Quiet Day

Henry was asleep for a good part of today. Jen was his day nurse. Although we had been told that they were going to test Henry's hematocrit levels today, they didn't do it. They decided not to transfuse based on the tests done on 7/6 (hematocrit at 23.5 and retic count at 4). It is a bit frustrating when we are told that they are going to do something and then they make decisions based on old information. I thought that Henry looked rather pale today, and he seemed more tired than usual. But I guess that they are waiting for him to have some bradys before they decide to transfuse. They decided in rounds to pull his IV (which Holly had already pulled out a few nights ago because it had gone bad). According to Jen, they don't want to transfuse because that would set back his red blood cell production 6 weeks. They also decided today to stop his caffeine prescription. He had been getting caffeine every day to help stimulate his heart rate and breathing.

I did skin-to-skin with him today. It had been a few days since we'd done skin-to-skin because he's been wearing outfits. Tried nursing, but he wasn't interested. I suspect that until he's slowly weaned off the continuous feeds, he isn't going to get excited about nursing. When Jen aspirated his stomach, he had 8 mls of breast milk in there. That's OK because preemies are allowed to have up to their hourly dose of milk in their stomachs when on continuous feeds. He's currently getting 9 mls of breast milk over the course of an hour. And the breast milk is still being fortified to 24 calories per ounce.

One of the frustrating things about the NICU (and I suppose medicine in general) is that we often get different instructions from different people. I was upset yesterday because in the discharge packet, they said that freshly expressed breast milk could only be refrigerated for 24 hours. But when we first arrived in the NICU, we were told that it could last a week. We had quite a few vials of breast milk in our fridge for 6 days, which were then moved to the freezer when it was clear that Henry wasn't going to use them right away (this was early on in our adventure). Henry has since consumed those vials of milk when we took the frozen vials into the NICU. I became concerned that they have been putting spoiled milk in his stomach. I asked Lisa G. yesterday, and she said that she wouldn't keep it for more than 24 hours. Then today, Jen thought it was a week, but she asked another nurse who said 48 hours. I ended up talking to the lactation consultant, Rene, who clarified that it was good for 1 week in the fridge at home (only 24 hours in the NICU because the NICU fridge is opened and closed 300 times a day).

My mom arrived at the NICU while I was holding Henry. I left around 2:30PM. She stayed with Henry. Then, Jeff stayed with Henry from 3:30PM until shift change.

I'm continuing to have problems with the insurance company (Schaller Anderson). University Physicians Healthcare sent me a bill for $170 that they said Schaller Anderson wouldn't pay. Basically, the anesthesiologist's bill for my c-section was $1020 for his time (64 minutes) and $170 for 2 units of emergency anesthesia. I called Schaller Anderson yesterday and they called back to say that I needed to call UPH to have them resubmit the bill as one item rather than two separate line times. My insurance is supposed to cover emergencies in total. Considering that the UPH bill is simply for the same event but broken down by detailed expenses, I don't understand what Schaller Anderson's problem is. The brain trust in the claims department categorized the emergency anesthesia line item as a "misc physical service." Under their codebook, that's usually reserved for cosmetic surgery (which they don't cover). I don't think that I would have been able to handle the c-section without the anesthesia (hence, it didn't seem cosmetic to me). I have a high pain threshold, but I suspect that the emergency c-section without the 2 units would have been beyond my pain tolerance capacity. I called UPH and asked them to resubmit the bill. According to them, the "misc physical service" category was done by Schaller Anderson's claim department. The UPH side clearly labeled the anesthesia as "emergency anesthesia 2 units." I considered calling my case worker Rhoda about this but her helpful advice is often to call the phone number at the back of my insurance card, which is of course what I did.