continues in an open bed. He is really just working on feeding now. I was able to hold him for about 25 minutes tonight. He's such a sweet little guy. Noah is derived from Hebrew and means rest, comfort, or peace. It truly fits him.

Missy continues to improve daily. She is eagerly anticipating Noah's discharge; Anna and I are as well. Miss is planning to go to work next week.

I don't have a whole lot more tonight. I want to spend some time talking to Miss before my four day trip to Memphis for Guard duty. It always seems that I have to do that when I want to be home the most.

In keeping with the verse that I included last night, I have decided on the subsequent verse in the 23rd Psalm. It's interesting that the verse says "He makes me lie down." That implies that the psalmist may not necessarily want to lie down, but God makes him. So often we are caught up in running to and fro busy with some self-induced hectic schedule that we don't have time to find rest. God wants us to be at rest, at peace. He makes us lie down in those green pastures of rest so that we may know that rest. The whole 23rd Psalm is about the rest, comfort, and peace that God provides us. It's interesting that I have been moved to recite that to Noah given the meaning of his name... The Lord is gracious.

Thanks for checking on Noah and Missy today.

Please pray for the following:
Noah, and his big sister Anna, that they would come to know the Lord at a young age
God's continued working in the lives of our friends and family
My mom (Susan) for continued comforting and encouragement after her surgery for a detached retina
Noah's neonatologists and nurses
Opportunities to be salt and light to others

Please thank God for (at least) the following:
His love, grace, faithfulness, and provision
His strengthening of our family
His working in the lives of all those who have played such an important part in Noah's life already: those who have and continue to pray for him

"He makes me lie down in green pastures, He leads me beside quiet waters."
Psalms 23:2

November 28, 2007

Today has been a crazy and wonderful day. Tom is having to work really late tonight and asked me to write for him. Sorry I am not quite as poetic as Tom. Noah looked great this morning. He looks so big to me now even though he is 4 lbs 2.3oz (1880 grams). I know most of you are thinking how in the world can 4lbs look big but remember he got down to 2 pounds and change at one point. He is doing very well and is really impressing the doctors and nurses with his progress. His nurse overwhelmed me a bit today by saying, "once he gets going with the bottle, he'll be home sooner than you think". So I replied " I know. Yesterday they said as early as next weekend." She looked me dead in the eyes and said " get ready, it is going to be sooner than you think." As we talked, I got the feeling it will be sometime next week! Very exciting and very overwhelming! So, I came home and did as she instructed...I started finishing getting ready.

Anna is so ready for her little brother to get home. I told her tonight that it would be soon and she quickly responded,"Tonight!" I told it would be in few days. She helped me get his room ready after she got home from church. What a great big sister she is! She had Spanish at school this morning and came home singing in Spanish and actually knew what it meant. She continues to amaze me. I can't wait until Anna and Noah can really play together.

Tom is heading to Memphis this weekend for Air National Guard drill. Please pray for safe and easy travel for him. His flights there always seem to be delayed or canceled and very frustrating.

Thank you so much for keeping up with Noah and his improvements. Thank you for your prayers, meals, rides, etc. The love we have been shown during this month has been truly amazing and inspiring.

I (Tom) just arrived home and wanted to be sure to add a verse to today's blog. I recited the 23rd Psalm to Noah the other evening when I visited him. As I was considering it, the first verse struck me. There is so much peace and assurance in that short verse. I think that it reminds us too that God is to be our focus. Not only will we not "want" because the Lord provides, but also we should not "want" what He does not provide. To some extent I can almost hear the psalmist saying "I shall not, I must not want." When we find our contentment in the Lord, we shall not want.

Please pray for the following:
Noah, and his big sister Anna, that they would come to know the Lord at a young age
God's continued working in the lives of our friends and family
My mom (Susan) with her difficulties after her surgery for a detached retina
Noah's neonatologists and nurses
Opportunities to be salt and light to others

Please thank God for (at least) the following:
His love, grace, faithfulness, and provision
His strengthening of our family
His working in the lives of all those who have played such an important part in Noah's life already: those who have and continue to pray for him

"The LORD is my shepherd; I shall not want."
Psalm 23:1

November 27th

In keeping with the tag team approach set forth by yesterday's entry, the following is Missy's update regarding Noah today.

When I walked into Noah’s pod in the NICU this morning, I exclaimed “Look at my big boy in a crib!”. The nurses laughed because I was so excited to see he was no longer in his isolette. As noted yesterday, this transition was expected to occur tomorrow (Nov. 28), but he was doing well enough to switch early. Each milestone is elating to me. He weighed in at 4 lbs 1.1 oz (1847 grams) this morning, and he took 36 % of his feeds orally! Again today, he received his entire 8 am feeding via bottle and was tired when I arrived at 10 am. I never realized eating could be such a good workout. Noah is having fewer and fewer events of oxygen desaturation and low heart rate each day. One thing I don’t think we have noted is that he already has a his own personality. He is so sweet and smiles all the time whether he is asleep or awake. Many of his facial expressions are identical to his sister’s. Anna and he are going to have so much fun together. He is progressing so well that we are hopeful he will be coming home in the next couple of weeks.

When I saw Noah, it was great to see the little guy in his open bed. He was sleeping soundly until I began to bother him at which point he quickly began to grunt and stretch around. I held him in the rocking chair for a bit and then had to hurry home. I can't wait until I get to come home and hold him here. I am quite suspicious that he will be coming home by the end of next week. I suspect his oral intake will take off over the next five or so days.

Missy is feeling well. She went to the office today and performed a couple of cleanings. She felt sore and tired afterward, but noted that she feels sore and tired every day, so this was not atypical. She is planning to have a full schedule on the docket next week.

My mom seems to be doing a little better today. She had a rough day with the sudden fear that she could never see out of her eye again. She was able to reason through that and God gave her a peace about it.

Tonight I was able to meet with my friend Scott Fisher. We meet weekly to discuss what God is doing in our lives, share scripture, and pray. It has been really good. He has been an encouragement and it's been great to get to know him. The opportunity to spend time as Solomon wrote in Proverbs 27:17 is invaluable; "As iron sharpens iron, so one man sharpens another." I think it is imperative that we as believers find others with whom we can maintain accountability and explore the word.

In keeping with what I wrote last night, I was considering grace and our inability to tip some fictitious scales of righteousness in our favor. So many of our family, friends, or neighbors plug along through life and think "if I do plenty of good things, I'll get to heaven." All the while, they miss the fact that any goodness that we generate is contaminated and far short of God's glory. In Isaiah 64:6, Isaiah wrote "for all of us have become like one who is unclean, and all our righteous deeds are like a filthy garment; And all of us wither like a leaf, and our iniquities, like the wind, take us away." Thank God that He has made a way that we might be made right through Christ.

Thanks for checking on Noah and Missy today.

Please pray for the following:
Noah, and his big sister Anna, that they would come to know the Lord at a young age
God's continued working in the lives of our friends and family
My mom (Susan) with her difficulties after her surgery for a detached retina
Noah's neonatologists and nurses
Opportunities to be salt and light to others

Please thank God for (at least) the following:
His love, grace, and faithfulness
His strengthening of our family
His working in the lives of all those who have played such an important part in Noah's life already: those who have and continue to pray for him

"For it is by grace you have been saved, through faith—and this not from yourselves, it is the gift of God— not by works, so that no one can boast. For we are God's workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do."
Ephesians 2:8-10

November 26th

For those who have been faithfully reading the updates on Noah's blog everyday, you might have noted that there was no post yesterday. Our internet connection seems to go out for 24-48 hour once a month or so. Yesterday was one of those days. Hopefully that won't be a problem again for a while.

Missy wrote the following for me as an update on Noah since I got home a bit late this evening.

Today Noah made great strides in the right direction! He weighed in at 1827 grams (4 lb 0.4 oz)... up 30 grams from yesterday. As a 4-pounder, he thought he could do some big boy things, like breathing totally by himself and feeding from a bottle (once)!!! It was so good to see him without the nasal cannula. His oxygen saturation remained at or near 100% since removing the cannula, so he may have breathing figured out. His nurse was very excited to report that he had his entire 8am feeding (35ml) from a bottle. At his 11 am feeding, he woke up enough to drink 8 ml by nursing and the rest by feeding tube because he fell asleep. His nurse said he wore himself out at the 8am feeding. It takes a lot of energy for little guys to feed orally. At first, he burns more calories trying to figure out what to do than he actually consumes! The temperature in his isolette has been lowered in increments and now he is maintaining his temperature on his own…another milestone toward coming home. By Wednesday, he should be in a crib instead of his isolette!

As you can read, Missy is a bit more emphatic in her updates than I am. Perhaps we should alternate days or something. My friends David and Jill Johnson do that with their daughter's (Hutton) site. You may have seen the link to her page on the right of Noah's page.

Noah is really doing quite well. I hope that he will add a little more oral intake every day. If he does that, it's not outside of the realm of possibility that he could come home next week. We are looking forward to the little man's arrival home. It'll be great to get to hold him and nuzzle him whenever we want to. It's such a blessing to see him progressing along so well.

Missy is really improving. She is going to go to work tomorrow for a short bit to do a couple of cleanings just as a test to see how she feels from that perspective. She is still tired, but it seems that is improving as well.

I spoke with my mom tonight and she is doing better in regards to her eye. She is having less pain and nausea. She said that she can see some colors out of the eye when she puts in her eye drops. It was great to hear her somewhat upbeat when I talked to her. When I talked to her the previous two days she was quite disheartened and fretful.

For all who have prayed for my friend Luke, thanks. He is safely back in Germany with his wife Ivy. I am sure that they are elated to be back together after such a protracted hiatus. I suspect they'll be jet setting around Europe whenever Luke has some time off. They deserve it.

Today is my 33rd birthday. It wasn't a very good one in regards to my day at work; however, the great news about Noah and Anna's hijinks upon my arrival home made up for it. Anna had "made" a special pumpkin pie "birthday cake" for me. While I have been writing this entry, she has insisted on having Elvis blasting out of the computer so that she can dance. Anna & I share "Suspicious Minds" as our favorite, though "A Little Less Conversation" is blaring right now.

In selecting a verse for today's entry, I am drawn to Isaiah 26:3 & 4. For those who have been reading regularly, I have included several verses that speak to the faithfulness of God and the peace He gives us as believers. This is a theme that I think is directly from the Lord as He works to grow me, as well as our family and even you as you read this, through the trial that has been the last 25 days. This is a thought that is really overwhelming to me. To think that the God of all creation is working in my life to make me more of what He wants me to be is incredible. I am reminded of, as written in Romans 7:24, "what a wretched man I am." In 1 Timothy 1:15, Paul writes "that Christ Jesus came into the world to save sinners; of whom I am chief." This is at the heart of the gospel; God loves us and wants to make us righteous. Thanks be to God that He refuses to give up on me!

Thanks for checking on Noah and Missy today.

Please pray for the following:
Noah, and his big sister Anna, that they would come to know the Lord at a young age
God's continued working in the lives of our friends and family
My mom (Susan) with her difficulties after her surgery for a detached retina
Noah's neonatologists and nurses
Opportunities to be salt and light to others

Please thank God for (at least) the following:
His love, grace, and faithfulness
His strengthening of our family
His working in the lives of all those who have played such an important part in Noah's life already: those who have and continue to pray for him

"You will keep in perfect peace him whose mind is steadfast, because he trusts in you. Trust in the LORD forever, for the LORD, the LORD, is the Rock eternal."
Isaiah 26:3 & 4

November 24th

Noah's weight keeps creeping up. He was up to 3 lb 13.5 oz (1744 grams). Hopefully he will keep on an upward trajectory. He'll be up to four big pounds in no time. This evening he attempted to nurse again and apparently did quite well. Once he gets that squared away, he'll be headed home.

They have weaned his isolette temperature to room temperature. He'll be out to an open bed in the next day or so. He is also down to 1/2 liter of 21% oxygen in his nasal cannula. That should continue to be weaned.

Missy is doing pretty well today. She continues to be fatigued, but her spirits are good. She is likely a bit more tired today as a result of a big outing that we had with Anna. I decided that it would be fun if we just went riding around on the trolleys and subway. We road the trolley to 69th street and then caught the subway down to City Hall. We jumped back on the subway and went back to 69th. We then road the trolley out to Norristown and back. It was about a two hour trip for the whole thing. Anna had a great time. She loves to ride trains.

Anna and I finally got an opportunity to see a UT game up here. Anna fell asleep on me after about the end of regulation. Noah was excited to hear that the Big Orange pulled it out in the 4th overtime, though he was disappointed with the fact that it went to overtime. He really did smile when I told him UT won. Of course, that was likely a result of releasing fumes or something...

My mom is having a very rough time after her surgery for the retinal detachment. She is in a significant amount of pain. She can't see at all from the affected eye and apparently is having trouble opening the other. Her equilibrium has been affected and she is quite nauseated. I pray that she improves soon. I know it must be a horrible thing. Not only does she have the issues with nausea and vomiting, but she also has the fear that she might never see from the eye again.
Please pray for her.

Thanks for checking on Noah and Missy today.

Please pray for the following:
My mom (Susan) with her difficulties after her surgery for a detached retina
Noah's neonatologists and nurses
God's continued working in the lives of our friends and family
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age
Our working with Anna during this difficult transition time for her
My friend Luke as he finally returns from Iraq after 15 months to Germany to be with his wonderful bride Ivy

Please thank God for (at least) the following:
His love, grace, and faithfulness as exhibited in our lives
God's strengthening of our family
His working in the lives of all those who have played such an important part in Noah's life already: those who have and continue to pray for him

"And the prayer offered in faith will restore the one who is sick, and the Lord will raise him up, and if he has committed sins, they will be forgiven him. Therefore, confess your sins to one another, and pray for one another so that you may be healed. The effective prayer of a righteous man can accomplish much."
James 5:15 & 16

November 23rd

Today was a somewhat uneventful day for Noah. He tried to nurse a bit while we were there. He didn't really accomplish much, but he demonstrated that he has the general idea of what he is supposed to be doing. His weight last night was up such a large amount that I think a measurement error occurred somewhere. We will see what they weigh him at tonight and that will give us a better idea.

His respiratory status continues to be good. He has some episodes still where he forgets to breathe for a short bit, otherwise he is doing pretty well there.

He is heading toward getting out of the isolette. They have been slowly weaning the temperature in his isolette down to room temperature and he has been able to maintain a good temp without problems. The move to an open bed may be in a couple of days.

Missy is slowly making improvements. She still has soreness and isn't moving with great haste. Her spirits seem to be pretty good.

Today, Anna went with the Gehrman family to Jumpers Gym. It's a place with a lot of inflated bouncy things that kids Anna's age love. She had a great time. Thanks Phil & Christine. This outing allowed Missy and I to spend a little time together out shopping and having lunch. It was a good time.

Tonight, after we watched the Arkansas Razorbacks upset the vaunted LSU Tigers, we went over to Paul and Nancy's house for some dessert and a rousing game of Taboo. We had a great time. Anna was the time keeper and became quite adept at yelling "Time!" whenever the timer would run out.

My mom's surgery went well. Apparently, she is not expected to be able to see out of the eye for three to four weeks. Thanks to everyone who prayed for her. Please continue to do so.

Thanks for checking on Noah and Missy today.

Please pray for the following:
My mom (Susan) after her surgery for a detached retina
Noah's neonatologists and nurses
God's continued working in the lives of our friends and family
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age
Our working with Anna during this difficult transition time for her
My friend Luke as he finally returns from Iraq after 15 months to Germany to be with his wonderful bride Ivy

Please thank God for (at least) the following:
His love, grace, and faithfulness as exhibited in our lives
God's strengthening of our family
His working in the lives of all those who have played such an important part in Noah's life already: those who have and continue to pray for him

"He who fears the LORD has a secure fortress, and for his children it will be a refuge."
Proverbs 14:26

Thanksgiving 2007

Noah's weight has leveled today. He seems to be stuck at 3 lbs 10 oz. Apparently the neonatologist is a bit concerned with Noah's weight gain. For those who have been reading the blog regularly, this is something that I have been concerned about for some time. I have been previously "reassured" that everything was fine. It's sort of annoying when that happens. I am not sure what their plan is to get him going. I don't know if there is any plan to evaluate reasons why he is being "pokey" with his weight gain. I was going to ask the neonatologist today when we visited, but there was no physician there because it was a holiday.

Noah continues to do fairly well off of CPAP. He has intermittent episodes where he forgets to breathe or he strains a bit and his heart rate decreases. Overall, he seems to be doing okay with that.

His jaundice looked a little bit better today. That may be related to his having had four stools overnight. Perhaps he won't have to go back under the lights.

Missy was having a lot of burning with her incision this morning when she woke up at 04:00 to pump. She also has been having some tenderness from the pumping. As a result, she stayed home while Anna and I went to the Philadelphia Thanksgiving Day Parade. Miss was able to get some sleep and seemed to be doing a bit better when we got home.

Anna and I were off to the parade this morning. The weather was great for it. We met our friends Forrest & Julie Fernandez and their children, and Elliot & Owen Tucker at the train station. We all road the train into Suburban Station and went to a spot by City Hall. I think everyone had a great time. Anna loved seeing the balloons and the Disney characters. It turns out, unbeknownst to myself or Missy, that Anna is a Daisy Duck fan. Who knew? We ended up leaving quite a bit before the parade was over so that we could catch our planned train back. The parade continued on for another 45 minutes or so after we departed. It was a wonderful time. Anna and I really wished that Miss could've been with us. Next year, the four of us will be able to go.

When we got home, we found that a couple of our friends from church were raking our yard. They knew we were going to the parade and had hoped to surprise us with a cleanly raked lawn. We caught 'em red handed! Can I say enough about our church? I won't name them by name because they may not want that. Suffice it to say, we are extraordinarily grateful for such a gracious gift. The thought was wonderful. Thank you too (you know who you are) for taking such great care of Anna on Wednesday nights!

I talked with my mom last night. It seems that she has been having some difficulty with her vision in one eye since she came up to visit us. At first she thought it was a cataract. I had encouraged her to see an ophthalmologist. She saw one yesterday and was found to have a detached retina. She is to undergo surgery tomorrow. She is quite concerned (worried) about the surgery and about the possibility of losing her vision in that eye. I have told her that I would let the people at our church know that this is going on. For those who read the blog, please pray for her and also be sure to pass it on to others to pray.

We were able to have a fabulous Thanksgiving dinner tonight at the Fernandez house. It was a great time. They are wonderful friends and we dearly love them. God has blessed us with so many amazing people. Thanks Fernandez family for a great dinner and great time.

As I thought about a verse to include tonight, I recalled Philippians 4:6 "Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God." However, I realized that I had used Philippians 4:6 & 7 to round out an earlier post on November 7th. As a result, I have selected another. I hope that everyone had a blessed Thanksgiving. Thanks for checking on Noah and Missy today.

Please pray for the following:
My mom (Susan) as she undergoes surgery for a detached retina
Noah's neonatologists and nurses
God's continued working in the lives of our friends and family
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age
Our working with Anna during this difficult transition time for her
My friend Luke as he finally returns from Iraq after 15 months to Germany to be with his wonderful bride Ivy

Please thank God for (at least) the following:
His love, grace, and faithfulness as exhibited in our lives
God's strengthening of our family
His working in the lives of all those who have played such an important part in Noah's life already: those who have and continue to pray for him

"Enter his gates with thanksgiving and his courts with praise; give thanks to him and praise his name."
Psalm 100:4

November 21st

Noah is up to 36 mL per feed. He took 10 mL from a bottle today, so he's getting going on the oral intake. He will just have to keep plugging away. He didn't do as well with it tonight as he had done earlier.

He remains off CPAP and is doing well from a respiratory standpoint. I looked at him tonight and he is a bit jaundiced. Based on his exam, he looks like his bilirubin level is about 7. I am not sure if they might put him back under the lights soon. I hope not.

Missy has been doing pretty well. She was hit in the abdomen by one of the little girls in Anna's class. Apparently the kid just ran right up and hit her with both fists. She's been significantly sore since then.

We are hopeful to go with our friends to see the Philadelphia Thanksgiving day parade tomorrow. Anna is eagerly anticipating it. She hopes that there aren't a lot of fire trucks and ambulances that tend to be present in smaller parades. I have never understood why emergency vehicles are a. in parades in the first place and b. find it a necessity to blare their horns. I always hated that as a kid (and still do) and it appears I have successfully passed that gene on to Anna.

I hope that everyone has a great Thanksgiving tomorrow. Enjoy the time with your family and loved ones. Take the opportunity to truly be thankful. You never know what tomorrow holds, just ask Missy and Noah.

The verse for today is actually repeated multiple times in the Bible. It is in keeping with a theme of thanksgiving. The verse is first found in 1 Chronicles 16:34. It is repeated four times in the book of Psalms and there are several other slight alterations to it in Psalms as well. I pray that we will all meditate on the goodness of God and truly give thanks to Him.

Thanks for checking on Noah and Missy today.

Please pray for the following:
Noah's neonatologists and nurses
God's continued working in the lives of our friends and family
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age
Our working with Anna during this difficult transition time for her
My friend Luke as he finally returns from Iraq after 15 months to Germany to be with his wonderful bride Ivy

Please thank God for (at least) the following:
His love, grace, and faithfulness as exhibited in our lives
God's strengthening of our family
His working in the lives of all those who have played such an important part in Noah's life already: those who have and continue to pray for him

"Give thanks to the LORD, for he is good; his love endures forever."
1 Chronicles 16:34

November 20th

Noah has been off of CPAP for 48 hours! He was breathing fine when I saw him this evening. He is still getting a little bit of oxygen through his nasal cannula, but he's doing great. I am hopeful that he will remain off the CPAP for good.

He is tolerating his feedings well and they are going to increase the fortifier in his breast milk to give him a few more calories. This will hopefully put some weight on him. He is going to try a little bit of bottle feeding soon.

Noah will be three weeks old on Thursday. It's hard to believe that so much has happened in such a short span. We can't thank everyone enough for all of the prayers, meals, and encouragement. This has been a trying time for our family and God has been faithful to give us the strength we need for the moment. I know that we have grown so much from this and I pray that we can use it to minister to others.

Missy continues to improve everyday, just like the little man. She is having less soreness and she looks better in general. She has been able to spend some time with her great friend Julie, which has been wonderful for Miss.

As Thanksgiving day continues to approach, we all become more cognizant of the many things that God has bestowed upon us. My grandmother's favorite hymn was "Count Your Blessings." I can't enumerate how many times I heard her say "If all we did was count our blessings, we wouldn't have time to do anything else." She was a fountain of faith and love, and that Godly wisdom couldn't be more true. God has been so gracious to our family in this time, as well as in all our lives heretofore. This Thanksgiving is certainly going to be one filled with more gratitude than the average. I pray that henceforth it will always be so, for our family as well as yours.

Thanks for checking on Noah and Missy today.

Please pray for the following:
Noah's neonatologists and nurses
God's continued working in the lives of our friends and family
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age
Our working with Anna during this difficult transition time for her
My friend Luke as he finally returns from Iraq after 15 months to Germany to be with his wonderful bride Ivy

Please thank God for (at least) the following:
His love, grace, and faithfulness as exhibited in our lives
God's strengthening of our family
His working in the lives of all those who have played such an important part in Noah's life already: those who have and continue to pray for him

"Give thanks to the LORD, call on his name; make known among the nations what he has done."
1 Chronicles 16:8

November 19th

Noah did well off of CPAP overnight last night. He is weaning off well and I hope that he will be able to remain off soon. One more little step toward home...

His feedings continue to be well tolerated. He attempted to breastfeed again today, but it seems he was having a little trouble staying awake. Perhaps he'll be able to keep awake for that tomorrow. They are working on trying to get his oral coordination going well.

There aren't a whole lot of other things to update on regarding Noah tonight. The less there is to update the better.

Missy continues to improve. She is moving better every day. She is still tired and isn't moving at normal speed, but she's getting there.

I didn't get by the hospital to see Noah tonight. I have had a bit of the sniffles and haven't been exactly exuding energy. I am hopeful that I will feel better tomorrow. Everyone else seems to be improving and I'm going in the wrong direction.

We are thinking about attending the Philadelphia Thanksgiving Day parade on Thursday morning. We feel like it will be an exciting event and will be a good time to be with Anna. With such a large focus on the little man, I don't want Anna to feel left out. Plus, I'll get to see the parade too!

We were able to spend some time with our friends Paul & Nancy Browne tonight. Paul and I had a good discussion about some things discussed in our small group Friday night. It was good to get his perspective on these things. The Browne's have served as God's arms in welcoming us here. They have become like family. We love them so much and they are always willing to share Godly wisdom with us. When my training is done here we're either going to have to stay here or pack them up and take them with us. Thanks Paul & Nancy for everything...

Thanks for checking on Noah and Missy today.

Please pray for the following:
Noah's neonatologists and nurses
God's continued working in the lives of our friends and family
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age
Our working with Anna during this difficult transition time for her
My friend Luke as he finally returns from Iraq after 15 months to Germany to be with his wonderful bride Ivy

Please thank God for (at least) the following:
His love, grace, and faithfulness as exhibited in our lives
God's strengthening of our family
His working in the lives of all those who have played such an important part in Noah's life already: those who have and continue to pray for him

"But he was pierced for our transgressions, he was crushed for our iniquities; the punishment that brought us peace was upon him, and by his wounds we are healed."
Isaiah 53:5

November 18th

Noah's weight sagged a little last night to 3 lbs 8.9 oz. They are going to increase the amount of calories by adding milk fortifier to his feeds. This should help him put on some weight. Missy is planning to try to work with him on nursing when she goes back to the hospital to visit tonight. I think that he's ready to get going on that.

Noah's breathing is still looking pretty good. He had some short episodes while we were there earlier where his oxygen level decreased a little bit. I think that this is due to reflux; he was receiving a feeding at the same time. Hopefully he won't start going back on longer CPAP periods.

Missy is continuing to improve. This morning she discovered that she could lie on her side when she sleeps. She was quite excited about that. She's not a back sleeper and that has contributed to her being extraordinarily tired (as has her anemia). Her soreness is slowly improving as well.

Missy's dad was able to go to church with us this morning. It was a great service. We (the praise team) had a really good time with the song set and it was wonderful. In practice this morning everything seemed to be completely wrong, but it worked out great for the service. I think that's because we gave it to God.

Jay arrived safely this morning. I picked him up and took him by Merion. He was delighted to see it. Missy had been afraid he would want to stop, jump out, run onto the course and try to hit a ball or something. She had visions of either his arrest or his being shot by armed guards of the grounds. Thankfully, neither scenario occurred and we were able to go get everyone else for lunch at the Llanerch Diner.

From the "It's a small world" file, there is a nurse named Ellen in the NICU who took care of Noah from Wednesday until Friday. It turns out that her daughter works at a mission facility named SOS in Memphis. Ellen's daughter is close friends with a girl who was three years behind me in my med/peds residency program. Her name is Shelly Basye. That's amazing to me...

Thanks for checking on Noah and Missy today.

Please pray for the following:
Noah's neonatologists and nurses
God's continued working in the lives of our friends and family
Strength for our family
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age
Our working with Anna during this difficult transition time for her

Please thank God for (at least) the following:
His love, grace, and faithfulness as exhibited in our lives
His working in the lives of all those who have played such an important part in Noah's life already: those who have and continue to pray for him

" By faith in the name of Jesus, this man whom you see and know was made strong. It is Jesus' name and the faith that comes through him that has given this complete healing to him, as you can all see."
Acts 3:16

November 17th with some pictures

Missy's dad arrived safely today from Mobile. We went immediately over to the hospital so that he could see Noah. Noah was off of CPAP and on the nasal cannula when we saw him. It was great to see his face and full head of hair. His sprints off of CPAP have been lengthened to 9 hours now and will be 12 hours with the next one. He is doing great there. I think it won't be long until he's off CPAP for good.

He continues to tolerate full feeds without a problem. They may add some calories so that he gets a boost in weight gain. That remains to be seen. I'm quite sure that they will start really working on oral feedings this week. I did a few things tonight to check to see if he has the reflexes needed to take oral feedings and everything was present. I can't wait until he's taking his feedings by mouth. Since I haven't given his weight lately, as of last night, he was 3 lb 9.5 oz (1630 grams). He hasn't been making huge gains, but he's making enough.

Miss is feeling good today. She was able to visit with the little man for a bit and took about 30 bottles of milk for Noah. His bin has been expanded to include a second one.

I was able to hold squirt tonight. He's still tiny and just sleeps there when I hold him, but it was great. I haven't held him in quite a few days. It's nice to kiss his little head. Poppa Tom was a bit afraid that he might break, so he didn't hold him. He's looking forward to when the little man doesn't come with wires, etc.

I was able to finally get some new pictures. I am going to put them in tonight. I am also going to throw in a couple of pictures of a tree that is in our front yard. I think it may be the most beautiful tree I have ever seen. It turns a brilliant orange every fall for about four or five days and then it's gone. Since I first saw it last year I have been eagerly anticipating it. God really made something spectacular with this tree. The pictures don't do it justice, but I want everyone to see it anyway.

Jay is set to arrive tomorrow morning and will stay the evening with us tomorrow night. It's his first visit to see us here. I am planning to drive him by Merion Golf Course, which is about 1 1/2 miles from our house. He's excited to see it. We're excited to see him. Jay and I have been best friends since I was about eight or nine I guess. I can't remember for sure. Having someone that has been there for so much of my life like Jay has is a blessing that I can't thank God enough for. I think in this day and age such a friendship is extraordinarily rare. We each have played a role in the other's development as a Christian, man, husband, and father. I can't thank God enough... I'll be glad to see Jay.

Thanks for checking on Noah and Missy today.

Please pray for the following:
Noah's neonatologists and nurses
God's continued working in the lives of our friends and family
Strength for our family
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age
Our working with Anna during this difficult transition time for her

Please thank God for (at least) the following:
His love, grace, and faithfulness as exhibited in our lives
His working in the lives of all those who have played such an important part in Noah's life already: those who have and continue to pray for him

"Do you not know? Have you not heard? The LORD is the everlasting God, the Creator of the ends of the earth. He will not grow tired or weary, and His understanding no one can fathom. He gives strength to the weary and increases the power of the weak. Even youths grow tired and weary, and young men stumble and fall; but those who hope in the LORD will renew their strength. They will soar on wings like eagles; they will run and not grow weary, they will walk and not be faint." Isaiah 40: 28-31

November 16th

We received some great news today. Noah's feeds have reached a level that allowed his belly button IV to be removed today! That's outstanding. It was great to see his little belly without the catheter sticking out of it. Also, they have been increasing his feeds more aggressively and he will receive his goal volume tomorrow morning. This is great. The next step is to work on oral and swallowing coordination. Once he has that down, he'll be set. This really will be the issue that keeps him in the hospital. The rest seem to be resolving.

His weaning from CPAP continues to go well. He is having minimal difficulty and he is tolerating the periods off of CPAP nicely. Maybe he'll be off that by Monday.

The bilirubin came down to a level of about 2 today and his phototherapy was discontinued. I think we likely won't see the "Close Encounters" lights again. His color looks great today as well.

While standing at Noah's bedside this evening, the father of a new baby in the bed space beside Noah started talking to me. He and his wife are from Sierra Leone on the western coast of Africa. They are Muslims; I found this out when I asked their son's name and was told it is "Hashim." Apparently that was Muhammad's last name or something. He asked what Noah's name was and when I told him he smiled and said, "Oh, he's going to stop the flood." I replied, "No, he's going to ride it out." May God continue to give us the strength to ride out this storm/flood in our family's life. It's been tough, but it's also been a wonderful growing experience. God has a great plan for all of this that He is working out. I am thankful that He is working in and through us. That's exciting.

Missy has been fairly tired today. I suspect that she is being a bit overzealous with her driving herself to the hospital. She also spent some time cleaning the house today. I think these things culminated to wipe her out. From a medical standpoint, I want her to be up and doing things as much as she is able to without significant discomfort. From a husband and father standpoint, I want her to do little to nothing. I hope that I am striking a balance, though I always feel as though the medical side wins out.

Anna is improving and really had a great day. She cleaned up her room all by herself today. She doesn't realize that she has proven that she is henceforth capable of doing this chore. She was preparing for "Poppa" (Missy's dad) to arrive tomorrow.

Tonight as I was driving from CHOP to the hospital where Noah is, I talked with my friend Jeff Williamson. Jeff is a great friend in many ways. He is faithful to always ask me how I am doing in the midst of these sorts of situations. He has noticed that since the first entry into Noah's blog I haven't really mentioned myself too much. Ultimately, that's because I don't think that people are tuning in to check on me. If I write a bunch of stuff about me, it's being whiny in my mind. As a father, I feel like I am supposed to support my family and sit back in the wings a bit. I should make sure they have what they need and I should sacrifice because that's what I think dads should do; we're supposed to be the ones with old, worn out shoes or old Hondas that still run but aren't hip. It's sort of a badge of honor of being a dad. Perhaps that's silly or something, but that's how I've romanticized part of being a dad. I guess if there is an overwhelming outcry from people wanting to know how I'm holding up, I'll respond, but otherwise I'll just keep plugging away.

Thanks for checking on Noah and Missy today.

Please pray for the following:
Noah's neonatologists and nurses
Missy's OB/GYN, Dr. Heinzel
Strength for our family, especially Missy
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age
Our working with Anna during this difficult transition time for her

"Endure hardship as discipline; God is treating you as sons. For what son is not disciplined by his father?"
Hebrews 12:7

November 15th

Tonight's update will hopefully be short and sweet. Noah is doing great! His feeds are up to a point now that allowed them to take out his belly button IV! This is outstanding because it decreases his risk of serious infections. This has been a big goal of ours so we are really happy about that.

He is increasing the interval length for the time that he is off of the CPAP. He is up to six hours now. They will keep stepping him up until he is finally off completely. Go Noah, Go!

His bilirubin is down markedly after 24 hours back under the lights. I hope that they will stop those soon. That's one more little step toward home.

Missy continues to improve. Her soreness is slowly improving. She has been driving to the hospital the last couple of days and feels okay with that.

Anna continues to be clingy and we are beginning to think that this is more of a regression phenomenon than her viral illness, though that is tough to tease out. I feel confident that she will begin to get a better grasp on the situation in a few weeks and begin to realize her role as a true big sister. I think she's going to be stellar at it.

That's all for tonight. Thanks for checking on Noah and Missy. Keep praying. God is working in so many ways and we are thankful to be a part of it.

Please pray for the following:
Noah's neonatologists and nurses
Missy's OB/GYN, Dr. Heinzel
Strength for our family, especially Missy
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age
Our working with Anna during this difficult transition time for her

"The LORD gives strength to his people; the LORD blesses his people with peace."
Psalm 29:11

November 14th

Tomorrow marks two weeks Noah was born. It's hard to believe that so much has happened in the life of our family in those short days. It's amazing.

I had planned not to stop into the NICU to see the little man tonight because I've had a "tickle" in my throat and have been concerned that I picked up Anna's parainfluenza virus. However, after I talked to Missy there were some questions as to what exactly was going on with Noah today so I felt obligated to go by. I scrubbed up, but didn't open the isolette and touch him or breathe on him.

Noah was placed back under the phototherapy lights today. His bilirubin level has crept back up and they are preemptively restarting the lights. It could be argued not to restart them, but it isn't going to hurt him. I suspect the cause is simply that he has a baby liver that isn't doing a great job with taking care of the bilirubin like it should yet. Also, being on IV nutrition for extended periods can cause some abnormalities in liver function. My hope is that when he is off of the IV it will improve.

Speaking of feeding and the IV, he continues to do well with his feeds. He is bumping up to 18 mL tonight. At the current rate of increase he'll be up to 30 mL per feed by Saturday night. I think that when he gets near that number they will stop his IV nutrition and will shortly thereafter get that belly button IV out. That will be fantastic! Apparently today when Miss was visiting the nurse put his feed in a pump and ran it in slowly over one hour. This wasn't the case with the night nurse, but the neonatologist said that sometimes they do that and it doesn't really mean anything.

The neonatologist told me that Noah could start practicing at the breast now. I let Missy know and I think that made her happy. He has to start working on coordination and swallowing. It will be quite a while before he's taking everything by mouth, most likely. We can always pray that he takes to it and doesn't have any problems, of course. I'm just glad to finally have the feeling that we're starting to make some progress.

Noah's sprints off of CPAP have been going fairly well. It appears from the apnea log that he is doing well from that standpoint. I hope that he continues to progress and perhaps he can be off of CPAP by the end of the weekend. Now that I think about it, it seems that this weekend may have quite a few milestones.

Because I've been asked so many times lately, I finally fired the question to the neonatologist; "when do you think Noah will be able to come home?" Of course, as all physicians do (myself included sometimes), she hedged. Ultimately, there is no way to predict such things and you don't want to either give a family false hope or dash hope either. She listed the following milestones that Noah must be able to do:

1. Take all of his feedings by mouth without difficulty. This doesn't have to be all breast feeding.
2. Breathe well on his own without significant apneic (pauses in breathing) or bradycardic (slow heart rate) episodes.
3. Maintain his body temperature well while in a crib. (Little guys have difficulty keeping their body temperature up.)

Notice that these do not include stipulations on weight or age. So, now we have some goals to hang our hat on...I guess.

Missy continues to improve daily. She had her followup visit with Dr. Heinzel today and actually drove herself to the appointment. It was apparently a fairly painful visit. He told her that she was progressing along an anticipated course and he feels she's doing pretty well all in all. She has to go back next week.

Miss drove to pick Anna up from school today and also drove her to church tonight. I think from this driving that she is feeling a bit better. I will say that her pain is still present because she still has poor posture and doesn't stand up when I hug her. We are progressing though. Thank you Lord for healing our family!

For those who are wondering why I haven't posted pictures lately, there are some good reasons. First, I have been dropping by the hospital on my way home from work lately so I don't have the camera. Also, Noah isn't doing a whole lot in the way of changing so he still looks like the pictures that I posted previously. I suppose I could lead everyone to believe that there are new pictures and post ones that I have on the computer but didn't post previously. I am hopeful to get some new photos this weekend when he (hopefully) meets some milestones.

Speaking of this weekend, we are going to have visitors. Missy's dad Tom is visiting from Saturday until Sunday. He frequently flies into visit for 23 to 24 hours and then is gone again back to Mobile. Anna always enjoys visits from "Poppa." Also this weekend, Jay will be visiting. He's pulling a visit a la Tom Galloway in that he will be flying in on Sunday afternoon and leaving on Monday morning. It will be great to get to visit with both of them even if the visits are truncated.

I had planned on writing some entertaining aside here; however, Anna has come in and insisted on sitting here and "helping Daddy" write this. She has seemed a bit better from a viral standpoint today, but she certainly has been much more clingy and whiny. Hopefully she will be back to her usual self soon. Due to her "helping," I think I'll have to end tonight's entry and hope for an opportunity to freelance some tomorrow.

Thanks for checking on Missy and Noah today.

Please pray for the following:
Noah's neonatologists and nurses
Missy's OB/GYN, Dr. Heinzel
Strength for our family, especially Missy
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age

"Yet I will rejoice in the LORD, I will be joyful in God my Savior. The Sovereign LORD is my strength; He makes my feet like the feet of a deer, He enables me to go on the heights."
Habakkuk 3:18 & 19

November 13th

Noah continues to plug along on his course to coming home. Missy was able to spend about two hours holding the little squirt today. He was off of the CPAP the whole time and seemed to do well. He is now starting to have "sprints" off of the CPAP. This will include three hour periods a couple of times a day to see how he tolerates being off CPAP. As he does well, they will increase the frequency and then the duration of the periods off of CPAP until he is completely off.

From a feeding perspective, Noah is up to 14 mL as of tonight. He's inching toward those full feeds. He continues to tolerate the feedings well. He's got more breast milk in the freezer at the hospital than the nurses know what to do with. I'm sure once he gets going though, he'll burn through that. He will get to try oral feedings next week according to the neonatologist. I suspect that this is more of an issue with his being off of CPAP completely. The swallow coordination comes together at 33 to 34 weeks gestational age and he will be 34 weeks on Saturday.

Missy is continuing to do better. She is moving around a bit better every day. I still suspect that she will be sore for six or more weeks as a result of all of the trauma that she endured. She has a follow up visit with Dr. Heinzel tomorrow and has quite a bit of trepidation regarding that, especially the examination portion. I thank God that she is here to fret over those sorts of things.

She's been having some back pain lately that I think is largely the result of her poor posture. She has been hunched forward since getting home from the hospital due to the pain from her incision. I have been trying to help with some back massage, but I'm not really a trained masseur.

Anna is better today. Her cough and other symptoms have improved. She was happy to see me when I arrived home and reported that she had a great day at school. We will likely not take her to see Noah until Thursday or Friday to allow for resolution of her symptoms. So far, she hasn't seemed to notice it much. She continues to faithfully pray every night that God will "help Noah get better." She's such a great big sister.

My schedule right now is not the best for our family situation. I didn't get out of the hospital until about 19:30 this evening. I went straight to see Noah for a little bit and then came home in time to read Anna her Bible stories. I am thankful that I at least got to visit with them both. There have been times before when I didn't get to see Anna awake for three days. Noah is almost always sleeping right now, so that's not a problem...

Thanks again to everyone who continues to read about Noah. Also, thanks to all our friends for their support in so many things. We can't do this without you. You are God's hands reaching into our lives. I pray that we will be able to reach into yours as well.

Thanks for checking on Missy and Noah today.

Please pray for the following:
Noah's neonatologists and nurses
Missy's OB/GYN, Dr. Heinzel
Strength for our family, especially Missy
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age
Anna's speedy recovery from her illness

"He will call upon me, and I will answer him; I will be with him in trouble, I will deliver him and honor him."
Psalm 91:15

November 12th

Noah continues to make little steps of progress. I suspect that is fitting for such a little man. He was reevaluated today by the pediatric cardiologist because the neonatologist heard a murmur. They repeated an echo and it showed no evidence of the PDA. Also, a portion of the heart that was a bit enlarged as a result of the PDA has returned to normal size. This is great news, though we already knew it over the weekend.

Noah's feeding will be advanced to 10 mL every 3 hours tonight. That's roughly 1/3rd of an ounce. His goal is going to be something on the order of 35 mL every 3 hours I suspect. So, we are a bit under 1/3rd of the way there. How often do we take a drink and it is far greater than Noah's goal volume for 3 hours!? This guy is little...

His CPAP "remains" at 5. The catch with that is that tonight when I went to see him his mask was not fitting very well. He was breathing fairly well and the CPAP was reading 2 or 3. This means that he can get by with less than the 5 that they think they have him set at. With this in mind, I am hopeful that he will be weaned in the next 24 to 48 hours.

All in all, I feel like little Noah is making some strides, small though they may be. It reminds me of my best friend's mantra of "slow and steady wins the race." I can't tell you how many times he recited that when he was first getting to know his wonderful bride Meredith. It applies aptly to Noah. We're not looking to break any hospital discharge records.

Missy had a pretty good day. She got to spend a good amount of time with Noah. Our friend Heidi took her to the hospital again today. Thanks Heidi for being there to shuttle Miss! We both greatly appreciate it and I'm sure that Noah would too if he knew that you were doing it.

Anna's illness is progressing. She began steroids last night for the croup and her cough has improved; however, she is now complaining that her ear is hurting. I hope that she doesn't have an ear infection. Perhaps she has been sniffling to the point that her ear drum has retracted, which is giving her some discomfort. I am presently operating on the "don't look at the ear drum and it won't be infected" sort of premise. She is somewhat cranky and looks a little ill tonight. I pray she gets better soon. It's hard to have Anna ill and Noah still in the hospital.

I spoke with my mom at about 19:30. She was in Detroit. It appears that the plane she was supposed to leave Philadelphia on was delayed coming in and she therefore didn't get out of Philly in a timely manner. She missed her flight in Detroit, but was rescheduled for a flight to get into Knoxville at 10:55. She was in good spirits and even alluded to future trips up to visit. That's exciting. I want to take the opportunity to thank Hobie for driving my mom to the airport. Hobie runs a not-for-profit shuttle service to the Philadelphia airport it seems.

I hope everyone reading Noah's blog is well. Thanks again for caring about our little man. I can't wait until he gets the chance to meet you all.

Please pray for the following:
Noah's neonatologists and nurses
Missy's OB/GYN, Dr. Heinzel
Strength for our family, especially Missy
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age
Anna's speedy recovery from her illness

"The LORD is my rock, my fortress and my deliverer; my God is my rock, in whom I take refuge. He is my shield and the horn of my salvation, my stronghold."
Psalm 18:2

November 11th

Happy Sunday evening to everyone. Today has been a good day. Noah's exam today continued to be consistent with the ductus arteriosus having closed, so the neonatologist decided to begin advancing his feeds. This is great. Hopefully this is the last we'll have to think about the PDA.

They increased the frequency of the feedings yesterday to every 3 hours, which is likely where it will remain. Today, they started increasing the volumes. He is going to be increasing by one mL every 12 hours for now. We'll see how he tolerates that. He should start growing a bit more once the feeds are where they need to be, though it will take some time to reach that goal rate. Today, he weighed 3 lb 6.7 oz (1550 grams), so he is slowly gaining. We'll take what we can get, but I would like for him to be gaining a minimum of 30 grams per day.

He continues to be on the CPAP of 5. This was increased yesterday from 4, but I'm not sure that he needs it. Half of the time that we were there, the CPAP machine was reading 3 or 4 and he was doing fine. I am hopeful that tomorrow or Tuesday they will wean that down and he will be off CPAP by the end of the week.

With the obvious exception of Noah, our family was able to attend worship this morning. That was great. Missy was really emotional during the service. She later told me that she was "just happy to be here." By "here," she meant alive. I assured her that I was happy too. We were able to visit with so many of our friends. We were encouraged by everyone who continues to pray for us. It's one thing to know that people are praying for you during times of trial, etc. It's something different when people take the minute to let you know they are praying for you. We are so thankful for all of you. If you are taking the time to read this, I am quite sure that you are praying for Noah and our family. Thanks. I can't verbalize how much that means to us.

Anna appears to have croup. She awoke last night with a textbook example of a croupy cough. I debated taking her to the emergency department, but decided to hold off. I talked to one of my friends from work asked him to call in some steroids. She has taken her first dose and hopefully we will be able to get passed this croup without any further intervention. Croup is a viral illness most commonly caused by parainfluenza virus. The steroids won't cure the viral illness, but they will help with the swelling in the airway that is the issue of concern. Since she is ill, we aren't going to be taking her to the hospital to see Noah for several days. This virus, and the other types that cause croup, can be quite severe in little fellows like Noah. She didn't seem to be bothered by it today, though she was accompanied by her friend Cathy Lathbury while we were gone so it was more of a fun time for her. Thanks Cathy!

I think that my mom has thoroughly enjoyed her visit. She is heading back to east Tennessee tomorrow and we likely won't see her for quite a while. I suspect the little man will at least be sitting up and doing other tricks by that time. Please remember to pray for her as she flies tomorrow. She's already getting nervous at the thought.

I want to take the opportunity to thank all of our friends/family at Grace Chapel who have showered my mom with the love of Christ. I have overheard her talking to multiple people on the phone and telling them how wonderful everyone here is. It's really been great for her. I told her that Hobie had suggested that she move up here because she "fit right in." She laughed heartily at the thought of that, but I know that it meant a lot to her. Thanks again. Your love for us and for my mom whom you do not know reminds me of John 13:35:

"By this all men will know that you are my disciples, if you love one another."

While we were at the hospital today, Missy held Noah for about 30 minutes. He snuggled up to her and was snoozing soundly. Mom remarked several times about how small he looked. It brought to mind some verses from Psalms.

"For you created my inmost being; you knit me together in my mother's womb. I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well. My frame was not hidden from you when I was made in the secret place. When I was woven together in the depths of the earth, your eyes saw my unformed body. All the days ordained for me were written in your book before one of them came to be." Psalm 139:13-16

Little Noah is fearfully and wonderfully made. We fret over things like how much feeding he's getting and what his CPAP setting is. Almighty God has ordained all the days of his life and He knows exactly the steps that Noah will take. More than we could ever love him, God has loved him. He has known his smile, his voice, his laugh before we ever saw him. He has held him, and continues to hold him in the palm of His hand. How wonderful and loving is the God whom we serve!?

Thanks for checking on Noah and Missy today.

Please pray for the following:
Noah's neonatologists and nurses
Missy's OB/GYN, Dr. Heinzel
Strength for our family, especially Missy
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age
Nana's flight back home

"The LORD is my light and my salvation— whom shall I fear? The LORD is the stronghold of my life— of whom shall I be afraid?"
Psalm 27:1

November 10th

Noah's up to 3 lb 5.8 oz (1526 grams) as of last night. They weigh him every night, so I don't know what he is for today yet. I am hopeful that this represents some actual weight gain and not just fluid retention. These little guys can have significant fluctuations in the fluid status, which would be reflected in their weight.

They are slowly increasing his feeds. He is now up to being fed every three hours. He is only getting 2 mL (less than 1/2 teaspoon) per feed. I'll be glad when the feeds can start being increased in volume and not just frequency.

He remains on CPAP. The nurse reported that his breathing was a bit more labored today, so they increased the pressure from 4 to 5. She also mentioned that the prongs were not in place, so hopefully that was actually not required. We will see what tomorrow holds from a respiratory standpoint. It's possible that some of that weight gain could be a bit of fluid in his lungs that is causing his breathing to be more labored. I'm sure that they will get a chest xray to check on that in the morning.

Noah is receiving his third dose of ibuprofen tonight at 20:00. This will complete the second course for treatment of the PDA. His blood pressure looked good today and his pulse didn't suggest a PDA. I listened to him when the took him off of the CPAP for a second and couldn't hear a PDA. I pray that it is completely closed. These things can be evanescent such that they are open at one point and closed at another.

Missy spent some time doing the skin-to-skin holding again today. I think that is really good for them. The nurse was trying to convince me to give it a try, but I was able to hold my ground. I feel as though I might be sucked into it though. The little guy is so cute, you just want to hold him close and nuzzle with him.

Anna and I took my mom for a little tour of Philadelphia after we went to see Noah. We drove by CHOP and through the University of Pennsylvania. We roared down Chestnut to Independence Hall and she saw the Liberty Bell. We then came back up Arch Street and drove up Ben Franklin Blvd so she could see the Art Museum. I couldn't convince her to get out and run up the steps like Rocky, though. We took West Riverside Drive and looked at Boathouse Row. There were several eights out rowing, likely as part of the Frostbite Regatta that was held today. We ended up coming along the Mainline and cutting by Merion Golf Course before coming back home. Anna did most of the touring with her eyes closed and a loud snore emanating from her mouth, but a good time was had by all.

Thanks for checking on Noah and Missy today.

Please pray for the following:
Noah's neonatologists and nurses
Missy's OB/GYN, Dr. Heinzel
Strength for our family, especially Missy
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age

"But as for me, I watch in hope for the LORD, I wait for God my Savior; my God will hear me."
Micah 7:7

November 9th

Today has been a good day. It hasn't been filled with great news or anything, but I feel that there is some on the horizon. Noah's blood pressures are the best that they have been. I listened to him tonight and could not detect a murmur that would suggest that the PDA is still present. He received a dose of ibuprofen at 20:00, which was after I listened to him. He will get another dose on Sunday.

Once the PDA is closed, I think things will start moving for the little man. He will be able to get fed more. He will start trying oral feeds this next week. Once he is receiving feedings at a normal rate, he will have his belly button IV removed. I feel like it's all about to happen. That's encouraging.

The nurse said that they will try to wean him off of the CPAP over the next couple of days. That would be great as well because it will decrease the air in his stomach and help him more readily able to tolerate larger volumes of feeds.

Missy and my mom felt that Noah's color was a bit better today. That made them feel quite encouraged. While I agreed that he looked a little bit better from a pigmentation standpoint, I suspect that part of it might be that his bilirubin level has increased a little since the high beams were discontinued yesterday.

Missy had a pretty good day. She was able to spend quite a bit of time with Noah and helped in his care. She also has had improvement with her pain, so she's getting around a little bit better. The four of us (Missy, Anna, my mom, and myself) went to eat at Anna's favorite restaurant, Peace A Pizza. Miss tolerated that well and we then went to Target to procure some items. Thanks mom for the gifts!

We continue to be extraordinarily blessed by encouraging friends and family. God has put us in a wonderful place surrounded by amazing people "for such a time as this." When we moved here from Memphis, we never anticipated that we would have such wonderful friends. Now, we can't imagine ever leaving all of our friends here. You all are such an amazing blessing. Our friends remind me of verses of scripture from Proverbs.

A friend loves at all times, and a brother is born for adversity. Proverbs 17:17

A man of many companions may come to ruin, but there is a friend who sticks closer than a brother. Proverbs 18:24

Recently, Miss has been able to spend a good amount of time with someone who has rapidly become one of her dearest friends; Julie Fernandez is that friend. It's really been great to get to talk with Missy as that friendship has grown and deepened. They have gotten to share a lot of their experiences during this trying time, as well as before the recent events. I really think that the Lord is using them to sharpen each other, and that's exciting. As a husband and friend of my wife, it delights me immensely to see her develop such meaningful and deep friendships. I praise God for such a wonderful friend as Julie.

Thanks for checking on Noah and Missy today.

Please pray for the following:
Noah's neonatologists and nurses
Missy's OB/GYN, Dr. Heinzel
Strength for our family, especially Missy
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age

"For I know the plans I have for you," declares the LORD, "plans to prosper you and not to harm you, plans to give you hope and a future. Then you will call upon me and come and pray to me, and I will listen to you. You will seek me and find me when you seek me with all your heart. I will be found by you," declares the LORD.
Jeremiah 29:11-14

November 8th

It's a late entry tonight, but at least I'm getting to it. We had a great time at our praise team Thanksgiving dinner. We are a couple of weeks early for the official Thanksgiving, but it's never a bad time to be thankful for all that God provides.

Missy has continued to improve in her ability to get around. She was able to attend the dinner without much discomfort until near the end. She began to have a fair amount of pain at that time. She, Anna, and my mom headed home while I stayed to practice.

Miss was able to spend a fairly long period with the little guy today. Emotionally she continues to have a rough time with Noah's general state and the fact that he has to stay at the hospital. I pray that God continues to give her strength in this trial. She's been through a huge amount and I know that it is difficult for her.

After our visit last night, I felt good that Noah's PDA had closed. However, this morning they heard a murmur and a repeat echo showed that there was a 1 mm PDA. Noah is undergoing a second course of ibuprofen. He will receive that nightly for three nights again. Clinically, he looks pretty good, though the difference between his upper and lower blood pressure numbers was quite wide today.

He continues to only receive about 2 mL of milk through the tube every 6 hours. He is getting almost all of his nutrition via the IV in his belly button. Once that blasted PDA closes, they will begin to ramp up his feeds so that the IV can come out. Also, he will get to start trying to take some feeding by mouth this coming week since he will be 33 weeks gestational age on Saturday (they normally start trying to feed by mouth between 33 and 34 weeks). Apparently when Miss visited with Noah today he started to root around like he was trying to nurse. That's a hilarious image to me; the little guy rooting around like he's on a mission... Miss keeps putting him back up and he keeps rooting down. "Hey mommy, I've got something I'm trying to do here!"

He was taken off of the phototherapy lights today. That's a step in the right direction. He was resting quite comfortably in his isolette when we saw him and it was nice not to be blinded by his phototherapy. Those lights make it look like "Close Encounters of the Third Kind."

As an aside, does anyone know what close encounters of the first, second, or fourth kinds are? Also, how do you have a distant encounter?

I had some things that I was going to discuss in the blog tonight, but those will have to wait for a later time as I'm a bit tired this evening. I am so thankful for everyone who continues to be such an encouragement to our family. We greatly appreciate the prayers, visits, calls, etc.

Thanks for checking on Noah and Missy today.

Please pray for the following:
Noah's neonatologists and nurses
Missy's OB/GYN, Dr. Heinzel
Strength for our family, especially Missy
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age

"I have told you these things, so that in me you may have peace. In this world you will have trouble. But take heart! I have overcome the world."
John 16:33

November 7th

Missy is beginning to get around more readily now. She is having less pain and has only been taking ibuprofen. She was able to get a shower on her own this evening as well.

Today, Miss went to the hospital to visit the little guy and was able to hold him for about an hour. She was able to hold him "skin-to-skin," which greatly improved her spirits. It has been extraordinarily tough for her to leave Noah at the hospital. Today was very good for her. I think that she was longing for bonding with him and it seems that she got that to some extent. Apparently they let dads do the "skin-to-skin" thing also, but I don't know if the little guy wants to be rooting around in chest hair; the poor chap would likely be scarred for life. I think I might stick with the more traditional form of holding for now.

From the reports that I have received via Miss & hospital email, Noah seems to be doing okay. He is up to 3 lb 2.9 oz (1443 grams) today. His feeds have been decreased to a very minimal amount. I am planning to interrogate the staff tonight when I visit to find out if this is due to Noah's poor tolerance of the feedings, or if it is due to reservations as a result of his receiving the ibuprofen.

The nurse at the hospital reported to Missy that Noah has less of a murmur and the neonatologist feels that the blood pressure is better now; that is to say that they feel the PDA is closing. I am inclined to evaluate the squirt when I get there for myself. I certainly am hopeful that the PDA is closing, though. That will be one less thing to check off of the list.

Noah's bilirubin has remained at 3.6 under the lights, but the staff apparently want to keep the lights on while he isn't taking much feeds. Their concern is that the bilirubin may build up if he doesn't have a lot of feed going through his gut. Bilirubin is broken down and excreted in stool. I think they are just trying to give the guy a sun tan so he won't be a pasty little white kid...

From a respiratory standpoint, Noah remains on CPAP. He only had one episode of apnea (forgot to breathe) with bradycardia (slow heart rate) yesterday, which is great. I suspect that they will keep him on CPAP for a couple of more days, depending on how his respiratory effort is. With the closure of the PDA, his respiratory status may improve and that would enable him to come off of CPAP more readily.

My mom (a.k.a. Nana) is en route from her connection in Detroit right now. Her first leg from Knoxville went quite well. She had a visit from Mr. Benzo prior to boarding and then was blessed with the company of a man who talked with her the whole time to keep her mind off of the flying. She sounded great when I spoke with her in Detroit and I'm sure that she's quite excited to get to visit with Anna and Noah.

Thanks for checking on Noah and Missy today.

Please pray for the following:
Noah's neonatologists
Missy's OB/GYNs, Drs. Laveren and Heinzel
Strength for our family
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age

"Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus." Philipians 4:6&7

November 6th Photos

Missy Is Home

The first step in getting our family all together has happened. Missy came home today! Four days ago she was in dire straits and the possibility of her not coming home was quite real. Now, 96 hours later, she is resting in her own bed. I am so thankful to have her home. I'm so thankful to have her...

Leaving the hospital was a bittersweet event for Miss, as was expected. She is having a tough time leaving the little guy at the hospital. As I mentioned previously, knowing in your head that it is better for him to be at the hospital and believing in your heart that it is true are two separate things. I pray that she would be encouraged about it all.

We were able to come home to a fairly clean house; I spent this morning vacuuming, sweeping, mopping, washing, drying, folding, storing, organizing, etc. Thanks to my mom and grandmother, I have more domestic skills than I really want. It would be much easier if I could say, "Oh, I would have done [insert random household chore here], but I just don't know how." When you are doing it out of love, it's not nearly as much work though. The thing is, Anna will come home from school and be able to transform everything into a disarrayed mess in a flash. She is simply trying to obey the second law of thermodynamics and increase the entropy of the system. Who knew we had a little physicist living with us?

Missy and I had a wonderful lunch consisting of homemade chicken soup. Our good friends Scott and Karen Alexander brought the soup over a couple of evenings ago. It was fabulous. Unfortunately, we scarfed every last drop of it, so I'll have to get the recipe from Scott.

Today when we visited Noah he was doing fairly well. The most notable change in his status is that he was placed back on nasal CPAP. Last night he was having increasing difficulty with breathing, so the decision was made to resume the CPAP. He looks much more comfortable today with his respiratory status as a result. I had the opportunity to see his chest xray and it looks like hyaline membrane disease (a.k.a. respiratory distress syndrome). This is fairly common in these little guys. Hopefully Noah will be on CPAP for a few more days and then will come off for good.

Noah received his first dose of ibuprofen last night. He will receive the second dose tonight and a third tomorrow night. I didn't examine him today, but the neonatologist said that he still has a murmur. The difference between his systolic (upper number) and diastolic (lower number) blood pressures was less than it had been over the preceding couple of days, so perhaps the PDA has decreased in diameter with the first dose of ibuprofen. We'll have to wait and see what we have after the three doses. I spoke with the neonatologist regarding the plan should this course of ibuprofen not close the PDA. She is inclined, as am I, to try a second course. Let's hope that the first course does the job.

While he's receiving the ibuprofen and is on CPAP, Noah's feeds have been decreased to 5 mL every six hours (he's still receiving nutrition via the IV in his belly button). Think about that. Five mL is the volume of a teaspoon! Of note, Noah's weight was back up to 3 lbs 1 oz at his nightly weigh-in yesterday. He's going to be huge in no time...

In other news, my mom is going to be flying up tomorrow night to stay with us for a few days. She's going to be helping Miss get around the house and will be playing with Anna. This is a huge thing for my mom. She has what could only be described as severe, if not paralyzing, acrophobia (fear of heights) that she acquired in elementary school. The story, as I recall it is that she went on a field trip to a fire tower (who thought that up?) and a kid pushed her out of the top. Her sweater caught on a rivet and she was dangling high above the ground by this sweater. Thank God for well made sweaters! Anyway, since that time she has been terribly afraid of heights and has never gotten on a plane thereafter. However, because she wants to help us out and also see Anna and Noah, she's hoping on a plane. I'm looking forward to having my mom up for a few days. I'm sure that she and Anna will have a big time.

Thanks for checking on Noah and Missy today.

Please pray for the following:
Noah's neonatologists
Missy's OB/GYNs, Drs. Laveren and Heinzel
Strength for our family
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age
Peace of mind for my mom as she flies to Philadelphia

"Do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand." Isaiah 41:10