For me, HSAs have been just a great way to pay for some stuff pre-tax (braces, expensive co-pays/deductibles) . . . We were able to have an HSA for 3 years, about 2-5 years ago, and we fully funded it each year (around 6k/yr IIRC) and we've now nearly spent it all, and will zero it out shortly when some recent big medical bills come in. We didn't use it for long term savings, but we were able to get some good returns on the account while the funds sat in a stock index fund for a few years, so that was nice, and the pre-tax thing is big for us as we're in a pretty darn high marginal tax bracket. I hope we can get an HSA plan again someday . . . for now, our insurance options are very limited, and the currently offered HSA plans aren't sensible (at all) for us in our current market. (I hate insurance. . . Maybe we'll get universal single payer coverage someday . . . that'd be way better than another HSA . . . lol).

There are a number of things that can cause ear issues, including ear infections of various varieties. The vet would do an "ear scrape" and look at it under the microscope (cytology) to determine what it is. IME, most of them are not mites but are infections. Or, they can be both. :) If you let ear infections go too long, the ear can get really nasty and inflamed and even require surgical correction. I'd take him to the vet and get his ears checked. They can also sell you better flea products than you can get at Petco (and generally not significantly more expensive, but much better). Probably under $200 in and out for the ear issues.

Our drywall crews were amazing. Super fast and efficient. They put up clear plastic sheeting to separate the working-area from finished spaces. If you can do that yourself, do it. Buy big rolls of it, and tape it securely. Just wall off all your finished spaces. Do a second "wall" of protection if possible . . . Say, at the steps to your upstairs/etc, as some dust will definitely escape through a single "wall" of it. Plan to vacuum well and the wet mop all possible surfaces. It'll be OK. Everything will be dusty, but it won't be too bad if you can seal things off. If they are there multiple days, then go ahead and sneak in and clean up after them and re-seal any goofed up plastic "walls" each day . . . IME, contractors aren't the best about that . . . and every little bit helps.

Personally, I would talk to your vet immediately. Make an appointment, so you have sufficient time and attention to consider options. Heartworm disease compromises the dog for sure, and I can see a good argument for delaying surgery due to that. However, IMHO, aggression is a fatal disease in dogs, especially in large dogs in a home with a fragile family member. So, to me, I'd accept an elevated surgical risk if that would help with the aggression. Your vet needs to know about this new problem so s/he can help decide what risk is greater . . . There are ways to minimize surgical risks in a compromised pet. I mean, if she were hit by a car tomorrow and needed a surgical repair, clearly, you'd do it then . . . This sort of behavior could rapidly become life-threatening to either a human or your dog, so if spaying now can help reduce that risk, then it may well be worth an elevated surgical risk. If at all possible, I'd involve a certified animal behaviorist ASAP. Hopefully, your vet can refer you to one, or, you can find one yourself. Either a veterinarian behaviorist or a certified animal behaviorist. The ones I've worked with (through our hospital, on behavior cases) were simply incredible in rapidly figuring out the causes of problem behaviors and finding solutions. Not all problems can be fixed, but in your case, given you've had her 6 months already with no disasters, I'm guessing this is a fixable problem. http://www.animalbehaviorsociety.org/web/applied-behavior-caab-directory.php http://www.dacvb.org/about/member-directory/ If it were me, I'd get in with the best behaviorist I could find ASAP, as in days, not weeks. Because, if that behavior escalates to a bite or similar, then 1) your MIL might be maimed or dead or traumatized or 2) the dog would be euthanized. I love, love, love dogs. I adore dogs. Our business (dh is a vet, we own a hospital) is caring for family pets. That said . . . I have zero tolerance for aggression in dogs. I won't risk a human life/limb for a dog. Find an expert, figure out what's going on in your dog's head to fix it or realize you can't fix it . . . Don't wait. A big dog with aggression issues (no matter the cause) is an emergency, IMHO and IME.

Probiotics and pre-biotics are my go-to-solution for any GI issue

dp

Well, 18 months ago . . . I took dd to the airport to check in for a flight back to school on SW. She forgot her phone and ID at our house (90 min away). The counter agents were very nice (as always, IME, for SW), and indicated that they could check *her* in to the flight, but no-way-no-how could they check her bag (which she definitely needed) w/o her ID. I don't know for sure if she had any alternate ID on her person at that time, but probably not, as she'd left her entire wallet at home. I'm not certain that they were willing to check her in w/ zero ID or if it was somehow contingent on me being there (with plenty of ID, of course, lol). We had to rebook on another flight the next day . . . UGH. Now I make her SHOW me her ID before getting in the car, lol. (I had verbally asked her . . . and she'd confirmed . . . because she *thought* it was in her purse . . . This is my brilliant 20 year old . . . who still needs a bit of help adult-ing, lol) So, anyway, I am sure the folks you spoke to are much more knowledgeable than I am. I just had that one experience.

IME, it is possible that SW will let your kid on the plane, but they will NOT let him check luggage w/o ID. If you can FedEx him an ID, I'd do it. If not, there's very little chance he'll be able to check a bag. And w/o you there to vouch for his identity, it's also dicey as to whether they'd let him board at all.

Good for your mom and good for you!! I am in total agreement with your mom's priorities, and I'm so glad she has her family who supports her choices. I'm glad you mentioned the book. I bought it a couple years ago after hearing the author on NPR, but my own mom's death was stills too fresh for me to be able to read it comfortably. I've got it on my kindle. I'll have to pick it back up and finish reading it now.

What happens is . . . People get legal RX opioids for some reasonable thing (injury, surgery, etc.) They don't get good support about how to use them safely and how to get off of them/wean/etc. They take them for a while, become addicted, then can't get more legal RX. They might try to buy them off the street for a while. Then they find they are too expensive, and heroin is much cheaper. Then they become heroin addicts. This is *exactly* what happened here in WV over the least 5 years. Our state cracked down on pill mills, etc a few years ago. The heroin dealers moved in. We now have a huge heroin problem. A pill of oxy/whatever might cost $40 on the street, whereas a dose of heroin $10 . . . I saw this, up front and personal, with a construction worker on my house. He had back/etc injuries a few years back from a car wreck +/- the brutally hard physical work he did (as do most of the low wage men in WV in construction, mining, etc.) . . . got addicted . . . when I knew him, he was in and out of jail, on and off Suboxone both legal and illegally -- depending on whether he could access medical care . .. He lived 90 min away from the Suboxone clinic and had limited transportation. He worked 7 long days a week when he was out of jail/rehab/etc. Eventually, he died in a car wreck in the summer of 2015, surely drug-related. He was fighting to good fight. He wanted to be well. He wanted help. One time, he was waiting until his next (drug related) court date, hoping to get put in rehab by the court, because that was the only way he could get into a detox. I tried to help; there was nothing I could do, even after consulting with my MD-addiction medicine friend. There are just not enough beds, and getting the bed is not at all easy. He couldn't get the help he needed. He's dead now. His young daughter and her drug-addicted mom may or may not be alive by now. In our (relatively well off) county here in WV, we observed a sudden and dramatic spike in all sorts of crime when the pill-mills got cracked down on because out-of-state (mostly from NJ, according to the police blotter in local papers) drug dealers moved in to sell heroin. All of a sudden, murders, armed robberies, etc were in the news routinely. There are some areas of our town where I wouldn't ever allow someone I loved to live or work. This was not the case before. The "need" for heroin access to replace the once-easily-and-cheaply-bought RX opioids drew in these nasty out-of-state drug cartels/gangsters/etc. They brought violence . . . People are dying day after day. Zillions. The drug companies POURED opioids into our state over recent years. I read something like 300+ opioid doses for every man, woman, and child per year were legally sold in our state a few years back. . . Much of these were pouring through pharmacies in tiny towns that have residents in the hundreds . . . It is all a huge, nasty, evil conspiracy. People should go to jail. Those people should include the pharmaceutical companies who knew *exactly* what they were doing. A few weeks ago, in the midst of my as-yet-undiagnosed excruciatingly painful case of Lyme meningitis . . . A primary care doc prescribed me 120 count of 10mg hydrocodone. That's the highest dose available. 5 to 10 count of 5 or 7.5 mg is typically what you get post-surgery (and is what I had in my medicine cabinet left over from oral surgery). 120 count . . . If I had taken them as prescribed (every 6 hours, around the clock, for 30 days), I would DEFINITELY have been addicted. Instead, I kept fighting for a diagnosis and was finally put on the appropriate antibiotic for Lyme a week later. My excruciating week+ long debilitating pain was resolved in 12 hours . . . but I took 10 more days to taper off the hydrocodone. . . No one told me how to taper -- I just knew how to do it because I am well educated in pain management and addiction. No one talked to me or my husband (who was with me) about addiction or warned/advised/etc about how to be safe with the addictive drug. No one even OFFERED a re-check appointment or helped me (I was begging) get in with a specialist to diagnose my incredible pain. Nope, they just RX'ed opioids + OTC pain meds . . . all for an as-yet-undiagnosed VERY painful condition. I didn't have any more DR appts until nearly 90 days later!! (I was BEGGING and SCREAMING for help, sooner.) I *needed* pain relief. For sure. But, I should have been sent to a specialist immediately or an inpatient facility if that's what it took to access specialists to diagnose the CAUSE of the pain. At the same appointment I was RX/ed the opioid, I was DENIED a Lyme test . . . Note, I have good insurance and plenty of $$ to pay DRs, am available any time for going to the DR w/o risking being fired or not having childcare, and I have decade+ relationship with the primary care practice that I was seeing. It took me 5 medical visits including 2 ER and 1 overnight hospitalization . . . to DX the root of my pain -- Lyme that had gotten into my brain/central nervous system -- and get appropriate antibiotics -- which nearly immediately resolved my pain. Not many people in our community have the connections to doctors/financial resources/ability to advocate for themselves, etc, that I do. If I hadn't had all those resources, I'd very likely be dead or addicted today. Instead, I'm not in pain, not on pain meds, and vacationing with my family in the Bahamas. It makes me incredibly angry and sad thinking of the alternate path my life might have taken if I hadn't been as fortunate as I am. I *strongly* believe that docs tend to RX higher doses/numbers of pills to avoid patients needing care after hours/coming back in/etc. If your surgeon only RXes 3 doses of opioids, and you need a second day of them due to being the 1 in 5 who needs more . . . then you call/hassle/need help. Good luck with that, because surgeons and other specialists don't want to waste their time dealign with post-op pain . . . when they could be doing another $1000 procedure in that 30 minutes instead of dealing with your re-check appointment or phone call, etc. If health care was free/cheap and readily available, I guarantee this would be a huge help in reducing addictions. Universal single payer comprehensive health care is what we need.

I live in the heart of it . . . and, no, we don't need a state of emergency. We need funded rehab, funded mental health, funded regular medical care (to treat pain properly, with follow up/recheck appointments, etc), funded child care for kids whose parents are in rehab -- in or out patient. We need more doctors allowed to prescribe suboxone. If rehab and health care were available and affordable, it would do a lot to heal the problem. Waiting lists are weeks to months long. I have a friend who is an MD working in addiction medicine (suboxone treatment, etc). There are a lot of problems that can be addressed to decrease the damage done by addiction. We just need the money to deal with it.

Sure, that makes sense. I'd think that a designated cabinet or a certain shelf in the pantry and/or a bin in the fridge would be helpful. You can always provide that space, and if he doesn't use/need it, then you can let it fall by the wayside. In my house, that'd make the most sense for keeping younger siblings from eating the older one's special snacks/treats/whatever. I agree that this transition is *rough* for me. Really rough. I'm just now feeling like I'm "getting" it. I told my kid (the 18 year old, he's much more challenging than his easy-going-people-pleasing big sis, lol) that "we are now in this together" insofar as figuring out our relationship . . . I find it much better going now that I'm "owning" my newbie-ness at parenting adults and openly asking for help in figuring it out. We had an "issue" the other day with ds, and he set a "boundary" that caught me by surprise. I thought about it . .. reconsidered my position, changed my position, and kept moving forward. I'm forcing myself not to get backed into corners or get stubborn . . . I'm not trying to be the "consistent rules" parent I long thought I had to be . . . now I'm just trying to be a consistently loving force in their lives . . . and to be loving, I have to be willing to be wrong, to change, to negotiate, to give up control . . . I think my 18 yo is going to help me be a much better parent of adults, lol. He's pushing me . . . and it's for the good . . . I believe. Meanwhile, for gosh sakes, pass me a glass of wine, lol.

As tempting it is to agree with your approach and push him out of the nest . . . I honestly think you'd likely be better keeping doing what you're doing and helping him with the adult-ing tasks he's falling down on. Believe me, I know your pain. My eldest is hitting 21 in a few months, and I'm still helping her adult. She's a brilliant, successful, super wonderful person. She just isn't very good at adult-ing yet. She got her water turned off twice last year because she just didn't remember to pay the bill. . . She still hasn't turned in her grad degree application (long story, but she can do it simultaneously with last couple years of undergrad) . . . etc, etc. I get it. I keep nudging, and reminding, and helping. I tried confrontation/arguing/etc. Last summer, she was home, and I spent a couple thousand bucks making her go to an expensive therapist after having a 4 hour neurological-psych eval . . . and, literally, the therapist pretty much tried to get her to use a f8cking google calendar to track tasks/etc. That was the entire point of therapy. She's, by all appearances and strong evidence, one of the happiest and healthiest people you'll ever meet. She just sucks at adult-ing and is not stressed, whatsoever, by her "misses" on adult tasks. I believe, strongly, that her issues are due to her lack of anxiety, and my concerns/issues are that I have too much anxiety. I have no cures or fixes, but I can say that year by year, month by month, she is getting better at adult ing. I think we're getting there. I think she'll get there. I don't think me having fits or trying harder or pushing harder will speed it up. So, I'm choosing to just love her and keep helping her and not fight it. Can't win, so may as well surrender.

I agree to consider serious probiotics. It's harmless and generally very beneficial for all sorts of health concerns, INCLUDING mental health. We take an assortment of 5-6 probiotics and prebiotics. Also, I'd super-prioritize the outdoor (in sunshine) exercise. Sprained ankles heal quickly. Get her out there for 1 hour + daily if at all possible. 1 hr every day is going to be more helpful than 2-3 hours a couple times a week IME. Also consider Vitamin D testing and/or supplementation. So far as the actual SSRIs, know that they aren't miracle cures. They are most helpful in allowing someone to get "over the hump" so they can make healthy life-choices (exercise, sleep, therapy, etc) in order to use those other techniques to deal with their issues enough to facilitate a long term fix/cure. Every individual is unique. Some respond well to one SSRI and poorly to others. It often if not usually takes a couple/few tries before finding the right match. In my family member's situation, Prozac was a disaster. It rapidly led to lots of free-wheeling and severe negative feelings. ("I'm really angry and don't know why." feelings that were overwhelming, long lasting for several days, and inexplicable.) My family member went off it within a couple weeks due to those scary effects, which resolved very quickly as soon as they went off the meds. Then the family member tried Zoloft, which, for them, worked very well. However, they chose to discontinue after several weeks due to just not wanting to be "on a drug" long term. I didn't like that choice at the time, but I left it up to them, and, ultimately it worked out very well as they continued to improve and responded very well to their weekly therapy and other good life choices. Probably not coincidentally, around that same time, I also implemented serious probiotic therapy, which very effectively treated their long-standing (many months) severe GI issues. I later realized that the probiotic regimen might have well played a part in their improved mental health. All this to say, be on the look out for both improvement OR decline in mental health, and respond/adjust/change as needed. It's to be expected not to find the exact cure on the first try. Also be aware to the increased risk of suicide on SSRI, particularly for teens. IME, when I saw the dramatic negative feelings caused by the Prozac, I could totally see this happening . . . Be in communication and discuss risks/etc with your kid, and don't hesitate to intervene if you see a problem.

Outdoor exercise. Good sleep (ideal 10, but at least 8, hours of sleep daily, on a regular schedule). Vitamin D.

Homeschooling, like parenting, is a one-step-at-a-time process. IMHO, you are doing a fantastic job. You make the best decisions you can when you get to them, make changes when it's in the best interest of your family, and you keep on keeping on doing the best you can. Parenting becomes much more complicated and more confusing as our kids come close to adulthood, IME. When you're parenting little kids, it's relatively easy (IME, with neurotypical kids w/o major issues) to raise them to be admirable and adorable and perfect in every normal-kid-like way because you control nearly everything in their universe. THey've got to grow up, though, and as you get closer and closer to that transition, it's no longer appropriate or healthy for you to control everything, so they get more and more freedom and more and more influence from the outer world . . . "Perfect" parenting is no longer simple or even possible. Life's just more complicated and more (very important, life-impacting) choices have to be made -- and they have to be made by those growing young people. You aren't making choices based on your ego or your politics . . . you're making choices, and changing your mind, and reevaluating, etc, when those choices need to be made, based on the best interests for your family and your love for your kids. The parents I respect and emulate and admire the most are those who do just what you are doing. Give yourself credit, and keep on keeping on. Get ready for the roller-coaster that is parenting young adults. IME, it is truly like beginning all over again, re-learning and re-evaluating the role you play in your kids' lives and your family. It's unsettling to suddenly be a beginner at the parenting thing when your identity has long-been defined by your competence and expertise in the parenting role . . . My oldest will be 21 in just a few months, and my youngest will be 15 before then . . . so I'm right in the thick of the transition from parent-of-kids to parent-of-adults, and it's been a rough few years (for me, not so much for them), and I'm still a beginner. It's getting easier as I have worked to *embrace* the change, but that came after a serious and long period of grieving for the loss of my former role and my despair at no longer being as competent as I used to feel. Heck, I spent an hour getting advice from my older, childless, brother the other night on parenting my 18 year old . . . That would *never* have happened when my kids were littles, as back then, I had very few quandaries and even less need for or respect for input from a childless adult on parenting . . . I've opened up and let go of my need to be the expert, and that really helps emotionally as well as practically. There are resources out there for me to learn how to be good at parenting adults . . . I just have to "go back to school" myself . . .

Am I the only one who giggled at the title of this post? Books and Tea are forever giggle-worthy thanks to this board, lol.

1) Note that Zofram dosages can vary widely, safely. My (idiot) doctor prescribed 4mg for my catastrophically bad nausea (from doxycycline) . . . It didn't do diddly . . . When I noticed I had 8mg pills in my medicine cabinet from a migraine a year or two ago, I googled dosages. Now I just take 8 mg when needed. It looked like dosing ranged up to 32mg or something like that. 2) If marijauna is available where you are, go to a dispensary and ask for a variety that is good for nausea. It's about a million times better than Zofram. 3) Take meds WITH FOOD. I had to experiment mightily with the doxy to figure out things that made me less likely to get vomit-y . . . I found I needed to have *some* food with it, but couldn't overeat, either. So a small meal was perfect, but if I ate a normal sized dinner, I'd get super nauseous. I find that I need to eat a bit, then take the med, then I can eat some more. Just experiment with different meal sizes/etc.

I'd suggest you reconsider your priorities wrt day time activities. Consider being willing to take a full day, or a couple part days, and dedicating them to whatever social outlets are available . . . Drop a subject if you need to. Or cut back on a couple subjects. Social relationships are important, as you know . . .

Run, don't walk, away. Return any keys/uniforms/other property, and give a written note, saying, "I resign, effective immediately. Please send my final paycheck to me at address x/y/z." Stay far, far, far away.

Shop around for your RX. That's a rip-off. I know drug pricing (and we buy doxy wholesale for our vet hospital). You paid way over whole sale price, so either you paid a (very high) retail price and your insurance sucks, or both. Check goodrx.com for local pricing, or call around. Personally, I'd find a new pharmacy. You got robbed.

IMHO, you need to be on doxycycline, 200 mg 2x/day for 20 days at least. (Make that 6 weeks since you have been on steroids.) They will, at best, prescribe 100 mg 2x/day for 14 days. Get what they'll give you, and then do your research and decide what to do next. If you get more symptoms . . . please seek out a really good doc who treats a lot of Lyme. If they don't at least prescribe doxy, I'd go to another DR (and then another) until someone prescribes it. Urgent cares might be of use. Since you are in a Lyme endemic area, hopefully your docs will be more on top of things than most . . . Not sure if it's soon enough for a positive test, but I'd ask for one today, and then test again in 14 days if you don't get a positive result today. Here's one (of a zillion) fairly recent article on the current state of Lyme medicine. http://www.mvtimes.com/2016/07/13/visiting-physician-sheds-new-light-lyme-disease/ It's particularly helpful in that it highlights the numerous areas of controversy in Lyme medicine.

My favorites are my AllClad stainless and LeCreuset enameled cast iron. If you can afford them, that's what I'd get. That said, I have a simple stainless set I bought at Macy's for under $200 around 1992 that is still in (heavy) use after 25+ years. If you can find a heavy stainless steel set that is cheaper, it might do well. Look for heavy stainless steel with no plastic parts. (My set was Tools of the Trade, sold at Macy's in the 90s. Looks like they still sell it, still cheap, but now the lids are glass, which stinks because in my klutzy house, they'd break long before the pans wore out.)

One thing to keep in mind . . . a woman I know of in our local hs community . . . Sorta' went nuts a few years ago. Got very into odd spiritual/religious stuff, changed her name, etc . . . left her husband . . . found a new mate online and moved him in with her and the kids . . . and during that period (months) indicated that she'd willingly give the 2 kids her soon-to-be-ex. Ex went so far as to establish residence near his parents (for support) and buy a home there for the kids and him . . . But, before it was all over, she changed her tune and kept the kids. I don't know her personally (I did several years before all this happened), so I have no idea how all those changes happened. So far as I can guess, she was just (and is still) off her rocker. Money might have changed her tune, too, when she figured out she couldn't live the way she wanted to w/o child support . . .