8/27/25

 I received a note from a NP that isn’t Ethan’s Regular heart NP letting us know that his rejection medication levels were low. She asked up to increase the dose of one of his medications by one mg, so his total would be 5 mg instead of 4.

This NP was taking over because our regular lady was on vacation. I assumed that there was some notes in Ethan’s chart regarding what we were trying to do with his medications. 

I read the note she sent over and immediately tensed up. The dose of 5 mg was responsible for causing the significant mouth sores that Ethan had in July.

When I looked at the blood results, they were on track for being within the combined medication goal of a level of 4-6. That is where his blood level reads for each medication and two of the problem and then they add them together. Typically the combined medication goal is 6-8. (Ethan is different of course).

I did let her know about the lower combined goal, and that Ethan can’t go higher than 4 mg on the one rejection medication due to the nasty mouth sores and that I thought his combine goal was lower than normal. I also let her know that he was in the lower goal range and I thought the next step would be a heart biopsy.

When she went over the notes again, she had misinterpreted what was written and that Ethan was comfortably in his lowered goal. 

The point…always question things. Advocate. We are all humans and we all make mistakes. Ethan isn’t the typical case. Had I not questioned it, we would be back to where we were in the beginning of July and Ethan would be on a fast track for mouth sores.

I was kind when I advocated for Ethan. I also could have been the one that misinterpreted things (but I knew I wasn’t). I brought up the discrepancy in a curious fashion instead of an accusatory fashion.  

I do believe I said outloud “oh HELL no!” When I read about the increased dose. That was not part of the original plan with our normal NP.

Today went well with work. I was hustling and bustling the entire day. After my day job, 

I then went on to job #2 at the vet office. I was saddened to see that an animal is sick from a disease that is 99.9% preventable with vaccines that the pet hadn’t received. That was frustrating.