Encouraging News

Last Thursday I arrived home to find a positive message left on our answering machine by James' Lung Specialist.

Last Monday I had taken James in for blood work before he went for his J tube change. The Specialist called to say that the blood work looked very positive and so she was wondering how James was actually doing clinically. In the blood work they evaluated whether is seems that James' body is having any sort of reaction or negative side effect from the treatment. This all came back looking fine and so they feel it safe to continue with the treatment.

The part of the blood work that they were most excited about was James' LDH (Lactic acid dehydrogenase) levels. This is an enzyme that is important in energy production in cells. LDH levels are monitored with PAP, these levels are often high when a person has PAP. LDH levels can be high for many reason and in many diseases and therefore do not give any sort of diagnosis, but are monitored once a diagnosis is made and treatment is being done. James' LDH levels were high already when we were trying to diagnois him last year and this is why they did a bone marrow biopsy as that time. After he was diagnosed with LPI these high levels seemed to have been forgotten ... until I started reading about PAP and a couple sites said how these levels were usually elevated.

So the phone message said James' LDH levels had dropped and they were happy with what they were seeing, at the same time they were hoping that my report would be just as positive. Unfortunately I was not able to call back with a very positive report, as clinically James seems to be going downhill. When James came home from Sick Kids he was on 1/8L oxygen. We had a short period where he was able to go without oxygen but then he once again required it 24 hours. Slowly his requirement went up to 1/4, next to 1/2 and now we're seeing him on 3/4L more often (and since Thursday when I called to give my report we've had to put him on 1L a few times).

As I mentioned in my last post James' vomitting had pretty much stopped, but as I evaluated my notes closely I came to see that as his vomitting amounts decrease his oxgyen requirements increased, and since the vomitting had stopped it increased even more. So although it was very difficult to watch him choke and gag each day, this did seem to be doing something good for him. Since I called on Thursday we've begun to see small vomitting episodes in the morning again ... but his oxygen requirements have not been better on those days.

The other not so positive things were the fact that we've been seeing a rise in his temperature lately. Occasionally in fever area, but usually hanging just below that area ... but stil higher then his norm. Along with this we're seeing his BPM (breath per minute) go up from 60 to the 70-80 area. James is basically housebound as even a short trip outside seems to deSAT him and once he deSATs we have to sock the oyxgen to him for the rest of the day.

So from our prespective the last weeks have been discouraging, yet the doctor comes with encouraging news. When looking at Jame's LDH levels in July he was 3700. For his age the normal woudl be between 500-900. She did not have the results in front of her when I called but she was pretty sure that they were below 1000. This is pretty much back into the normal range and this was why they were so excited and gave us a call. We like to see these discouraging times as temporary. One theory can be that the treatment is working but since it is loosening everything up it is making it difficult for him to breath at this time .... but with time it will improve again as we get rid of all that sits in his lungs. We really have no idea, it's all a guessing came. This is just a theory and unfortunately we have no idea and so we just keep working with the situation and praying and praying that indeed things will improve.

The higher oxygen requirements mean another change in our house as we will need to change the way we get our oxygen. On low amounts we can just use smaller more portable tanks, but now we are going thru far too many and need to get a larger non-portable tank or an actual machine that converts the oxygen (not sure how that works, we'll see). Of course we'll still need the small tanks for when we go out etc, so we also have to continue to store these somewhere. We're left scratching our heads again wondering where we're gonna fit this change in our already congested house. We're often left wondering if it's time to move (as must as we rather not). We must be hitting the three year mark ... seems every three years we find ourselves dealing with this question.

I should just update on the G-tube situation. It's going well and we're glad we made the change. James continues to pick at foods. He is not eating much, but he's showing interest, trying foods, eating a few bites here and there ... all very postive after not touching a thing for two months. At this time we don't expect him to eat much as we are still "stretching" his stomach (not that we really ever expect him to eat much as he never did before either). After two months of not using his stomach it would have shrunk and so as we slowly increase the rate we feed him at we also increase his stomach size back to what it was. As we increase the rate we give him more time off the pump, which right now we mostly do at night so that his stomach is empty in the morning in case he vomits. As we suspected the vomitting is related to his lungs and was not due to the j-tube.

Coincidence??

Today James went in to have his J-tube removed and a G-tube put back in. I must say I was dreading this appointment but it went much better then expected.

After having tried to pull the J-tube ourselves and being unsuccessful I was worried about how much it would hurt James to get it out. It seems that we just needed to be a bit braver and tug a bit harder and we would have had it out on our own. Once the balloon was deflated it bunched up a bit at the bottom and that's why we had trouble getting it out, a good tug and it was through. Radiology did use a guide wire when taking it out, we're guessing this was to help prevent any sort of shifting of his stomach while it was being done. Whatever the case we're now back to a g-tube ... again our nice Mic-Key Button kind. Upon looking at the size of the tube that they withdrew from James' stomach it's no wonder the child was moaning and complaning, it was much larger then the first j-tube they put in ... quite large for such a little guy.

A couple hours later James asked for a cracker from his diaper bag and then proceeded to actually put it in his mouth ... not just a lick, not just one bite ... he ate half the cracker. A hour later he sat down for snack with the girls and ate a few rice krispies and drank some juice. At supper time he asked for Ranch Salad dressing, licking the lid when finished pouring it and judging from what was on his face he also licked up some of what he put on his plate. He had some rice, eating one piece at a time ... only amounting to maybe 10 little pieces, but they went in his mouth and he didn't spit them out again. To the average person this means nothing, but to us it's a big step for a boy who we flood with praise when he takes a tiny nibble or lick of something. All this in one afternoon after two months of refusing to touch food, only occasionally licking something and seldom swallowing it, with the occasional sips of juice. Coincidence?? Only time will tell.

We continue to remain thankful for the surgical backlog when we were in hospital. If there had not been a backlog James would of ended up with a fundoplication instead of just a j-tube. He went through alot to have the j-tube placed, but it was a reversible treatment ... the fundoplication would not have been. Time and again we are reminded of how good it is that this surgery did not happen ... especially in light of James' daily vomitting, which a fundo would make very difficult to almost impossible, never mind how painful. Only with time will we be able to tell if the move back to a g-tube was a good move, but we are quite confident that we've made the right decision.

Speaking of vomitting ... for over a week now James is no longer vomitting daily in the mornings. We have had several vomitting episodes. A couple in the late evening after he receives his last medication for the day (on a bright note when given it tonight he didn't even moan, cry or move ... something he always did before). We're not sure what brings on the late night episodes. A few other episodes happened after he got overly worked up, from being hurt or disciplined. But it seems that this situation is getting better ... of course we were never really able to determine if it was a good or bad thing ... good because he's getting rid of the stuff in his lungs ... bad because, well, why was it happening?

And now I must get to bed for some of that much desired and often lacking sleep.

Nothing New!

Not much new to report from here. We packed in five appointments in three days so far this week ... so hopefully we can enjoy the next two days off! :)

Only one of those appointments was for James and it was nothing major, just a pediatrician appointment, mostly just to review what's been going on as she doesn't get the information as quickly now that it has to come from Toronto. We have decided to pull the J-tube and go back to a G-tube and she was in agreement with our decision. For three nights we did not feed James and he slept peacefully. He did call us once or twice, but for no reason other then to make sure we're still around. The J-tube is not sitting well with him and by stopping the night feeds we are losing more feeds then what he might vomit up if on G-tube feeds. At the same time we will likely go back to bolus feeding instead of continous feeding. This means that we would give James four "meals" a day instead of having the pump run most of the day. Since James cannot tolerate his feeds too quickly that would mean that each "meal" will take approximately 1 hour and 45 minutes to pump into him. Previously we were unable to get the full volume that James required into him by doing bolus feeds, but at one point he was growing okay on what we were giving him so there wasn't much concern to meet the required volume. Since James is no longer growing full volume has now become a priority and we have worked to concentrate his formula so we can get the proper nutrition into him and at the same time keep him properly hydrated. We hope that he can go back to the bolus feeds as he had as this in our opinion is a more normal and natural way for a persons body to function. We have never cared for the idea of continous feeds because it just didn't seem proper to feed a person around the clock ... but then nothing with James (or most g-tube people) is normal so we had to give in when continous feeds seemed the only way to help him grow.

So that being said James is scheduled to have the tube change done on Monday. From there we will see what his stomach can handle and work on his feeding schedule so we feed him as minimal as possible at nights ... allowing his gut to rest and hopefully preventing him from vomitting up feeds in the mornings. We will have to start on continuous feeds but hope to work towards bolus feeds over time.

For the past week James' vomitting has been somewhat better. He is either not vomitting or vomitting less, especially less bile. He wakes up with quite the froggy in his throat and sometimes vomits up phlegm, other time the froggy just goes away with time. We try to teach him to cough it out of the way, but he won't cough for us ... likely fear that it will cause him to vomit. The discouraging news is that he's been requiring more oxygen lately to keep him stable. It also seems that he really can't handle the outside air. We had been looking forward to the heat leaving and to fall coming ... but even yesterday on a rather cool and breezy day he still would deSAT on us if we didn't crank up the oxygen while he was out there.

But yes, didn't I say not much happening here ... and really not much, just appointments and regular hectic life of having four kids, one being a (sort-of) newborn. Matthew is now three weeks old and weighed in at 8lbs 10oz on Monday. Matthew is a medicore kind of baby. He does sleep throughout the day so we do have peaceful times, but when awake he's either eating or being held. He goes into panic mode and screams up a storm about 30 seconds after being put down ... we've got some training to do in that area ... for now his adoring sisters are quite happy to hold him and keep him quiet. Thankfully I have these helpers, otherwise I'd would be complaining more about him ...or just simply going crazy listening to his screaming. He continues to like to feed frequently, altho this has gotten somewhat better ... he has cluster feeds and then goes for 3 hours ... and we're even gotten some longer 7-8 hour nighttime stretches a few times. They grow up so fast so we're trying to remember to cherish this time and not let our upsidedown lives get in the way.

Not an uncommon sight in the evenings. Matthew loves his tummy and loves to snuggle on a persons chest or shoulder, especially daddy's. Rob likes it too .... it's an excuse to snooze away the evening without feeling like he wasn't doing anything :)

CT Scan and Lung Specialist Visit

It's hard to say whether todays visit brought favourable results. I guess it's easier to say that they didn't bring unfavourable results.

James did relatively well for the CT Scan. He lay nice and still. He had to have his hands up over his head, but he did okay with this also. He cried throughout the scan, which made it a bit harder to get a good pictures, but they were happy with what they were able to get. We were very thankful that he was so cooperative and hopefully after a few times of doing this he will be more calm knowing that it won't hurt.

Because James' last CT Scan was done at Mac on a different system our doctor was not able to pull up the pictures of both scans and look at them side by side, instead she had to go by memory when reviewing them. She felt that todays imagine was about the same or maybe slightly better. Of course we would have liked to hear that there was an obvious improvement, but what we did hear today can still be considered positive. In March and June James had CT Scans done and the June CT showed significant progression of the PAP. This was over a three month period. So that fact that todays scan was not worse is considered positive. Another thing to consider is that previous CT's were done sedated and todays was done unsedated. Unsedated makes the pictures less clear because he will still have slight movements, and the fact that he was crying makes it even worse. So todays pictures may not be as clear and with that in mind could be better then we think.

Based on this we cannot say for sure that the GM-CSF Treatment is actually working, but at the same time we cannot say it is not working either. She felt it was still early and there is no reason why we can't carry on with the treatment. At the same time she felt it was too early to make a call to move on to doing a Whole Lung Lavage (this is where they wash out the lungs), especially considering the risks of this procedure, which she was clear in pointing out that these risks include death. If successful this treatment could be very beneficial, but at this time we are not out of time and options and so we do not need to move to such a dangerous procedure. The plan is to carry on with the treatment for another two months. They will re-evaluate each month, doing another CT Scan at the end of two months.

It is felt that James' vomitting is indeed related to his treatment. This in light of the fact that recent vomits have been more of a white foamy phelgm or phelgm chuncks and less bile. The foamy phlegm is characteristic to PAP. Likely he is throwing out the bile because he is heaving so hard. We discussed the G vs J tube. She still maintains that James does not need a J tube ... but (yes, there always seems to be a but to make decisions so much harder) ... our concern is that if we go back to a G tube he may start hurling out his feeds, thus losing precious calaries. On that note, I weighed James yesterday and much to our disappointment he has not gained any weight but is still 10.7kg (23lbs 9oz). Today we measured James and found he has growned 3 cm and is 86.5cm. So in light of the fact that he is still not gaining weight we really can't afford to lose any of his feeds from him throwing up. As well, throwing up formula each day can get a bit hard on the esphogis. She felt that this concern about vomitting was valid but at the same time we have to bear in mind the moaning and groaning he does and how the tube is effecting him. She left it in our hands to decide what we would like to do, suggesting that it may be a good idea to wait another month before we pull the j-tube and hopefully by then the vomitting has settled a bit.

The J-tube can come out but we could end up with bigger vomits then. At the same time, each night we turn off James' pump for a period of time because he is moaning and so we are losing feeding time each day because of this. We will have to do some thinking and evaluating to decide if there is a way we change James' current feeding pattern to allow us to stop feeding him part of the night and so allow his stomach to digest the food in it before he wakes in the morning and throws up. The G-tube has the advantage of allowing more feeding flexibility, as well we were able to feed him at a faster rate allowing him more time off his feeds each day, which would mean we'd have more flexibility for taking him off feeds at night. Previously we strived to give him as many hours as possible off his feeds during the day because then he could run and play, but now that his is hooked up to oxgyen pretty much 24 hours of the day it really makes no difference if we feed him all day as well. We'll have to do some thinking over the next few day ... just never seems to be any straight forward answers around here.

We remain thankful that we did not receive a negative report today and continue to pray that the next couple months will bring a clearer and even more positive result. We continue to look to Him who is in control of all things, knowing that James is in His care.

J-Tube Study

Well, much to our surprise, we managed to get the J-Tube Study done today. The results show that the tube is in proper place and they do not see any problems with it.

James did well for the study. I was worried how things would go and how this would effect tomorrow's CT Scan, but I think it went okay and hopefully will be helpful for tomorrow. I got the typical repetative "no hurt, no hurt" already before we arrived at the hospital (before the hospital was even in view and I even took a different way then normal). The "no hurt, not hurt" continued on as we arrived, checked in, and waited. Finally he was distracted by someplaying and colouring ... only to start again when they brought us to another waiting room. And then when we finally got in for the test it was in the same room where they originally put the j-tube in ... where they attempted to sedate him and later had to put him completely under by general anesthetic ... so of course he paniced. But even though he cried through the whole thing and continued to say "no hurt, no hurt"... and it broke my heart listening to him ... he did lay completely still. The test was quick and did not hurt, just as I promised.

I told them right away that if they needed to pull the tube we wanted a G-tube put in, not a J. So then I had to explain why I wanted this. They did the test and found everything okay and then consulted with the GI Doctor because I had said I wanted the J-tube removed. He gave the go ahead to do this, but unfortunately (and fortunately) the could not do it today. Why they couldn't have just given the go ahead before we did the test is beyond me.

They could not do it because they explained that since James' J-tube had only been in a short while they have to do a different/longer procedure to put the G-tube back in and they did not have time today. I did not totally understand the reasoning behind this (the trouble with foreigners who cannot clearly explain things to you). He talked about the stomach collapsing because the J-tube was in less then 3 months. I'm not sure if this would happen when you pull the tube or when you put a g-tube in. Regardless it seems it's a good thing we didn't manage to get the tube out on our own last week. He did say that there is nothing behind the balloon and likely James' hole just closed up a bit too much and they'll have to give a good tug to get the J-tube out. This is where it's fortunate that they couldn't take it out today. If James had been "hurt" today he would have no faith in us tomorrow and would definitely not cooperate for the CT Scan. So they are going to call us back and hopefully get us in sometime next week to do the switch back to a G-tube.

Tomorrow is our big day off to Toronto for another CT Scan and an evaluation of James' treatment. As mentioned before this CT Scan will be done unsedated and we will only get results if James lays still long enough for the pictures. If he does as he did today then we should be able to get some good pictures. Please pray for James ... that the test may go well and most of all that we may receive favourable results regarding his treatment.

Baptism

Yesterday we had the opportunity to present Matthew for baptism. It is a reminder to us that God has made a covenant with us, an eternal one, and therefore we do not have to despair when we are burdened by the brokeness of this life. He claims us for himself, and will also provide for us when we live in obedience. Although we have received a full plate from our Lord, we can still profess that "our cup overfloweth" (Psalm 23.:5). All gratitude is to Him, who has provided for us in mulitple ways.

Matthew took this opportunity to introduce himself but letting everyone know what a good set of lungs he has (he's had lots of practice :) I had nursed him just before we came into church ... but nursing isn't working all that well and it proved not to be effective once again. To make matters worse I had forgotten the back-up bottles at home. Thankfully we realized this as we got to church and so we sent my dad to the house to get them. They arrived a few minutes into the service, after Matthew had made his presence known. Everyone knew when the bottle arrived as it was instantly quiet. This kept him quiet until after the service. After supper he started again on one of his hourly feeding binges ... and for those who think formula lasts longer ... not for this child. But, after all his fussing he slept 8 hours last night!! And seeing as I went to bed very shortly after he did ... that means I got a decent sleep too!! :)

We didn't get any good pictures yesterday ... it was just too busy to bother with pictures.

J-tube

We finally made up our mind. Instead of chasing after having James' j-tube tested and having him go through yet another round of x-rays and trauma we decided we would just pull out James' j-tube and put a g-tube back in.

So, on Friday night we prepped all we needed for the change and went to work. Only to find out that they really took us seriously when we told them we wanted a tube that was secure. We deflated the balloon which holds the tube in and tried to pull the tube out. After some tugging and cries from James we realized that there was another disc after the balloon which would not allow us to pull the tube out. This caused a bit of panic as we worried whether we'd be able to put it back in or if we had dislodge it from it's place in the intestine. But we were sucessful in pushing the tube back in and inflating the balloon again.

We restarted his feeds and everything has been going fine. So we're still stuck with a j-tube. We were suppose to get a call on Thursday or Friday to have the tube checked, but we did not get a call and I did not chase after them since we were just going to pull the tube anyways. Of course ... it's a long weekend and so Tuesday morning I have to get right on it, but I already know it won't get done before Thursday when we go back to see the Lung Specialist. This is really disappointing as we will not have a clear answer about the j-tube and therefore won't be able to clearly discuss what is causing James' vomitting ... altho recently we have become quite confident that it is chest related. Likely the bile comes from the heaving of his chest which also makes him heave out what in his gut.

Regardless of the cause of his vomitting we still would like the j-tube removed as we're seeing a pattern of James moaning and crying at nights. We turn off his feeding pump and he stops moaning. We're not sure of the reasoning behind why he only moans at nights and not during the day, but we definitely see how the tube does not agree with him all the time. He also continues to tell us at times (usually during the night) that he has "owee tummy".

On a happy note, we do think that the continous feeds is working in James' favour. We haven't got a weight on him lately but we are eager to get an updated one as he seems to be filling out and putting on some weight.

Long Overdue Haircut

For a long time I've debated cutting James' hair, but because it's so fine and thin I was afraid he would look awful with it short/shaved. When James is having difficulties with breathing he sweats really bad, and lately every morning with his vomitting spells he would sweat up a storm and then his hair would be greasy and sticky. A morning bath would help, but it wasn't uncommon for him to also sweat his way through nap-time, so finally I decided we had no choice but to cut his hair as it really looked awful most of the time. It turned out to be one of those things that you wish you had done a long time ago ... especially before he was in the hospital where bath times were limited. We're happy with how it turned out.

Before: (Grandma did the actual shaving/clipping. James was quite excited and sat completely still)

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After: (I couldn't get any good ones of after, his hair is too blonde!! These will have to do!)

Matthew

Matthew had a couple appointments this week ... just to keep me busy! :)

When discharge from hospital Matthew's was looking a bit jaundice and a blood test showed his levels were slightly high, so we had to bring him back in on Monday to have him retested. The blood retest showed Matthew's levels to be okay. At this appointment they also did the general baby check-up which bought me a few more days before I had to bring him in to my own family doctor to have his check-up.

Today I brought Matthew to the family doctor for the regular baby check-up that they do after being born. He has caught up to his birth weight again, weighing in at 7lbs 10ozs.

These simple appointments are so nice!! :)

James

Well as I mentioned the appointments haven't stopped just because I'd like some extra rest. Thankfully some things have been done via phone, so I haven't had to go running all over the place.

On Monday I made an overdue call to the Chest Clinic in Toronto to discuss how James is doing. I had wanted to make the call last week as we were becoming concerned about his vomitting and increased oxygen needs. He seems to be getting worse instead of better. I was scared to call because I knew I myself was scheduled to be in hospital and I didn't want them to ask us to bring James back in and him be stuck in Toronto while I was in Hamilton.

James continues to vomit daily, sometimes bile, sometime phlegm. We're having a hard time determining what is causing this. We want to think that it's a good thing as we're loosening the phlegm and it's coming out of his lungs, but all the pieces of the puzzle don't fit together. He continues to tell us at times that his tummy hurts, he doesn't dwell on it much, but it's enough to make us wonder. Lately we've experienced where he moans and groans during the nights, sometimes waking, sometimes not. If we turn his feeds off then he stops moaning. The dietician has suggest that the j-tube could be blocking his intestines, therefore not allowing the bile to get through very well and the excess bile in his stomach is causing him to vomit. This along with his complaining makes us wonder about the whole j-tube. But at the same time, he has a phlemgy sounding cough with his vomits, and you can also question whether the coughing and heaving just causes him to eject whatevers in his stomach along with whatever he can get out of his lungs. On top of the vomitting we've experience occasional fevers. A treatment of tylenol and ibprophen and the fever is gone again, but we're left wondering what has brought these on. And then there's the fact that we're pretty much back to 24 hours of oxygen, sometimes requiring higher amounts then he used to.

After reviewing everything with the clinic nurse she discussed the situation with our Lung Specialist and called me back. They are a bit concerned that things are not going so well. They would like us to have James' J-tube checked for placement before they make any further decisions. We are suppose to go in on August 9 for a CT Scan and follow-up appointment to get a better idea of how James is doing. For now we need to rule out the j-tubes involvement in this situatin, if we can get the j-tube looked at before our they can make a better call on what to do.

The Lung Specialist has previously told us that the j-tube is not necessary as James does not have aspiration pneumonia. So we are left questioning whether it would just be easier to pull the j-tube and go back to g-tube. After all we went through to get this tube in we don't want to make a hasty decision and so we keep hashing it out but come up with no clear answer.

So that being said I had to chase after a few doctors to discuss the situation, but it seems no one wants to make a call on whether to leave it in or not ... almost wish he would decide to play car mechanic again and pull it out ... too bad this one is in so good! I really don't want to traumatize James with another test if unnecessary, but it seems this the route the doctors want to take. I am still waiting back for a call on when they want to do this j-tube study, which involvs putting a dye down the tube and then doing a series of x-rays. Seems it seems the final decision is going to be left up to us and we keep talking about pulling the tube, but don't really dare to.

Yesterday I took James to the ENT (Ears, Nose, Throat) Specialist. This was an appointment we should have gone to long ago. We had requested this referral in March after getting repeated results of fluid behind his ears. I called a couple weeks ago because we never got an appointment and found out the referral never made it to the ENT office. James no longer pulls on his ears and so I didn't know how necessary it was to bother with the whole thing again, but when they squeezed us in quickly I figured it was best just to take the appointment and get our foot in the door.

Here again I learned never to promise the child that there won't be any owees. He has become more and more afraid of doctors and goes into this trance of saying over and over "no hurt" when we get to a clinic or any sort of doctor related place. They had to clean the wax out of his ears. They use a vacuum to do this and said it did not hurt it was just very loud, but regardless they had to wrap him up so he would keep his arms and legs still and then they held his head still while they did it ... that's enough to traumatize the poor guy, never mind the actual noise in his ears. He received a toy boat for being a good boy and walks around proudly with this boat, takes it to bed with him, in the tub with him ... it's very cute ... and he'll point at his ears to remind us of how he got the boat.

At the end of the appointment it was determined that he still has fluid behind his left ear. The right has cleared up. They have put him on the list for tubes, which takes about six months. In the meantime he will have another checkup in 3 months to see if it clears up on it's own. If that is the case we just take him off the surgery list.

One Week Later

What can I say ... life has been extremely busy. Appointments don't stop, neither do the phone calls (medically speaking, not friendly speaking :),rest hasn't come as often as liked and Matthew isn't always as content as wished for. It's not that he's colicy, he just likes to be held and eats freqently ... but it's only been a week, we'll get used to each other and hopefully settle into a routine before long :)

An update is due, but for now I will just post some pictures and relay the happy news that the results from Matthew's urine test show that he does not have LPI. As LPI is uncommon and they are not 100% sure when it would actually show up on the tests we will need to repeat the test again at one month of age to see if we get the same results, but for the time being he is considered healthy!

A couple days old ... still in hopsital:

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Thrilled siblings, always fighting for a chance to hold Matthew ... especially James who loves to hold and watch Matthew, he is completely fascinated by this little bundle.

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A few more miscellanous pics: