She's a Smart Cookie

Meds and sleep continue to be a struggle for Miss Olivia.  Any masking agent for her crushed up pills is only working for a matter of days before she catches on and starts her dry heaves with every spoonful of applesauce, yogurt or pudding.  The compounded liquid meds are actually slightly easier to deal with because Brian's been mixing them with really strong liquid flavors like VitaRain or Propel and Olivia's just desperately thirsty and will chug it down even if it doesn't taste great.

My understanding was she didn't sleep much at all last night, thirst getting the best of her.  There's been continued effort to pump her full of salt with just about anything she's eating and that's making her thirst even worse.  Sadly, she's also waking up frequently looking for medical staff to take vitals, administer meds or draw blood.  I think Brian's going to back off all the salty foods today to see how her behavior changes if at all and that makes their day a little easier to deal.  Liv has become extremely attached to her blankets, wanting to be covered as if they will protect her from anyone poking and prodding her.  She took a few steps last night but is still generally refusing to stand on her own.

The incision is definitely angrier looking the other two from the Norwood and Glenn.  As I understand it, this is relatively normal as there was more scar tissue to cut through and her sternum was harder so there is going to be more inflammation and swelling this time.  Keeping up with the med schedule is getting better and I'm so excited to use this pill organizer I got from work.  It's a 7 day organizer with 4 boxes per day for multiple dosages and each day is portable if we were to be out and about.  Very neat, kind of sad that this makes me excited, but I'm trying to find little positives along the way.  Another positive, the shirts that the Grandmas and I spent time trying to rush through Pre-Fontan have really come in handy.  They're all Olivia's wearing right now. The ribbon closures were best for the hospital just as I expected with the chest tubes and additional lines and now she's sporting mostly the Velcro closures.  I'll try to get a picture soon to post but Miss Liv is really not feeling herself and basically refuses or cries anytime someone attempts to take her picture.  It's like she knows that she's not looking her best and doesn't want those to circulate.  Heart-breaking!

Where She Belongs

After much waiting around and anticipation of the echo results the nurse strolled into Olivia's room yesterday around 4 to give us the official boot from the hospital.  It was quick by any hospital discharge standards as we'd already gone over all the rules and regulations earlier in the day.  Olivia wasn't really sure what to make in the change in scenery.  Normally one to get excited about taking a ride out somewhere, she seemed very skeptical of the whole process.  Her initial reaction once back in her own environment was less than enthusiastic too; not even her playroom was of much interest.

Later in the evening my mom and I went to stock up on super salty non-healthy foods for the Livster's new high sodium diet and pick up all her new meds she seemed much happier watching Mickey Mouse hanging out on the couch.  A Daddy's girl through and through, she really only finds comfort right now from Brian.  Even as she's drifting off to sleep you can hear a faint "Dada" repeated over and over again.  The few times that she tried to sleep in her own room she would wake up and it would start off calm but if he didn't hustle up there it would eventually escalate to a "Dadaaaaaaaaaaaaa".  Only once she really gets desperate will she throw a "Mama" in there too.

Brian needs to take Olivia back in on Friday for a post-op follow up appointment to review the incision line, get follow up lab work to review liver, sodium and electrolytes, her second INR to review the Coumadin and a chest x-ray to make sure there's no fluid build up.

Rules and regulations so far as it pertains to post-op Fontan:

• No lifting under the arms for eight weeks, this includes if she may be falling; we need to resist the natural urge to reach out and grab an arm to steady her
• No direct sunlight on the incision for a year, regardless of the use of sunscreen - it's a no go
• No pool for one month post-op
• No soaking in water for two weeks or until chest tube sites have healed closed
• No ointment, lotions or any scar treatment on any of the sites for three months
• Exposure to the extreme heat is additionally dangerous for Olivia while she's on fluid restriction paired with the use of dieuretics (should be about 4-8 weeks)
• Avoiding large crowds, anyone with school age children or anyone who has recently been sick for the next 4 weeks
• Dieuretics and Enalapril cannot be given together as they could bottom out her BP; so administering meds has become a little more complex

Despite all of these new restrictions it is so amazing to have her back in her own digs and she gets a little better each day that passes.  

Today's Gameplan

I'm currently at the office trying to get caught up on everything that I missed last week, but my PC is trying to update my massive email box and it's bogging down everything I'm working on, so I'll blog while it restarts.  Today Olivia needs to have an echo, EKG, chest x-ray and blood work looking at INR levels to see how her body is reacting to the first three Coumadin doses, draw the level of Amiodarone in her blood treating the PVCs, look at the electrolytes since we know that Sodium and Potassium have continued to be low with all the dieuretics and review the liver and pancreas function.  If everything looks good on all of the above, she will get her central line pulled and discharged today.

It seems like we have the meds on a better schedule now with doses given at 7am, 8am, 1pm, 4pm, 7pm, 8pm and 2am.  If she gets to drop the sodium choloride and lower the frequency of lasix throughout the day at least two of those med times will go away - I'm especially looking forward to getting rid of the 2am dose.

Another big focus for Liv in the upcoming weeks or two will be getting her sitting upright more frequently, tolerating being held and walking again on her own.  Right now she's really refusing to walk or sit upright much because we think the central line is causing her pain in one of her legs with it's placement and when she sits upright it forces her to cough and that pulls on the incision causing her additional pain.  We want good productive coughs because that's what is best for her lungs, but she sees it from a different perspective - PAIN is baddddd.  I don't blame her, but those little lungs need to stay nice and clear.  Lastly, she wants no snuggles or to be held again because this is causing her pain on her chest.  It's sad to not be able to hold her and comfort her off to sleep but at the same time it turned out to be a blessing because it has not been an a fight to keep her in her crib after making floor rounds in her sporty red Radio Flyer wagon.

I'll keep you posted as the day progresses

The View from the 2nd Floor

It looks pretty darn good. Discharge talk is in the air, as early as tomorrow but it sounds like Wednesday is a sure thing if that sort of thing even exists. Olivia looks amazing. Thursday she had clinically made a lot of improvement but she was so dried out that she was sad to look at. The only negative to speak of at this moment is the amount of meds that need to be given.

Here's the current running list:

Amiodarone: arrythmia drug to prevent Liv's irritable heart from making more PVC's, should be short term and further testing revealed that her liver enzyme levels were just a delayed reaction to being on bypass as the level of Amiodarone in her blood was only trace amounts
Aspirin: now a whole 81mg post-op, should be a lifelong blood thinner
Calcitriol: calcium supplement to help replace what diereutics strip out, short term med
Enalapril: Blood pressure med that will likely be lifelong for Liv to make sure each constriction of her heart is as effective as possible
Furosemide: lasix to remove additional fluids off of her as she heals, short term med
Multi-vitamin: Just general good health practice
Potassium choloride: May be discontinued upon discharge, currently needed to replace what dieuretics are removing
Sodium choloride: yuckkkkk like drinking salt water to replace whats being lost by dieuretics, please hope this is done with discharge
Aldactone: another dieuretic to pull fluid from Liv's body this one is designed to keep potassium in her body since her levels are already low
Coumadin: serious blood thinner for a little kid, how long this will be needed is debatable at least for the next year (I'll talk more about this later)

Thats all that I know of for now but it may change upon discharge. For now Liv is eating up a storm, begging for water and starting to play a bit. So blessed

Trust in Mother's Intuition

Before Olivia I had often been told that a Mother's intuition when it came to one of her childrens welfare was one of the strongest reliable natural insticts out there. In both good and bad that instinct has not failed me to prepare for things with Olivia throughout her life thus far. It first hit me when I knew it when I had this overwhelming feeling that I was pregnant before any over the counter test could tell me. Then very early on when I knew something would be different in the pregnance from the norm, later confirmed by her HLHS diagnosis. Even the premonition that I would have a girl, so convinced I only had the name Olivia Giuliana picked out and didnt really consider any boys names.

Weeks ago the feeling came to me again after her Fontan surgery had been set that this surgery would not fare as well, to what extent I did not know and it worried me. I remember trying to hone in exactly and what I found troubling at the prospect of the next surgery and whether it was fear or my gut really telling me something? When the doctors brought her out of the OR telling us they had had to re-intubate and shock her into rhythm I was worried about the road ahead but not surprised. Each day as it has brought its small complications in bloodwork levels, pleural effusions, lethargy, arrythmias, eating, over drying from dieuretics; it hasnt come as any surprise because I had already mentally prepped myself for the Fontan recovery to be worse than her previous surgeries.

Tonight as she continues to get stronger she is begging me for "wa wa". With only 3oz left in her 24 hr max of 28 total fluid intake Im trying to budget her until 7 am when the daily intake retakes. Right now Im just thrilled she has the energy to repeatedly request it. Chest tube output was insignificant and they are talking about sending Liv to the floor today after rounds. Fingers crossed!

Eat, Eat, EAT!

As you may be able to tell by today's title, Liv is eating successfully. This morning's labs showed liver enzymes were normal, pancreatitis had subsided. Todays successful meals and snacks have consisted of: yogurt, hard boiled egg, shredded cheese, steamed rice, mac n cheese, apple juice, chocolate milk, froot loops, banana, pears. So you can say shes making up for lost time. Everything has stayed down and Olivia seems to be more satisfied. She is having a few PVCs but they are not making any med changes. Chest tube output really dropped again and thats all good news. We can now add chocolate pudding to the list of treats today too. That was a first and she really enjoyed it.

Win Some, Lose Some

Today's Wins:
- Chest tube drainage output dropped substantially, one step closer to coming out
- There have been no additional PAC's in over 24 hours
- Fluids that Liv took in actually stayed in her tummy including 2oz of chocolate milk
- The dreadlocks that Liv was rocking have been tamed and shes sporting one of her new shirts
- I got to hold her for over two hours this morning and it was precious
- Her lips are a beautiful shade of pink

Today's Losses:
- Liv is NPO once again
- Her pancreas is stressed from surgery and the curento the inflammation is discontinuing food and fluids by mouth!
- The med that was helping with the PACs messed with a liver enzyme making her incredibly fatigued, now discontinued because there have been no PACs even as drug was weaned
-All the things we did today to get Liv more on track were actually creating setbacks

Tomorrow: let her rest and enjoy iv fluids, see how bloodwork looks and go from there

Checkin In

Sorry there was no 3am post today, Liv was sleeping when I got here so I did too. The water and food have been slow going. Livvy has been pretty queasy and not much has stayed down until the last six hours. Her post op echo showed decreased heart function, pretty normal for these kids but also an explanation why shes been so sleepy even off pain and sedation meds. The staff is not concerned because all her labs are great and liver, pancreas and kidney function are perfect. If things were sliding South her numbers would show stress on other organs. She's happier this morning but really wants to be picked up. So far both Brian and I have refused her because we fear she'll really fight us when the time comes to go back in the crib. Chest tube drainage is continuing to slow and lasix are doing their job because shes not as puffy. Her EKG from yesterday showed that the PACs have slowed considerably so another step in the right direction. Dont know what today brings but hopefully Miss Liv will start showing some interest in all the toys she has waiting for her to play with just for this trip.

Delish

She didnt say it but I'm sure thats what Liv was thinking today when she had some applesauce at 330, her first meal in over 48 hours. Thats a big deal pairnwith some fluids orally. In the next 24 hours Midge can have 28oz of Pedialyte. Not a whole heck of a lot but better than nothing. As for keeping people on their toes; Olivia has a PhD in that field. She somehow managed to find a way to sleep last night that made her heart rate monitor stop reading and the nursing staff came running in to find her snoring happily. Brian might have needed some oxygen to recover from that little wake up. Then on my watch missy decided to pull herself upright using the crib rail and before I could get out of my chair she spun herself around and got all knotted in her lines and tubes. It was amzing how fast she did it and it took two nurses and myself 15 minutes to fix it all. As for the irritable heart- its still irritable. Her one atrium and one ventricle (you and I have two of each) are not pumping in sync. When shes on a specific dose of Amlodarome her rate is beautiful, when they go down on it she has the out of sync pumping. So short story shes going to be discharged on some of this med for the short term. Her calcium, magnesium and potassium levels have all been low and supplemented during the past two days. This is common since she hadnt eaten. Once she is having regular fluids and meals the staff will take her baseline levels and decide what she still needs to be given in the way of additional meds.

Sleepy Mimis

Miss Liv spent most of today sleeping...with the occasional hallucination. The staff wants her really awake before they try to give her food or fluids, so Versed pump is going bye-bye. She still has some irregular heart rate going on, all her blood work looks great, they attribute the funky beats to an "irritable heart". No treatment for it, just let it get to its happy place once more with some R & R and time OUT of the OR (yes, I thought that was witty). If I had to wager Livvy is going to show her 'tude sometime later tonight on my shift. Just a hunch or mothers intuition. If she plays nice the staff may let her try jello or broth tonight. Catheter stayed in to get a more accurate read on output now that Lasix are on board. All lines are still in but chest tube drainge is slowing. Temperature remained normal all day and that about overs todays events from bed 7 here in the PSHU. Over and out

Post Fontan

Do I dare say it aloud? That Olivia has climbed and conquered yet another mountain in her journey with HLHS? Last night things were okay not great. Today things look really good. So goes life post-op with these babies and kids. Her last x- ray showed some fluid around the right lung, but the tube is draining plenty of fluid. It's just not draining it fast enough so Liv was given her first dose of Lasix after am rounds. Its already working as her face which was puffy this morning is already looking more like normal. She is still on the med that helped her heart rate get under control last night but they are going to start weaning that tonight I believe. Her nasal cannaula is still giving some oxygen to help stabilize her and theyre bringing that down as well. Her temp is completely back to normal so no infection (yay). I feel like Im missing some big detail or development but i think thats about it right now. If she gets food or drink tonight I'll update. Otherwise no news is good news

Adios Tube!

Liv was extubated around 1am. She had been awake for some time and was going to to do it herself if the team didnt get busy and make it happen. Its about 3 now and shes resting comfortably after a little versed. She is totally with it asking to be picked up and/or leave the unit pointing to the door. Much to my surprise she has her normal voice which is kind of stunning after being intubated twice yesterday. As for her post op issues- the staff spent the betternpart of the night mixing drugs to find the right formula to get her stressed heart under control and in normal rhythm. They took the crash cart out around 1 and we dont forsee a need for it! Her temp which was steadily climbing has now dropped back into normal range after a dose of Moitrin. Now extubated her bloodflow through the new circulation is ideal and pulses to her extremities have improved. She is thirsty. We are allowed to dip a stponge in a cup of water and give it to her. My first attempt she bit off the sponge and almost took my finger when I went in her mouth to get it. Oucccch, the fluid battle has begun. Chest tubes are producing quite a bit of fluid, but nothing milky white so we like that. Brian and I are alternating four hour shifts so she always has a parent with her and are taking notes to keep everything of great importance on record. Her sats are currently 97 and shes got two periphereal lines one in each foot, an arterial in left groin and central line in right. This gives my little monkey full use of her hands which is good and bad. Now she just needs to rest and get on the road to recovery.

Give & Take

Liv is officially post-Fontan. Amazing. But the road to here tonight was a long one for that little girl. She is resting comfortably tonight, however still intubated. The surgery was a success and she was originally extubated but an episode of tachycardia (fast heart rate) led to her being shocked back into normal rhythm and re-intubated just in case she decides to be naughty again. She is on pain and sedation meds to keep her quiet on the vent tonight and lidocaine to get rate back under control. Blood gas looks good and she is satting 100% like you and I would with minmal help from the vent. Its a bummer shes on the vent and has a right and medial chest tube - but all of these are within normal post-op complications. Her chest xray looks good and the plan is to be off the vent by tomorrow morning. We already know Liv does what she wants when she wants, so who knows? Slow and steady wins the race. Thank you all for your prayers and support!

Wrapping Up

Final word came out of OR. They were closing her up and getting her cozy with pain medicine to prep for extubation. Around 630 she should be in a room and ready to be loved on. Can't wait!

2nd update

About 15 minutes ago the OR nurse came out an let us know they are going to be taking her off of bypass. Bleeding has been minimal thus far and nothing out of the ordinary. Next update should be around 530 CST

Stay tuned

1st OR Update

She's on bypass and doing well. Vitals are stable and they are beginning repair. It'll be at least another 1.5 hrs before there's any additional news.

She's In

In what was my worst moment as a parent the surgical nurse took Liv from Brian's arm kicking and screaming and into the OR. We could hear her screaming the entire length of the hallway. A code blue in the peds cath lab rang out as I called my parents with an update and a group of techs wheeled an ECMO by as we talked.

Today will be the longest day of our lives

Thank You Versed

Its in and shes loopy...should be soon now

A non update update

Word came about 20 minutes ago that 1st case isn't going well and it looks like it may still be a couple of hours before Liv goes back. Not what we wanted to hear but my heart aches for that other family and I pray their outcome is a good one.

Pre-op

Blood draw is done. They are going to give Versed around 9:10 and take her back around 9:30. She is very unhappy right now and wants to be left alone. Seems pretty reasonable to me

8AM on May 21st

That is THE TIME - it's official.  Hospital just called, reminded me no food or dairy after midnight.  She can have water and apple juice until 5:30 and no meds are to be given on the day of surgery.

Olivia's second case, but first case has to be there at 7:30 so they will take the first baby back, have that team start on him/her and then take Livster back and have two kiddos worked on at the same time.

Standard instructions for the weekend are to watch her making sure she doesn't develop any symptoms that indicate she may be getting sick and call in ASAP if something looks amiss.

Assuming there's no news, you won't hear from me again until Monday morning, so not to worry.  On the day of I'll be updating Facebook and here as the updates come in from the OR.

Thank you all very much for your well wishes and prayers.  We know Olivia is a very loved little girl and she's got a whole lot of people rooting her on.

Pre-Op: Done!

With a bit more anticipation than usual, we got all ready for today's prep for the Fontan.  It was really pie.  The blood draw was dreaded but they got it over and done in one stick (thank you nurses!)  Olivia was hysterical for the duration, but I guess as sad as it is, I'm becoming hardened to her hysterics with all things medical.  Our Nurse Practitioner is actually a friend of a friend so that made it even better.

Chest x-ray was a snap and the four hour appointment that they had us all prepped for was over in two hours.  That's about the only experience we've ever had where we got out faster than expected.  Who knew?

The Pediatric Surgical Heart Unit (PSHU) has been below census in their ten beds for months.  This week? They are booked solid and have four sweet little babies on ECMO all at once.  It comes as no big shock given that there were four Norwoods done the week Liv was born and when she was in for the Glenn they were so over-booked that we got kicked to the PICU to spend that dreaded "Black Friday" on August 5th, 2010.  Ideally she goes to the PSHU but the PICU is a little more lax so there's trade-offs for both; whatever is best for her care is paramount.  Goal is she comes out extubated, stays nicely sedated all of Monday and most of Tuesday.  By Wednesday morning we should be able to start giving her minimal fluids and food.  She will be on fluid restriction until they've deemed her chest drainage to an acceptable level and we confirm that she didn't develop a chylothorax.

Chylothorax: A sort of pleural effusion (build up of fluid in the tissue within the lungs), in this particular instance she would be dripping fat into her chest cavity and have to go on a fat-free diet until the milky white fatty liquid stops draining

Post-Fontan is a little different than I had envisioned.  They're going to want to see her pretty regularly again for cardiac clinic to make sure she's not retaining fluid, adjusting lasix as needed and she'll need to go to her peds or the local lab near us to make sure her Coumadin is at a therapeutic level.  After the first 90 days on Coumadin, it sounds like we will be dispensed a meter similar to a glucometer for diabetics that will measure her clotting levels and make adjustments as needed based on the readings I get from her.  I dislike this but prefer it to constantly taking her in to get the levels read so it's all about the trade-off.

Still waiting on the exact time for the surgery on Monday but the hospital has already called to tell me that her bloodwork came back great and they found the results to her holter test which was perfectly normal.  I do love getting good news!

Just Days to Go

This time next week Olivia will be post-Fontan.  In the meantime it's becoming a mad dash to get everything done before she goes in.  Thursday's a wash with the pre-op appointment never really knowing how long it'll last.  The hospital said to expect about a four hour visit which translates into about six hours.  I got the best idea ever just yesterday to make little gown like shirts for Liv.  With the help of some of my more sewingly gifted coworkers they suggested that I make some with velcro closures, ribbon closures and snaps like you'd find on a onesie.  Easy right?  I ran to Old Navy and bought up all the little girls shirts and tanks that I could find at $4 to either cut them right up the middle or straight down the back depending on the style of the shirt.

But when exactly am I going to sew in the velcro and/or ribbon or put in the snaps on top of making this super cute fleece throw that I bought all the material for?  Somewhere in between all the meetings at work that need to be juggled trying to prep to be out for a few weeks.  Hmmm....if only these great ideas had struck me a little sooner.  So Tia Mari if you're reading this - your help would be greatly appreciated!!!  Nonna's going to get all the new clothes washed today and then I'll start working on them tonight.  It's either going to be a breeze or a battle, there's no middle ground here.  I'll post pictures if they turn out well enough :)

On a high note, in between Target and the Old Navy that I hit up was a dollar store and I managed to find a bunch of cute little toys to give Liv daily in hopes of keeping her entertained with new loot for the duration of the stay.  Nothing over the top, just your everyday tiara, bracelets, a princess sippy cup with a crazy straw, a coloring book and an old fashioned tin lunchbox/purse featuring none other than Tinkerbell.  She should be a styling little diva at the very least.

Stay tuned on updates with all of my crazy projects.

Meant to Be

I sent out an email earlier this week to some of my large vendors to let them know that I would be out starting 5/21 for Liv's surgery and received several responses of well wishes and support along the way.  A few expressed their apologies that we are going through another surgery of which I promptly replied that it wasn't necessary.  I am not sorry that this is the path that was chosen for Olivia's life, quite simply this was all meant to be.

My only living grandparent (Gram - Mom's Mom) passed away in January of 2010 at the blessed age of 94.  The loss of her sent my mom reeling for quite some time as they were close (even though Gram had her way of making everyone feel like they were her favorite).  When I shared the news that my mom would be a Nonna in the summer of 2010 she started to snap back into life here in the moment.  Suddenly she had something to look forward to again.  That November when we got Olivia's diagnosis Mom snapped into action.  She went with me to get the amnio and shockingly didn't faint as they stuck that ginormous needle in my belly.  She made sure she was always available for my fetal echos and stress tests if I needed her to be my wing woman altering her work schedule to accommodate the weekly appointments.  Once Olivia was born, through the Norwood and discharged my mom dropped everything to be with me during the day a few times a week just to help out and go to the weekly Cardiology clinics.  Then when I went back to work between the Norwood and the Glenn it was my mom and Olivia all week long.  Thick as thieves Mom would diligently chart every ounce of milk consumed, every wet and/or dirty diaper, meds administered, you name it the woman charted it.

Linda and I are quite certain that Mom enjoys being Nonna to Olivia more than she ever enjoyed being a mother to Lind and I as we were growing up.  (Mom denies this)  But I have seen my mom step out of her zone and sit on the floor of the playroom to read her Precious aka Olivia books, be silly playing with stuffed animals and find just about everything that Olivia does to be the stuff of geniuses.  My own mother brags to me about MY child.  It's amusing and exhausting all at the same time.  If a few days go by without Nonna seeing her precious, she starts to get a little whiney and wants to me to make sure the Munchita knows that her Nonna misses her.  "Riiiiight because she's forgotten you in the three days since she's last seen you" I say with a smile.

I look at all the things that Olivia brings to the table on a daily basis and one of those is giving a purpose and new sense of responsibility but youthfulness to my mom.  She gets to do all of the things that she couldn't do with us when we were young and she worked full time now with Olivia and ultimately not have to have all of the responsibilities that go along with being the actual parent.  What a fantastic arrangement!  All of the cuteness and spoiling and none of the discipline - sounds like a winner to me!  I'm making fun but I am so thankful that I have my mom around just a phone call away even when she makes me crazy asking for the fifth Olivia update of the day.  All daughters and granddaughters should be so lucky to have a Nonna/Mom like Olivia & I do.

Happy Mother's Day Mom!  We love you

Quarantine Begins

Surgery's now two weeks out and Olivia's "house arrest" officially begins.  She had her farewell tour to the public - visiting such fave places as Target, Costco, the mall and Chik-Fil-A.  She got to see a bunch of the extended family over the weekend and now it's time to be extra cautious.  If any adult has been on a flight as of late we are asking for them to stay away from her for 48-72 hours just to make sure there's no germies to avoid.  If you have school age children or children in day care, Liv will see you once she's on her road to recovery because we can't take any chances that she gets sick pre-op for her best odds of a speedy recovery.

Of course, Murphy's Law being what it is, today its doom and gloom outside so my midge is going to be angry that she can't even go outside and play.  The weather forecast looks promising for the rest of the week so hopefully she'll get lots of fresh air with water table action and taking her little baby doll and stroller all around the neighborhood.  Aspirin needs to be discontinued on Thursday, I must have it noted in about 5 or 6 different places just to make sure she doesn't get it when she's not supposed to!  Grandma's take note in case neither parent reminds you!  Other than that, nothing big on the calendar until next week's pre-op workup.  I'll make sure to post some new pics soon, I think she's growing weekly, it's surreal.