Saturday, November 22, 2008

Homeward Bound

Yes, that's right, we are COMING HOME!!! We have the okay, FINALLY, from the doctors and surgeons to go home. I just noticed that I haven't updated the blog in the past couple of days, so sorry. I will update more when I get home, but for now, good bye to this wonderful hospital, nurses, surgeons and staff, and HELLO to BOiSE! We cannot wait to be home. We love you all and thank you again for all your prayers and fasting in Burke's behalf, it has helped a ton! See you soon!

Wednesday, November 19, 2008

Day 8 and 9

Burke says hi to everyone at home! (okay he was really reaching for the camera, but a shout out to his friends and family was cuter!) He also keeps reminding us about his last IV left in his foot. (Just so we won't forget!)

Yesterday, Burke was moved to the third floor surgical unit. We have our own room and we can close the door and Burke can actually sleep in the dark and quiet. This floor is quite busy though so it is not terribly quite, but more quiet than the PICU for sure. We are glad Burke has moved from the PICU to the "floor" as the staff calls it, but there is a different feel on this floor compared with the PICU. This is so bad to say but I kind of miss the PICU. The nurses there are amazing. Some more than others, but for the most part those nurses and nurse practitioners are just awesome! In the PICU you don't have your own room there are just curtains to divide the patients and there is generally one nurse per patient. When the patient becomes more stable then one nurse will oversee two patients. I think we miss the one on one attention the most. If we think he need anything, the nurse is right there doing what needs to be done. Now, on the "floor", one nurse has maybe three or four patients and they are not right here to make sure Burke is perfectly okay. Yesterday, I took the change harder than today. I don't like change, and coming to the floor was a definite change. But today is better. It is a good reality check for me. I loved getting the one on one attention I know Burke needed while he was in the PICU, but they moved him to the floor for a reason, because he doesn't need to be checked all the time. And the nurses here are just outside our room and they have monitors at their desks that show each of their patients' monitors. The difference is that they are not in our room 24/7 checking on every move that Burke makes. It is different and I know he is where he needs to be, but I know with out a doubt in my mind that the PICU is a special place. The atmosphere is unique and the people who care for my child and all the other children in there are gifted and special. I will never forget how those people have touched me.

These nurses on the "floor" are special and great too, but I don't feel as connected with them as I did when we were in the PICU. We haven't overcome the major challenges and obstacles that we had to hurdle across while in the PICU, and I know that brings people together. Heavenly Father is teaching us something when we go through our challenges. It brings us to our knees more. It bonds people and helps us rely on others for help, strength and support when we are challenged. And ultimately it brings us closer to one another and closer to Him. I am so grateful for all that we have gone through. Though I am not pleased that Burke has to be the one experiencing the pain, our trial with our dear heart baby is something we need to go through right now in our lives.

Burke is doing well. He had a great day yesterday and we even went on two wagon rides!! He LOVED getting out. We went into the playroom for the first time and he just came alive. It was great to see him want to play again.Today, Wednesday, was also a good day and pretty uneventful. Burke woke up this morning pretty crankey and we were thinking that he might be coming down with a little cold. He sounds congested and was acting very miserable. But when they gave him his pain medicine a little while later he went right back to sleep and slept all morning long. He had a lung profusion test done today (which I don't really know what that entails), and we will know more about how his lungs looked when the doctors come around tomorrow morning. They will look at his chest x-ray that was also done this morning and make sure he is okay to be discharged. If everything comes out good on those two tests then we might be headed home tomorrow! Can you believe it!! And only the ones who have read this whole post will know that, so thanks for reading, you guys get the golden star! We might be coming home as soon as tomorrow!!! We will know tomorrow for sure when we get to go home. YIPPEE!

After the lung test Burke slept all afternoon too. He is finally in a quiet room and is quite enjoying it, as are we. They took out his feeding tube tonight and I know he loves having that out! We also went to the playroom again today and he stood up for the first time since before his surgery! I was so happy. But about 30 sec. after he stood up, he let out this HUGE gassy bubble and he pretty much had the hugest blow out ever! Yep, so the playroom did it to him today. We didn't stay long, and I didn't get a picture of him standing up or sitting and playing in the playroom, but for the short time we were there he was loving it!Here is tired brother at the end of the day! Put me to sleep momma!

Tuesday, November 18, 2008

Day 7 Recap

Yesterday, (Monday) was day 7 after surgery. He is still in the PICU but he has made great progress. They took out his pacing wires and his ART line (the main IV in his hand). Boy is he glad to have that IV out.Here is the picture of that ART line before they took it out. They have kept one IV in his foot just in case they need to put medications through it. The pacing wires are wires that are connected to the sac around the heart. They needed to hook up these wires to the pace maker only once while we have been here. He was put on a sedative that he had never been on and it made his heart rate sky rocket. So, they tried to capture the HR and bring it down using the pace maker. It was amazing to watch that happen. I maybe have written about this before, but anyways, they had to use it only once with him. But these wires are sown into his stomach right below his sternum. (Most of the major IVs and chest tubes are sown in so they won't get pulled out as easily.) So, while they were cutting out the stitch Burke was such a trooper. I can only imagine the pain he was going through. There were about four of us holding him down while I was trying to help comfort him. He did great. But right after the nurse practitioner was done he automatically put up his foot with the IV still in it like he was ready and waiting for them to take that one out next! It was hilarious. This kid is so smart. Here are a couple of pictures of his foot with the last IV. He pretty much has it up all the time. This is while he was talking to Emma on the phone. He loved talking with her. He was jabbering a ton and didn't want to get off the phone with her. They are such good buds and I know that it has been hard on both of them to be away from each other. Notice the elevated foot!

He loves helping the nurses out by moving the oxygen prob to a different finger. He usually doesn't even have to be asked to help out, he just does it on his own! What a big helper! Notice the foot up in the air. He was loving being held by daddy!Grandma and Grandpa Bates have been here visiting and helping with Burke since Saturday. This was last night when they were leaving, he melted all of our hearts when he was giving them a big good bye wave!! Thank you so much for all your help while you were here mom and dad. Burke loved seeing you and loved how you made him smile and laugh. We love you both so much and are grateful for your love and support!

Monday, November 17, 2008

One of Tyler's Childhood dreams

We have meet so many amazing people here at Primary's. Many of the nurses are so awesome and we have bonded with a lot of them who have watched over and taken care of Burke. We have made great friends, and one of those amazing people is a nurse practitioner named Kristin Print. It seems she does everything here, including the Life Flight team! Yeah sweet huh! Tonight she stopped by to check on Burke and we were asking about her sweet red life flight jump suit. She looked hard core. Ty was being himself and was asking her as many questions as he could about helicopters and difficult flying conditions and so on. He then asked about where the helicopters land here at Primary's. She then proceeded to ask us if we wanted to go up and see the pad where they land. Of course we could not turn down that kind of an offer. Considering helicopters are like the coolest thing to Tyler. There was not a helicopter up there at the time, but it was so awesome to go up there and check it out. She was so nice to just let us look around and check it out. Right when we got up on the roof we could see AirMed which is a helicopter that is a rival to Life Flight, right above us. It was just leaving the University hospital which is next door to Primary's. Then we saw another helicopter coming straight for the pad. We were so excited! She was a little alarmed because she usually gets paged when there is an incoming patient and she hadn't been paged nor was their a team on the roof ready to receive the incoming patient but all the roof landing pad lights were on. She was a little confused but she then figured that it must be flying overhead to land at the University Hospital. We kept watching as the helicopter approached and to our disappointment Krisin was right, it flew right over us and went to the University Hospital instead. We were bummed that it wasn't landing here. It would have been so cool to see it land. None the less, for a completely random tour of the hospital roof we timed things pretty well.

Burke talks to Emma

Sunday, November 16, 2008

Day 6 Post op

Well, day 6 post op in the PICU is coming to a close. We have had a great day and Burke is recovering really well. Here are some pictures to compare the medications he was on the day after surgery (picture on the left) and the meds he is currently on (picture on the right). There were 8 monitors next to his bed then and now there are only two, and one is not even being used, it is just there in case they need it. They have weened him off of most of his sedation medications. He will be on diuretics and some more meds to replace the potassium he looses because he pees so much from the diuretics. We should be released from the PICU tomorrow and be "on the floor" which is a regular hospital room until we go home. We anticipate being there for only a week or so. He is doing great and is awake more often now. We got to hold him more today. Tyler and Grandma Bates were able to hold him for the first time today. And Grandpa Bates made him smile for the first time!! He was talking to grandpa for a long time and just telling him all about what he has been going through. He talks a lot more and is more alert. He has great coloring and is pink and looks great, though he probably has lost a few pounds after surgery.His first smile after surgery!!

Saturday, November 15, 2008

Day 4 and 5 Post-Op

Burke is beginning to act more like himself. At home he always puts his feet through the ballusters of his crib. As you can see he has begun doing that here as well.

Today Burke was extabated. As you can see from the previous picture, the tape across his upper lip that held the bluish tube in place has been taken out. He is noticeably a lot more comfortable with this tube gone. His oxygen saturations have actually done better without the ventilator as well. In fact, when I arrived back here at the hospital earlier today I walked up behind the Respiratory Therapist just in time to hear her say, "His sats are better off the respirator than they were on it. I've never seen that before." Today the nurses were also able to take the i.v. out of his neck. Without going into a lot of details let me just say that a lot of progress was made today.... He even pooped...why do I mention this you might ask, because look at his belly in the upper picture, no he isn't taking out after his dad, he just has a lot of buildup. Poor kid!

This is what I call a happy Momma!!! This is proof positive that Burke is doing better. Rachel got to rock him to sleep this evening. I am sure he enjoyed it just as much as she did.

Burke wants to play...

While Rachel and I have been here at PCMC with Burke, Emma has been staying with one of my sisters and her family back in Boise. Since being down here we have called Emma nearly everyday. Each time we talk to her she says, "I want to talk to Burkie." Burke, of coarse, has been knocked out with medications so we have had to tell Emma that "Burkie is asleep so he can't talk right now." Her reply to this has usually been, "He's sleeping...... when he wakes up I want to talk to Burkie." To this we have said, "OK" but we know full well that it is going to be several days before he can talk with her.

Rachel and I wondered how long it would be before Emma grew tired of this response. Well, on Thursday Emma didn't like that answer any more so after Rachel told Emma that "Burkie is asleep..." she replied with, "well wake him up." To this we have tried to give here a 3 year old version of why Burke is always sleeping.

Burke woke up for a little while Friday and was calmly laying there in his bed looking around when we thought, now would be a great time for Emma to finally talk with Burke. We hesitated a little not knowing how Burke would respond. We decided to give it a try. So I quickly sent a text off to my sister Becca with his bedside telephone number asking her to call so Emma could finally talk with Burke. Very quickly they called. I passed the phone to Rachel who then put the phone down to Burke's ear. The instant Burke heard Emma's voice he went NUTS. He must have thought it was playtime. He squirmed all over that bed trying to escape all the tubes and restraints. Rachel quickly pulled the phone away and handed it back to me. I put the phone to my ear just in time to hear Emma say, "I love you Burkie." While I finished quickly with Emma and Becca, Rachel was trying to calm Burke down. Rachel settled him down but it was very apparent that Emma's voice to Burkie meant it was playtime....and it is, but not quite yet....Burke just needs a few more days.

Friday, November 14, 2008

Day 3 Post-Op

Burke woke up for little while in the morning. He was relaxed and just looking around. It was great to see his little eyes again. Later on that day while I was taking a nap, Tyler and Jan were able to see him wide awake for a long time. Martha was there for part of the time too. He will begin to wake up more and more as the days pass.

Today is the beginning of day 4 post-op but here is a summary of yesterday (day 3). Burke's 3 chest tubes were taken out. There was one draining fluids behind each lung and one draining the fluid behind the heart. I am told that older patients recovering from heart surgery, say that can verbally communicate their discomfort, that chest tubes are their #1 complaint. With these chest tubes gone Burke seems to be resting more comfortably and his vital signs have normalized. This probably doesn't mean a whole lot to many people but these vital sign numbers are what we watch on the monitor for most of the day. Today's stats were a welcomed sight. His heart rate has been hanging around 135-140 which is basically his heart rate when we are at home. His systolic blood pressure has been in the 95 /120's and his oxygen saturations range from 72 to 79. For Burke, these are the vitals he needs to hold on to. Another improvement today has been when Burke has his moments that he squirms and tries to escape. In days past his vitals would go everywhere, today during these episodes he has held descent vitals and they quickly go back to normal when he settles down. Needless to say today has been a welcomed day.

Burke was weened from the nitric acid that was used to keep his Pulmonary Arteries open and relaxed. He seemed to handled it quite well - this basically means that we are one more step closer to leaving the PICU and ultimately one step closer to heading home. Tomorrow we are hopeful that he will come off the ventilator (breathing machine) and then begin to be weened off a medication that he cannot be on when he goes to a normal hospital room.Burke's medication lines. There's a couple of them don't you think?

Wednesday, November 12, 2008

Day 2 post-op

Well, today has been an eventful day. And usually in the PICU eventful doesn't mean good. Having said that however, Burke is doing a lot better today than yesterday. Today the nurses have been trying to ween him off of the many medications that he is on. One in particular is the paralytic. As he comes off this he tries so hard to roll over and pull his breathing tube out. I must say I can’t blame him. Having a large breathing tube down your throat, a feeding tube down your nose, 3 drainage tubes coming out of your chest, along with everything else he is hooked up to - lets just say it can’t be pleasant. As they take him off the paralytic they replace it with another sedative to help keep him sleepy and calm in hopes that he doesn’t fully wake up. Well today while we were just sitting around waiting for him to wake up, all of a sudden he woke up and was really agitated. He started moving all around grabbing his tubes and simply trying to get away from all this stuff. While he was moving around his sats declined to 45 which is WAY too low. They increased his oxygen and increased his dose of the sedative to help him stabilize. Slowly he began to calm down and went back to sleep. When this first episode happened this morning, his heart rate (HR) went sky high – almost 200 beats per minute. A heart cannot sustain a rapid pace like this for very long before it begins to give up. The nurses hooked him up to a pace maker in hopes of taking control of his heart beat then slowly bringing it down to a lower pace. This worked until about 180 bpm but then his heart climbed right back up. At one point one of the nurses turned to the nurse practitioner to say “what’s plan G.” Unfortunately the last resort plan of stopping his heart with medications then starting it up again was quickly approaching. As you can imagine we were all pretty worried about this option. Despite this high heart rate Burke seemed to be comfortable so rather than do something dramatic like stopping his heart they decided to switch his sedative medication thinking this high heart rate might be a side effect of the one he was on. Sure enough as they switched the medication his heart rate slowly began to decline throughout the day. It fell to about 165 bpm and stayed their most of the today. At times it would dip down to 135 but then go back up to 165. Hopefully with more time that medication will wear off and his heart rate will stay down at the 135 level.

All the events of today have shown us that there is certainly an art to health care. The nurses are constantly adjusting medications to keep him comfortable and sedated but also trying to let him come closer to waking up so he can, for example, begin to breath on his own and be extabated.

Tonight the nurse ended up putting him temporarily back on the paralytic because he was waking up and squirming around too much. As I am sitting here writing this the paralytic should have worn off by now and he should be resting comfortable with the pain killers and sedative. His oxygen saturations right now are 77 which is great and they are decreasing how much oxygen % they are giving him. He is down to 45% on the machine. His blood pressure is good and his heart rate is still high (165ish). His heart has a normal beat whereas earlier today it was somewhat irregular. His blood gas (which is the blood count) is 49 which is great. So his body is doing what it needs to in order to heal and recover from this major surgery. Heidi our PICU nurse (she has been here the past two nights and is on tonight also) said, "he is doing much better than he was yesterday." She also mentioned that she is coming down on the Nitric acid which helps keep his Pulmonary artery relaxed and open. Burke is certainly in great hands and we are so grateful for all the nurses, nurse practitioners, doctors, and surgeons who all care for and worrying about Burke. Thank you for all your prayers, they truly help.

Tuesday, November 11, 2008

Post-op pictures

Here is Burke today, just hanging out spread eagle.

A view in of his living quarters in the PICU at Primary's.

Day after Surgery

Burke's surgery went well. It was a long day and took about 6 hours from start to finish. Both Dr. Kouretas and Dr. Hawkins were in the operating room working on Burke's heart. They did a lot of patch work on his pulmonary artery. They went out the the branches as far as they could. They also put in a 10 mm sized gortex shunt from his right ventricle to his pulmonary artery. We have a piece of what they used and it is huge. That will help hopefully help his artery to grow. The branches of his artery that go to both lungs are very small still so his saturation levels are still pretty low because they can't expand automatically to get more blood to his lungs. Dr. Hawkins said it could take months for his sats to increase because it will take time for the branches of his pulmonary artery to grow. Now, we are learning there is a chance that those arteries won't grow. We asked a doctor today what would happen if his arteries for some weird reason just won't grow. He said that his life expectancy would be shortened and it would basically be a slow gradual decline in his health. It is good to know that information so we know what to expect, but we are not thinking about that too much. Time will tell, and we are very hopeful that because of the increased size in shunt that it will cause more blood to go through those arteries and cause growth in the branches. We are very hopeful.

Well, it is now the day after surgery and Burke is now stable and doing fine. Last night was rough though. His oxygen levels were low all night and they were pretty worried about him throughout the night. They finally ended up giving him Nitric Acid, a gas, to help relax his pulmonary bed in his lungs so that oxygen will flow more freely and get his oxygen levels higher. This morning his sats were in the high 70's where in the night time they dipped into the low 50's.

He is much more stable today than yesterday. He is on a lot of medications to keep him stable and he was on a paralytic to keep him from moving and possibly pulling out his breathing tube. This morning they have weened him off of the paralytic but they have found that as he begins to wake up more, his Sats drop and his blood pressure goes up. As a result they have given him versed (sp?) to help keep him sleepy without giving him the paralytic. I was just in with him when he was starting to wake up more than he has, and he was moving more than they wanted him to. They quickly gave him versed again, and he is back asleep and content. He almost pulled his breathing tube out. He was very fidgety and did not want to be held down. When he would fight us to move, his oxygen levels decreased and so it told them that he is not quite ready to be awake today. They also ordered restraints, so he has his arms tied to the bed right now. It is so sad, because Burke does not like to be held down in any way.

He does have a breathing tube like I just said, and they are giving him oxygen through the tube. He is gradually being weened off the oxygen so that he can breathe more on his own. They should be able to take out the breathing tube in a few days or so, but it might take some time. This morning they also put in a feeding tube (through his nose) so they can get some food to him. They want it to go directly into his intestines, but they just reviewed the x-ray they did after putting in the tube and it looks like the tube is in his stomach. They are trying to manipulate the tube to have it go to the proper place. I do not know why they want to by-pass his stomach, but obviously it is necessary right now.

He has many tubes in his body right now, and I wish I had a picture of him, but I have not taken one yet. He surprisingly looks very good for what he has been through. He appears to be swollen (which is expected) but not as swollen as I thought he would be. He has a catheter in his little pee pee, and his urine output is very good, so that means his kidneys are working properly because his heart is working well. He has three chest tubes. One, that is draining blood from the sac around his heart. The other two tubes are draining fluid from the sacs around his lungs. Last night he was bleeding a lot through the tube in the middle coming from the sac around his heart. They were pretty concerned with that and wanted to monitor it though the night. His bleeding is now under control so they will not have to open him back up again.

We are hanging in there and doing well. A little sleep deprived, but we are good considering what out child has undergone. Burke is doing well, and we are hopeful of a good recovery. We will post a picture sometime this afternoon. We love you all and are so grateful for all your love and support and prayers in Burke's behalf. He is being watched over and we are grateful for his progress and for what the doctors have done and are doing to keep him stable and comfortable.

Monday, November 10, 2008

Pictures of the Weekend

Burke is in Surgery

Burke's surgery was moved up to today because the surgeon had a cancellation. It was scheduled for today at 6am but shortly thereafter the procedure was bumped to 12noon because a newborn was life flighted in last night and needed the 6am time slot.

After all the administrative check-in was complete the Anesthesiologist came to get Burke prepped for surgery. With all the equipment and monitors that is required for this surgery the Anesthesiologist needs 1 to 1.5 hours of hooking Burke up to everything before the actual surgery can begin. That 1 hour or so gave Rachel and I time to meet with Dr. Kouretas (the surgeon) to discuss today's procedure.

The results of last Friday's MRI showed that Burke's Pulmonary Arteries have not grown very much. In fact, there is some indication that the right branch (the branch that in the past was growing quite well) is now shrinking and the left branch which was ballooned during the 2nd heart catheter (in June) has not grown like they had hoped it would. With these MRI results there is no way a full repair of Burke's heart can happen. The procedure that is planned now is very similar to his 1st surgery. I don't have AutoCAD on this computer so I will have to use some of the drawings from previous posts to explain what the new procedure is all about. The drawing below is of Burke's 1st heart surgery. The patch work that is shown in that drawing is very similar to what Dr. Kouretas is planning on doing during today's surgery - except a lot more of it. He said he is going to split-open and patch-over as much of the left and right branches as possible.

The other part of Burke's surgery today will be to remove the Central shunt that joins the two Arteries. When he removes this shunt he will sew up the hole in the Aorta (the artery shown in red) where the shunt was. He will then connect a conduit to the Pulmonary Artery that extends down into the Right Ventricle (as shown in Orange in the next drawing below labeled "Burke's 2nd Surgery plan "A"") The conduit will be 7 to 8 millimeters in diameter where as the old shunt was only 4 millimeters in diameter. This should provide ample blood flow to the Pulmonary Arteries and blood flow is what makes tissues grow. We hope and pray that the Arteries will respond to this increase in blood flow. Today's surgery is anticipated to last between 4 to 6 hours. Burke's heart will not need to be stopped but he will be hooked up to the heart-lung machine so that the blood can be oxygenated - since no blood will be going to the lungs while they work on the Pulmonary Artery.

Friday, November 7, 2008

Burke's Anatomy (Part 2)

The drawing below shows what Burke's 1st surgery was all about. The surgeon linked the two major arteries together with a Central Shunt so that blood could get to the lungs by bypassing the non-functional Pulmonary Valve. The detail on the left of this drawing shows what the Patch is all about. The surgeon slit open Burke's Pulmonary Artery where it splits into the left and right branches. He then split open a Cadavers Artery and sewed the ends together to make a larger artery. The results of this 1st surgery brought Burke's oxygen saturation levels from the low 50's to the mid 70's.
Graphic #4

I am jumping ahead to Burke's 2nd Heart Catheter. A Heart Catheter is where a Cardiologist inserts a small tube into one of the major veins in the growing area. He then pushes that tube through that vein (the vein essentially acts as a conduit) and into the heart. Once the tube is in the heart the cardiologist can do a number of things. One in particular is to inject die into the blood that makes the blood visible with X-rays. This then helps the doctors see the different parts of the heart. This is what Burke's 1st heart catheter was really all about. We learned alot about what his anatomy looked like from this procedure but there really isn't anything cool to show as a result of it. The 2nd Heart Catheter on the other hand was a bit more involved. The surgeons not only inject die, they also tried a few other things in hopes of making progress towards a normal heart without an actual surgery. The drawing below illustrates how the Cardiologist was trying to pick away at the Pulmonary Valve in hopes of getting it to tear open but he was unsuccessful.

Graphic #5

With the help of the die, the Cardiologist saw that Burke's upper small hole had healed over. This was good news but the Doctors thought that the hole was probably working in Burke's favor because it was allowing un-oxygenated and oxygenated blood to mix - something that for Burke is a good thing. The drawing below illustrates the small hole being re-opened by pushing the catheter into the then almost completely sealed off small hole then ballooning the catheter up to stretch open the hole.

Graphic #6

This next graphic has a little background that makes it more meaningful than it otherwise would be. Before this heart catheter procedure began the cardiologist explaned that the main objective of this procedure was to baloon the left branch of the pulmonary artery. To do this, he was banking on the fact that he would be able to work his way through the Pulmonary vavle (as shown in graphic #5). If he was unable to get through that valve then the only other way to get to the left branch of the Pulmonary Artery was to go through the shunt. Going through the shunt however was not something he was willing to do because of the likelyhood of causing damage to that shunt and because of the overall risk to Burke's already fragile well being.
While this procedure was going on the nurses said they would give Rachel and I periodic updates. The first update was to tell us that they were not able to get through the Pulmonary Valve. Needless to say, this news made our hearts completely sink. I can still vividly remember the overwhelming feeling of that moment.

I'll finish the rest of this post later.

Thursday, November 6, 2008

Happy Birthday Emma!

I can't believe Emma is already 3!! It seems like her whole 2 year old life went by so quickly! I think having another baby when she was 2 made that time go by so much quicker. Anyways, we actually celebrated Emma's birthday today, yet she doesn't technically turn 3 until Saturday. But since I am leaving tomorrow morning with Burke to go down for testing on his heart, we needed to celebrate today! I love getting so excited with Emma for her birthday. Last year she still didn't have a clue what a birthday was, but this year I tried to get her excited about it a couple of weeks before today so that she would really know what to expect. We made a birthday chain, and she LOVED tearing one chain off each day!
When she woke up this morning we opened presents and admired Tyler's AMAZING SCHOOL BUS CAKE that Emma requested! Seriously, my man can decorate a cake! And I love it, because it is a HUGE stress that I don't have to worry about, (he does)! No, he worked so hard and created this awesome school bus cake that she loved!Isn't the coolest cake you've ever seen!?
She also thought it was pretty cool to have a lot of pictures of her around the house. I wanted to make today so special for her, because sometimes I think we seem to focus a lot on Burke. So I just wanted to make sure she knew how much we love and adore her and how much she means to us in our lives.

Then we got ready to go to her birthday party which was at Grandma J's house. We had such a fun time. The party was so fun and total chaos the whole time! But I think overall it turned out great, and I think those who came thought so too! There were a lot of people there who love Emma so much, and I thank all those who came, it meant a lot to Emma that you were there because she loves all of you! She loved her presents and her phone call and singing Happy Birthday from Grandma and Grandpa Bates too! She has been singing that all day to herself. And to top it off she gets to go to the Ranch! What more could this little girl ask for? Her day is complete because she gets to go to the Ranch for a couple of days and hang out with all her cousins and she gets to ride on Hawkeye! She wanted to so bad and when we said she was going to she was beside herself! This girl has died and gone to heaven! What a great day to end on before we go in for testing and surgery for Burke. We will see you all when we see you, and up- date you more on Friday when we know what the test results are.I love this one, Parker looks totally overwhelmed By the way Melissa, I LOVE the hat you gave her! I have always wanted one, so thank you!