Happy Mother's Day!

Dane just wanted to say Happy Mother's Day to all the mothers out there, especially his grandmas.

The Damages Thus Far

Nothing in life is free and that includes pregnancy. I'm sure it depends on your insurance (hopefully you have insurance!) but having a baby is not, by any means, cheap. We have received most, but not all, of our bills from Larissa's and Dane's times at Central Dupage Hospital. Larissa's bill was impressive but not overly surprising. Dane's NICU bill, however, almost made us cry and wish we had our own diapers. Anyway, without further adoo... (Drum roll)

Larissa's bill:
$4,100 (OB bill from delivery)
$1,520 (Anesthesiologist bill for epidural)
$17,838 (Delivery / Hospitalization bill)

Dane's bill:
$177,185 (NICU bill)
$14,567 (Neonatologists' bills from time in NICU)
$3,516 (Send-out lab tests)

Grand total: $218,726 (so far...we think this includes all bills through Dane coming home from the NICU. It doesn't include follow-up outpatient visits, etc.) To put this in perspective, because it is such a large number: Dane has already cost slightly more than 4 years of medical school...

We will be accepting donations. (As you can see in the photo, Dane offered to pitch in $10 but we don't think that will cover much of the bill...)

Now that you feel bad for us, I should also point out that these numbers are all pre-insurance payments. The good news is that once we surpassed our deductible, we had a 10% coinsurance payment up to a cap. Because of the cap, we will end up paying less than 2% of the total bill, which is still a fair amount of $$, but much better than it could have been. The good news of all this is that we don't foresee any further medical expenses until 2010 for our entire family...I guess that's good news. Also, we realize that the bill could have been A LOT more.

Random slightly-related thoughts of an almost-doctor after seeing medical care from the standpoint of the patient / family:
1) Why are medical bills so expensive? Would the same care have been cheaper in countries with more nationalized healthcare? Or would the physician bills, at least, be lower if physicians weren't graduating from medical school with > $200k in loan debts (like me)? Were there aspects of Dane's time in the hospital that could have been done without if the doctors weren't practicing "defensive medicine," making sure they were safe from any lawsuits. (Note that, as parents, we wanted EVERYTHING done for Dane regardless of the costs, especially since insurance was paying, which is why the decision to do or not do tests wasn't up to us...)
2) Along with our medical bills, it shows how much the bill is discounted for the insurance company. One bill of ~$8,000 had ~$1,000 written off because it was paid by the insurance company. This never made sense to me in the past, but it is how all insurance companies function... in accepting a certain insurance, a physician opens themselves up to all the patients covered by that insurance company but they also will accept less than their billed amount. One number I have heard to show the worst-case reimbursement is that hospitals/physicians usually receive ~25 cents for every dollar billed to Medicare and ~18 cents for every dollar billed to Medicaid. Insurance companies usually base their reimbursement rates somewhere above these Medicare/Medicaid numbers. So how do physicians and hospitals make up for these lower reimbursements? They bill higher than their best insurance repayments so that people without insurance will help their bottom line and so that they guarantee maximum insurance reimbursements. I don't know if there is a way to improve on this system, but by charging more to people without insurance, it seems to be most hurting people least able to pay.
3) Even as we complain about these medical bills, we are so thankful we have insurance. We would be completely financially crippled if we didn't have insurance. Also, holding Dane in our arms, even at 4am when he's ornery and crying and has his second dirty diaper in 10 minutes, we are so thankful for him and say he was worth "any price."
4) Universal healthcare. I agree there are good reasons for universal healthcare, but how would it work / how would it be paid for? And what would we have done if we didn't have insurance? Again, what would we have done in Dane's case without decent insurance?
5) Should we have gotten a different insurance plan? (Hindsight being 20/20)... Would we have been better off with a higher deductible for lower co-insurance cap or lower monthly premiums?

It all comes down to "I don't know." I don't know how to fix the system to make it more available, more affordable. And I'm glad that we had insurance to cover the vast majority of the bill...

visiting the pediatrician

Today was another pediatrician appointment for our little guy, mostly just for a weight check. Dane is still growing, actually gaining 2 oz since his weighing yesterday at the lactation consultant, and 7 since his appointment last Thursday. Newborns are supposed to grow at approximately .5 to 1 oz per day, so he's on the high end of the curve, which is encouraging. Our pediatrician is a fellow Loyola grad, and she said we were doing great with him so far. She suggested that we follow the lactation consultant's schedule for breastfeeding and see how his weight gain continues. It was good to hear that despite our uncertainties and fears about caring for him, he's doing well!

We also had another visitor, Steph from Tyndale. She brought us a pot of excellent homemade chili, which we enjoyed for dinner tonight. Dane was excited to meet his mom's former cube neighbor, who gave him his first happy meal toy, even before he was born. It's still at work, since I wasn't expecting to need it so soon!

Finally, we looked at apartments in our complex to move into once our lease in our current apartment ends. We've decided to stay in the same building since it has almost (someday we'll have laundry and our own garage!) everything we want and it'll make moving slightly more convenient. We're looking forward to having our families down to help move around graduation since it will be such a crazy time for us. It will be great to be in a place that has enough room for Dane and all of his accompanying stuff :) It will also be nice to have a second bedroom and bathroom for visitors, as well as more storage space. It's amazing how we accumulated stuff once we got married!

Exams, breastfeeding, and hairdos

It's been a busy, tiring couple days. First, I found out that I passed my oncology exam. This was a big relief since i took it 90% asleep ~9 hours after Dane was born after spending the evening prior, when I'd planned on studying, in the delivery room at CDH instead of in the library at Loyola. Glad that is done and behind me...

Also, Larissa had a meeting with the lactation consultants at the hospital today. They said that if she was going to be exclusively breastfeeding that she should be feeding 8 - 12 times/day (Dane currently has 6 feeds per day). The plan now is to breastfeed with some bottle supplementation for 4 feeds per day (during the day) and do 2 full bottles (at midnight and 4am).

We also think that Larissa's milk supply may finally be decreasing. It SHOULD be decreasing since we have tried everything: weaning + benadryl + sudafed + starting the birth control pill. We are still frustrated that nobody told us ahead of time to avoid overpumping to avoid milk oversupply. And we are annoyed that people were hesitant to recommend starting the birth control pill, even when max doses of benadryl + sudafed didn't help at all. After only 2 birth control pills, Larissa's milk supply seems to have decreased by ~25%... magic! But even better than a decrease in her milk volume is the decreased engorgement she experiences between pumpings. She can now sleep between pumpings, even though it is still uncomfortable to sleep in any position other than on her back.

One of Larissa's coworkers from Tyndale, Kendra, visited today. She brought us a pot pie, which was awesome. She also brought her 10-week old daughter, Addison. I'm sure Dane enjoyed starting to meet some people his own age.

We have decided that we should be careful what we wish for... Dane is no longer constipated but now he is having frequent prolific loose stools. He is also getting in the habit of holding just enough poop in reserve to soil his clean diaper within ~6 minutes. We got a "diaper genie" that claims to hold up to 180 diapers without stinking up the room... it seems to work great and the room doesn't stink, but it is starting to feel full and I am dreading opening it to change the bag. I pushed the diapers down earlier today to compress them for some extra space and, in addition to getting a dirty hand, blew a horribly foul smelling breeze into the room.

Finally, Dane got an awesome hair-do today. Like it? :) Clearly Dane likes it.

The first week home

The first week is a hard one, which any of you who've had children know. Dane is only giving us around 2-6 hours of sleep each night, broken up into 2-3 hour intervals. For me these 4ish hours are poor sleep too; we moved his crib from our bedroom to the living room and are using a monitor. While Mark is a solid sleeper, I wake up at every grunt and squeak he makes. Last night, he was unusually unhappy for no reason Mark and I could figure out, and I ended up just having to hold him from 3 am until around 7 am, after only getting a couple hours in between the 8 and 12 feedings. We have discovered that the bouncer seat is helpful sometimes, giving him the more vertical position that helps his reflux. One of the reasons feedings have been taking so long is that he needs to be upright for ~20 minutes after each one so he doesn't spit up. Mark has mastered the knee-hold, while I pump and then we both change him and clean up. The first thing everyone has asked is, "Do you have help?". Unfortunately, we don't have room for my mom to stay down here, as every inch of the apartment is covered in baby stuff, but I definitely wish we were closer to family during this time. It would be so nice to have some reassurance that we'll get past this part and onto something less overwhelming. In the next two weeks, we have 6 doctors appointments; thankfully, Mark will be able to be around for them.

On a related note, if you were one of the many people who offered to bring a meal once the babe came home, we would LOVE to take you up on it now! We're trying to eat decently, but I've realized that we've had yogurt or cereal for most of the last couple meals. It's too much work right now to do anything complicated or requiring much cleanup. When we're washing bottles and pumping equipment 6 times a day, we don't want to add any more cleanup than necessary. We'd love your prayers for Dane's getting onto a regular sleep schedule, along with eating more consistently. I also have an appointment with the lactation consultants at CDH tomorrow, so I'd love prayer that we'll figure something out about how to decrease my supply and help Dane start to breastfeed. I talked to the OB about it yesterday and he said that in this case, the only remaining option may be to completely wean, which is frustrating. We really wanted to have him on breastmilk for at least 6 months. Finally, please pray that we can have peace about the huge medical bills we've been receiving. Apparently, 5 weeks in the NICU is not a cheap thing...more on that later. (But to give you an idea, the total bill for Dane and I will be more than 4 years of med school...insurance helps, but it's still a daunting amount)

As you can see in the picture, we gave the BabyBjorn and try and realized that Dane needs to grow a bit more before we can really enjoy taking him on walks with it.

Maintaining the Status Quo

Not much new on the Dane front. He's still doing pretty well. Sleeping only about 2 1/2 hours at a stretch overnight (eating every 4 hours, takes about an hour to eat and get burped then immediately falls asleep and wakes up about 1/2 hour prior to his next feeding), so we are really tired. We have began putting a little extra formula in his bottle for some of the nighttime meals which adds a bit more "bang for the buck" and helps him sleep a bit harder / longer. Larissa doesn't sleep as hard as I do, so she is waking up whenever he makes a squeak and is getting even less sleep than I am. She is, however, getting better at napping - something she's never been able to do in the past. Dane got another bath yesterday (in the sink this time), which he clearly was very excited about.

We are also hoping that he is getting a bit more "regular" with his bowel movements. Seems like he is going every other day (on his own) right now.

Lastly, it is BEAUTIFUL outside today! Larissa and I have been trying to get out of the house more so that we don't get stir crazy. We aren't sure when Dane will be ready to go outside, so we have been alternating working out outside. I went for a great bike ride today (first of the season on the road bike!) then Larissa went for a walk/jog when I got home (she still hasn't been officially "cleared" for exercise involving impact). We are considering seeing if we can fit Dane securely in the stroller because we would love to go out for a walk as a full family.

4:30am

Saturday, 4:30am. It's already getting light out and I just heard a bird chirping outside. Why are we awake? Just a joy of parenting... Hopefully someday we'll be able to once again 1) sleep a full night straight and 2) sleep in on a Saturday morning. It's already been almost a week without sleeping more than 3 hours in any single stretch...that's rough. Even during my hardest med school months I'd still get a somewhat decent night's sleep two out of every three nights...

Dane has been very grumpy tonight. He hadn't pooped since Wednesday morning (almost 3 full days ago!), which is long enough to make anyone unhappy. We haven't gotten a lot of sleep. We are currently fortifying his bottle-feeds of breast milk with some formula to bring breast milk (20 calories per ounce) up to 22 calories per ounce. For a while in the NICU he was getting 24 calories per ounce but they reduced the fortification to make him more hungry and to take more fluids. We think that he might benefit from more than 22cal/ounce right now and might fortify a little more for a day or two. He seems to be hungry but unable to tolerate more volume of milk because once he takes the full 60mL (every 4 hours), he has been spitting up some of it even when we keep him upright for 20 minutes and burp him well. My theory is that his stomach didn't have a lot of space due to all of the poop in his system. (Like his parents, Dane is occasionally full of crap! Hahahaha.) So if we increase the calories/ounce, he won't need to eat as much volume in order to achieve the same caloric intake, hopefully meaning decreased spitting up.

Anyway, I said that Dane hadn't pooped since Wednesday. Tonight it turns out that the big reason he was ornery, at least at his 4:30am wake-up, was because there was poop on the way. I'd heard the horror stories of poop shooting up all the way up the baby's back so the waistband on Dane's diaper was very snug. What I hadn't thought about was that, after he fills the diaper like a balloon, the poo still has to go somewhere. In this case, it couldn't go up his back so it shot out the leg holes in an explosion all the way to both knees. Not pretty. Larissa and I had to change that diaper as a team...not enough wipes have ever been made to clean that mess. And thank goodness that we have bought a Diaper Genie, a contraption that holds up to 180 diapers in an air-tight (read that "smell-proof") bag until it is full and we can throw them all out at once...

OK, almost enough news for today. Other than being hungry and occasionally ornery and continuing to get a bit backed up with poop, Dane is doing really well. He is able to lift his head up (off the floor during tummy-time or off my chest when I'm burping him), which is exciting. When he does lift his head up, he is far from stable - we watch his head wobble from side to side before usually crashing in a face-plant back into the damp burp rag. We are just hoping that now that's he is fed and pooped he will sleep for a solid 3 to 4 hours so that we can get some uninterrupted sleep. Life right now revolves around sleep, bottles, and diapers - life isn't exactly exciting but it is still such a blessing to have Dane home and in our lives. He's worth all of the sleepless nights and dirty diapers (or at least we hope we'll feel that way looking back on it!)