Saturday, January 29, 2011

Chasin' the clouds away...

Happy four month birthday, Timmy! He loves to sit up so much that his Mommy and Daddy got him a Bumbo—he loves it! He just could not get enough of looking around. He was pretty proud of himself for being such a big boy. I am so happy that he was not recovering from a major surgery on his birthday! His Daddy said that he had to make 5 trips to 4 different stores just to get the right color Bumbo…WOW! that’s dedication! (Timmy could not have a pink Bumbo. Eww!)

Yesterday he had two MRIs. I was not happy at first because they said my antlers were too big to fit in the MRI machine and they would not let me go along. The first MRI was of his spine. He has something called a low lying conus, and they wanted to make sure his spinal cord was not tethered. And it is not! So that is a big piece of good news!

The second MRI was of his brain, and the news from that is mixed, though mostly good. About 50% of kids with Opitz G/BBB are missing the tissue that connects the right and left halves of the brain (the corpus callosum). This results in developmental delays/intellectual disability, etc. But Timmy’s corpus callosum is there and is normal for a baby his age! They did find some punctates (little hemorrhages) in his brain—this is fairly common in babies that have been so sick and have undergone so much stress. They are not likely to have any big affect on him. The other thing they found in the MRI was evidence of an “insult” (damage to his brain, most likely due to a slightly prolonged period of oxygen deprivation) in the motor skills area of his brain. Our best guess is that this may have happened when he was in distress right before he was born (the reason for the emergency C-section). As we understand it, this may or may not affect him in any way. The brain is a pretty phenomenal thing, and is quite capable of compensating for stuff like this, it is just something for us to be aware of. (And, of course, it is one of those things that we never would have known about if there had not been another reason to do an MRI.) So all in all, the news from the brain MRI was fantastic! PURPLE POWER!!!

The other piece of wonderful news is that Timmy does not need an intestinal surgery after all! The surgeons say that his J-tube can be pulled out bedside and the hole should heal up on its own. This means that it is possible that we may all get to go home in three weeks or so!

Timmy’s Mommy and Daddy and I have been thinking back over the first few months, and the number of times we said to each other that we just wanted Timmy to have two good days in a row. It seemed like every time he had one good day, it was immediately followed by a major setback. Recently he has been having so many good days it makes my heinie squeaker squeak!

Today we got a visit from a speech pathologist who was wanting to see how Timmy would do with more milk. We got a video tape of him sucking away 5 ml’s through a bottle nipple and she said that he did really, really well. Everybody clap your hooves together and say, "Yay Timmy!" He latched on to the nipple and sucked harder than he ever sucked just a pacifier. She said that the only thing for his Mommy and Daddy to worry about will be to pace him so that he does not fill his Timmy tummy too quickly all at once. He was quite the show-off! We are expecting him to have no problems at all with the swallow study on Monday. The doctors want to x-ray Timmy when he drinks some dye so that they can see inside his little body where the dye goes to make sure it is going to all the right places. I have been practicing my cheers and I will bring my pom-poms to make sure we all celebrate after the swallow study.

Thanks for reading ya’ll!

Wednesday, January 26, 2011

Polished purple antlers, milk, an MRI, and Harry Potter

Today's big news: I got my antlers polished. Today's other big news: The doctors took another look down Timmy's throat and found out that the skin stuff around his surgery site is exactly the way it should be (in medical terms it is completely "mucosalized"). So that meant that they are planning on doing a swallow study on Monday to see if his swallow muscles will work correctly. That also meant that they wanted Timmy to get used to the idea of using his tongue to taste things hence the pictures. In the top picture, the nurse lady is just putting some milk on his binky and in the other picture the nurse lady put a teensy bit of milk in the bottle nipple. He seemed to enjoy it and slurped everything right up.

In other news, Timmy will be having an MRI done of his spine and brain this Friday at around 11:30am. The doctors were planning on doing an MRI of his spine anyway and the brain was added when we got news of his actual diagnosis (Opitz G/BBB). The geneticist doctors at Nationwide Children's hospital in Columbus said that an MRI of his brain might yield different or more specific results than the ultrasound of his brain that they took during his first month of life. We are hoping that everything is normal although with my friend Timmy I think we can expect to expect the para-normal :)

In other news, Harry Potter and the Deathly Hallows Part 2 is released in theaters on July 15 2011.

In other news, it is past 11pm and this little moose is totally tuckered. This is Mortimer signing off.

Tuesday, January 25, 2011

G! no J!

This is Mortimer here wishing you all a very fine Tuesday morning. You might guess from the picture to the left that I am just hanging out with my very tubed friend Timmy. Well you would be right except I wanted to show you that the little yellow tube with the orange cap directly below me is his now useless j-tube! That is correct folks, Timmy is now being fed completely through his g-tube (22ml/hour) and nothing through his j-tube (0ml/hour)!! and here is more proof (see pic to the right):

We are all really excited about this because this is the first time Timmy's stomach will have been used without risk of milk going into his lungs!

And how you may ask does little
Timmy feel about this milestone?

Well, to be fair, in this picture he was really just mad about being put in his bouncer but he really is just as excited about being fed exclusively through his g-tube as we are.

Anyway, thanks for reading. Stay tuned for my field trip to the Ronald McDonald House. Timmy's mom and dad keep promising me that they will take me but then they forget and I forgive them.

Monday, January 24, 2011

A boring medical update...

Well, Mortimer hasn't had any brilliant ideas for posts lately, so he asked me to write an update about all the medical stuff...I'll stick in some pictures to make it more interesting.

Timmy has been doing extremely well on his G-tube feeds. Right now, he's taking 21 ml an hour through his G-tube (yay!) and 1 ml/hr through his J. That means that at 6pm tonight, he'll be on full feeds through the G and we can clamp the J! The next step will be deciding what exactly to do about the J (how to get it out). During rounds this morning it seemed like there are a couple of different opinions on what the best next step is. Some seem to think that it won't be a problem to simply pull the J out and let it heal up on its own (that's what we'll eventually do when the G comes out). Others are of the opinion that he'll need another surgery to close up the hole where the J is. The surgery option is the assumption we've been operating under--at least several more weeks before the surgery and then a few more weeks in the hospital after that. But if it ends up being possible to pull the J without surgery, we could be home sooner!

Respiratory-wise, Timmy has been doing great! He's still on the mist collar, which no one predicted (he's breathing way better than the condition of his bronchi would indicate). My main concern if he does come home on mist collar is what happens when he gets a cold--I'd hate for a normal run-of-the-mill cold to land him back in the hospital. Timmy is scheduled for another scope Wednesday morning. We're hoping that the graft has healed completely--if so, we may start talking about a swallow study soon!

The other big news is that Timmy has been diagnosed with x-linked Opitz B/GGG syndrome. If you're interested, there's some good information here. The x-linked version is (of course) extremely rare, affecting 1 in 50,000-100,000 boys (lucky us!). The diagnosis doesn't change any of our plans for Timmy; it just gives us an explanation for everything.

T will be four months old on Saturday. He's 8lbs, 2oz. Since he's such a little guy, they're supplementing his milk with extra calories to help him grow.

We've been talking with his discharge coordinator about fun stuff like home medical equipment and home nursing. Even though we know it'll still be awhile, talking about things involving the word "home" is pretty nice!

We're starting to do tummy time a little more often (though once he switched over to mist collar we had to come up with a completely new system, since the trach was no longer protected by vent tubing). T does really well holding his head up! He also loves his swing, hates his baths (yup, he got another one!), and loves sitting up (if he's upset, 9 times out of 10, helping him sit up calms him right down). He charms his nurses' socks off!

Friday, January 21, 2011

Meet the Family

I have already started receiving fan mail. Keep it coming!

At the request of one of my newest fans, I thought that I would tell you a little more about our family.
I was born on a dark and stormy night in a Lamaze factory. I spent my early days sitting on a shelf in Buy Buy Baby. Thankfully on the day Timmy’s parents came to visit me, I was on sale, because I do not think Timmy’s parents would have spent twenty bucks on me (thankfully now they know better…I am worth my weight in purple gold!) After adopting me, they took me to the hospital to meet Timmy. It was love at first sight! From the first moment he saw me, Timmy could not get enough of my purple antlers. We have been best buds ever since. The rest of our crew includes an elephant, several monkeys, a camel, a white rat, a baby lion, and a Christmas turkey. One of the monkeys is named Arthur, but Timmy’s parents are open to suggestions for everybody else! Other friends include a kangaroo, a blue bear, and a hippo that are all waiting in Timmy’s nursery at home.

Timmy’s daddy’s name is Mark. He works in Westerville, OH coordinating delivery of medical supplies to workers comp patients all over the country. In what little spare time he has these days, he spends his time reading Harry Potter novels and watching Harry Potter movies and listening to Harry Potter soundtracks (do you sense a theme here?). Much as he enjoys his job, his biggest dream in life is to become independently wealthy so that he no longer needs insurance and doesn’t have to spend five days a week away from his family.

Timmy’s mommy is named Michelle. She’s a grad student and is working on her dissertation in linguistics. She’s lucky enough to get to stay in Cincinnati, so she gets to hang out with Timmy and me every single day. Sometime in the future Timmy’s mommy and daddy have promised me that I’ll get to take a field trip to the place where she’s staying—a place called the Ronald McDonald House. I hear that it is a wonderful place and it is right next to the hospital. Timmy’s mommy thinks one of the hardest things right now is learning how to balance taking care of me and Timmy with working on her dissertation and missing her husband.

And of course we all know and love Timmy! He is now 16 weeks old and weighs nearly 8 lbs. His favorite things in life are his pacifier and me and looking at himself in the mirror and me and his mobile and me and looking at all the flashing lights when his alarms go off and me. Aww, I love Timmy too!

Someone asked where I can receive fan mail. The best way to send me letters is to send them to Timmy's mommy at the Ronald McDonald House in Cincinnati. Then she can give them to me. The address is 350 Erkenbrecher Ave., Cincinnati, OH 45229. (You could probably also use this address to write a letter to Timmy, too.)

Wednesday, January 19, 2011

Bath time!

Hello everyone! Guess what! Timmy had his first bath today! I mean his first bath in a bath tub. I took some pictures as you can see (it's hard to hold the camera with hooves!). I think Timmy did not like it very much. I kept wondering if they were using ice cold water the way he was crying the whole time but Timmy's mommy assured me that it was nice warm water. Afterward Timmy was very tired and slept for a long time. He was a tuckered little tike!

In other news, Timmy's feeds are up to 2 ml/hour in his G-tube and 20 ml/hour in his J and still no sign of trouble. The doctors also decided to put Timmy on a mist collar starting a
t 2pm today. He is still on it and handling it very well. He has been on CPAP and the ventilator for a very long time. Just to give you an idea of the levels of breathing support that we are looking at: The ventilator gives the most support, CPAP a little less, the mist collar only humidifies the air before he breaths it into his lungs, an external nose still humidifies the air but just less so, and last we have the trach by itself. The last time he was on mist collar was before the scope before this past surgery about a month ago. Since then he has only been on the vent or CPAP. So this is really encouraging that he is doing so well on the mist collar.

Not much else to report from Timmy's room. It certainly smells a lot better with a clean baby bunking next to me :)

G for Grrrrreat!

Mortimer here again wishing you all a happy Tuesday. Some great things happened today. Timmy and I had some fun time on the floor today with Mommy. Timmy really can't stop looking around his new room. That means that he doesn't really get a lot of sleep. His eyes keep drooping and then he pops them awake not wanting to miss anything. I think I am a bad influence since I can not close my eyes. I will have to work on that.

The other wonderfu
l thing that happened was that the doctors decided to try to start feeding Timmy through his G-tube. The G-tube is the big white plastic tube with the big circle on his belly that you see in the picture on the left. Before today he was getting all 22 ml/hour of mommy's milk in his J-tube which is the smaller yellow tube right under the G-tube. The J-tube goes right into Timmy's intestine and the G-tube goes right into his stomach. They have never put anything in his G-tube since they did not want anything to go up his esophagus and into his throat and possibly into his lungs. But now that the hole between his trachea and esophagus is closed up it is safe to try just 1 ml/hour while 21 ml/hour of mommy's milk are still being fed into his J tube. It is important for the doctors to figure out if it is possible to use Timmy's stomach. Once they know whether or not Timmy can have milk in his stomach, they will be able to make a plan. Hopefully we will get to the place where the J-tube will not be needed anymore. (By the way, Timmy's foot is not channeling Rudolph, that little red light is a little machine that measures the amount of oxygen in his blood. Do not ask this moose how it works!)

In other news: Timmy's Daddy misses Timmy very very much (my sources are very good on this news!). Oh and it is now Wednesday. Happy Wednesday everyone!

Monday, January 17, 2011

Timmy's New Digs

Mortimer here. I am so excited that I am fit to burst! Timmy has his very own room now! The nice nurse lady moved us to Timmy's new room just last night. It was so quiet that I could hear my hooves crinkle! No more crying babies and only one set of alarms now to tell us when Timmy is on cloud less than nine. Here it is:

We had a very hard time keeping things organized in the E pod. Now we have a lot more room to store things in this closet space. And we have our own TV so that Timmy and I can enjoy my favorite (I mean our favorite) cartoon: Bullwinkle!!!

Nurse lady says that the hospital is trying out these cameras so that the people in the next room can make sure Timmy is doing well even when they are not in the room with him. Someone still always has to be in the room with Timmy at all times whether it is his Mommy or Daddy or nurse lady or me.

It is very very important that you wash your hooves, hands and paws when you enter Timmy's room. That is why we have our very own sink with special soaps:

This is the ventilator machine that helps Timmy breath in and out:

And here is Timmy's bulletin board. WE LOVE YOU TIMOTHY (fish fish fish)!!!

And here I am helping Timmy's mommy write her dissertation at the desk that is next to Timmy's crib:

I hope you have enjoyed this tour of Timmy's new room!

Timmy makes trouble!

As a lot of you know, Timmy has a habit of taking his medical care into his own hands and causing all sorts of chaos. When he was intubated (pre-trach) and had a critical airway after his first surgery, the doctors began talking about the possibility of extubating him (pulling out his breathing tube). That night Timmy decided he was done with the breathing tube and managed to work his breathing tube out. (That didn't go so well and he was back on the ventilator a few days later.)

For awhile now, they've been talking about the need to downsize Timmy's G-tube. It's so big that it's actually sucking part of his stomach up into it. Well, several nights ago Timmy apparently got fed up waiting for them to decide what to do, and he yanked his G-tube out. No harm done in the end, but when they put a new one in, they put a smaller size in! (This new one has been a constant pain, though, as the drain is always coming off, resulting in gastric secretions everywhere...yummy...)

So Timmy's latest escapade involved the suctioning adapter on his trach. The suctioning adapter is essentially a little piece of plastic that attaches to his trach (between the trach and ventilator tubing). It has a little flip-open cap that you can open up to stick a suction catheter down to suction out his airway secretions. When Timmy came back from the OR last Friday, the suction catheter was missing (the vent tubing was attached directly to the trach). So they tracked down a new one, but apparently the hospital had just switched to a new brand. They put that one on and we used it for a day or two. Then a couple of nights ago, apparently somehow a little piece of plastic broke off the adapter and went down his trach tube. This was potentially an extremely dangerous situation, but thankfully they got the plastic out and Timmy is fine.

The end result of Timmy's most recent adventure? The hospital pulled the trach adapters from all the kids in the hospital. And now apparently the company that made the adapter is issuing a country-wide recall. All due to Timmy. :)

(I don't mean to make light of what could have been a potentially very serious situation. But thankfully the flaw in the adapters was found before anyone was seriously hurt. Unfortunately, though, that means that for now you have to pop off the vent tubing in order to suction Timmy. That's fine for Timmy since he does really well off the vent, but for the kids who are much more vent dependent it's a more difficult situation. I talked with the respiratory therapist today about getting a different type of suction set up for Timmy--an in-line suction catheter, which is what we used in Columbus. Hopefully we'll have that ready to go later today.)

--Timmy is up to 7lbs, 15.6 oz today! He's now nearly 16 weeks old, and it's exactly two months past his due date. He's finally starting to fit into 0-3 month clothes. He's reaching for things more often and loves interacting with people.

(Mortimer is taking a brief hiatus from posting, so he asked me to step in with an update.)

Saturday, January 15, 2011

Timmy pooped on me today

This morning I had been dreaming about a world full of my favorite color, purple. I woke up and noticed that I was at the bottom of my friend Timmy's crib instead of the top. Hmmm I said to myself, that is odd. Usually I am at the top of my friend Timmy's crib so that I can talk with my friend Timmy. But today I started out the day at the bottom and the nice nurse lady, she was doing what is called "doing my friend Timmy's assessment". For that usually the nurse lady takes his temperature with a stick in his arm pit, takes his blood pressure with a little bracelet around his leg with wires coming out of it, and changes his diaper with a very teeny tiny diaper. I was excited to get to tell my friend Timmy what it is like to see the diaper change from the bottom of the crib. It would give us something else to talk about besides how much we like being friends.

But then, I am very unsure how it happened, all of a sudden the nurse lady, she did not have him covered up at the right time and KABLOOEE! I was covered from striped red and orange scarf to purple antler in my friend Timmy's mushy icky stuff. Then the nurse lady wiped me off a little bit and banished me to the laundry bag where I could not talk to my friend Timmy about anything at all. It was a very sad day. Finally, my friend Timmy's mommy came and scrubbed and scrubbed and scrubbed me in the bathroom sink and then I took a fun ride in a washing machine and a drying machine and I came out spic and span and I was at the TOP of my friend Timmy's crib where we could talk about being friends again. I love my friend Timmy!

Tummy time!

If you saw this picture, you'd think it was of some crazy procedure, right?

Well, you'd be wrong. The doctors finally approved tummy time for Timmy for the first time since he was about a week old. It took a nurse, an occupational therapist, and a physical therapist (along with two parents looking on) to figure out how to do it. But finally (with the help of a Boppy pillow and four different z-flow pillows in three sizes), Timmy made it onto his belly!

The secret is mashing divets in the z-flows for T's trach, for his j-tube, his g-tube, and his knees. You also have to make sure the duck on his pacifier is upside down so that it doesn't keep falling out of his mouth. Once we got him situated, he loved it!

Mortimer welcomes you!

Hello, my name is Mortimer. Mortimer the Moose. I have a wonderful friend named Timothy and he is a wonderful, wonderful friend. I am putting this blog together to tell you about all the wonderful things we get to do together every day. I wanted to tell you about his life so far from the beginning but I did not know him until he was 35 days old. So I have asked his parents to write a brief history of little Timmy's life from the very start. It has been a scary journey (sometimes I think I have lost a bit of the purple color in my antlers!) but I believe Timmy and I will be good friends for a very long time. Thank you for reading and looking at all the fun pictures of me and my friend. I love Timmy and I love you too!

A short (haǃ) recap of Timmy’s first 15 ½ weeks…

Timmy was born 7 weeks early on September 29, 3lbs 9oz, 16.5 inches long. For the first several days of his life we thought his problems were normal preemie issues. He was transferred to Children’s Hospital in Columbus when he was four days old for further testing. Over the next week or so we learned that T was born with a number of birth defects, ranging from extremely minor (missing a set of ribs and having an extra vein into his heart) to severe. The biggie was a Type 3 laryngeal cleft. This means that a portion of the wall that should separate his trachea and esophagus was missing. Obviously this is a pretty big problem—much of the milk that he had been fed for his first several days of life (through a feeding tube) had ended up in his lungs, causing pneumonia. The first several days of Timmy’s life when he was “just a preemie” were extremely difficult for us, but then being told that our tiny three and a half pound baby needed major surgery in order to be able to live was heartbreaking. The next several weeks of adjusting to life in the NICU were scary—saying good-bye to Timmy as he went to the OR (for a scope under anesthesia) for the first time, watching him struggle to breathe, learning to be comfortable with cords and tubes, watching him drop down to 3lbs, 5oz, and seeing plans for his first surgery canceled because he was too tiny.

Finally on October 26 Timmy went down to the OR for major airway reconstruction. At that point we were nervous but so relieved that things would finally be “fixed”. We thought he’d have his surgery, everything would heal up, and we’d be teaching him to eat a month later. The surgery went great—the next week was pretty rough (he spent his first month birthday paralyzed to keep him from moving and damaging the repair), but we handled it pretty well, knowing that it was what he needed to live a normal life. The surgeon had given us approximate 70% odds of complete success. Though we knew that Timmy’s condition was extremely rare, we were fairly confident that everything would go well, especially after a bronchoscopy one week post-surgery confirmed that everything was healing perfectly. Unfortunately a week or so after that we got the news that the cleft repair had started to pull apart. A week or so after that we got the news that there was very little left of the original repair. And so we were back to square one.

On November 9 Timmy went down to radiology to have a fairly routine procedure done. He’d been taking all his nutrition via IV (TPN) for his first six weeks of life, and he needed to have a j-tube threaded through his existing g-tube (placed in his stomach at the same time as his airway surgery) so that he’d be able to take milk straight into his intestines. A couple of days later, Timmy started showing signs of extreme distress. We discovered on November 12 that the j-tube had perforated his intestines, causing a life-threatening infection. Because Timmy was too critical to be moved downstairs to the OR, the entire surgical team (and all their equipment) came up to the NICU and performed emergency surgery to try to repair his intestines. They were unable to fix the perforation, so they put a tube in to patch up the hole. At the same time, because of concerns about repeated intubation and extubation damaging what was left of the cleft repair, ENT came up to the NICU and performed a tracheostomy. That night, sitting in the NICU waiting room, we were faced with the very real possibility that Timmy wouldn’t survive the procedure. But he’s a little fighter, and pulled through. The next few days were scary—he had something like 9 different IV pumps and was on the ventilator again (though the first thing we learned to love about the trach was that we could finally see his whole face for the first time!).

A few weeks later, once Timmy was a bit more stable, we started to learn how to do all his trach care. It was incredibly intimidating at first-the first time we thought his trach had come out, my heart stopped and I started shaking all over. But gradually we learned to be more comfortable with it, and at the beginning of December they started talking about discharge in a few weeks. At that point we knew that there was nothing left of the original repair and that Timmy would need another airway reconstruction in 2-6 months time, along with a second abdominal surgery to repair the perforation in his intestines at some point down the road. Unfortunately, though, he took a turn for the worse, and due to a number of factors, we decided to have him transferred to Cincinnati Children’s Hospital on December 17 to see what the doctors there could do for him.

People from all over the country bring their kids with laryngeal clefts to Cincinnati. We were amazed when we first got here—we went from having a child with a condition that few of our doctors had ever seen to having a child with a condition that was almost routine! A few days after arriving in Cincinnati, ENT, pulmonary, and GI each examined Timmy down in the OR and our world was turned upside down once again. Before Timmy’s scope, Mark and I had been doing all his trach care. We were completely comfortable getting him out of bed, and we were learning to treat him (somewhat) like a “normal” baby. After the scope his airway was designated as critical—we were no longer allowed to do his trach care or even hold him. They wanted to schedule a second repair attempt ASAP, and they diagnosed him with severe laryngo/tracheo/bronchomalacia (airway floppiness).

December 28 was his second big airway surgery. This time around they used a rib graft to reinforce the repair. Now, two and a half weeks out from that surgery, things are still looking good. Yesterday they took him down to the OR for yet another bronchoscopy (his eighth). An A+ would have been a repair that was completely intact that had also fully mucosalized (essentially meaning integrating with the tracheal/esophageal wall). Though the repair still hasn’t fully mucosalized, a good portion of it has, and there aren’t any holes, which is great news! We’re finding that we’re having a hard time celebrating, though—I think that’s because we’ve dealt with so many ups and downs over the last several months that we’ve adopted a kind of “we’ll believe it when we see it” mentality.

So, as the situation currently stands, Timmy will have his trach for at least a few years (we’re not really sure how long). When it comes time for decannulation (removal of the trach) he may need to have a second airway reconstruction. He’ll likely come home on a ventilator, but we’re hoping that he won’t need that for longer than several months. He has a G-tube (feeding tube into his stomach) which isn’t currently being used for anything except a drain. He also has a surgically placed J-tube (the tube that was used to plug the perforation in his intestines) which we’re using to feed him. He’s getting over his most recent bout of tracheitis—this time around it’s pseudomonas and serratia (in the past he’s also had staph infections in his trach).

Our plans for T are fairly up in the air right now, but tentatively it looks like another abdominal surgery (to remove that J-tube and patch up the perforation) in 3-7 (ish) weeks. A few weeks after that, we might be able to take him home! In the meantime we’re waiting for the graft in his airway to fully mucosalize. Once that happens, T will do a swallow study so that they can make sure it’s safe for him to eat. If that goes well, we might get starting to teach him to eat! From what we understand, the learning to eat may not be an easy process, since we’ve skipped the period when babies usually learn to coordinate sucking, swallowing, and breathing. But at least getting to put stuff besides his pacifier in his mouth will be a huge milestone! Once he goes several months being able to take all his feeds orally, we’ll hopefully get to pull the tube in his stomach.