Breast Reconstruction: Step 1 (of many...)

On Monday Brian and I met with the Plastic Surgeon who will be performing and perfecting my new boob surgery.    Her name is Teresa Buescher, she is at KU, board certified and specializes in breast recontruction surgery.  I had the pleasure of listening to her speak at Gilda's Club in October about the different types of reconstruction surgeries she performs and a panel of women were present each who had chosen a different type of surgery. 

Breast Reconstruction surgery is typically done in stages, as mine will be.  I opted not to have tissue expanders placed at the time of my mastectomy, because, well, honestly it wasn't greatly suggested to me by my surgeon.  He felt the most important thing to do was heal and get through chemo and worry about reconstruction later.  I would have to agree, though I know no different at this point, having been without boobs for almost 9 months.  As it turns out, using such a large chunk of my FMLA for my mastectomy and chemo, I wouldn't have quite had enough time to be off and have my job protected had I done it the other way. 

I love Dr Buescher, and Brian was very pleased with her.  We talked about kids, my job, dogs (she has 8!) and the options available to me.  The route I have chosen to take is not any better/worse than what anyone else you know has/had done.  It's what works for us.  That was the wonderful thing about talking to her.  Whatever works for my life.
 We talked pros and cons. 
I have a job that involves lifting and pulling.
 I have a totally dependent child I need to be able to pick up and carry around.  Forever. 
So, like I said above, it may not be the route your mom, sister, bestie, or cousin's neighbor's aunt's Mom followed, it's MINE.  And no, it's not like getting implants placed for breast enhancement, so many of the typical rules for recovery don't apply here.  I encourage you to share your stories of reconstruction with me, after all, alot of what I know I learned from survivors willing to share with me. And I greatly appreciate their honesty and candor about what they did/would have done different. 
 BUT,  (always a but...) if you think about opening the hole in your face and saying to me something along the lines of how what's-her-stick didn't have to be off that long, or have a drain, or had this/that/the other for restrictions, or anything that remotely feels negative, STOP.  Especially if you've never been through it.

I found during chemo that more than one person said to me "My friend/mom/aunt/neighbor/ what's-her-stick didn't take ANY time off during her chemo....."  Well, I did.  And I felt guilty enough about that as it was, even though you may never have been able to tell, as I just nodded and smiled.   It took, takes work to stop feeling guilty still.   Probably always will.  I don't like to let people down. And I don't like to rely on others.  And though I know the people who said those words to me didn't mean it in a nasty way, the perception on my part of what they said when I already felt crappy, only made it worse.  I won't let someone else make me feel that way. 
So, what I'm getting at is simply this; this is MY choice, MY life, MY story. 
Why share it then you ask?  Because maybe you've been in my shoes and spent too much time nodding and smiling at the things people said to you that only make you feel worse about yourself, and this helps you realize you don't have to anymore. 
 OR maybe you are that person who thought sharing the story you heard would help.  It doesn't, it sounds and feels judgemental, even when it's not meant to be. 
And chances are, if you are following my blog, you love me and care about me, like to read what I write and just want to know what route I've chosen, so you can support me. 
Or your a stalker, and I'm ok with that too. 

Anywho....on to surgery!   I have chosen to have tissue expanders placed in preparation for a DIEP Flap procedure.  DIEP stands for Deep Inferior Epigastric Perforators-or the blood vessels in the lower abdomen.  Flap being skin and fat attached to those vessels. 
The first step being the tissue expanders will be placed on January 25th, 2013. The expanders are a sack with a port on it placed under the Pectoralis muscle.  This surgery takes a few hours, and will keep me in the hospital for a few days and maybe have a drain afterward.  I have a small seroma on my right side from my mastectomy which has never gone away-or a small pocket of serous fluid.  This may be what causes me to need a drain post-op, but Dr Buescher feels is not too significant, and doesn't need to be drained prior to having my expanders placed.
 Below is a good picture of what the process looks like from expander to implant.  She will place the expanders with a small amount of saline initially-only about 50cc's.  Then starting at 2 weeks post-op I will make weekly or bi-weekly visits to the office for them to locate the port and fill the expander with 50cc's of saline at each visit.  The expanders do exactly what the name is-expand the tissue and muscle which I  have lying flat against my chest right now.   Recovery time is 2 weeks of no lifting anything greater than 10-15 lbs, and raising nothing above my head.  Then possibly one more week, depending on how I'm doing at the two week point with arm movement and pain control.  

 

 

 





We will fill the expanders until I am happy with the size, then we hold fills for one month allowing maximum stretching of the muscle and skin.  The fills are quick 20 minute in office procedures with little pain afterward, but no restrictions.  This can take 3-6 months to achieve the size I want, but I can keep the expanders in for as long as 2 years.  Though about 8 months is as long as Dr Buescher likes.  But again, we are on MY schedule.   Below is a more accuarate pic of the what the expander looks like, and the card I get to carry while they are in.  They port has metal in it to help in locating it for fills, but also can set off metal detectors.  So, to hopefully prevent from being felt up by any TSA Agents should my boobs set off the metal dectectors at the airport, I will be sure and keep this card handy....

 



 

 

Remember these are in preparation for the DIEP Flap procedure.  Many women do the expanders, then trade out for implants once desired size is achieved.  I am looking at the DIEP Flap, which will take my abdominal fat and tissue and put it in where my new 'breast pockets'  or 'skin envelopes' have been formed.  The DIEP does NOT cut into the abdominal muscles, so I won't have the concern for lifting or carrying Ethan or doing my job, or hernias.  All in all, it's a tummy tuck/boob job combo.  This procedure is quite more intense than the implant exchange-a 12-15 hour surgery and 6 week recovery.  But it is completely autogolous-or means using all my own body parts. If you google it, the pics are kinda freaky, don't say I didn't tell you.  Dr Buescher specializes in this surgery, which makes me very comfortable with my choice.

 As of right now, I am a candidate for the DIEP, but that could change if I lose weight and in turn tissue off my abdomen.  And since it would be late next spring or summer, I may not be a candidate for this particular type of surgery, and instead do an implant exchange.  That is why we are starting with the expanders for now, and will just take it day by day, or fill by fill, boob by boob til I'm happy and ready. 

I'm excited to start this process, as it kind of feels like a new beginning, and end to my year of cancer.

And I'm ready to have boobs again. 

 

And how appropriate to be starting in January....

 

If the world doesn't end on 12/12/12.



Happy Rad Tech Week!

Happy Radiologic Technologist Week to my fellow co-workers and friends!  The pic above shows basically what I do all night.  Though many times it involves straps, lots of tape and often repeating myself over and over again.  A lot like Motherhood. 
I get to see some pretty cool stuff in my job, and having done it for as long as I have-egads-20 years next July-nothing and I repeat NOTHING surprises me.  Ok, almost nothing.

The x-ray below is of a child who ate magnets. Lots of them.  For the record and HIPPA and everyone I know who reads my blog and is freaking out right now-I found this image on Google.
However, having spent 8 years at Children's Mercy-I took a few of these x-rays.   And if you ever want me to tell you how to remove a coin from a child's throat with a foley cath and fluoro, just ask.  If  I've done one coin removal, I've done a bajillion.

 

 

The above pic is a CT Scan of a brain.  An angry one.  That big white thing-a-ma-jig is a bleed in said person's brain.  Again-Google.  This is what I mostly do. 

 Not find bleeds thank goodness-but produce beautiful CT scans of brains. 

And yes, everyone has one, and no, not everyone uses theirs.

 

I thought I would post an X-Ray Top 10 List in honor of my beloved profession, but am having a really hard time with what to call my list. 

 

Top 10 X-Ray Tech Pet Peeves?

Top 10 Dumbest Things an X-Ray Tech Has Ever Heard?

 

But my list requires many more than 10, so I'm just calling it:

 

A Day in the Life of an X-Ray Tech:

 

1.  No, your other left.

 

2.  No, it doesn't taste bad.

 

3.  Yes, I'm going to put that tube in there.

 

4.  No, I can't do a CT Angio with a 22g. 

In the toe.

 

5.  No, there are no cats in here.

 

6.  No, you will not glow in the dark.  Nor will your pee.

 

7.  Yes, your colon will hold ALL of that Barium.

 

8.  Yes, please leave your shoes on while on the table. 

 

9.  I'm sure glad you decided to come in tonight for that headache of 3 years.

 

10.  The gown opens in the back, yes, but it does tie.

 

11.  No, you did not pee on yourself.

 

12.  Yep, that's gonna leave a scar.

 

13.  Yes, undressing means your jeans too.

 

14.  Kinda looks like chocolate milk.

 

15.  Believe me, we do this all day long.

 

16.  I don't read the pictures, I only take them.

 

and my very favorite...

 

drumroll please....

 

I'm a Radiologic Technologist. 

 

Not a Technician. 

 

I don't do nails. 

 

 

I have had the honor to work with some pretty fabulous folks, and X-Ray people are a species all their own.  They know how to work hard, party hard and get the job done.  So if you are a fellow tech pat yourself on the back today from me, and if you know one-tell them how awesome they are. 

 

 For without us....

 

You couldn't be open to trauma.

 

Enough said.

 

 

Love you Rad Techs! 

*and miss you Kristin Saragusa

 

 

Now for some quick Rawley Family updates:

Halloween was fabulous

The bald  kid was Elliot from ET!

 

Brian and I went to the Radiology Halloween Costume party

 



As the Powder Puff Girls and Mojo Jo Jo

 

And remember how I mentioned X-Ray Techs know how to party?  Well, the Radiologists know how to throw a rager, and didn't let us down this year either!  There was a lot of time traveling going on that night, and at least I'm not the only one who can't remember all of it. 

At least I have an excuse.

 I have cancer.

But at least I didn't throw up in my boot.

 

 

Next year, no shots.

 

 

 

 

 

I guess pink IS my new color!

The ER had a surprise Pink Out for me last Friday night!

Everybody wore pink, or a pink something-bandana, scarf, whatever!!  It was such a nice surprise and honor!  It made me tear up when I walked in the lounge and saw all of this:

One of the Docs who planned all of this said some very nice things about me, about how I handled my cancer and worked and always had a smile on my face and made this fight look easy.  Little do they know it was all the support from my family and friends that made it easier!  Going to work on treatment was a nice break to being 'sick', and made me feel productive!  Thanks NKCH ER for all your support and this awesome night!

Last week our hospital's Pink Glove Dance video was published on Medline's site too.  I had been asked to participate, but had no idea I would be featured as much as I was!  Mind you-I had just had knee surgery 2 days prior to this video, so as you notice I'm not dancing around as much as some people-note the bum knee!
  Please go to www.pinkglovedance.com  to watch and vote for North Kansas City Hospital's video.  If we win, our donation will be given to the Jennifer Ireland Foundation.  A foundation honoring a young woman who lost her battle to colon cancer, and now the foundation in her name helps other families in financial difficulties due to cancer.

I know October is Breast Cancer awareness month, and in all the support and PINK  I have seen all over the city, the internet, everywhere this month, I have also seen the negativity about devoting a month and a color to just one form of cancer.  I get it. 
I had a second mother lose her battle to Appendical Cancer-it has no special month and color.
I have a step sister who fought Hodgkin's Lymphoma-no special month and color.
My Mother-in-Law lost her battle to Liver Cancer-no special month or color.
My brother had Thyroid Cancer-again, no special month or color.
An uncle with Testicular Cancer-again, no special month or color.
I could, unfortunately, go on and on.
And prior to my diagnosis-even having a beloved Grandmother lose her battle to breast cancer-I know I didn't own this much pink!
I wish each form of cancer had a month and a color-but more than anything I really wish we didn't have any special cancer months or colors because that ugly disease had been eradicated! 
I think all anyone hopes for is awareness about this terrible illness that takes 40,000 lives a year, not wanting to take away from anyone else's type of cancer.   Awareness that simple things like a self exam or a mammogram could save a woman's life.  It saved mine.

As you know, my cancer was found by my annual mammogram.  But many of you don't know the story behind it.
I had my annual well-woman appointment with my Ob/Gyn Dr Morgan.  Now Dr Morgan has delivered all of my children, did my D&C for one of my miscarriages and helped me through 2 others.  We're pretty close as you can imagine.  We are joking about this, that and what not-who doesn't when your feet are in the stirrups???  He then reminds me I am still 40-but almost 41, and haven't had another mammogram since my baseline at age 35.  Yep, I know.  Go see Donna-Dr Morgan's nurse for forever-and a fellow copper wife-she will make your appointment.  Idle chit chat with Donna while she is on hold with Imaging for Women.  I'm thinking about when on earth I will squeeze (pun intended) a mammo in with the way my schedule is looking for the next few months.
Brian is due to have surgery on his shoulder, I'm working for the next 6 days, Hailey has volleyball, etc. etc. etc.  In the back of my mind I've already put it off til about May.

They can get you in today-in about an hour
Sure, why not?  I drive right by there on my way home and if not today-not gonna happen for several months.

Everything happens for a reason, and we all know the results of that mammogram.
Had they not gotten me in that day, and left it to me to schedule, would I be where I am right now?  I shudder to think. 
AWARENESS.  That's all any of this pink means. 
I can't tell you since my diagnosis how many other survivors I have run into-support groups, work, in public.  And how many of those women say they found a lump-but waited months, one even a year, before getting a mammo.  I'm guessing their lives would be different now too had they been more aware.
And maybe once all these crazy pink ladies-and men-wipe Breast cancer off the face of this planet, they can go to work on another one! 

So, as you can see, Pink is my new color, and probably will be forever.  And though it's not a sisterhood I ever wanted to be a part of, I am, and will fight for a cure for it as long as I'm alive, whether it be October or pink.

Now for some kiddo updates:

Hailey went to Wichita to go to Homecoming with her new beau Jonny, looking gorgeous as ever:

 

 

Parker has been taking golf lessons and is getting very good!

 

 

 

Ethan is finally WELL (knock on wood) and went back to school this week.  He  received a Special Olympics medal AND his new CD 'RED' by the one and only Taylor Swift came in the mail. 

 He's all smiles listening to it as you can see....

 

 

 

 

And the newest baby....well, he's still pretty darn sweet that Frankie...

 

check out his tongue while sleeping on Brian's lap!!

 

 

Discharged!

By the time Brian and I were heading back to town Sunday, Dr Waldman was calling me telling me she thought the bald kid was ready to go home. Though she didn't actually call him the bald kid- she called him that sweet boy of yours.  By the time we got down there, all his paperwork was done, and his nurse was ready to pull his IV and send us on our way. Fastest discharge from The Mercy ever.

Flashback to Friday night....my sister Kate went down to be with him at the hospital, and said he was yet still possessed. If she even looked at him he screamed. All he wanted to do was lie in his bed and rock out to Taylor Swift. Good thing Dad remembered to bring his CDs.  

Then I guess sometime during the night his feeding tube came open and in the yuckiness of his stomach contents they found blood. Surgery was called to do a consult, and they felt he may have had a bleeding ulcer. Hmmmmm. Ok.  So they switched his feeds off and put him on all Pedialyte.
He got another enema, fearing he was still constipated, thus the crummy attitude.

He was weaned down to 1/2 liter of oxygen by nasal cannula on Friday night, and by Saturday night they turned it off, and he stayed above 90 on room air even while sleeping.

Because he got the dose of IVIG on Friday, he won't get his subQ dose at home until weekend after next.   Immunology felt like the parainfluenza virus was the one that hit him hard, and was worse because of his lower IgG.   They may increase his home dose this winter if we start seeing hospitalizations from these viruses.   I'd rather not wait until we have any more hospitalizations, but what do I know??

We are back on Pulmicort twice daily and his nasal spray once a day to help keep the respiratory stuff under control.  It seems to be helping, so we will stick with it!

Dr Waldman was very concerned about his heart rate. I explained that we and Dr Kaine know about his bradycardia, and it really is just Ethan's normal. However he did get down as low as 38 and hovered around 44 for a while. But during those episodes didn't appear to be in any distress, and then would recover and jump back up into the 60's.  Dr Waldman spoke with Dr Kaine himself, and he assured her this was his normal.  But, we are following up with Cardiology in December instead of January now.

The Rawleys spent Sunday night making laundry soap so we could do all our laundry, made some homemade chicken and noodles for dinner,  "bathed" the hospital funk off the baldy, and then hunkered down for our favorite Sunday night shows including the season premiere of The Walking Dead.   We love that show. And it sure helps prep us for the zombie apocalypse.

I have another follow up for my knee tomorrow, and Ethan has a discharge follow up in the Pediatric Care Center.  If all goes well, he's going back to school Wednesday, only to be off Thursday and Friday for teacher inservice days!  Oh well, it will be a short week for him!  Thank goodness Brian is off those days too!

Thanks everyone for helping us out this weekend so Brian and I could still go on our weekend 'date'.  We tried a new restaurant on Friday night-The Vinyards and it was fantastic!  As always lunch at The Avalon was wonderful and more so with our new friends the Satters.  And  Thanks Vuljes for joining us at O'Malleys!  We hope you had a good time!  And thank you to everyone who took care of our little guy this visit. He had a fabulous team and awesome nurses. One of his nurses took care of him when was admitted in March the same day I had my surgery and she remembered him. We realized that we have a friend in common, one also with a child with 18q!  Small, small world!  

Tonight we watched Katy Perry's movie, and Ethan really enjoyed it. 
The blonde singer in his life might just have some competition from a dark haired one. 
Or pink haired.
 Or blue haired. 
Whatever-he sure loved her music and we loved seeing him laugh again!  

TGIF, TGIIF and TGWHGF

Thank Goodness it's Friday-I'm assuming most if you know that one

TGIIF-or Thank Goodness it's Irish Fest-our favorite Fest!

And TGWHGF or Thank Goodness we have GREAT Family!!

Ethan had an ok night on Thursday, but by the time I got down there Friday morning, his happy personality had been overtaken by a demon.   He was not happy.  He's ready to go home.

Silver Team is the service he's on now,and Dr Waldman came in with a plan.
Immunology weighed in, and since his IgG upon admission was 762, they feel it was too low for him, and his immune system was compromised, thus the bad effects from these viruses.  He is getting a 6 hour dose of immunoglobulin as we speak- thank goodness for vascular access getting a new IV for him!

Dr Waldman was highly concerned about his heart rate only being in the 50's all day, and asked Cardiology to consult again.  Since whoever the Card on did not know Ethan, and clearly didn't read his history for the last year, they freaked and are having his Digoxin held and a level drawn. I'm guessing that will be normal since his heart rate has been in the 50's for a year now and Dr Kaine has not been worried.  It's Ethan's normal. 

Stinky got a suppository, and lived up to his nickname shortly after.

He's still on oxygen, but only 1/2 liter by nasal cannula. We thought we would try to wean that today, but once he's off for a minute, he drops to 80's.

All in all he's kind of in a holding pattern of crappiness. And I feel so bad for him. He hasn't had to do this hospital stay stuff for so long, he's forgotten how to deal with it. Not that anyone should ever have to learn, but his coping skills are far from desired. I'm sure he annoyed the heck out of everyone else this morning when he screamed at the top of his lungs for 30 minutes while I tried to wrestle him into submission.   It was like wrestling a howler monkey on crack.  He won.
I came home at 1 to get a nap since I worked last night and hadn't been to sleep.
Brian just got home , and he was sleeping soundly and comfortably, finally.

We have had plans and reservations to go to the Weston Irish Fest for months now, so thanks to my family, we are going.  People can think we are terrible parents, and they can then kiss my behind.  We are leaving him in trustworthy, capable hands and we are only a phone call and a 30 minute drive away.  Brian and I need a break together, and we are taking one.    Of course the forecast is saying thunderstorms and possible tornadic activity. Go figure.
My sister Kate is going down to sit with him tonight, my step-mom Teresa is sitting with him tomorrow, my other sister Kim is going down this weekend too, and my mom is coming to stay with Hailey and Parker.  Like I said TGWHGF!
Bring on the hot cider with schnapps and the coddle!! Slainte!

Thanks everyone for your help, thoughts and prayers!

Miserable baby

Ethan was pretty miserable Wednesday, didn't want to be held or messed with. Just wanted to lay in his bed and listen to Taylor Swift on his iPod.   He threw a good number of temper tantrums complete with biting his oxygen mask and grabbing the tubing and pulling it off his face a few times. I think he was really pissed off that he couldn't squeeze all his fingers though the little hole on the side of the mask and shove them in his mouth!

Not that I blame him in the least bit. Let's see, what did we find out yesterday???

He is, wait, was, constipated.  Good ole molasses enema took care of that.

He's still on 5 liters of 30% oxygen by face mask.

His virus panel was positive for three viruses: parainfluenza virus, rhinovirus, and enterovirus.
Sounds like the bubonic plague, right?  Nope-would only be cold-like symptoms in most people.

He got  more Vancomycin and Rocephin, and thus lost his only IV.
So Vascular Access had to be called to get him a new IV
AND he got stuck once more in his hand and finally his cute little bald head for the BNP.

I might be kinda pissed off too.

Good news?  Echo unchanged from July. BNP normal-no failure. Thus the Cardiology service punted him to Silver Team. Which we are ok with!

Bad news?  Ethan is terribly ill from minor viruses, so they are concerned his immunoglobulin dose is not enough or not working.  Easy fix?  Increase dose right?  Unfortunately we can't because his liver function tests are borderline high and increasing that med is contraindicated in that case.  So back to the drawing board with Immunology has got to happen soon.
They are going to put him on an aggressive asthma action plan to try and stay ahead of the respiratory crap this winter.

In the meantime, they have got to try and wean him off oxygen to get him home, so it will clearly be a few days before he's home.

I will update later today when we know more!

Welcoming fall, good and bad!

It's October, and that time of year again.....

Cooler weather
Sweatshirts and flannel jammies
Hot cocoa and apple cider
Weston Irish Fest
Irish car bombs and Seth drinks ( hot apple cider and cinnamon Schnapps-yum!)
Halloween
Hospital stays
And new this October- a newly licensed driver in our house!

Yep, Hailey got her license this week, and has tried to think of any and every excuse to leave the house.  I could really work that to my advantage.
 Need groceries?  Hailey. 
Need gas?  Hailey.
Need prescriptions picked up?  Hailey.
Brothers need a ride somewhere? Hailey.

We'll see how long the newness lasts at that rate!

I'm sure most of you know by now that Ethan was admitted to Children's Mercy on Tuesday evening. He's been on a slow decline for a couple of weeks now, all finally came to a head and here we are 4 Sutherland Room 5.   His sats are crappy-he was 86 on admission. They got him 92 on 5 liters of oxygen by face mask, so they tried switching him to a nasal cannula, but he kept dropping to high 70's with 5 liters.  So they went  back to a face mask, but at 8 liters couldn't keep him above 87.  Respiratory came in and decided to switch him to a different mask called a Venturi mask that delivers 40% oxygen, still on 6 liters, but hanging at 96. This mask helps tell how much oxygen he is truly requiring, as it mixes oxygen with the regular air we breathe. And I may be completely wrong on that explanation-it's how I understood it. I'm an RT, but not that kind!  Since Ethan is a mouth breather, it makes it difficult to tell how much he really is needing.

They drew blood cultures, and then gave him a dose of Rocephin and Vancomycin-antibiotics.  Transport team mentioned they were starting right off with the big guns for him!  Yeah, we can't afford to mess around.  Blood culture results won't start showing up for 12-24 hours, depending on if there is an infection brewing.

Immunology has been consulted tonight. They had no suggestions at this point, but will get involved if needed as labs come back.

X-rays of chest and abdomen were taken. No big pneumonia on the chest. So concerning for high O2 need and fever of 102.  No results on abdomen films yet.

Labs show sed rate elevated-which is an inflammatory marker indicating a process of some type going on. White count NOT elevated, so kind of confusing.

They think he is having febrile seizures, as he seems to have these funky quivers of his legs. Or they think it could  be shivering from being cold, but having a fever. His hands and feet are mottled and cold and blue.  So even with the fever they have piled on the warm blankets.

One of the nurses at CMH North knows Ethan well, and said she knew he was sick when she stuck him, and no one had to hold him down.  Only 3 sticks to get blood and an IV, and only one more for cultures.   At one point they were talking about getting access by way of IO if needed. Glad we didn't have to do that!   IO means intraosseous, where immediate access is gained by injecting directly into the bone marrow. This is obtained by putting the needle right into the leg below the knee cap. I say needle, but it's much more than a regular IV needle. Google it-it's creepy looking. And painful looking.  Again- glad we didn't have to go that route!  They are keeping him on the antibiotic doses, and he's getting his second dose of Rocephin now-which clearly burns going in by the reaction I'm getting. And he will get another dose of Vanc in the am. Hoping the little hand IV he has holds out
for these heavy duty drugs!    

The big question in the back of my mind, and I think the team's mind is the million dollar one. Is his leaking new pulmonary valve the culprit here??  This is the same crap we went through a year ago before finding out he was in heart failure and being admitted to the ICU-after 3 separate admissions just like this.  I have asked for his BNP-Brain Natriuretic Peptide to be drawn, but the residents on tonight are punting that decision to the attendings in the a.m.  Don't think I'm letting that one go. It's the one test last year that gave us a definitive answer he was in failure. On a scale of 1-10 in kids- his was markedly elevated at 3300. I don't want it to get that bad if we can help it.   

I may have to pull out the pitiful cancer card to get my way if needed. 

If not, I'll try throwing myself on the floor kicking and screaming.  

This same post will be on his carepage for those of you who check that too!  

Gotta go, sats dropping again, getting a roomful of concerned nurses.  More later.