Sunday, June 29, 2008

Brief Update

I have to be brief because it's late and I'm worn out but here are the important bits of info for all you Dylan watchers out there...

His weight is up to 2586g or 5 lbs, 11 oz.

He is receiving 48cc of breastmilk with each feeding.

Also, since 6am Saturday moring, he has been feeding exclusively by bottle. His feeding tube has been removed.

This is very encouraging news. It's just more steps in the right direction.

I plan on getting in touch with either Dylan's doctor or nurse practicioner tomorrow to get their opinion on his progress and what it means in terms of his discharge, as well as any other "tests" he may need to pass before he can be sent home.

Anyway, that's all for now. I'll try to post something a bit more detailed tomorrow.

Thursday, June 26, 2008

More Progress, More Encouragement

Tomorrow marks Dylan's 5-week birthday. As of his last weigh-in, he is 5 lbs 6 oz, and he continues to grow with each passing day. He is now eating 45cc of breatmilk with each feeding, along with receiving his multivitamin twice each day. He is tolerating his feeds well, with only slight desats after eating, which may be indicative of a touch of reflux. Yup, the same acid reflux us adults can get after too much chili and pizza, he can suffer from as well. The muscle at the top of your stomach that opens and closes to let food in and keep it in is usually a bit weak on preemies, and it sometimes allows for a bit of "bouce-back" when they eat, which can be uncomfortable, causing stress which leads to O2 desaturation. By itself, a mild case of reflux is not a big deal, as long as it is recognized and treated. Left unchecked, it can cause damage to the esophagus and vocal chords. In Dylan's case, it's not so severe as to cause any concern, other than to monitor his O2 sats and make sure it doesn't progress any further.

His oxygen saturation has become a bit of a focus lately, as he has made good progress over a few other hurdles. While his sats never drop dangerously low, they do drop on occassion, and the docs are trying to figure out why. He does drop a bit after feeding, but not always. Sometimes he drops his sats while sleeping soundly, under no stress at all. Other times it may be a positional thing- he is not in a good position to maintain his airway or he maybe a bit squashed and be unable to expand his lungs like he should. The nurses are tracking the instances of desat much more closely to try and determine a cause.

One possible cause that has been advanced by his medical team is that of muscle tone. A physical therapist has been working with Dylan over the last few days. During her initial assesment, she noted that Dylan had low muscle tone in his upper body and torso. Essentially, by missing out on some of the time that would normally be spent in utero, he is lagging a bit behind in the development of his muscles. Any time a baby in the womb kicks or flails about with their arms, they are met with the resistance provided by the uterus. This acts as something of a workout. Since Dylan has instead been in an isolette, he hasn't been able to get that workout. Now, with some help from his therapist, he will. He actually has exercise he needs to do. Who would have thought a 1 month old baby would be doing a workout? It's pretty cool stuff, if you ask me. Some of it is basic movement of his arms and legs, some of it is massaging certain muscle groups to stimulate them. All of it is designed to help him develop his muscle tone to be better able to control his head, arms and legs, and strengthen the muscles that help him expand his chest to breathe. The therapist noted that Dylan tends to breathe shallowly when he is relaxed, which can lead to him not getting as much oxygen into his blood. A stronger core will help him overcome this.

One thing that I feel I should mention is that Dylan continues to do a great job of maintaining his body temperature. He is going to be staying in his open air basinette from now on. That's a big step in the journey on the road home. One other great thing about the basinette is that Barbara gets to dress him up now. All this time in the isolette, he has been naked except for his diaper. Now that he's in his basinette, he's wearing cute little onesies with the little feet on them. It's really something to see how cute he is in them, even if they are a bit big on him. That, plus it's much easier to change his diapers and pick him up and put him down again. It seems to me that he's a bit more comfortable in it as well, but that could just be my imagination.

Anyway, that's all for now. I keep trying to update the blog more frequently, but it seems that when I get home, I'm just too pooped to get it done. I'll try to keep it going every other day or so. We'll see how it goes!




Monday, June 23, 2008

Accelaration

I'm at a bit of a loss right now to explain quite how I feel, so let me sum it up with a brief explanation of the important stuff...

Dylan finished off another full 39cc bottle while Barba and I were there. We watched his nurse feed him to pick up on the finer points of feeding a preemie that doesn't quite have it all figured out yet.

He spent the day with the top of his isolette open, so essentially, he was in an open basinette with the option to close it and warm him quickly if necessary.

After we left, he finished off another bottle, or all of it but 2cc (close enough in my book).

And, oh yeah, he has been moved to a full-time open basinette.

Dylan is maintaining his body temp. He is eating from a bottle. He is not having significant bradychardia or apneas...

This adds up to Dylan coming home sooner, rather than later- provided he can keep this up for a little while.

I'm not going to try and guess exactly when he will be coming home, but this is all very encouraging news. If things continue at this pace, and he does not run into further complications, it could be soon!

Woooooo Hooooo!

Sunday, June 22, 2008

Wow...

It's been a few days since my last post, so there are a few things to cover.

First, Dylan hit 4 weeks old last Friday. It's weird because it seems like such a long time that he's been in the NICU, but at the same time, it doesn't seem nearly long enough to be 4 weeks since he has arrived.

He is also packing on the weight. As of tonight, Dylan weighs 2270 grams, or 5 lbs!!!
That's right... 5 lbs. Now, it was quite a considerable weight gain from yesterday, so it's likely that he may lose a bit of that weight, but still... 5 lbs!

In my last entry I mentioned that Dylan had started with trying to master bottle feeding. That is going fairly well also. His nurse for the day shift today noticed that Dylan was sticking his tongue to the roof of his mouth, making it impossible for him to get good suction or flow from the bottle. She worked with him for a while, and got him to eat his full 39cc from his bottle this afternoon. She also had the on-call doctor today order physical therapy for him to work with the technique for moving his tongue to the right place in order to eat from a bottle. It may seem odd to have a 4 week old infant getting physical therapy to help him eat, but because he's a preemie, it's something that is often needed, or at least very helpful. Keep in mind, if things had gone as planned, Dylan wouldn't be worried about where his tongue was at feeding time. He'd still have another 4 to 6 weeks in the womb to think things over. Since he's here now though, he'll need a little help getting the more advanced things down pat. Working to suck from a bottle, swallow his milk, and breathe at the right times without choking is quite a feat for someone who is supposed to be weeks away from breathing at all, and getting all of his nutrition from an umbilical cord. Tonight, he didn't do nearly as well, but it's all part of the learning process.

One other development that has come up... His day nurse feels that it may be time to consider an open air crib instead of the isolette he is currently residing in. This is a big step if he can do it, because it means that Dylan can maintain his own body temp- one of the precursors to being able to come home. Now, he's not quite ready for this step yet, but it may come soon. We just don't want to rush things, because it takes energy to feed, energy to grow, and energy to stay healthy. Putting another load on his energy reserves to keep himself warm may not be the best idea- at least not until he has mastered the bottle feeding thing. Still, we brought up some of his preemie outfits for him to wear when the time comes. He'll be looking good when he's ready to show it all off.

Well... that's all for now. I'm off to bed. I'll try to update a bit more often, but things get kinda hectic, so don't count on it. :)

Wednesday, June 18, 2008

Milestone!

I'm extremely happy to announce that Dylan hit his first significant milestone today!

Tonight, we were able to have Dylan make his first attempts at eating from a bottle. He was a bit tentative at first, but then, he went to work on it wholeheartedly. In all, he ate 6cc from the bottle.

For a first-timer, that's quite a bit. Keep in mind that he still should be in Mom's womb, so any eating at this point is significant. Eating the little bit that he did was quite a drain on him, and he went to sleep right after, getting the rest of his 37cc in his NG tube. We didn't get a weight for him tonight, as we and the nurse thought it best to let him rest and do the hands-on assessment later.



In other news, I spoke with Dylan's doc today regarding the neuro consult. Essentially, the neurologist had the same things to say: Dylan is at risk for developmental delays, either cognitive or motor related or both. They would not or could not place odds on what type of challenges Dylan may face or how severe they may be, but his doc did say that she would be "very surprised" if he did not have some sort of consequences of this brain abnormality. Whatever comes, will come, and Barbara and I are prepared to meet it all head on.

One minor note from the neurologist- they are no longer calling what they see in Dylan's brain leukomalacia. Instead they are referring to it as suspected neuronal migration abnormality. A slightly different condition, but the prognosis is the same.

Tuesday, June 17, 2008

Back from the NICU

We're back from the NICU for the night, and Dylan continues his encouraging growth.


Tonight, he weighed in at 4 lbs, 9 oz or 2060g. Of course, not long after that, he unloaed the biggest pile of poop I've ever seen him let loose with. And guess whos turn it was to change his diaper?


Yep- mine. Not only did he have a dirty diaper when we opened it up, but as I was changing it, he decided to fill up the new one I had underneath him. And then, just when I thought it was safe to put the third diaper on him, he unloaded some more. I'm not going to speculate which of us he inherited this trait from.


There's not much else new going on right now. Tomorrow morning I'll be going up to see Dylan during the time that the docs make their rounds. I'll be speaking with Dyalns doc to get the latest info from the neuro consult regarding the brain issue and what sort of prognosis we are looking at. Of course, it's all just specualtion, at best, but at least with the neuro consult, we can have something of a better idea what to expect.


Anyway, that's all for now.


I thought I would leave you all with a collection of photos of some of Dylan's favorite nurses...







A brief update before bed...

A few pertinent notes...

Dylan's weight is up to 2010g or 4 lbs 7 oz. He is eating 37cc of breastmilk with each feeding.

Also, he can suck on a pacifier pretty darn well. We popped a binky in his mouth during his feeding last night, and he sucked away at it like a champ!

That's very encouraging news, as preemies don't always learn to suck very easily, and this is a sign that bottle or breast feeding will soon be an option.

The doc wants to try him on a bottle this week. We'll let you all know how that goes as soon as it happens.

Anyway, that's all I have time for right now... More tomorrow, maybe!

Sunday, June 15, 2008

Slide Show Updated

I've just updated Dylan's slideshow to include more recent pictures, so if you're the picture loving type, have a look.

Also, I realized I neglected to mention Dylan's weight in my last note, so let me tell you that he is up to 4lbs 5oz, or 1960g. His feedings as of this morning are up to 37cc per serving.

There's really nothing new to note, other than today is my first Father's Day. I spent a few hours up with Dylan this morning, just kangarooing and enjoying each other's company. There's nothing better than just sitting there holding him and loving him.

Anyway, I will probably not update again for couple of days, but keep an eye out, as you never know when I might have something to say ;)

Saturday, June 14, 2008

The latest

The follow up ultrasound was performed on Thursday, but it was later in the afternoon, so results were not available until Friday. Friday morning, I received a call on my cell phone from Dylan's doctor. The latest ultrasound did not show any further swelling of the ventricles, nor did it indicate any need for surgery.

But...

There's always a "but", it seems. This time, the but was that she also reviewed the original MRI with a neurologist and "there is some cause for additional concern" that she wanted to speak with Barbara and I in person about. After a few hours of distress, worry and fear of the coming conference, we finally sat down with his doctor, LPN and a social worker.

Here is the gist of our discussion in a nutshell... Dylan does indeed have enlarged ventricles, but it appears to not be caused by a clot or by a drainage issue. Instead, the white brain matter around the ventricles appears to not be as large as expected. Also, it is not as mature as is expected. These are conditions known as leukomalacia and delayed myelination.

This means that Dylan will possibly experience developmental delays of either or both a motor control nature or cognitive nature. There is no way to predict the nature or extent of the delays, or even if they will definately occur. Another MRI was ordered to get more detailed imagery of the affected areas, ostensibly to better ascertain the extent of the condition.

Although this means that there may be some unexpected challlenges down the road for us, it's not a worst case scenraio, by any means. If Dylan needs some extra time to develop or to learn certain things, he'll be given all the time he needs. If he needs physical therapy, speech therapy, occupational therapy or other help, he'll be sure to get it. If he needs more attention than the typical baby, we've got all the attention and love in the world to give him.

I'll have more later as I digest the information, research the conditions and talk with his doctor some more about it.

Tuesday, June 10, 2008

4lbs, 1 oz!

This entry's title kind of says it all... Dylan weighed in at 4 lbs, 1 oz tonight! Breaking the 4 lb milestone is a big deal to Barb and I. It's very encouraging to see him growing at such a healthy rate.


His feedings are up to 34 cc each also.


Even better is his overall disposition. Since Friday afternoon, Dylan has been kind of sleepy and tired throughout our entire visits, having somewhat steady problems with his O2 saturation and heart rate, and he has been very susceptible to any kinds of stress- be it from handling, feeding, lights... whatever.


Well, last night and tonight have been a complete reversal of those trends. Last night, I was able to kangaroo with Dylan for over 2 hours, during which he had no desats, no bradychardias and no apneas. He tolerated his feeding well, while on my chest and he was alert and playful through a large portion of my time with him. Tonight, Barbara had the same results in her 1 1/2 hour with him. His eyes were open for the majority of the visit, he was swinging his arms about, making faces and just generally seeming to be very comfortable. Again, he had no desats or bradys or apneas. We're both so happy to be able to hold him again. Although it was only one night where he was so stressed that we could not handle him, it was more than either of us would like to deal with again.


As for the enlarged ventricles and the progress there... well, there is no progress, and that's sort of a good thing. He won't have a repeat ultrasound until Thursday, so the only news we could bring you about it at this point would be if things got worse, and they certainly have not. There was a 1/2 cm difference in his head circumference today, but that can easily be attributed to human error in the measurement (measuring in a different place) growth, or a combination of the two. He may even have a bit of swelling from the hydrocephalus, but he remians asymptomatic, so there really is nothing to be done there. All in all, the whole hydrocephalus thing is status quo, and I'll take that over getting worse, any day.

Monday, June 9, 2008

MRI Results...

We're back from the NICU for a little while to take care of the animals and to have dinner, so I thought I'd update any readers with the MRI results.

It turns out that the structure of the aqueducts seems to be fine and that the enalrgement of the ventricles is indeed caused by a residual clot from an undetected bleed. The bleed must have been very small, the doc says, because it was very difficult to detect the clot.

So... what this means is this: First off, Dylan is in no immediate danger. The doc believes that the clot could actually disolve and we could be lucky enough to have the entire situation resolve itself without any intervention. The plan is to monitor his head circumference and perform repeat ultrasounds twice a week to watch the size of the ventricles themselves. Should it not resolve on it's own, then they will attempt to draw out the clot with a spinal tap. They would also consider a tap if the pressure actually were to increase to the point of causing symptoms.

Secondly, there is the issue of the brain bleed itself. Brain bleeds can come in many shapes and sizes, with varying degrees of severity. This one was apparently not severe at all, so the outlook is good. Severe brain bleeds can lead to neurological impairment, learning disabilities, ADD and other issues. While there is a slight chance of Dylan being affected in this way, the odds are favorable that this will not be the case, given the apparent insignificance of the bleed.

Overall, although we would have liked more of a resolution, it's good news. There is currently no reason to perform any surgery, and the future outlook is also good.

In other news...

Dyaln's weight is up to 1745 g as of last night. That's 3lbs, 14oz! He's growing like a weed!

And that may actually be the cause of the episodes of bradychardia and low O2 saturation from the last few days. Barbara and I were concerned that inter-cranial pressure caused by the enlarged ventricles was causing neurological difficulty, leading to these issues, but the doctor assures us that these are not issues related to hydrocephalus at all. Increased ventricle size like Dylan has would not actually lead to additional pressure on the brain, unless his head had swollen as well, and all available space was already taken. I turns out that Dylan is simply growing faster than his cardio-pulminary systems can keep up with. It's almost like he is doing "too well".

They wouldn't want to do anything to slow his growth, as growing is what he needs to do most. If the O2 sat and the bradychardia issues become worse, they may have to put Dylan on oxygen to help him keep up with things. This may seem like a step back, but if it does come to pass, it simply means that some systems are growing faster than others. We wouldn't be too concerned about that. It will all even out in due time.

Anyway, that's it for now... more later, maybe.

Sunday, June 8, 2008

The NICU Roller Coaster

Since Dylan was born, I've been reading everything I can find about premature babies, NICUs and other related topics. One thing I keep seeing is mention of "The NICU roller coaster". The phrase refers to how your emotions can have you feeling up, down, twisted around and upside down and then up and down some more over the course of a baby's stay in the NICU. I believe I am finally beginning to get an idea of what that is all about...

Friday afternoon, the nurse practitioner in charge of Dylan's care called to give me an update before going off for the weekend. The basics of the update were that he has been doing very well, especially for a 30-weeker. His feedings were going great and he continues to put on weight. She did notice one abnormal thing which shouldn't be great cause for concern, but she wanted to let me know, just to be thorough. While doing his exam, she thought his fontanels felt puffy or swollen. She told me that they would be performing an ultrasound to check things out. She said it could be from any number of reasons, including that he was just fussy at the time of the exam.

Barb and I worried a bit about it, but when we went to see him Friday night, everything was fine. The nurse did mention that he had a few apneas, but only one or two- nothing to worry about. The results of the ultrasound would likely not be available until Saturday, they said.

Saturday afternoon, I got a phone call from the covering nurse practitioner. It turns out that the ultrasound revealed that Dylan's ventricles were enlarged. She could only say that it was not cause by a brain bleed, which is good news, but couldn't say much more until they got an MRI and could get a closer look at it. Now we were starting to really worry.

When we got to the hospital Saturday afternoon, we asked to speak to the physician on call to get an explanation of everything that was happening with Dylan. Dr Wynne was very detailed in his explanation, showing us pictures of normal ventricle size and then comparing them to images of Dylan's. He showed us the results of the MRI and explained exactly what we were looking at. Through it all, one thing really stuck in my head- "These are really enlarged ventricles", he said.

The proper course of action at the time though, is to keep a close eye on things and wait to see what, if anything develops. Dylan is exhibiting no symptoms that would be problematic or cause for further concern as of yet. Dr Wynne wants to watch him over the weekend and have a specialist look at the MRI on Monday to determine if anything needs to be done. If things were to change dramatically, such as rapid enlargement of his head from inter cranial pressure, severe drops in heart rate or episodes of apnea that require stimulation to recover from, then they could treat him emergently and either tap the fluid to allow it to drain or do the same with a shunt. But at the moment, it's just wait and see.

After hearing all of this, Barbara really needed to hold her baby, so she began to kangaroo with him. Dylan was his normal self at first, but after about 1/2 an hour, he became restless and fussy. His oxygen saturation levels began to drop intermittently from the 95-100 range where he would normally measure down into the low 80's with some dips into the 70's and 60's. The nurse suspected that this was due mostly to his stressful day. To perform the MRI, Dylan had to be bundled up and transported to a different building of the hospital where the MRIs are performed. For you and I this wouldn't be a big deal at all, but for an infant, especially a preemie, this can be quite taxing. So, assuming he was worn out, we put him back in his isolette to let him relax in as much comfort as possible. His sats levelled out a bit, and we felt comfortable enough to head downstairs to get something to eat.

When we returned from eating, Dylan was resting quite comfortably, having just been fed. His oxygen saturation (sats) was at 99-100% and he was sleeping peacefully. The big problem though, was that we couldn't hold him, touch him or do anything that might disturb him. After what was a very stressful day for him, he needed no additional stress from his parents. Not being able to hold and comfort our baby was tough. Just sitting there, knowing that there was something going on in his head that could cause problems, without being able to do anything for him... it's not something I want to go through again.

Hopefully, the rest did him some good. Today, it's back to watching and waiting, hopefully for nothing.

And by the way, Dylan's weight is up to 1705 grams, or 3lbs 12 oz.

Friday, June 6, 2008

Progress Report

Back from the NICU yet agin, with all of the latest news about the world's cutest baby...

Vitals:

Weight: 1575 grams or 3 lbs, 8 oz
Feedings: 30 cc breastmilk

Changes: PICC line removed
All IVs discontinued
Began receiving supplemental vitamins mixed with breastmilk, 1/2 cc 2 x daily

So there you have "Dylan by Numbers".

He's really doing well, as I guess you can tell from the large increase in his feedings and the fact that he is completely off of any IVs. He doesn't have any holes in him now that he didn't come with from the factory.

This is actually great news for Barb and I, as now that he no loner has the PICC line, we can pick him up at any time, without needing a nurses supervision. Previously, because the PICC line does run fairly close to his heart, he could only be picked up with supervision, to make sure the line didn't move, causing a potentially dangerous situation. Now, we can take a look at his situation, and pick him up if we see fit.

Now, this doesn't mean that we're going to pick him up every 5 minutes, though. For instance, this evening when we arrived, he had just been fed, changed and tucked back into bed. Shift change was coming in 45 minutes. We weren't going to rouse him from sleep just to have to put him back down again in such a short period of time. Instead, we waited until after shift change, when Barbara was able to kangaroo for over an hour, and then she handed him off to me for some more kangaroo time. I don't know... with all of this kangaroo care, he may wind up with an Australian accent.

Sorry this is so short, but it's the late end of a long day. If you have any questions, feel free to click the link directly below the post marked "comments".

Until next time...

Tuesday, June 3, 2008

Lots to Update

Back to Work...

Sorry that it's been a few days since my last update. I went back to work for the first time in a few weeks on Monday, and it's a bit of an adjustment for me. Let's just say that it's tough to focus on the job at hand when you know you have a little one waiting for you 45 miles away. Needlesss to say, we've been straight up to the NICU after work each night, and not getting back until rather late. I should be updating a bit more regularly now- maybe every 2 days or so.

What's New?

Well... let's see- Dylan is now receiving 23cc of breastmilk with each feeding. His IV nutrients have been discontinued, and mom's milk is all he's getting now (score one for Mom!). His weight is up to 1575g or about 3 lbs, 7 1/2 oz. Also, he has grown 1/2 of an inch since birth, to 17 inches long. Today, he also passed his first hearing test. We weren't there at the time, but there was a note attached to his isolette which explained that the test was performed and that he passed and also that they would be back to do a folllow up test in the future. Otherwise, there hasn't been much change to things. There is some small concern about his red blood cell counts, and that is something that they are monitoring closely. If they feel that he is not producing enough on his own, they can give him a shot of something called Epogen to help him do so.

He's gotten very comfortable with all of the handling from the nurses, and typically doesn't get very upset about anything that they need to do with him. He has earned himself a bit of a reputation though. Nurses warn each other as they change shifts, that he may try to pee on them or poop on them. Apparently, he has gotten a few of them. Dylan especially likes to wait until you are changing a dirty diaper to poop some more- into the clean diaper, of course.

Even better though, is what he did to me tonight. The way the nurses weigh him is a bit of a process. First, they pick him up off of his bed totally naked and weigh it with his bedding. Then they place him back on the bed and weigh everything again, this time including Dylan. The difference, of course, is what Dylan's weight is. Tonight, I offered to help by holding Dylan while the nurse noted the weights. So, while I was holding him suspended over his bed, he decided to poop right into my hand. There was no warning at all- just a handful of baby poop.

I'm so proud of him :)

Graduation

I would be remiss if I didn't mention that Dylan has officially graduated to NICU2, where as one nurse puts it, they focus on getting them home, not just getting them better. Basically, it's the same setup as NICU3, but the nurses each handle 4 babies in NICU2 where they handle only 2 in NICU3. The nurses even rotate between both NICUs, so we can request, as we did, nurses that we have already grown comfortable with.

Speaking of Nurses...

I think it's important that I give mention to the great nurses that have been taking such good care of Dylan these first 11 days. Shands must really have the cream of the crop. It seems that the vast majority of the nurses there truly care about the babies almost as they would if they were there own children. Simple things like using pressure to clot blood after a pin prick to check the blood sugar rather than using a band-aid, because the band-aid hurts the baby when they are removed, or taking the time to slow down when taking vitals if the baby seems restless or agitated- these are things that they don't have to do, but the good nurses do because they care. It's really heart-warming to know that he is being taken such good care of when we can not be there.

Looking Ahead...

So what's in store for Dylan over the next few days?

By the time I am posting this, he should be completely off of any IVs. When we left, his lipids were on their last dose, and when that ran out, it was to be turned off for good. This also means that his PICC line, or central IV, will be coming out entirely. The only things he will be hooked up to now will be the monitors that watch his heart, respirations and temperature, and his feeding tube.

Also, a Nurse Practicioner called today to talk to Barbara about the possibility of moving Dylan to another hospital. Apparently they feel that he is doing well enough that he doesn't need the level of care that Shands provides. My personal opinion is that they are crowded and could use his spot for another baby. The problem is this- there are two hospitals in the area that they are affiliated with. There is one in Gainesville, which is a bit further up the road from where he is now, and one in Ocala which is currently full. Simply put- they want us to OK moving him even further away. FAT CHANCE. Regardless of the reasons, there's just no way he's getting any further away, even if it's only an additional 15 minutes.

Otherwise, it's just more of the same for little Dylan- steadily increasing feedings, watching closely to make sure things are progressing normally, lots of rest, and quite a bit of worry from his parents.