Wednesday, November 26, 2014

Back to Edmonton we go!

A recap of days 49, 50, 51 & 52 in the PICU:

Sunday and Monday were pretty quiet around here. The phrase of the week has been "keeping things in a holding pattern" as we await to see what Edmonton had to say. On Sunday, I got to hold her for a few hours, and as my Facebook friends read, Evanna smiled at us for the first time in 7 weeks on Monday! It was such a tender moment for Nick and I, as we got a glimpse of the old Evanna and see our happy baby girl.

Tuesday was the big day, as we finally got to hear what the medical team in Edmonton wanted to do in regards to her heart and respiratory problems. It was an unanimous decision that a Cath needed to be done sooner rather then later to get a full picture of her heart and possibly see what could be done about the collaterals on the left side. Things "seemed" to be a bit more positive from that aspect, but I'm still consciously aware of our reality and that we may not hear things we will necessarily like.
The thing up for debate is whether or not another kind of surgery will be beneficial for Evanna. They're wondering if maybe her aorta is slightly compressing on her trachea, making the Tracheomalacia worse. It's a procedure we won't necessarily see immediate results, and EVERY surgery comes with its risks and benefits. Evanna is still getting a trach, but this procedure could help things in the long term in that she may not need it for as long. It's called an aortapexy, and basically they would go in and "pin" her aorta to the sternum to lift it off her trachea. So while they do her Cath, the ENT specialist will go in and do another bronchoscopy to see if he can see anything that might be pressing on her trachea making the Tracheomalacia worse.

So for the next week, we are continuing with this "holding pattern" in keeping her stable and happy until the transfer back up to Edmonton (this will be her 3rd plane ride) next week for her Cath and bronchoscopy. If they decide to go ahead with the aortapexy, we could be in Edmonton for another month, and then back down to Calgary for the tracheostomy.
I've come to the realization that hospital life will be my reality for quite sometime, and because of that, I've been handling hospital life a lot better and not being so emotional when it comes to thinking how long we've been in the hospital, and how much longer we have yet to go. Going back to Edmonton is very bittersweet because we already know the team up there, and I'm actually excited to see some our favourite intentivists again. It definitely sucks that I have to pack again, and relocate to another city, but we have resources in place that make the blow a little less hard (our names are on the Ronald McDonald waiting list and it'll be good to see everyone again).

At this point Evanna is having a good day, and I even got some smiles again today! I am asking that for everyone willing and able, to join us in fasting for Evanna this Sunday. Next week is a very big week with lots of important tests and discussions happening, and we need all the prayers we can get. So prayers, prayer circles/lists, good thoughts, whatever you do to get through a hard time are welcome and appreciated.

Thank you from the bottom of our hearts and Evanna's special heart,

xo The Irvine Family

// This stunning pink headwrap was made by @noxxaz (an Etsy shop) and graciously gifted to us by Instagram follower @margaret_font
xxoo Thank you so much! Again the generosity and kindness bestowed upon our family during this time has truly been overwhelming in the best way possible!

Saturday, November 22, 2014

Another Intubation, New Plans and Bad News

My heart is absolutely broken. I'm devastated and starting to loose a little faith and hope.

They had to reintubate Evanna late on Monday night. Her heart rate was very high, her oxygen levels were consistently dropping and her CO2 levels were starting to climb. They were very scared that she was going to crash again, so they decided to intubate her before she got to that point again.

Over the past week, we've been going over what our  next step is going to be, and with 4 failed extubations, we're now facing the fact that Evanna needs a tracheotomy. It's been a major shock and took a few days to wrap our heads around it, considering this was nowhere on our radar just 4 weeks ago. We know this is a temporary option - but it will be a LONG TERM thing that we have to deal with. How long? Well respirology and ENT have said that it can take years for children to grow out of Tracheomalacia. This step isn't necessarily going to get us home super quick either. First there's the procedure, then recovery, and after that it can take MONTHS to tweak vent settings, train Nick and I how to care for Evanna, and then on top of that - setting up homecare. What is homecare? Well basically, for the duration of time that Evanna has a trach, care providers (generally nursing aids and LPNs) come over to our house and watch Evanna at night, so we can sleep. We have so much information being thrown at us, your head would spin.  
It definitely took us a few days for us to come to term with the situation, and while we're still processing the impact this is going to have on our life, we know that this will soon become our "new normal".

On top of all of this, they also decided to take a look at Evanna's heart and to see where she stood from a cardiac standpoint. On Wednesday they did an MRI, and while it showed that her bottom ventricles were doing better compared to last weekend, Evanna had had some significant narrowing in her collaterals on the left side and not very much blood flow into that lung. They're sending those images to Dr. Rebeyka and Dr. Rutledge in Edmonton to take a look, and they're going to discuss her next week at Tuesdays cardiac board meeting. Dr. Fruitman said that the narrowing is bad enough, that there is a possibility they won't be able to do anything about it (ie. balloon or place a stent into it). After some conversation, I asked her to be a bit more frank with me and what this means for Evanna's life. She said that at this point it's hard to predict her life expectancy, and we could be facing the fact that she's terminal (nothing in the immediate future, but something we may need to come to terms with).

So now what? Well everything is on pause until Tuesdays meeting with Edmonton. We need to see what Dr. Rutledge (she performs the Cath) says and determine what order to do things in. Do we go transfer Evanna back up to Edmonton immediately to do a Cath and then back to Calgary for the tracheotomy, or do we proceed with the trach and hopefully a Cath can be done in the next few months.

It's been an incredibly hard week for us and there are just a lot of unknowns and new plans that have been thrown our way. We'll know more after Tuesday and I just hope there is something they can do for her heart. In the meantime, I had them switch our her oral intubation tube for a nasal one so Evanna could at least have her soother back (it was the least I could to do - poor girl deserves a break). She also got her 6 month immunizations and the flu shot.

xo The Irvine Family

Sunday, November 16, 2014

PICU Day 39, 40, 41 & 42

I could just cry when I see that we're into the 40s in regards to how many days we've been in the PICU, and we're not really that close to going home. We're making progress, but it's so incredibly slow, it's almost gut wrenching.

Evanna was extubated on Thursday around noon, and handled it very well - just like I knew she would. The intentivists were very impressed with her, and happy with her breathing on BiPAP. They actually put her on a newer type of BiPAP/CPAP called NAVA, that is really cool. Basically they put an NG tube down into her diaphragm that measures and senses the type of breath Evanna is taking, and the machine delivers the amount of oxygen that she needs. As humans, we don't always take the same type of breath each time. Sometimes we take long and deep breaths, and at other times, we take short and quicks breaths. The regular BiPAP machine delivers the same breath all the time, but the NAVA caters to what Evanna wants and needs with every breath. It will even signal when she needs less support, decreasing its support automatically.

Evanna had a very good Thursday night and Friday morning, but things quickly changed and I got a good reminder that this rollercoaster ride we're on, is far from over. On Friday afternoon, Evanna had a very high heart rate, but because she had no other signs of withdrawal (high temp, agitation, etc), and her feet had a blue tinge to them and were very cold, they were very sure that something was up. They also noticed her liver was enlarged, so they quickly called for an xray and ECHO. The xray showed nothing, but the ECHO showed that her right and left ventricles had mild to moderate decrease in function. They started her on a drug called Milrinone to help with the squeeze of her heart (it does a few other things, but sometimes all these drugs go over my head). They also decided to start her on a low dosage of epinephrine, but as soon as it hit her body, her heart rate jumped up to over 200 beats per minute and I screamed for our nurse to turn it off (our nurse that day was awesome by the way). I was so scared that Evanna was going to code again, as she was doing some of the same things she did last time, just before she coded. They stopped the epinephrine and never turned it back on. They just kept her on the Milrinone, and waited to see how her body would respond to that. They said that if her lactate levels got high, we were automatically looking at ANOTHER intubation. It was an extremely stressful and high tense day for us. They were so worried about her crashing, that they had sedation and paralytic medications drawn up, the intubation cart near by, and even measured her for the ECMO circuit (this is a type of life support). Even the intentivist on for that day (Dr. Megan Mahoney), didn't leave work until she was satisfied that Evanna stabled out. Finally around 9:30pm, Nick and I finally felt comfortable with Evanna's improvement and progress, that we decided to leave and get some sleep.
I called twice during the night to see how Evanna was doing, but both times they said her heart rate was good and her lactate levels were still low.

Evanna had a very good day on Saturday. The doctors decided to pretty much leave her alone for the day and not really change much in regards to her medication. Nick held her for a few hours, and she enjoyed that very much! We had some friends come join us for lunch and hang out at the hospital, and Nick and I were even comfortable enough to leave around 6pm and go for dinner to somewhat celebrate my birthday (this will definitely be a birthday I never forget).

Today was a little rocky again, as her heart rate was a little high. Dr. Dickie (the cardiologist) came down to redo her ECHO from Friday to see if there was any improvement and during the ECHO he told me that her heart function looked better. He checked her liver and said that it too had improved, but because of her high heart rate, he decided the best coarse of action was to give her some more fluid (this helps with relieving some pressure off her heart). Evanna's heart rate remained relatively high all day, and I finally decided to hold her around 4pm. Slowly her heart rate decreased (down into the 130s!!), and Evanna is now in a very peaceful sleep.

They have mentioned that if Evanna continues to have rocky days, they may transfer her back up to Edmonton for another Cath to help get to the root of the problem. This is ONLY if she continues to not improve over the next week, that they'll take such drastic measures. As much as it would suck to have to go back to Edmonton (it would be such a step backwards), at least we know the staff there very well, and I do consider the Stollery our second home.

Overall, though Evanna is extubated, we still have a long way to go. The intentivists and cardiologists best guess as to why this is all happening is that her body is trying to get use to her "new" heart and "new" diaphragm. She was intubated for such a long time, and now that the support has been taken away from her, Evanna's body has to learn how to do all of the work all over again with newly arranged anatomy.

Thanks for continuing to follow our little journey,

xo The Irvine Family

Wednesday, November 12, 2014

PICU Day 35, 36, 37 & 38

Update, update, who wants an update?

This is probably the longest I've gone between updates, so I'm sorry to all of our loyal followers. 
Things have been pretty slow since Saturday, so I guess I just haven't felt the need to write anything. Other then Evanna still being intubated, the other major thing that we're dealing with is all of the weaning we have to do with all of the sedation and painkillers she's on. Her body is use to such hard and heavy drugs, that the weaning has to be extremely slow to avoid withdrawals. Heck, because of how slow we have to go, we may even go HOME on a weaning schedule (which is not unheard of). It'll definitely be weird picking up morphine at the pharmacy for a 6/7 month old!

In regards to my last post, things are definitely better here at the Alberta Children's Hospital. I guess I wasn't prepared for the change in culture that anyone would experience when you are transferred to a different hospital. Every hospital and unit has their own way of doing things and it just takes time to get use to it. On the flip side, they also had to get to know Evanna. She came from a different facility with a long list of issues that would be scary to any new team (especially a team that isn't necessarily experienced with cardiac kids), so they just had to get to know her.
In conjunction with all of this, I have to tell you about a tender mercy that happened on Saturday night after the terrible day I had here in the PICU, and then posted about it. In the middle of the nursing shift change, I looked out into the hallway from Evanna's room, and I see a nurse that I recognise from the Stollery. It took me a few moments to make sure I wasn't experiencing déjà vu, and reconfirm that she was indeed a Stollery nurse who has watched over Evanna in the PCICU after her open heart surgery. After confirming with our new nurse that the woman outside our door was indeed Donna, I walked out to talk to her. I started tearing up immediately, and told her what had occurred over the last 12 hours and my concerns with being at ACH. She told me that while I was correct in that the Stollery is an amazing hospital, with an amazing team of intentivists and nurses, Evanna was exactly where she needed to be, and she would receive excellent care here. She told me to give myself a few days to get use to the unit and staff here, and everything will work out. Evanna didn't need to be at the Stollery anymore, because she is stable from a cardiac perspective, and the Alberta Children's Hospital is more than capable of handling her complexity. Donna was the direct answer that I needed to the many prayers I had said that day.

The last 4 days have mostly consisted of drug and ventilator change ups to prepare her for extubation tomorrow. Most of the harder medications have been transition to oral, which will make it easier to wean in the long run. Due to Evanna having 3 failed extubations (though I don't count the last one as a fail as she was extubated for 4 days before she coded), they are just super paranoid to doing a fourth extubation, and have been holding off for as long as they can.

Other things to take note of, is Evanna did have a head MRI on Monday. Not exactly sure why they went to this extent, but I guess they want to dot all their i's, and cross all of their t's. They also haven't taken out any lines since we got here, but that's because they don't want loose any access in case she were to fail extubation again.

I've gotten into a new routine since being back, and though Evanna is still in the PICU, we've still made dinner plans for this weekend for my birthday and a fun girls night this coming Monday.

Thanks for all of the support,

xo The Irvine

Saturday, November 8, 2014

PICU Day 33 & 34

So a part of me is regretting our transfer back to Calgary. I know everyone is going to be surprised to hear that, especially after fighting so hard to get "home", but hindsight is always 20/20.

Evanna is still stable (something that I have to constantly remind myself when we're not moving forward at the pace I would like), but things aren't necessarily going the way I had hoped. 
We were transferred under the impression that we had a straight forward plan, but the plan isn't necessarily being followed, so it's been a frustrating day for me. I thought being here in Calgary would be such a huge step forward, but in reality, it's not. Evanna is a new patient to them, and to them - the past is the past. They want to run tests they've ALREADY done in Edmonton down here again and I'm learning real fast how different each intentivist is. I'm all for new ideas, but not when it doesn't make a whole lot of sense. I'm quickly seeing that they don't have a whole lot of experience with cardiac/22q kids, and her medical history can definitely pose as very scary situation to a new team.

I'm definitely feeling extremely guilty for pushing for the transfer and even regretting my decision. We had built such amazing relationships with the team up there, and they are definitely more experienced when it comes to dealing with babies like Evanna. I'm sure once they get to know Evanna, and we get more comfortable at ACH, things will get better, but the transfer definitely hindered Evanna's progress, and it will take me a little while to get over that. 
Yes, it's great to be a bit closer to home, and be near our supports, but I'm thinking at what cost? A few people tried to kindly warn me of the differences, and I wish I would have listened a bit better. Overall, I'm just REALLY missing our Edmonton medical team.

Not much has happened (in my opinion) since the transfer. They're still working on weaning her sedation. This is taking such a long time, but it's because Evanna has been on such heavy and hard drugs for an extended amount of time, so her body is use to them. Yesterday they were talking about a Sunday/Monday extubation, but the intentivist on today was hinting at a much longer intubation (like 3-4 weeks). This is where I am having major issues, and will be bringing up my concerns to the intentivist on tonight.

They're giving Evanna another transfusion today to get her hemoglobin up, as Evanna requires higher hemoglobin levels than a normal person, so her body receives more oxygen while she still has a VSD (hole in her heart). They are continuing to work on weaning her sedation levels, and doing different things to get that right upper lobe in her lung to open up. We'll see what the next few days bring, but I'll be definitely fighting to get them to extubate her by the end of the week, as I am NOT in board with keeping her intubated any longer then that.

xo The Irvine Family

Thursday, November 6, 2014

PCICU Day 31 & 32

We're back in Calgary!!

Evanna was transferred from the PCICU at the Stollery Children's Hospital in Edmonton to the PICU at the Alberta Children's Hospital in Calgary yesterday afternoon, and for the first time in over a month, I got to sleep in my own bed.

Yesterday, the Calgary transfer team ended up picking her up, and because their plane is a little smaller, I had to drive down (which wasn't a big deal, and just meant one less trip that Nick would have had to make to go pick up my car).
The transfer team arrived around noon, and slowly packed her up. It was quite the ordeal and took almost an hour for them to pack her up and leave the Stollery. It was definitely bittersweet leaving Edmonton. We built such amazing relationships with the staff at the Stollery, and we're definitely going to miss them. We loved all the intentivists, surgeons, nurses, RT's and social workers that we dealt with. They kept the picture we hung on her monitor and made us promise to come visit when we go back to Edmonton for her Cath in a couple of months.

The transfer went really smoothly, and she was either asleep or awake keeping a watchful eye on the nurse, RT's and Paramedics, but overall she was very content. The nurse even texted me a few pictures of her on the plane, which I greatly appreciated.

I arrived to ACH about an hour after the transport team did (they may have commented that I made very good time....), and after Nick's mom and sister visited (with a cheeseburger in hand), I decided it was time for me to go home, as I had been up since 5am that morning. It was strange walking through my front door, but the moment I hopped into my bed, I felt right at home.

This morning we took our time getting to the hospital, as we wanted to enjoy and take advantage of some alone time in the comfort of our home. When we arrived they had already done rounds, and we found out that the goal of the day was to start weaning and mainstreaming her medications to more manageable and appropriate dosages. They had to retape her intubation tube, so that made her very angry. Finally after some sedation meds and Evanna maneuvering herself into a horizontal position on the bed, she settled out, so they decided to leave her the way she was (it was actually pretty funny).
Evanna had and another ECHO done, and our friend Whitney came for a quick visit with some yummy snacks (thank you!!). This evening they weighed Evanna, and then transferred her to Nick's lap. So for the first time in 31 days, Nick got to hold his little girl.

The next few days will consist of continuing to lower her sedation medication and visitors galore (just shoot me a text if you're wanting to stop by). Hopefully they can extubate her this weekend and work on weaning her oxygen support.

xo The Irvine Family

Tuesday, November 4, 2014

PCICU Day 29 & 30 (Mama Bear)

So as my Facebook friends saw, I hit my breaking point yesterday when Evanna's plication (pinning down of her diaphragm) surgery got bumped from yesterday to today. It wasn't even about the bumping, it was them bumping us from last case yesterday to last case today that made me furious.

Yesterday was a pretty calm day. Evanna mostly slept, and Dr. Rebeyka came by to have me sign the consent form. They had 3 cases that day (open heart surgeries), but we were still hoping that they would get to Evanna, because of how easy and simple her procedure was. However, around 2pm, Dr. Rebeyka came by to inform me that they were not going to get to her, and we were going to have to wait another day. I asked him what time to expect her surgery to take place, and he responded in saying he wasn't sure, and it probably wouldn't happen until the afternoon. He did however state that they only had 2 cases today, and so Evanna's surgery would definitely get done. 
It took me about 10 minutes to digest the information, and once I did, I started to get extremely upset. I ended up leaving the unit and had to go for a walk to try and cool down. After coming back, I was still angry - so I didn't stay too long before heading back to the Ronald McDonald House to get a break and try to calm down. 
Back at the house I decided to try and distract myself and do what I could to take my mind off things. Finally around shift change, I decided to head back to the hospital for night rounds and see Evanna. I was surprised at how angry I still was and definitely talked to the staff and Dr. Garros about my concerns and try to come up with a solution. I decided to make it an early night, because I planned on coming back the next day at 6am to catch cardiac rounds and talk to them directly.

The next morning, I got up extremely early and got to the hospital at 6am like I said I would. The nurses that were still on stated that they were rooting for me and the mission I was on. Finally around 7:30am, cardiac rounds showed up, and after they discussed Evanna, I asked if she was going to be the second on third case of the day. When they responded that she would most likely be the third case, I decided it was time to bring up my concerns. I expressed that we were still hoping for a Calgary transfer on Wednesday, so to be fair to Evanna, the earlier her surgery could be - the better, as it would give her more time to heal. I expressed that we've been here for over a month, and we are ready to go home. Evanna has been intubated long enough, and I want her extubated as soon as possible so we can hold her again. Dr. Rebeyka said Evanna was his only case today, so no matter what, she was having the surgery, but the OR time wasn't really up to him, because it was Dr. Ross's OR day and his cases.
They left, and I wasn't sure so of the impact I had made, but about an hour later, a nurse came over to tell me that Evanna was now going to be the second case! I was so ecstatic and happy that things were finally going my way.At rounds Dr. Ryerson confirmed the switch and said we were very lucky Dr. Ross was so willing to let us squeeze Evanna between his two cases and I owe him a bag of Doritos (which I complied too with a thank you card). After rounds, I left to grab a bit to eat, where I ran into Dr. Cave and Dr. Duff in the hallway where they stopped to tell me how proud they were of me for speaking up and advocating for Evanna. They said it was pretty brave of me, and I pretty much just did their job lol.

Evanna went in for surgery at 12:30pm, and Dr. Rebeyka came out just after 1pm saying everything went well, and that Evanna would be out soon. Social work also found me in the hallway and stated they had heard about my little "speech" and asked if I needed anything else. Dr. Horn (Dr. Rebeyka's right hand surgeon) also found me in the hallway to ask if I was okay. I guess I was taken back by all the attention I was receiving, and surprised at the impact I had made for just expressing my concerns (in a mature manner) at cardiac rounds. I guess they just aren't use to parents speaking up like that, so they knew I was a bit angry and wanted my concerns addressed.

Evanna handled the surgery very well, and after she was back on the unit and settled, I decided to leave to run some errands and go back to the Ronald McDonald to pack a few things up.
Tonight Evanna is still doing very well. They did up her pain medications by a little bit (from what she was on pre-surgery) and she has a drainage tube again. She did have one angry episode, so they had to give her a few more shots of pain meds and sedation, but other then that, she's been a little trooper.

Tomorrow we are hopefully continuing with the plan of transferring Evanna back to Calgary. So far all systems are a go, but Evanna needs to have a good night and Calgary still needs to have a bed available (though they are ready and willing to accept us at the moment) before we get the official green light.

Thanks for following along,
xo The Irvine Family

Sunday, November 2, 2014

Another surgery and possible transport

So we have a plan, and though another surgery will be involved, I am happy with it nonetheless. 

Saturday was a busy day full of LOTS of talk and planning. Evanna had a bronchoscopy booked, but depending on those results, we had to decide what the next step would be. It has been pretty much decided that Evanna's cardiac arrest was most likely due to a build up of secretions and mucus that blocked the airway. Though they can't prove it, it's honestly the best answer they have, because every test they've done hasn't proved otherwise, and you should of seen the amount of oral secretions that Evanna produced while she was on BiPAP.

Evanna was kind of restless all Saturday morning and I felt terrible that I couldn't just pick her up and take her home. She was still orally intubated (meaning the breathing tube went through her mouth), and so I couldn't give her a soother to keep her calm and relaxed. They had stopped her feeds at 3am, so I was really hoping the bronchoscopy was going to happen earlier in the day. At 3pm, anaesthesiology finally came and got Evanna, and I politely asked that when they extubate her to do the bronchoscopy (they have to take the breathing tube out so they have a space to put the camera down her trachea), to do a nasal intubation instead. They said they prefer nasal intubation with babies anyways, because the tube doesn't move as much, and it's more comfortable for them. The only reason she had had a oral intubation was because they had to intubate her as quickly as possible when she coded on Monday night.

After the bronchoscopy Dr. El-Hakim said he couldn't find anything wrong. No web or granulations had grown back, and while she still has tracheomalacia, it hadn't got worse. His best advice was to go ahead with the plication (which means going in and "pinning" down her diaphragm) of Evanna's paradoxical diaphragm to give her the best chance of a successful extubation.

Nick and I were now placed with a choice: Either extubate Evanna on Sunday or plication (surgery) of Evanna's right diaphragm on Monday.
If we were to extubate today (Sunday), we would slowly try wean her oxygen support over the next few weeks in Edmonton and hope that a surgical intervention wouldn't need to take place. However there was a big possibility that her diaphragm wouldn't heal on its own, which means that we would be right back where we started - having to do the plication anyways, and wasting weeks in hospital. Some other things to consider is that the plication HAS to be done in Edmonton. This is because it can't be done by laparoscopy (the normal method) because of the uniqueness of Evanna's heart anatomy. They are scared that they would run into trouble if the scope touched one of her collaterals, so the surgery has to be done through the abdomen (ie. Evanna gets another lovely scar). That's why they also wouldn't send us back to Calgary to work on weaning oxygen, because if they figured it wasn't working, they would be sending us back to Edmonton anyways. Other problems we could face is due to the fact that we're still in an ICU, Evanna has a huge risk of getting another infection, and lines (which are also prone to infections) are still in Evanna.

The other option that I stated was to not extubate Evanna today, and go ahead plication on Monday, and transport Evanna while she's still intubated to Calgary (its safer to transport her while still intubated) a few days later if Calgary willing to accept us, and wean her oxygen there. Evanna basically has three problems contributing to her extubation issue: 1) Her right upper lobe is still collapsed, and they're sure the only thing that's going to fix it, will be a good cry from Miss Evanna 2)tracheomalacia, and this just takes TIME to heal and 3) right sided paradoxical diaphragm. They're thinking is if they could take away just one of these issues, we're setting Evanna up for a successful extubation.

It was a little hard trying to make the decision. Do we be patient and let Evanna try to wean on her own (with a BIG possibility of ending back where we started), or do we go the more invasive route and do surgery right off the bat? Dr. Rebeyka (our cardiac surgeon) and Dr. El-Hakim (the ENT specialist) were both for surgery, while our intentivist (Dr. Ryerson, Dr. Duff and Dr. Cave - whom I asked that they call and get his input), were initially for the wait and see plan. However, as the day wore on, and the results of the bronchoscopy came back, talks turned more and more to doing the plication on Monday.
After one final talk with Dr. Duff, we finally landed on our decision to do surgery on Monday. Today, we have let Evanna rest and get things ready for tomorrow's surgery. Now please note - this surgery is NOTHING compared to her open heart surgery, so I'm really not worried. It's a quick in and out procedure, and hopefully we can be on our way to Calgary later this week if they accept us.

Prayers for an easy and successful surgery tomorrow, and a smooth road to Calgary please!
xo The Irvine Family