Yikes! We got an amazing deal on our second home (like DH and I seriously prayed for the sellers because we figured they must have something really bad in their lives to be selling at about a quarter of market value) but it was still a little over $200,000. I can't imagine paying that for insurance! I presume that you have already checked out the insurance exchange for your state but if for some reason you haven't you could start there. Some on the forum have reported amazing rates and deals so it is worth looking at if you haven't. I checked last year just so we would have all the information to make an informed decision. In our case, continuing with covering the family through the plan DH carries for his employees was definitely cheaper than going through the exchange but DH has worked a bit with the carrier to carve out a good plan. We also cover the whole family on my insurance through the hospital I work for because it is essentially free coverage. It is also good coverage in some senses with a very low deductible and no coinsurance or copay. Unfortunately it is also a plan with a very limited network and essentially no out of network coverage so it is great for routine things but it doesn't cover some of the specialists our kids see. That is where we depend on DH's plan which also reimburses us the majority of the costs for the pediatrician who no longer takes any commercial plans.

As long as the appendix has not perforated then they should be able to do a laparoscopic appendectomy. The appendix moves up as the uterus expands so pregnant women usually do not present with RLQ pain and tenderness. On the other hand if she is actually in premature labor and the appendicitis has developed into a systemic infection then they may have no choice but to deliver the baby (especially if he/she appears to be in distress). I'm thinking positive thoughts for your sister and her child.

I work at least two days a week as an EM physician. Our kids are in a bit of a different situation because we are using a hybrid approach (so they spend between 5-9 hours a week on a school campus and cover some coursework there) and because their dad is perfectly capable of and willing to work with them on days when he is home with them. In your case, would it be possible for your daughter to do some work on the days she is with grandma. You could have her do math problems to reinforce concepts that you taught on the days you were home. She could also do independent reading, etc. Another option would be to still do school five days a week and use the weekends to achieve this. We don't formally do this but our kids do work on "homework" over weekends so some would argue that they do.

Do you receive EOB statements from your insurance company? If so, those should quite clearly explain what amount you owe the provider or hospital and you should be able to just send a check without having to call anyone.

-If their doctor hasn't ordered baseline pulmonary function testing along with the additional exercise protocol testing that would be the place to start. -Asthma can certainly present in adolescence or even adulthood. Of course not all asthma presents with wheezing and not all wheezing is asthma so it is important to be sure the diagnosis is correct and confirmed by some objective measures. -If asthma is the correct diagnosis then developing a plan for maintenance (if indicated), pretreatment before exercise or other triggers (if indicated) and an action plan for rescue during an acute exacerbation are critical. Eliminating and avoiding relevant triggers (everything from dust, pets, pollen, certain climates, aspirin, sulfur, etc depending on the individual) will be helpful in reducing exacerbations. -If your child does have an exercise induced exacerbation remember that the peak bronchospasm period is usually five to ten minutes after stopping exercise. This is why I always would cringe when I saw kids on opposing teams come off the field in my daughter's soccer game, take a few "hits" of their inhaler and go back to playing. This can be very dangerous and actually end in a status asthmaticus scenario.

Societal perceptions and presumed ideals can be weird sometimes. My husband's son was four when his first wife was killed. I'm sure he had been involved and loving dad before (I honestly didn't know him them but based on who he is and things my stepson says about the times when both his parents were alive this fits) but in a moment a he had no choice but to be the best single dad he could. When I met him later I would have said he was stepping up to the challenge well. Even so, when we married I know several people presumed and shared with me their belief that he was remarrying so he would have someone to raise his son. In reality, we married because we loved each and believed we could build a life together. His son was always part of that life together we were/are building and I can't imagine he would have ever really considered marrying a woman who didn't share that vision but he wasn't looking to abdicate his own parental responsibility in any sense.

I think this could be very helpful from a logistical standpoint. My stepson was active duty military for a period but this was before he met his wife and long before they adopted their son so I really don't have a good sense of the actual day to logistics of this. My stepson also was deployed into the middle east for the majority of his service period so that makes the situation very different than your husband's situation.

I agree with a lot of this. Our kids are blessed to have an amazing dad who is very capable of being a loving, competent, emotionally evolved primary caretaker. I leave our kids home with him and work ED physician shifts and truly feel comfortable that they are safe and loved and very fortunate. Or most days I do. Sometimes my mommy guilt kicks in but I try to stay logical and rationale and realize that my kids are blessed to have an amazing dad and to have two parents who love them and are both capable of being good primary caretakers.

At the time they were eleven going on twelve and fifteen going on sixteen and that may have made it easier. They did text a fair amount during that split and I think that helped. The reality that in some ways DD15 probably attached to having a sister before she really attached to DH and I as parents may have also contributed in some way. [i realize that to an outside observer this may seem very off but when DH and I thought about it it made sense. In her first family both parents were physically and emotionally abusive so perhaps they poisoned the well on the idea that parents could be loving, supportive and nurturing. She was an only child so she had no experience with siblings (other than a close friend who has a cool big brother) so she had more of an open mind for our daughter. Then she was exposed to the relationship DH and I have with our other kids and got brave enough to take a chance.] I will also say that DDalmost5 and DD15 are very close as well and reconnected quite easily once we were all back together. Our eldest daughter is a wonderful big sister so that probably helped because she modeled and fostered that sibling connection extending. However, that sibling connection has grown even stronger over time and DD19 left for college when she was seventeen (and thus, was only able to support their connection from a far for most of that time). For example DDalmost5 really started gymnastics because she could be in the pre-school class her big sister was helping. Swimming is her first love sport (as much as a kid can have a first love sport when they aren't quite five) but lately she has started to talk about wanting to do team for gymnastics. I don't think she is changing her mind about swimming because she seriously spent time last week writing a list of why we should let her go to junior swim team four days a week instead of only two days but I think she thinks it is cool to do something her big sister does.

Families are definitely unique, as are all of the children in the family. Our eldest daughter and DD15 were separated when we had to do our temporary split. They are incredibly close now. They do function independently and are very different individuals but they also love and respect each other and I think they will continue to be connected and sisters for life.

We did do a temporary family split which lasted a little more than three months several years. Our situation was a little different, as situations always are. I am going to share our situation and experiences in hope that it will help you be able to see all sides of the situation and make the decision that is right for your family. At the time DD[just turned]15 was DFD11 and we really believed that an out of state trauma program was at least her best, and maybe her only, option to address the PTSD from the years of abuse she suffered while living with her abusive biological parents. Initially she/we had done outpatient TF-CBT with an skilled therapist twice weekly. DH and I encouraged and modeled skills use at home in between session and I really think everyone did the best they could but it wasn't enough. We feared that the symptoms would become entrenched to the point that it could become a lifelong affliction and we knew as her parents we had to find something else or something more. We initially looked for something in state but really didn't find anything appropriate. Eventually a friend from the area where I did some of my medical training attended a great pediatric grand rounds on PTSD and emailed me about the amazing child psychiatrist that was running a program in the area. DH and I did some research and decided that it really was what she needed. We owned a house in the area so we decided that we would just send one parent with her and figure out a way to make it work. That parent ended up being DH. At the time we did this I was working full time as an emergency medicine physician and he had a corporate law firm. He was in a position to do his work elsewhere and I really wasn't, so that was how it all settled out. I won't say it was easy, because it wasn't. I missed my husband. I missed my daughter. Our eldest daughter was fifteen and our then youngest (now DDalmost5) was almost twenty months. Our eldest daughter understood why we were doing what we were doing and while she wished things were different she was mature enough to grasp that they weren't. She actually told us that we wouldn't be the parents she knew if we weren't doing this and that she knew that we and her older brothers had literally put our lives on hold for her in the past and she wanted to do anything we needed her to do. She is really an amazing young woman! Our youngest daughter really was too young to completely understand so although we tried to explain we really just focusing on making sure she was always secure and safe with someone who loved her and made the most of the moments together we could. In spite of the struggles we did make it work. Our daughter benefitted a lot from her participation in the program. Daily therapy allowed for consolidation and actual ability to use skills. I would have said she and DH had a connected good relationship before but I do think that they connected in a bit of a deeper way during that time. I took our other daughters to visit DH a few times during this split and he and our daughter came home for a few long weekends during this period as well. Our eldest daughter also played in a soccer tournament near where DH and daughter were during the split so they made it those games and then hosted a pool party at our house for her team to celebrate their tournament success. We did plan for a transition home and there was one but in many ways the reality that she was healthy and we were all back together worked a bit of magic I suppose. It probably also helped that we were reunited shortly before Thanksgiving so it tied in with a season of grace and mercy. Other things which I think helped us: -We did have a home in the area so there was some familiarity with the area and it made the original "move" and subsequent visits easier. -I still had friends in the area. I enlisted one of my best friends to be my husband's backup if he ever had a "yeah, I get it you just need your mom and she is hundreds of miles away". He never needed to push that panic button but I felt better to know that he had it to push. -Our main home is near most of my DH's family and my mom was able to come for an extended visit to help as well. This was great because I had a lot of support when I was essentially single parenting and working as a physician. I never had to leave our then youngest with someone who was not family and that was important to me. -We were able to do a lot of weekend visits which allowed the whole family to be together. -My younger daughter and I and DH and our eldest daughter had journals that we passed back and forth each time visits occurred. I also left a stack of pre-wrapped special gifts with DH for our daughter to help with some of the missing mom moments. -We had family speaker phone dinners where we ate dinner "together" even though we were eating in houses hundreds of miles apart. This allowed us to maintain a connection and a sense of at least new normalcy. I wish you well, no matter what option you choose.

The navicular bone is part of the foot articulation. If you are going from lateral to medial then it is scaphoid-lunate-triquetrium-psiform (proximal row) trapezium-trapezoid-capitate-hamate (distal row) which medical students learn as: Some Lovers Try Positions That They Can't Handle *You may or may not want to share this with your daughter.* You can also think tibia=toe because the tibia is medial to the fibula just like the big toe is always medial when standing in anatomic position.

We're blessed to have a greenhouse so we have fresh spinach and lettuce throughout the winter. My husband is very functional in the kitchen and even has certain dishes that he makes better than I do. On the days he is home with the kids he makes/supervises them making lunch. None of them are big sandwich fans so they do eat a lot of hearty salads for lunch.

Most drug stores have it. Quasi Related PSA: If you, or anyone else, have Ipecac at home then please dispose of it safely. There is not a clinical situation where Ipecac will help and many where it will harm.

I'm presuming you have the 160mg/5mL concentration. If so he received 400mg which is just under 15mg/kg. 15mg/kg is actually an appropriate weight based dosing to use as long as you do not give more than 5 doses per day.

What about adding it to salad? My husband did that for lunch with the kids this afternoon while I was working a lovely physician ED shift.

How large was the total dose he received? How much does he weigh?

I voted: -other recipe [my grandMIL] -I make a crust from scratch [although more often my husband makes the crust from scratch in reality] -I cook a pie pumpkin [this is non-negotiable!] Happy Thanksgiving!

We are in the process of adopting a sibling group of two (DFD6 and DFD10). We also briefly took a sibling group of four as an emergency placement. We knew when we took them that it was a short period while CP/FS finished getting a more long term option arranged. We did it so they could stay together rather than being split into different placements and because we trusted the organization to follow through and get the kinship placement arranged. We had those children for a few weeks and it was doable because we knew it was finite. I think the experience did show us that having nine dependent children at home long-term would likely be a less than ideal situation for our family. That doesn't mean it wouldn't be a perfectly workable situation for another family with a different composition. I think the key is figuring out what is a workable situation for your family and not being afraid to acknowledge that something is unlikely to be tenable over the long term. I will also share that although we have adopted through foster care we have never really done foster-adopt. The program we foster through actually requires waivers for kids without parental reunification as part of the case plan and we have always taken kids with a goal of meeting their needs in that moment and helping them heal and grow. Sometimes that growth has resulted in them growing into our family. Sometimes that growth has helped them to be successful in a placement that would not have succeeded earlier. Other times that growth, along with some good growth on their parents parts, has resulted in a successful family reunification. I think you know how much DH and I both love DD14, and how at this point we couldn't imagine our family without her, but when she first came to us our goal was getting her health to a point where she wouldn't require a medically fragile special disclosures placement. Excepting the chronic renal issues, which have improved as much as is possible, are being managed, and are likely to be manageable over her life with good care, I think she has gotten there. Of course in the process she also became our daughter and her adoption grew out of that reality. I think it is ok for you and your husband to agree to take these kids as a foster placement, do everything you can to meet their needs now, and let the rest play out as it does. I realize that although your kids are all older they all still have some challenges and will likely need you and DH in their lives much more than many other 18-24 year olds. I sense you don't really know how their needs and the needs of the new sibling trio will mesh and I understand why that might be hard to know unless you have actually try to live a few days of life and see how it plays out. From what you have written I suspect that your organization/agency/CP/FS will not abandon you if this placement doesn't work so I think you have an opportunity to try here. [if I'm wrong about this then I would advise investigating this further and treading more carefully if warranted.] Perhaps it will work logistically, financially, and emotionally. Perhaps a year or two from now you will be posting as a mom of six kids or perhaps a year from now the sibling trio will be in a different forever home and grateful for the family who allowed them a place to be together until they found their forever family. I wish you and your whole family all of the best with this journey. No matter how this ends, I agree with others who have said that it is great you are considering this so carefully and wanting to do what is right for all involved.

Before your son starts providing medical care to anyone in his immediate family, please make sure that he looks at how his state medical board would view his actions. Generally, I believe that physicians should only be treating family members in life threatening emergencies when they are the only available physician [either literally or because they happen to be the only one available with certain specific training in the emergency]. Your son doesn't need to share my view but he does need to make sure that his practices are in line with the licensing board(s) in the state(s) he practices in. I'm not trying to be difficult I'm just genuinely surprised sometimes at physicians who were apparently oblivious on this point and then end up with action taken against their license because they have been treating and or prescribing to family members. [Yes, I realize that some prescribing to family members is just an iceberg tip in terms of controlled substance diversion but I've seen licenses encumbered for what is "legitimate" prescribing as in there wouldn't be an issue if the prescription wasn't written for mom.]

I think we need to consider this in the context of suicide statistics for the general populace. Notably, suicide rates in the US have risen over the past decade and are currently at 12.5 people per 100,000. Sadly over 40,000 people complete suicide in the US so I'm not sure that 400 of them being physicians necessarily identifies medicine as a high suicide field. Having said that, I do think that medicine can be a hard (physically, emotionally, and cognitively) field and I think you really do need to be emotionally and physically healthy before you venture down that path. Successful physicians will continue to devote time to maintaining their own health in all spheres as they journey through their training and practice. Some more random thoughts [from a mom who is a physician, has one child who is a surgical intern, and has at least one more child who is pretty much determined that at least a MD is in her future]: -On the steering children thread at least one person stated they would steer away from medicine (and some other careers I don't recall at the moment) as it (they) was a (were) pretty thankless profession(s). In many ways I don't disagree that there are some very thankless aspects of medicine. Our health care system is really very broken and many competent compassionate physicians have to wade through a lot of bureaucracy and regulatory barriers (that in some cases actually promote and reward unsafe practices) just to do what is right (or even evidence based) for the patient. I have to admit that this has only gotten worse over the past few years and I'm afraid it will continue to get worse before we really fix things. In some systems top heavy administration with mid/high six figure salaried CEOs who have very little or no actual health care knowledge or experience and see increased regulation as job security exacerbate this problem further in some areas and systems. The hospital I currently work is very physician administrative driven so we don't find ourselves in situations where hospital policy is geared to maximize patient satisfaction with full realization that human lives will be sacrificed to satisfy that end. Personally I could never work in such a place but I do have a few former classmates who feel that they really don't have any other options because that is just the reality of medicine in the year 2014 in their area. I'm optimistic that perhaps they are overly pessimistic but I really don't know. -At least in the US there are at least very vocal minority groups (and perhaps even a majority exists we don't really have great data on this) that have very little respect for physicians as a professional group or as individuals. A recent glance at the WTM chat forum [http://forums.welltrainedmind.com/topic/534355-vent-doctors-and-common-sense/] certainly bears some of this out. -Many physicians are coming out medical school now with huge amounts of debt so they are under a lot of financial pressure. It can be hard to not feel overwhelmed when you are making around 50,000 and owe 250,000+ or more (which is continuing to accrue interest). The financial pressure probably does contribute to some physicians who feel they are stuck in pretty hostile work environments. -I think medicine has always been a career where liability and responsibility are very high and autonomy is often reasonably low. By definition this is going to be stressful and we've seen a lot of autonomy erosion over the past decade as well. I'm a bit fortunate to work in a hospital where physicians are respected and valued so I know that at the end of the day if I'm following the standard of care and practicing appropriately in an evidence based fashion my colleagues and administration will have my back. -I haven't discouraged our children from medicine because I do still believe that it can be a rewarding profession. I know it is a very needed profession; and I'm praying that by the time my daughter is at the place in her career that I am we will have stopped playing lip service to fixing our broken health care system and actually done the hard work and due diligence necessary. We're also in a position now to be able to pay for our daughter's medical school tuition (partly because we aren't paying for her undergraduate because she is an athlete) and I do think that removing the financial pressure piece of the equation will make it much easier for her to take a deep breath, practice appropriately, and be confident enough in herself and her skill set to realize that she wants no part of a job or health care system that doesn't at least allow that and ideally encourage it. That is very inherent in her personality overall so I think if she continues on her planned path she will be ok.

Happy Birthday to your daughter! I agree the cake looks great (and I say that as someone who isn't a huge snake fan).

When you have more than one child you have to figure out how to make sure that everyone's needs are getting met. Sometimes this requires some sacrificing of the wants of some but, in our experience, if you do this in an overall environment of love and justice then your kids will get the message even if life feels very unfair [and perhaps even is because, well, sometimes life is unfair] in the moment.

I read SWB's book when it first came out (our oldest daughter was four then) and then sent my child off to this amazing classical private school. I have no regrets about that. She got an amazing education that went wide and deep in a way that she was challenged, actively engaged, and thinking. Technically her dad and I "after schooled" but really we more enjoyed raising an inquisitive child. We actually fell into homeschooling [in a hybrid conjunction with the gifted charter track of our public school] when she was in junior high for medical reasons. When we ignored the why behind our approach we really enjoyed working with her and it definitely added another dimension to our relationship. We continued using a hybrid approach even after it was no longer medically necessary for that reason and we're using a hybrid approach with her younger sisters for similar reasons. I do think that WTM can be a great framework for the classical side of education. Both my husband and I have felt that it has been very important to build onto that framework and go much wider and deeper in upper mathematics and the sciences. Perhaps that is our bias as I'm a physician and engineering was one of his undergraduate majors but we want to make sure that we give our kids access to a rigorous and well rounded education so we aren't prematurely closing any doors.

This is so key! I do think sometimes this gets lost in the shuffle when parents have strong ideas about how things should be. So much of parenting is adapting to the challenges your family is facing in the moment and adapting to parent your kids the way they need in the situation you are in.