Pictures

Here are some pictures from uncle Aaron.

Emma

Mommy and Adalyn

Double Time with Daddy

Today was my first day taking care of the girls all by myself for the whole day. Abi went back to work today so last night I did the 12am feeding by myself and let her sleep so that she could get some good rest. Besides having no time to do anything else, everything went great! The day just flew by and I just love hanging out with my little girls. It is sad how fast those two tiny babies wrapped me around their little fingers. Uncle Brian and Aunt Sue stopped by at lunch time to feed the girls for me and spent some quality cuddle time with Adalyn and Emma, everyone involved seemed to really enjoy their time together.

The girls are still struggling with their reflux and continue to spit up every feeding. Because of this, Abi and Dr. G decided to try thickening their formula. We started at the 9pm feeding last night and so far it really seems to be helping with their spiting. They still reflux but at least they have kept their food down. When Abi got home from the hospital tonight we loaded up Adalyn and Emma into the minivan and snuck them in after hours at the office and got the girls weights and lengths. Adalyn weighed 5lbs 13oz and is 18-1/4" long. Emma weighs 5lbs 2.5oz and is 18" long. Way to go girls! Even with the spit ups they put on an ounce a day since their last doctors visit on January 21. Besides their reflux the girls continue to do amazingly well. Both girls sleep really well in between their feedings and have some good quiet alert times during the day.(Even when they are sleeping they still make all kinds of noises original to them, I fear the day when they start to talk.) We have been giving them "tummy time" before their day time feedings and they actually seem to enjoy it. They both are really good at picking up their heads and moving them from one side to the other. On Wednesday Emma rolled over from her tummy to her back and Adalyn did it today! We know that it is a little soon for this and it was probably a one time deal but we are still so proud.(Abi was really excited both times.)

Please continue to pray that GOD heals their reflux and protects them from illness/infection. Praise His name and give thanks for almost 2 great weeks at home.

GOD Is In Control.

Minivan

It has been over a week now that both girls have been home and we continue to adjust daily. The twinners definitely keep us hopping and on our toes...and we love it! It is amazing how having children really changes who you are. I never understood how people could be so protective of their children...now I do. I never understood why so many moms drove minivans...now I do. Yeah that is right. Dave won. As many of you know Dave has wanted a minivan for quite a while...even before we had kids. He thought they were great because of all the space they have. Well I was not on the same page as him. I could not get over how unattractive of a vehicle they are (no offense to those of you have have and love your minivan). Well, I changed my mind the day we brought Adalyn home. Allow me to pain you a little picture.

...Dave and I head up to the hospital to pick up Emma. Adalyn is along for moral support. We get both of the girls packed up and into their double stroller (which is much like a stretch limo in terms of stroller size). We head out to the car and get both girls car seats locked into their bases in the back seat of my lovely volkswagen golf. The stroller gets very strategically placed into the "trunk". The girl's monitor occupy the only space left in the back seat. The diaper bag get crammed behind the passenger seat. I get into the car and I am sitting a little closer to the dash then usual, but since I am not really what most people would call tall, I seem to fit just fine. Dave on the other hand looks like a large person driving a smart car...in other words...he just does not fit. His seat has to be so far forward that he has to drive the entire way home with his knees touching the dashboard. Poor Dave had to listen to me giggle at him almost the whole way home. However, it was at this point where I realized that we needed something with more space and really a minivan was the most practical choice.



So in this instance my girls changed who I was in terms of my car. You see I have always become friends with my cars. My little white volkswagen golf was very "me" and I lovingly called it princess. Well we traded princess in at the end of last week for a white chevy venture. And now rather than having a car named princess I have a car that I can very comfortably use to transport my princesses. You see I really no longer care what kind of vehicle I drive as long as it is the best thing for my family. I am still getting to know my minivan so I have not come up with a name for it yet, but I will :)

Things continue to go well at home. Dave & I are still adjusting to getting no more than 2 consecutive hours of sleep at night. We are also adjusting to almost always smelling like spit up. And we are adjusting to the joy of parenting such wonderful miracles. We continue to feel blessed on a daily basis and it is our prayer that it never changes.

The girls had another eye exam yesterday. Emma has stage 2 ROP of both eyes and Adalyn's eyes are still immature, but show no signs of disease. So both girls will continue to go in for eye exams until their eyes are mature which usually occurs between 40-44 weeks gestation.



Both girls continue to struggle with their reflux, Emma still more than Adalyn. Please boldly ask God to heal there reflux. I am okay with them spitting up as long as they gain weight, are comfortable, and do not have alarms. Well they are gaining weight, but there are times where their reflux seems to bother them despite being on Zantac. And they are still having some alarms when they spit up. Please pray that they continue to grow and develop well and that God protect them from illness and infection.

On another note. Dave & I were contacted last week by a reporter from the Holland Sentinel wanting to do a piece about our girls. The story is in today's paper in the Life Style section. It can also be found on there website by following this link: http://www.hollandsentinel.com/feature/x1920340700/Tiny-blessings.

11 weeks old

I am eternally greatful for the two miracles God has given us. Every time I look at my girls I am reminded of the abosultely amazing gift that they are. 10 weeks in NICU, it really did not seem that long. However when I look back at where the girls started, we have come so far. I am reminded of that every time I look at my girls, and several times a day that moves me to tears. I never thought that at 36 weeks gestation I would have both of the girls home. What another amazing gift. God is so faithful! I love having them home. I love being the one to feed them, to change them, and to console them when the cry. Even though it has been an adjustment, I love getting up with them at night to feed them. Every night at midnight, 3 am and 6 am the Lamars have some family time. Sometimes Dave and I just sit there and smile as we hold our girls and listen to them coo while they eat. I think that one of my favorite things is that I do not have to call their nurse in Grand Rapids to find out how they are doing and what kind of day/night they are having. Although I do miss chatting with the nurses :)

I am currently trying to figure out how to get anything done durring the day since the bulk of my time is spent feeding the twinners. Don't get me wrong, I am okay with that because that is what they need. I just have to make extremely efficient use of my "free time." Dave & I both enjoy not having to make the daily hike to Grand Rapids.

Emma went to the doctor today and she is 4 lbs 10 oz. Adalyn came along for moral support and to get her weight checked again. She was 5 lbs 4 oz today. So their reflux and spitting up does not seem to be affecting their weight gain which Dave & I are very thankful for. However, we ask that you continue to pray that God heal their reflux. We ask that you pray this because the reflux is still uncomfortable for them at times and also because it causes them to have alarms. Please also continue to pray for growth and development and that God continue to protect them from infection.

Day 75: Home

That's right, both Adalyn and Emma are home!!!
GOD Is In Control

Day 73: A day with daddy

Today Adalyn and I spent the whole day together because Abi had to work and today was her day to go up and visit Emma. Adalyn did great last night and all day today. She is one noisy baby! She doesn't cry a lot but just makes noise all the time, little grunts and squeaks.(Emma does the same thing so when she comes home it will be even worse.) Abi and I would just start laughing in the middle of the night because of some of the strange sounds she makes. Even though I really missed Emma today it was really nice to sit home all day and hang out with Adalyn. We watched some TV, folded some laundry, and even took a 2 hour nap in the chair together. She did have a few alarms today but they were all quick and self resolved meaning we didn't need to stimulate her. Abi talked to the doctor and nurse while she was at the hospital and they think it is probably from the drive yesterday and the change in scenery so hopefully she doesn't have as many/any tomorrow. Please continue to pray for her to stay healthy and that her reflux will get better.(She did spit up her usual 1ml every feeding today with no other major episodes.)

Emma kind of had a "rough night" last night. She had 1 episode were she alarmed and needed suction and the nurse used the wall suction instead of the handheld ball suction that we have at home so we are hoping that will not set her back at all. She also spit up a lot because her nurse didn't realize she needed to be held upright for about 20 minutes after her feedings to help with her reflux. She had a much better day today with her usual spit ups but that was about it. Emma and mommy really enjoyed their time together but Emma wants to get home soon to be with her sister. Tonight she weighed 4lbs 5oz(1970). She had lost 50 grams yesterday so we are happy with her 20 gram increase tonight. Please pray that GOD heals her reflux, helps both girls gain weight, stay free from infection, and that Emma will be provided the strength to come home.

Day 72: Adalyn is Home!!!

Thats right, Adalyn is home tonight! I cannot believe that this day is here. If you would have asked me 72 days ago if I would have thought that she would be home before her due date I would have said no, but here she is at 10 weeks and 1 day old.(35 weeks and 3 days gestation.) I have posted a video above so if you can't see it let me know. It has been a long day so I will post more tomorrow on the girls. Emma has had a pretty good day but she lost weight tonight so please pray that she can gain more weight tomorrow. Please also pray that GOD takes away both of the girls reflux and protects them from infection. Praise GOD for how awesome both of the girls are doing!

Day 71: Happy 10 Weeks!

Wow, 10 weeks. Has it been that long? Has it gone by that fast? This week has been a roller coaster. Adalyn is doing great and we hope to have her home soon. She did gain weight tonight and is up to 4lbs 13oz. There is not much else to say because she has been doing great and she has had no trouble eating since Tuesday. She continues to spit up about 2 ml a feeding and her reflux still bothers her. Please pray that GOD preforms another miracle and takes it away from her. Also continue to pray that she stays free from infection, gains weight, and digests well.

Emma has had another great week! She continues to surpass our expectations and for those who are counting is on feeding number 13 out of 16. The doctors say she will not come home this week but maybe next week. I cannot believe the giant steps she has taken over the last couple of weeks! She is catching up to big sis. Her reflux still seems to be worse than Adalyn's, please pray that GOD takes away BOTH of their reflux. This is what is keeping them there. She has had very few alarms over the last couple of days and the Zantac really seems to be keeping her comfortable. She also gained weight and is up to 4lbs 6oz. Please pray that she can continue to stay free from infection, gain weight, digest well, and that GOD grants her the strength she needs to come home. Please also pray that the doctors be given the wisdom to know when both of the girls are ready to come home.

On another note, even if you don't know them, please pray for our friends from the NICU. Max (Who was sent home 2 weeks ago.) and Wes: Pray that they continue to do good at home and can stay there. Give their parents and nurses the wisdom they need to keep them on the path that GOD has set before them. Also pray for Melanie who went home today so that she can stay healthy and get to know her big sisters!

GOD Is In Control.

Day 70: Swing...and a miss

As some of you know Dave & I were supposed to take Adalyn home yesterday. We never said a specific day on the blog because the world of premies can change at any moment. Adalyn was definitely the one running the show yesterday. In the morning she was spitting up a lot and a couple of the events lead to alarms and one needed suctioning. So the doctors re-evaluated whether or not she was ready to leave. The consensus was made to have Dave & I room in with Adalyn last night and regroup in the morning after we saw how the night went. Well the night went great, both Dave & I enjoyed hearing her coo, grunt, cry etc. She did have some spit ups, but nothing major. This morning Dr. B (who tends to be a little more on the conservative side) said that all the neonatologists agreed that Adalyn should stay til at least Friday and see how she does. The other glitch is that she lost some more weight. So Adalyn is staying in the NICU with her sister & only God knows when she will be ready to come home. Dave & I are bummed, but greatful at the same time. We believe that Adalyn had this event for a reason. Maybe because God knew it was not time for her to come home yet & if she had something bad would have happened. Maybe it was to better prepare Dave & I for what could happen at home. Maybe it is that Miss Adalyn was not ready to leave her sister.

We will post a little more extensive update later on both girls. Emma is doing well & is taking about 50% of her feedings by bottle and loving it.

Please pray that God heal both girls reflux. That He prepare them for home. That he continue to help them grow, develop and progress in the right direction. And please pray that God help Dave & I be accepting of whatever happens, that He keep us positive, and help us not to get worn down.

God is in control!

Day 67: Big Girl Beds

That's right, both girls are now in their "normal cribs" at the hospital! Adalyn continues to do great and is on 27 full bottle feedings in a row. We also think that she passed her "car seat test" but have to hear the official word from the doctors. We also hope that tomorrow we can talk to the doctors about the date that Adalyn gets to come home. She lost 20 grams last night but was back up 15 grams tonight and is weighing in at 4lbs 11oz(2145) tonight. We think that her weight loss is probably from all the bottle/breast feeding she has done and she is now on the formula she is going home on which has less calories. She seems to be slowing down a little bit with her feedings so please continue to pray that GOD gives her the strength she needs so that she can prove herself ready to come home.

Emma has had a really good week! We are so proud of her and the big steps forward that she has taken. She proved to everyone that she didn't need the CPAP anymore, a couple days later she came off of the high flow nasal cannula, and now they have compressed her feedings to 33ml over 2.5 hours instead of a continuous drip. She tolerated that so well that today we were able to start bottle feeding her 10ml every 3 hours!(She gets the remaining 23ml compressed over 2 hours.) So far she has done that 3 times in a row and she loves it as much as her big sister. She has had fewer spit ups but continues to struggle with her reflux.(We are just happy she is keeping her food down.) Emma gained 5 grams yesterday and 20 grams tonight which puts her weight at 4lbs 3oz.(1910) Please continue to pray that GOD takes away her reflux and that she continues to tolerate her feedings. Please also pray for both girls to stay free from infection.

GOD is in Control!

Day 65: Feedings

Adalyn is doing great! She has now taken 12 full feedings in a row from her bottle. 2 of those feedings were a combination of breast feeding and bottle and she did both wonderfully. It is so amazing to watch this tiny baby that has never eaten by mouth before just latch on and go to town. She enjoys it so much and makes the cutest cooing noises while she eats. As some of you know the requirements for the girls to come home before their due date are: to be 34 weeks gestation, over 4 pounds and holding their own temperature up, off oxygen and any other breathing support, and to take all of their feedings by mouth for 48 hours(16 in a row) and digesting well. Abi and I talked to the doctor today because Adalyn meets all of these except the feedings and she appears to be well on her way to 16 in a row now that she is at 12. The doctor said that because Adalyn is only just 34 weeks gestation the standard 2 days will not be enough and he is looking for more like 5 days in a row instead. This is just to make sure she doesn't tire out after a few days. Having the word HOME come up in our conversations is really weird/exciting after 9 weeks in the NICU and 14 weeks since Abi was put on bed rest. We have now begun to prepare for Adalyn's departure from the hospital and have everything ready at home. We also have had all our education and training except for her meds because we are unsure of what she will come home on. Her weight tonight was 4lbs 12oz. Please pray that Adalyn continues to do as well as she has been and that she doesn't tire out with her feedings. Please also keep Abi and I in your prayers as we prepare to have one child at home and one in the NICU.

Emma is also doing great! She has now been off the high flow nasal cannula for 3 days and is have fewer alarms. As Abi wrote yesterday, the doctors decided to pull Emma's NJ back to an NG today.(nose to intestines=NJ/nose to stomach=NG) She has done well all day but seems to continue to reflux a lot. She has not had any major spit ups and the Zantac seems to make her much more comfortable. If she continues to do as well as she did today they will probably start compressing her feeds again on Sunday. Abi and I are worried about her reflux and are praying that this doesn't cause her to stay at the hospital too much longer than her sister. Emma's weight was 4lbs 2oz tonight. Please pray that GOD takes away her reflux, she looks so uncomfortable when she does this and it breaks our hearts to see her have that pain. (It reminds us of dry-heaving) Please also pray that she continues to do well off of the nasal cannula and CPAP so that she can put those things behind her. Also pray that she continues to tolerate the NG feeding tube. GOD, thank you for all the many blessings You have showered upon our daughters. We know that You are in Control! Amen.

Day 64: 9 weeks old

The girls are doing well. Emma has done well off the high flow. There has been an increase in her number of alarms, but nothing more than she had had on the CPAP in the past. They are all quick and self-resolved so the doctors are not concerned. She is still at 10ml an hour on her feedings and doing fine with that through the NJ. They are talking about moving her feedings to NG tomorrow if she has a good night tonight. Her weight tonight was 4lbs 2oz (1875 grams).

Adalyn had a good day as well. She is now allowed to feed by mouth at any of her care times if she is awake and showing interest. She still gets 15 minutes to take as much as she can and what she does not take gets compressed over 30 minutes. So far she has taken all of her noon, 3pm, 6pm & 9pm feedings by mouth. She also got moved to a memory monitor which is the type of monitor she will come home on. Her weight tonight was 4lbs 10oz (2110 grams).

Please pray that...
-Emma continues to do well off the high flow cannula.
-When they move Emma to NG feeds that she tolerates that well.
-Both girls continue to have less and less alarms.
-Adalyn continue to do well with her oral feedings and not get too tired.
-Both girls continue to grow and develop well.
-God protect both girls from infection.
-God heal Emma's reflux.

Thanks for faithfully praying for the twinners!

Day 63: 2 months old!

So the twinners were 2 months old yesterday, wow! They have come so far in the past 2 months & I praise God for that! I must say they are the most beautiful, most precious, 2 month old twins around :)

The girls are doing well. Emma has had no bleeding since Monday afternoon. So today they took the IV out that they placed monday while her feedings were on hold. They are continuing Zantac for now via her feeding tube to see if it makes her more comfortable from her reflux. And...she is off her high flow nasal cannula and on room air! Pray with us that she will get to stay off! So far so good! Her weight tonight was 4lbs 2oz (1885 grams).

Adalyn is doing well also. She is still doing well taking her full bottle 3 times a day so today they increased it so she can nipple 4 times a day. She has been doing a little more spitting up but nothing excessive. Adalyn's remaining 4 feedings for the day will be compressed over 1 hour. Her weight tonight was 4lbs 9oz (2080 grams).

Both girls continue to have some alarms, pray that this continues to improve. Please pray that Emma can stay off the high flow cannula and on room air. Also, the Zantac that Emma is on for her reflux makes her gut more susceptible to infection. Please pray that God continue to protect both girls from infection. Praise God for the girl's weight gain! And pray that God continue to help them grow and develop well. Please pray that God heal Emma's eyes so that there is no worsening of her ROP.

Day 61: A rocky start

Adalyn and Emma had a rocky start to their day today. A little background first. Adalyn took a full bottle (36 mL) at 9pm on Sunday and 3am Monday for her nurse Erin. She took the bottles in 15 minutes or less, with no alarms, spit ups, and burped like a champ. Then this morning at her 9am care time she spit up a fair amount and her belly measurement was up 2 cm. So this started the usual process of put the feeds on hold, call the doctors, and wait. Well the docs were not worried. They felt it was pretty appropriate given that she was for the first time in a long time taking a large volume all at once. So they resumed her feeds. At noon she took a full bottle again. Later that afternoon the docs decided to increase her feeding volume to 39 mL every 3 hours. They did not increase how often she is allowed to take a feeding by mouth. So her orders are still that she can take a feeding by mouth 3 times a day and she gets 15 minutes to take as much as she can. What she does not take in 15 minutes gets compressed over 1 1/2 hours. Her other feedings she gets 39mL compressed over 2 hours. So after a rocky start she ended up having a fine day. She did good with her alarms. At 9pm Dave got to give her a bottle. This was her first bottle of the new volume. She still did great, but was only able to get 30 mL in in 15 minutes. So they had to compress 9mL over 1 1/2 hours...seems a little silly :) But Adalyn was pooped and ready to cuddle with Dad anyway. Her weight last night was 4lbs 9oz (2070 grams)...what a little piggy :)

Emma's rough start yesterday lasted a bit longer than Adalyn's. In the morning Emma spit up some dark brown coffee ground looking emesis (which means it is old blood). She has done this before if you will recall. So the nurse called the doctors and they put Emma's feedings on hold and did an abdominal x-ray. The x-ray looked fine so they restarted her feedings at 11mL an hour just like they were before. In the afternoon Emma spit up fresh blood. So her nurse aspirated her OG tube and got some more fresh blood from there. So she called Dr. S who put Emma's feedings on hold again and ordered another abdominal x-ray and some blood work. In the meantime they put an IV in Emma's foot to give her IV fluid so that she would not get dehydrated. They also started her on Zantac and Maalox. The blood work looked fine. The x-ray showed that her OG tube was in too far which is what Dr. S thinks caused the bleed (irritation from the OG tube rubbing on her stomach). So they resumed her feedings at 10mL an hour and left her IV running at 1mL an hour. She is still getting the Zantac which I think is good because it will help her not to feel so uncomfortable from her reflux. The whole rest of the day she did not get any blood out of her stomach via her OG or through spit up...yay! She had another eye exam yesterday which showed that the ROP in her right eye is the same, Stage 1 and that she also has stage 1 in her left eye. I am happy to report that through all of what Emma went through yesterday she hardly had any alarms! Her nurse said that Emma had not had the bleeding in her stomach they probably would have trialed her off the high flow nasal cannula. Oh well, another day. I am just so proud of Emma for being such a big girl through all of that! Also, with a rough day where her feedings were on hold twice she still gained some weight! Emma's weight last night was 4 lbs (1815 grams).

Oh wait, I don't think I ever gave you Sunday's measurements. Adalyn was 4 lbs 7oz (2000 grams) and 17 1/4 inches long. Emma was 4 lbs (1800 grams) and 17 1/4 inches long.

Please pray that God continues to help Adalyn progress well with her feedings. Pray that this is the last time Emma has to have bleeding in her belly. Join us in praising God that the bleeding stopped and there were no signs of NEC. Pray that God heal Emma's reflux so that she can make progress with her feedings. Praise God for both of the girls having few alarms yesterday! Pray that God heal Emma's eyes and prevent any further progression of the ROP. Pray that He protect Adalyn's eyes from developing ROP. Please continue to pray that God help the twinners grow and develop well and that He protect them from infection.

Day 60: Big girls

Emma

Adalyn

Soooooooooo sorry I have been a bad blogger. I promise I will try get back into the routine of posting a new blog every evening...or Dave will if I cannot. Again, there have been quite a few changes since the last time I posted. Let's start with Emma. On Wednesday when I posted Emma was off CPAP. She remained off CPAP through the night, but according to her nurse Erin she looked tired. So on Thursday afternoon they put her back on CPAP. She did well through the rest of Thursday and Friday morning so around 11am Friday they decided to try her off the CPAP once again (what a roller coaster). They also decided to change her OJ to an NJ and discontinue her OG. Well, within the first hour she had about 3 brady alarms and she was retching. So her wonderful nurse Marsha had the idea to give her the OG back and try her on a high flow nasal cannula (on room air) before she got too tired. So that is what Emma has been on since about 12:30pm on Friday, we are so proud of her! She has been doing well, but she continues to have alarms on and off. The doctors are not concerned because she holds her oxygen saturations with all of them and they are all self-resolved. Her feedings continue to go at 11 mL an hour via her NJ tube and her OG tube is open to vent to help with her reflux. She is still definitely struggling with the reflux and has some retching off and on, but has not been spitting up much with the OG. Emma was moved to an open crib Saturday morning and is maintaining her temperature well. Dave gave Emma her first tub bath today and he did great, and so did she, but I am not convinced she liked it a whole lot :). Emma's weight last night was 3lbs 15oz (1775 grams)...way to go girl!

Adalyn is still in an open crib and on room air and doing great. She has a few brady alarms here and there, but not much. Her big changes lately have been with her feedings. Her feeding orders as of yesterday were that she was allowed to try breast/bottle feed 2 times a day and what she does not take by mouth and for the other feedings of the day she gets 36mL compressed over 2 hours. So, she got to try a bottle for the first time yesterday! Dave fed her and she was allowed to take 10mL which she took like a champ in 7 minutes with no alarms and no spitting up. She also got to breast feed in the evening which she did pretty good with, but it made her really sleepy. Since she did so well yesterday, her new feeding orders for today were that she can try breast/bottle feed 3 times a day and she gets 15 minutes to take as much as she can. What she does not take by mouth gets compressed over 1 1/2 hours. The other feedings of the day she gets 36mL compressed over 2 hours. I got to give her a bottle today and she took all 36mL! It took her a bit longer than 15 minutes, but her nurse wanted to let her keep going because she was doing so well with it. She paced herself (coordinated suck, swallow & breathe) and had no alarms or spit ups. We are so proud. Adalyn also got a tub bath today, her's was from me, and she was not real amused either :) Oh, and Adalyn passed her hearing test the other night and Emma should be getting her's today. Adalyn's weight last night was 4lbs 6oz (1980 grams).

A HUGE prayer request that we would like everyone to be praying earnestly for is that God heal Emma's reflux. Her reflux affects her feeding progression and causes her to have brady alarms. But it also makes her uncomfortable, which is the hardest thing for Dave and I to see. Please pray for this so Emma can make progress towards coming home and so that she can be more comfortable. Emma has another eye exam this week so please pray that there is no progression in her ROP. Please also pray that Emma does not have to go back on CPAP and that she continues to make progress in the right direction so that she can come off the high flow nasal cannula soon. Adalyn's final hurdle at this point before she can come home is that she has to take all her feedings by mouth for 48 hours and have good weight gain. So please pray that she continues to do well with her feedings and weight gain. Please continue to pray that God help Adalyn & Emma develop appropriately and that He protect them from infection.