Flashback - Birth till discharge

before you freak out and wondering what happened again??? this is a post of the past that i had to write up to submit to the institutes to apply for a seminar so i thought i post it here as well. so this is what happened last year in 2006

Right after I birthed Jere, the neo natalogist Dr Simon Ng was called into the delivery suite to examine him, briefly told us about Jere's birth condition and had Jere wheeled straight into the Neo Natal Intensive Care Unit (NICU) I was not allowed to breastfeed him Baby J was scheduled for operation at 1600 hr to cover up the spine. Then at about 9 plus that morning, it was the first time we met Dr Choo Su May, the anaesthetist for the op later. Was given the greenlight to feed till 1330hr.

Baby Jeremiah had a smooth operation 5th July, 2006, yes the first day of his life to cover up the open neural tube defect and was on morphine till 5am, 6th July, the following day. At first Jere was laid prone to rest but due to the bouts of apnea (stop breathing)he was flipped over from prone to supine (on the back) hoping that there won't be any more such episodes. The doctors told us that breathing was slow. He had a plastic box over his head which they explained was the oxygen tank and MRI and blood count and other tests were ordered for him.
We were told that Jere had no Babinski reflex ( that is the doctor's term of running a key or tickling the soles of the foot and the toes should curl up). He seemed to have no feeling. There was also little or no anus puckering when the dr stimulated him near his bum. He also pee only when the nurses did bladder compression.
The doctor explained that this means his motor movement of his legs and feet, his bowel and urinary movement are all affected.

On the 7th July the results were all out. Blood count ok MRI scan shows chiari malformation type 2, syringomyelia and myelomeningocele and an absense of corpus callosum(the bunch of nerves that communicates between the right and left brain) and mild hydrocephalus (water accumulating in the head) is seen. There is also more than normal water in the spine, supposedly due to the syringomyelia.
Good news is later that evening, no more episodes of stop breathing and he was allowed to take 5ml of ebm every 3 hourly. The doctor was monitoring his liquid intake as there is more than normal amount of water in his head and spine.
On the 8th July, 3 days post op, the nurses said he had slight jaundice and had to be put under the light. Other than that, his recovery from his op was uneventful.

On the 9th July, Jere stepped down. His condition was more stabilised and they moved his bed. There are different classes. The class he is in now is more stable kind... without the oxygen tank and what nots...though still in neo natal intensive care unit (NICU).

2006 12th July Jerry is done with his antibiotics. Plug taken off. Doctors are monitoring him for another two to three days about what I have mentioned before, water system in head, spine and suspect of leakage at his operation wound site.
2006 13th July In the morning we were told there seemed swelling at the operation site. Neuro surgeon is monitoring for leakage. Doc says there is water that just wont drain off. Usually it should go into the blood stream but seems like it's not happening. The swell and bulge could also be due to water leaking coz there was not enough tissue to cover when the op was done as bb jerry was only less than a day old then.
Afternoon about 1600hr, the neuro surgeon Dr Tang called to say that he had to schedule Jerry in for an op to repair the leakage at 1900. We pushed him into the operating theatre at 1915. At 2215, Jerry finally was pushed up. Dr Tang said no problem and explained he had put in artificial tissue and glue and Jerry would be put on antibiotics for next 7 days and be observed.
2006 14th July Baby J was still in the warmer and a little fretful so paracetemol was given.

2006 15th July Dr Tang called to say that fontanelle is soft but head circumference is 35 cm and to continue monitoring. He is on drip by the foot as his hands swelled. Looking hungry but not allowed more milk as they are monitoring the liquid

2006 16th July Dr Tang called to say the fontanelle is sometimes tense and bulge at the operation wound and explained that could be due to the water up in the head and to KIV a CT scan tomorrow. Other than that the wound looks alright and no fever.
2006 17th July Dr Tang said could hold the CT scan. Jerry’s head circumference increased to 37 cm from 35.5 and Dr Koh say that it's obvious there is water. Scan results is out. Dr Tang says does not warrant a surgery yet. Praise God.
Now monitoring head circumference. if it stays that way, Dr say will let it be. Dr also says pray for the op wound to heal nice as it shows a little bulge. on a positive note, so far lab tests for bacteria is negative which is good news.
Praise the Lord. Jerry's now weighin 3.8kg from his 3.37kg at birth on the 5th july.
He smiles when we talk about him or talk to him. His wound seems a little bulging now according to Dr. May be fluid inside....
2006 19th July Jerry condition is stable. Head circumference remained constant. Praise the Lord! Today last day of antibiotics. To be under observation for next three days. Please pray for no complication and infection so jerry can come home this weekend. He is two weeks old today. no news from doctors = good news i would say.

2006 20th July Done with antibiotics. Plug will be removed today. will be given bcg and hep vaccination. Please pray against all complication and infection so that jerry will be discharged soon. As his spina bifida's condition may affect from his waist down, tomorrow jerry will be doing an ultrasound on his kidneys.
2006 21st July baby Jeremiah Liauw is discharged back home after two ops and sixteen days in Neo natal intensive care.

2006 24th July It's been a little madness as we try to maintain the cleanliness of his op wound as it's so near to the buttocks that when bb jerry poos, sometimes it gets to the wound. And though the dressing is supposed to be water proof, it somehow seeps in. then it's crazy for us as we try to take the dressing out and change the new one. It’s so painful for jerry and so painful for us to see as well. We use an 8 by 5 dressing for the op wound so that is about how big the wound is. God please grant jerry complete healing.

This wed 26th, jerry is due to be checked by the pediatrician.
Thurs 27th, we got a referral letter to be seen by the pediatric surgical dept in kkh
Fri 28th, jerry is due to remove his stitches of his operation. Please pray against leakage and all complications.

So far, what I know of jerry's case is it's myelomeningocele ( the more serious case of spina bifida), syringomyelia (related to Chiari Malformation) and chiari malformation type II.
Also, there is absense of corpus callosum which worries me as i read that it's the nerves that communicates between the right and left brain.
As for his no control over his bladder and bowel movement, please continue praying. It’s probably caused by syringomyelia which is something like a cyst growing on the cervical cord. In Jerry's case, his MRI scan shows syringomyelia in the lower cervical cord extending along the entire length of the cord. This syringomyelia also cause the obstruction in the normal flow of cerebospinal fluid (CSF) thus, we hear of fluid in the spine as well as the head (hydocephalus)

Please continue to pray for Jeremiah Liauw
2006 27th July Yesterday went to kkh.
Did urine culture and urine analysis tests. Results not out. It was so hard trying to catch his urine as he was laid down and we just waited and of coz he was not comfortable so he cried throughout.
appointments were given for several other tests of which all are intrusive



2006 28th July Baby Jerry went to remove stitches today.
Really stressful for bb, dr, nurse and mummy.
Mummy went with bb J.
He was not sedated or anything, just some lotion applied before removing the stitches.
He was crying throughout.
finally doc removed some and said to return on mon (31/ to remove the rest.

What’s lined up for Jerry?

Aug 1, Tues - Micturating Cystogram (MCU) A fine tube will be put through the urethra (the hole thru which urine is passed) with a special solution running slowly thru the fine tube into the bladder. x rays films are taken by the radiologist durin and after the procedure.

Aug 8, following Tues - Urodynamics (UDS) a cold liquid is used to clean the part where pee comes out from (penis) then some numbing gel will be applied then a small tube will be inserted into the bladder and another small tube that goes in through the anus. it will be monitored for about 15 min then the child is to pee out.

Aug 21 Mon - Nuclear Medicine Treatment (DMSA) a nuclear medicine (radioactive agent) or (radiopharmaceutical = a chemical compound that contains a small and safe amount of radio active substance with a very short half-life which means they cease to be radioactive within a day) is injected into the vein of the child. Images are then taken either immediately or within the next few hours. the child will be positioned on a special detector called a gamma camera which picks up signals from the radiopharmaceuticals the child received.

all the above are tests from the urologists as spina bifida cases tend to affect waist down so they need to find out how well is the bladders, kidneys, etc.

Please pray for BB Jerry.
I know it's gonna be painful coz my dad been through those with the tube inserted thru the penis and anus. my dad has a high threshold of pain such that he can do a colonscope without being sedated or taking any pain relief but he was screaming through out the procedure where they insert the tube in his penis and anus even after taking panadol and the so called numbing gel.
Please pray for positively good results

then bb jerry will return to doc and get further blood tests.

Please continue to pray for bb Jerry and us as in our family. This really needs so much strength and I tell myself everyday I will not be beaten! I will not fall and I won't fail my God, jerry and of coz all that are behind me which includes all of u. Thank u again.

Flashback - Labour and Delivery

In case you're wondering why I am writing about the past, this is because I gotta submit a detailed description of pregnancy, labour and delivery to apply for the "what to do about your brain injured child" seminar.
so here goes...

Labour and Delivery

2006 Jul 4 Had mild contractions from morning. Not regular. Still can walk.

6 plus in the evening Contractions more close and uncomfortable. Informed sister to standby to take care of the older preschooler brother, Nat.

7 plus in the evening Sister and brother in law came to pick nat up.

8 plus, almost 9 Left home for the hospital.

9.15pm Reached hospital. Admitted and was sent straight to delivery suite. Changed into gown and was monitored for contractions.

10 plus pm Midwife checked for dilation. 5 cm! Enema given. Gynae was activated. Overheard from the nurses that the gynae asked the nurses to put a drip for me and to burst my waterbag but I refused. All natural, I said.

11.20 pm Gynae Dr Goh came in and burst my water bag. Said baby head high up and told me high risk and said must put life line otherwise later hard to find vein. I refused. Dr Goh seemed exasperated trying to convince me. He left the suite asking me to think about it. Dear hubby Tim and I discussed and we prayed as I was not comfortable about being poked at all.

11.45 pm Could feel baby moving. Contractions got really stronger. Asked for gas.

2006 Jul 5
Midnight Super painful. Midwife checked and said already 8-9cm and called for the gynae.
0045 Jeremiah aka Jerry was born weighing in at 3.37kg, 51 cm in length and a head circumference of 34 cm
au naturale birth :) juz like what i had for nat, my first born almost the same process .... admitted hospital around the same time and birthing somewhere past midnight. This time even better than nat in the sense that i had no pethidine injection at the thigh and feeling bruised thereafter and it was an unassisted birth as in no forceps or vaccuum was used. Praise the Lord!

Neo natologist was called in to check on Jerry and we were told that Jerry had a condition of Spina Bifida and he was wheeled straight into the Neo Natal Intensive Care Unit

The story continues at Jeremiah trackback section. http://amothersjourneyinfaith.blogspot.com/search/label/Jeremiah%20Trackback

Flashback - Pregnancy

FLASHBACK FLASHBACK FLASHBACK

It's strange how I am forced to dig out my diary and document it all down. Had to do this for the upcoming seminar that I have registered to secure my place.

Here it goes

Pregnancy
2005 Oct 28 Tested positive on HCG test. (Gave the test kit in a anniversary card to dear hubby Tim. Boy! you guys should have caught his face! It was our 4th year traditional wedding anniversary)

2005 Oct 29 Saw the gynae Dr Goh but could not see anything with the abdominal scan. Turned down an internal scan.

2005 Nov 5 Saw pregnancy sac with abdominal scan this time at gynae’s. Dr Goh said implantation ok. To return in 3 weeks.

2005 Nov 18 Saw the gynae Dr Goh earlier by 1 week as my car got banged by another in the carpark as I was inching out of my lot. Dr Goh did a scan and cleared everything and to monitor next 3 days. No negative signs. Asked to return next week to monitor.

2005 Nov 26 Saw Dr Goh. Everything seems ok. Gained a total of 1.4kg at 8 week 5 day gestation. Had been having loose stools and bloat.

2005 Nov 27 Temper’s very bad. Still very bloated and very loose stools.

2005 Nov 28 Consulted family physician, Dr Hing and was prescribed rest, loperamide for diarrhea, Buscopan for pain, Meteorspasml for wind and cramp. Called the gynae Dr Goh to check if medication was ok. Was advised not to take meteorspasml. Took the rest of the medication and slept all day. Cramps still persisted.

2005 Nov 29 Called the gynae Dr Goh again to check but gynae outstation.

2005 Nov 30 Consulted another Gynae Dr Paul Tseng. Was prescribed Losec and 3 days medical leave but I had my misgivings about the medication so did not take the medication and just rested.

2005 Dec 1 Still gassy and bloated but did not take Medication.

2005 Dec 2 Still feeling as bloated.

2005 Dec 17 At 11weeks 1 day gestation, a total weight gain of 1.2kg. Foetus measuring 4.6cm.

2006 Jan 7 At 14 weeks 1 day gestation, a total weight gain of 2 kg. Foetus measuring 8.4cm.

2006 Feb 4 At 18 weeks 1 day gestation, a total weight gain of 5 kg. Foetus measuring 13.2cm.
2006 Mar 4 At 22 weeks gestation, a total weight gain of 7.3kg for mummy and baby estimated weight to be 495g. Blood test results were out. Dr Goh said it’s all ok. Did not proceed to do detailed scan as Dr Goh said it was optional and not necessary since we were young, should be fine.

2006 Apr 9 At 30 weeks gestation, a total weight gain of 11kg for mummy and baby estimated weight to be 1.5kg

2006 May 20 At 33 weeks gestation, a total weight gain of 13.7kg for mummy and baby estimated weight to be 2.5kg. Blood pressure at routine check up with gynae shows ok. However, Dr said sugar level a little high, maybe due to the little more ice cream I have consumed. Gained too much weight, almost 3 kg in 3 weeks. Blood volume also low so was advised to take iron tabs.
2006 Jun 1 Routine check up with gynae. Lost 1.9 kg in 2 weeks with a nett weight gain of 11.8kg for mummy. Baby estimated weight at 2.6kg.

2006 Jun 16 Routine check up with gynae. Total weight gain of 13.5kg for mummy. Baby estimated weight at 2.8 - 2.9kg.

2006 Jun 23 Routine check up with gynae. Total weight gain of 13.4kg for mummy. No more scanning of baby. Heartbeat ok.

2006 Jun 30 Routine check with gynae. Total weight gain of 13.5kg for mummy. No more scanning of baby. Heartbeat ok.

well, if i have not answered your question, no, the problem that jerry has was not diagnosed prenatally.

J trackback : 13th July 2006 afternoon

1600hr Dr Tang called to say that he had to op on Jerry
at 1900. I rushed down to the hospital
at 1700 to sign the papers.
1745 Jerry woke and cried for feed but NIL by mouth. He cried till
1915 when i brought him down to the operation theatre. Poor boy. God be with Jerry baby. Staff nurse Joanne was really sweet as she accompanied us down to the operation theatre.Being a mother herself, i guess she really sympathised with me as my tears kept rolling dowm my cheeks. i could hear her walking over to tim and asking tim to give me some comfort.
Tim and I handed Jerry baby over to the people at the operating theatre after we whispered our prayers in between sobs. Jerry was still screaming away as i handed him over.
1915 We headed to the cafeteria to try to grab a bite but we could hardly eat.
1945 Went back to NICU to express milk
2100 Gladys and Jason came to hospital and prayed for us and with us as we waited.
2215 Jerry finally was pushed up. Dr Tang said no problem and explained he had put in artificial tissue and glue and Jerry would be put on antibiotics for next 7 days and be observed.
It was the first time after more than a week that Gladys and Jason saw baby J for the first time. They prayed over him.

J trackback : 13th July 2006

I am still praying for a miracle and i am really blessed and comforted to know that there's so many in the prayer loop for bb Jeremiah. From family to colleagues, locally to globally, friends and all their cell groups, friends from the local forum m4m who's been my support since nat's days. Lynn and Mandy from there were even thoughtful enough to start a fund raising drive to help us and Ratna have so big heartedly approved of it Thank you people! Your blessings will go a long way!

Today's update is:
Doc says gotta look out for infection since bb Jerry is off antibiotics. Please pray against infection.
Neuro surgeon will remove stitches on Fri 14 July and monitor for any leakage. Please pray against leakage and complications of bb Jerry as he gotta go into op straight to repair if necessary. Presently, there is swelling on the operated site. Doc says there is water that just wont drain off. Usually it should go into the blood stream but seems like it's not happening. Still we pray that it doesn't get bigger. The swell and bulge could also be due to water leaking coz there was not enough tissue to cover when the op was done as bb jerry was only less than a day old then. If after removing stitches, all is well, doc will review jerry in six to eight weeks with regard to his op wound and more MRI scans and go into op only then as new tissues and membranes would have grown by then.
Please pray that the swell would go, tissues and membranes would grow and the MRI scans would be positive in six to eight weeks and that no further surgery is needed.
Prayers are powerful.
Please pray for BB Jerry's condition.
Thank you all.

J trackback : 12th July 2006

It's 0737 in the morning.
Every morning without fail i will be there with my little angel. Look at him! People say he looked like me, mummy upon showing them our precious little one's pics. To date, nobody except us parents have seen him coz they are really strict in NICU. Only parents, pastors, priests, nuns allowed. All the others only saw the pics.
Our PRECIOUS!

Jerry is done with his antibiotics. Plug taken off. Doctors are monitoring him for another two to three days about what I have mentioned before, water system in head, spine and suspect of leakage at his operation wound site. Please pray that the water system either remain constant or drains off naturally to normal and the tissue and membranes to grow so that the doctors do not need to do any repair. Jerry will be a week old in just a few hours. We give thanks for this wonderful precious gift from Him.

Please continue to pray for little jerry.

J trackback : 9th July 2006

Jere is 4 days old! Look at the sweetpea. Sleeping so contentedly. His condition is more stabilised and they moved his bed. There are different classes. The class he is in now is more stable kind... without the oxygen tank and what nots...though still in neo natal intensive care unit (NICU).

Thank you Lord! We are taking baby steps....

J trackback : 8th July 2006

3 days post op. It was 0719 in the morning
I was allowed to cuddle Jere and nurse him. Afraid as I was to hurt him, i managed him gently. To be able to carry the little one was so much joy. Imagine having given birth and not being able to carry the little one for days.... and watching him suffer and not being able to alleviate his pain in the least. Not being able to hold him close and whisper to him you love him.


Carried him for a mere 15 minutes and the nurses said he had slight jaundice and had to be put under the light. i remember thinking it was so much torture when Nat had to be put under the light some 4 years back. Now i realise how we whine over the slightest thing. The light now seems miniscule in comparison to all that he's been through.
My baby. My warrior!

J trackback : 7th July 2006 - update

Well, that's me! looking quite fresh ah?
But of coz! That is 0730 in the morning.
Every morning, i would rush to hospital juz to say the morning prayers for my little one and also to catch the doctors who make their rounds at that time for updates.

and so this was the update i got
Blood count ok

MRI scan shows chiari malformation type 2 and syringomyelia
and myelomeningocele
there is absense of corpus callosum(the bunch of nerves that communicates between the right and left brain) and mild hydrocephalus (water accumulating in the head) is seen. we gotta pray against the increase in circumference of his head in terms of water accumulating there.

there is also more than normal water in the spine which we pray that all the extra water would miraculously by the grace of GOD return to normal.

Jere's a fighter and a sweetpea.
He opened his eyes and smiled at me this morning.
I know I gotta keep strong and positive.
I am praying hard and I know lots of people out there are doing that for bb jere too. Thank you Lord.

Good news is latest update in the evening, no more episodes of stop breathing.
and he's allowed to take 5ml of ebm every 3 hourly. doc is monitoring his liquid intake as there is more than normal amount of water in his head and spine which I pray that it will drain off and disapear miraculously by God's grace and will soon revert back to normal.

Also please pray for the control of his bladder and bowel movement. So far when stimulated, seems like no response. and his toes and feet too when stimulated also toes not moving. Please pray that all these will develop.

thank u all.

oh ... nat is ok. doesn't really know. cannot tell him. he thinks too much. so now he juz thinks bb in hospital coz still too small, well, that's what we told him.
he is really anxious to meet his didi

J trackback : 6th July 2006 - post surgery

Baby Jeremiah had a smooth op 5th July, 2006, yes the first day of his life to cover up the open neural tube defect and was on morphine till 5am, 6th July, the following day. Yes, morphine at not even a day old. Poor baby! My heart sank when the doctor told me that. The surgery must be so painful then for them to administer morphine. Breathing was slow and he had episodes of apnea(stopping to breathe). I asked to be discharged after my gynae,Dr Goh came to check me as I felt too stressed in hospital. I could not do anything for bb jere and milk wont come. I must breastfeed him as that is the best i could give him.


Here he is, still in neo natal intensive. The plastic box over his head is actually the oxygen tank.
MRI and blood count and other tests were ordered for him. Could not direct feed as better not to lift him unnecessarily.I had to get my spirits up and get the milk coming.

Everyone was activated in prayer asking God to keep Jere safe and a speedy recovery.

J trackback : 6th July 2006 - evening update

At first Jere was laid prone (on the front) to rest as seen in the earlier picture but due to the bouts of apnea (stop breathing)he was flipped over from prone to supine (on the back) hoping that there won't be any more such episodes. Prayers are activated against that coz it may bring about the delay of discharge or even another surgery. It was so painful seeing so many wires and tubes on him.

We were told that Jere had no Babinski reflex ( that is the doctor's term of running a key or tickling the soles of the foot and the toes should curl up). He seemed to have no feeling. There was also no anus puckering when the dr stimulated him near his bum. He also pee only when the nurses did bladder compression.
This means his motor movement of his legs and feet, his bowel and urinary movement are all affected.
We asked everyone to pray for all these in particular.
We just have to trust and pray.

J trackback: 5th July, 2006

That day is a haze as i recall now.

Tim and I left the NICU after 2pm the visiting hour. We went back to my room and so many thoughts were racing thru our minds. Yes, we were afraid and we know we had to pray. We called Gladys who was babysitting Nat the Korkor. Seems that Korkor is fine.We did not know what to tell Nat.


Nat's the korkor and he's been anxious to meet his little brother. We've brought Nat to visit friends when they gave birth. Nat sure wants to meet his didi when he comes. What should we tell him?

Our first visitors....

Shan came with her baby, Jerry and her mother in law.
Tim excused himself to go get something to bite since i had friends. He returned soon after. I know he must be feeling pretty lousy himself. Not being able to carry our little Jeremiah and Nat's not visiting yet... as he's with my sister, Gladys. They would only come after Jason, Gladys' husband finish work. Tim must be feeling as terrible as I did but we kinda suppress our emotions as we went through the day. I knew he needed not jus a pat but a hug as badly as I do.
And so our little valentine baby Jerry who was born on Valentine's day 2006 did the job.


The people at Nick sent a hamper and a card most sweet. Some of them sms me if was ok to visit but frankly, I'm not quite ready. Can't speak without crying most times.

Shan's mil was really nice. She told me that if we were ever in need of funds, she could help... no need to go to the banks coz their interests are so so high.

the rest of the crew angel and hengjong, qiuyan, xinling, ben, kelly, jo all came in the evening. tim's mother also came. I could see they all tried to hold back their tears too. I know they felt our pain.
Kelly brought holy water from Lourdes, a rosary and a little motorcycle gift for nat and some pocky snack for Tim. how thoughtful.

My dear nat came with my sis Gladys and Jason later that evening. Nat came right up to my bed and pressed my tummy. Of coz the tummy have not went down so he thought baby was not out yet. We gave him toys and distracted him. He kept asking and we kept distracting. Lord lead us.

God bless these people who came and reach out to us with their hearts.

J trackback: 2006 - Just Born and the News of Surgery

This picture was taken 5th July 0653am about 6 hours after Jeremiah was born.

Right after i birthed Jere, the neo natalogist Dr Simon Ng was called into the delivery suite to examine him, briefly told us about Jere's birth condition and had Jere wheeled straight into the Neo Natal Intensive Care Unit (NICU) I was not allowed to breastfeed him :( I was wheeled into the ward and could not sleep all night thinking of my baby.

Baby J was scheduled for op at 1600 hr to cover up the spine. It was not easy at all when I saw him all hooked up to drips.

Then at about 9 plus that morning, it was the first time we met Dr Choo Su May, the anaesthetist for the op later. Was given the greenlight to feed till 1330hr. I was so happy. Poor baby. He must be so hungry. I immediately latch him on. He was so little...it was so much comfort to be able to put him to my breasts.

After nursing Jere for a while, I decided to return to my room as I felt like there was no milk.

Just when I was about to leave the NICU, Sister Bernardette came in. Seems like a God sent! I really needed someone like that. I cried as I talked to Sister Bernadette and she prayed for me to surrender it to the Lord and peace to be with me. After which I returned to my room. I started to sms everyone that I know, informing about Jere's birth and the impending surgery and asked everyone to pray for a smooth procedure and no complications to arise.

We met Dr Tang Kok Kee about 1 plus that afternoon. He was the neuro surgeon that would operate on baby Jere. He explained to us about the open neural tube defect in more detail and told us that he would be the operating surgeon and we could ask him any questions if need be. I could not hear much or ask much as I was concerned to give Jere as much milk as I could before his op. Dr Tang then left me to nurse Jere.