:grouphug: Hugs! I do get the whole anticonvulsant nightmare. We're currently in Keppra limbo because it is working but she is slowly losing weight and definitely not gaining and growing. The pediatrician and peds neurologist have had an extensive conversation and he is afraid to switch her to something else and now wants to do more of a metabolic workup because he really thinks the weight loss is just more evidence that there is something else going on. The metabolism guru wants to do a muscle biopsy but now anesthesia is not wanting to put her to sleep to do that and peds surgery will not do it under local [which is good because I don't think I would let him if he wanted to]. All involved physicians will be conference calling on Friday and coming to some new plan I hope. The idea to have your pediatrician talk to the neurologist is a good one. Will your pediatrician do that? As far as doing an informal second opinion it will need to be set up through your physician because in a sense they are really just curb siding their colleague for some help---it is possible this has already happened behind the scenes if her seizures have been challenging to manage. What MommyMonster is referring to with "file review" is more common in the hematology/oncology world because really what they are giving their opinion on is the pathology slides, and or imaging studies and this is done without the patent present in the usual course of action. Our daughter's biopsy slides were reviewed by two different pathologists beyond the pathologist at the hospital where she had the original biopsy done. The first one was a matter of course because the standard is that slides be reviewed and diagnoses affirmed by another pathologist before making certain diagnoses. The second was the pathologist at the children's hospital where we sought a second surgical opinion. You might be able to set up a similar scenario for an EEG being rescored by a different neurologist but when you start getting into prescribing anticonvulsants it is unlikely that anyone would do that without seeing the patient. As far as getting an official second opinion, ideally you can ask your original physician for a referral and they will set it up. Yes, because physicians are human some may get offended but most won't. When we were trying to decide about surgery for our daughter the surgeon she saw here was completely behind us going to a children's hospital in a nearby state for another opinion. It probably helped that the place we wanted to go happened to be where he did his peds fellowship so he knew people there. In the end we had the surgery done locally and everything went well but I needed to know that we had really looked at all the options. If you're in a position where the financial cost of travel is a big impediment to getting that second opinion there are some options to make it affordable at least from a flight standpoint with angel flights.

I would just explain to her that his given name is John not Jonathan. Ideally I would do this sometime when it is just the two of you and be matter of fact about it. One of my friends would empathize; her given name is Jennie. It is not short for Jennifer, or Jeannette, or anything like that, and she definitely spent some time correcting teachers when we were younger.

:grouphug: Hugs!

Although probably not cozy or quirky, doing her RN at the local community college and then bridging into a BSN program might be a great option for her.

Maybe a little off topic, or perhaps not, but I also think that some kids do better with coming across questions they don't know without it throwing them. They may take a quick educated guess and mark it for later if they have time to go back and see if they can reason it through but move on to answer what they do know without trauma. This is something that my stepson and eldest daughter have always been very good at doing. If time allows also both kind of get into the challenge, see it as a puzzle and want to work through it (and often will be able to) but have no problem prioritizing skipping it to get to the questions they do know and can do well with. For example when our eldest daughter was in 8th grade she was taking algebra which our state requires the student to pass a comprehensive exam to get credit. For various reasons she was basically teaching herself with back from DH or myself as needed but to get credit for the course she was following the high school course schedule, using their chosen textbook, doing (and turning in)the assigned problem sets and taking all of the class exams on campus. She was doing very well in the course (she may have even had a 100% average) when midterms rolled around. The course instructor didn't feel like making a midterm exam so he opted to give the students the state exam even though they hadn't finished the course. The deal was he would give everyone enough points for whoever had the highest score to earn 100 on the exam. Our daughter ended up scoring an 85 on the exam. Since she was working independently to an extent she had gotten ahead of the class so she had been exposed to some material other kids hadn't but she certainly hadn't been exposed to the entire course. What really allowed her to excel was that she just took a deep breath and moved along when she saw something she hadn't learned. She had time at the end of the exam so she went back to the stuff that was unfamiliar and figured out some of the questions just extrapolating from what she did know. She came out of that exam all excited about stuff she had "learned" while taking the test and went into her textbook to check and see that she was correct. Her older brother had a much better math teacher who didn't put him in that situation but I know he would have reacted similarly. At the same time, both our foster son (who struggled some academically but ultimately made it through his bachelors and is a very competent detective with our state police) and DD14 are much more phased when they come up against stuff that they are not completely certain of. DD14 is very bright and had an amazingly high IQ when tested as a pre-schooler but DH and I both took time with her in the car before dropping her off for her AP exams last spring to remind her that she wasn't expected to know all the questions and that it would be ok, just breathe, etc. She rocked her AP exams and I think for her some of this really is a remnant of the self esteem issues we're still helping her work on overall.

My licensing exams in medical school (NBME/USMLE 1-3) were similar in timeframe. Now they have added in a PE component to step 2 so that is different but it is in addition to the computer click single best answer timed exam for step 2 and both must be passed independently. Step 3 gets a little creative with combining the timed computer click single best answer followed by second phase where there are cases/simulations. I would say that the written component of my specialty (post residency) boards also resembled this. In our specialty passing the written exam gives us the opportunity to take our oral boards. We must pass both to be board certified.

I'm sorry her scores were not what she had hoped. As others have suggested she may want to consider schools that either allow students to waive SAT/ACT scores if any of these are good fits otherwise. She may also find that starting at one school, doing well there for two years, and then transferring is a good option. Or she may find that staying there beyond two years is a good option as well. A lot of literature now is suggesting that there is additional benefit to students who are really the bigger fishes in their college/university pond. My personal opinion is that there is a lot of variability around this theme and there are some students who probably should go to their reach if they get in there and other students who would have done much better in all aspects if they went to a school which appears a bit of a step down on paper.

I would still be a physician but in my dream world our health care system would be overhauled in several areas.

I agree with your realtor that with ensuite master baths two sinks are pretty much expected. We have two sinks in our master bath and I believe that the vanity is 84" so there is adequate room on both sides of each sink. We're in general anti counter clutter people so it is mostly empty space but I think that is probably what buyers want to see anyway. We also have two sinks in most of the other full bathrooms in our main home. Vanity spans in those bathrooms are all at least five feet. If you really only have 48" inches to work with, I would be afraid that the sinks would seem to be almost on top of each other and that would be a buyer turnoff. In that case, I would probably focus on doing a nice single sink with plenty of storage.

-Codeine is a pro-drug so it is converted to morphine. The how fast, and how much, of this is dependent on individual genetic make up and it can be hard to predict. In some cases "ultrametabolizers" have suffered death and respiratory arrest with theoretically safe doses. This is even more of a concern with children (although the OP's daughter is admittedly approaching adult physiology). -The sedation and respiratory depression are more of an issue if you are dealing with someone who already has some degree of impaired pulmonary function and or impaired alveolar gas exchange. I've intubated "overdose" patients who were really probably much more of misusing pain medicine on top of an underlying pneumonia than a true overdose (ie. if they had taken the same thing and not been sick they probably wouldn't have ended up unresponsive). -The potential for addiction, and misuse/abuse of the prescription concerns you mentioned are valid. -There are growing concerns (and literature to back them up) about cardiac toxicity with codeine. -Some of the FM folk in our area love Phenergan with Codeine which adds in the concern for dystonic reactions and additional respiratory depression on top of this. -Then there is the issue that coughing is actually part of the pulmonary toilet process. When we artificially suppress coughing we increase the likelihood of pneumonia, pulmonary effusions, and empyemas. I admit that the last reason is probably the main reason I am unlikely to prescribe cough syrups from the ED. I do use Albuterol if it is bronchospasm [i also stress to parents that getting up with the kid and doing treatments at night may just be their reality for the next few days---I say this from a position of experience because we have two children at home now with asthma and two of our older kids would push their asthma over the edge when they were sick so DH and I have done and will do a lot of this ourselves] and I will use Tessalon for irritant cough in appropriate patients. I also recommend using honey at bedtime (and don't laugh this is actually an evidence based suggestion) for kids who are over a year [below that there is a concern for botulism]. Really it all comes down to risk. I would definitely try honey and an albuterol treatment thirty minutes before bed before considering anything else.

Eclectic Thoughts: -If she is really still coughing up blood then I would take her to the ED. That is hemoptysis and can be a medical emergency! -Adding in some leftover antibiotics is usually a bad idea because in most cases they aren't targeted to the bacteria in question so are less likely to be helpful but still but the child at risk of associated C.difficile, allergies/anaphylaxis, and other associated side effects without much, or any, benefit. Additionally if you complete less than a full course then you are also potentially setting yourself up to select for resistant organisms. -From your description this cough sounds bronchospastic. You might want to ask about an Albuterol Inhaler. [i swear I'm not just typing this because I think cough syrup with codeine causes more harm than good in at least 90% of clinical scenarios. I never prescribe it but somehow it seems like I get to deal with all the disasters that result from others prescribing it when I'm working in the ED.] -If you have had Pertussis in your community then it would be reasonable for someone to send a DFA for that. This is one scenario where I do believe Azithromycin is truly the drug of choice and because you really need to start antibiotics in the first week or so to get clinical benefit this is also a scenario where I will prescribe antibiotics for what is likely bronchitis if the DFA is negative. -Someone else's suggestion that chalk dust has led to a hypersensitivity pneumonitis is certainly possible (although hopefully not the answer) and if symptoms persist then further evaluation, PFTs, +/- pulmonology referral would be a good plan. Good Luck! I hope she feels better soon!

Oh, yes, I'm aware that as it currently stands there is no rule against running JO kids in/out/through the Xcel precious medals. The sense our HC has gotten from region meetings, and congress is that USAG is working to make Xcel more of a recreation stream for children training fewer hours etc. For this reason he has made the executive decision that we now use L6 for girls who aren't ready for L7 or need a low key year to work on something specific training wise. One thing I will say for our HC is that he really does try to keep the playing field level and really prides himself on the sportsmanship that the girls show. I also recognize that some programs really eschew the compulsory levels. Ultimately, if that works for them then I think that is great. However, at least in our area, most of the gyms that do that never really compete consistently well at L9 and L10 when those girls reach there.

Isn't the flyaway the dismount for the compulsory L5 bars routine? It seems that it was the required dismount for the old L6. I suspect our daughters' gym would have probably either given them the option to compete L5 mid season and beyond after they mastered their skills, or repeat L4. I realize that they may feel like they are repeating for a second time at L4 but they really wouldn't have been. Although "our" gym never competed L4 until L5 was renamed L4 we do have some girls in our gym who are doing a second year of L4 this year and are really in the same situation your daughters group could have been in. Of course if the girls are excited to have their own routines then I can see the appeal and if their coach has had success with this approach in the past then he probably is cognizant not to sacrifice solid building block skills for score maximizing work arounds. Best wishes to both of your girls. Do be careful with bridging skills with your four year old. I always get a little nervous when I read about kids under five doing these. At DD4's gym these are not even introduced or allowed until the kids come out of the preschool gym into the developmental program sometime after their fifth birthday.

Obviously I'm missing an inside joke. I wash any of the kids washable winter coats. I send the ones that can't be washed to the dry cleaner. DD14 has a Landsend Parka which she wears for skiing/hiking. She has a long black wool coat and a shorter pea coat which is a creamy grey which she wears for more dressy occasions. She also has one of the 2 in 1 shell/fleece jackets which she wears for most other days between October and May.

Gymnastics is a journey. The road isn't always smooth or linear. Also I believe that if she competes L2 this year it will be the equivalent of what was called L3 two years ago. Between old L2 and old L6 everything just moved down a level. Our daughters' gym never used to compete before L5. Now they compete L4 because USAG has renamed their old L5 and calls it L4. Best of luck to Tori this year!

DD14 will be embarking on yet another season of L10. I've been told her piked Jaegar is solid awesome and now connected into her pak. We'll see if I'm burying my head in DH's shoulder when she competes it. DD4 is still playing in the pre school gym. Her gym is good about being developmentally appropriate so bars are the only apparatus where she has a lot skills that look like "real gymnastics" [as she puts it]. She has both of her hip circles, a pullover, and a strong cast. DD14 says that she is actually scarily close to having a kip so we might have another bars girl or we may be raising a fish--who knows? I will agree with others that the idea of scoring out of L5 when you aren't ready for L6 is a bit baffling. It was also my understanding that L6 requirements are actually a little easier than L5 which makes the idea more confusing. Our daughters' gym does a year of L4 and a year of L5 with all the kids. The kids who are doing well go right to L7 either to compete or score out to L8. L6 can be skipped without scoring out so our HC now uses it for girls who aren't ready to make the jump from L5 to L7 after a single year of L5. In the past [when L5 was called L6] he often funneled these girls through Prep-Opt [which has no become Xcel] to allow them to get their taste of optionals and not get frustrated as they worked to address the form and strength deficiencies which were keeping them from progressing to L7. It was my impression that USAG now really wants Xcel to be a separate stream [somewhat of a competitive rec scenario] from JO and prefers that kids who are planning to go back to JO not hang out in Xcel while perfecting their giants. Or at least this is what our HC believes so he is trying to "play fair" and have these girls compete L6 unless they request to make a lateral move into the Xcel stream.

The HUD/Section 8 requirements in terms of rental condition are very reasonable so that shouldn't be a deterrent. Their fair market scale is also reasonable if you have a mid-range rental property in a relatively uniform MSA. We have several different rental properties in the same state as our main home. Two are in the same county as our main home and their actual value exceeds what HUD considers fair market value because the real estate prices and accepted rental prices in our county are higher than the other counties in the MSA that HUD uses. For this reason, we are less likely to accept a tenant with a housing voucher because we will need to reduce the rent below true market value. The other rental properties we own are in counties that are in line with the MSA so we are more able to accept potential tenants with vouchers, have taken them in the past, and would take them in the future as long as the tenant was acceptable otherwise. We do screen all potential tenants with good due diligence and if anything doesn't check out we just move on to the next candidate. We have only had problems with one tenant and those only cropped up after more than a year of being a decent tenant. There were other issues involved there and, in many ways, it was an unfortunate situation for all involved. I generally believe that the key to minimizing problems is good due diligence before selecting a tenant for all potential tenants. In our experience, tenants with housing vouchers, who passed through our screening process without issue, were no more of a problem as tenants than those without vouchers.

Congratulations, Martha (and Martha's Husband)! Best wishes for a happy and healthy rest of the pregnancy!

I won't say that our eldest daughter didn't consider Ivy league schools or top schools because she did. She just didn't consider Ivy just for the sake of saying she went to an Ivy a big goal. Ultimately she looked at schools in terms of educational quality and opportunities for research in her area of interest (molecular biology, biochemistry, and cell biology). The school she selected outranks or equals the Ivy programs in these areas [and is a top 10 ranked school overall so not exactly something that will require explanation down the road] so I'm not sure beyond "Ivy bias" what the advantage would be for her to have attended an Ivy league school. I'm not opposed to Ivy grads because, well, I married one and I may be raising another. I just don't believe that an Ivy degree is the only path to success. I do think that the Ivy bias is stronger (and also likely more likely to actually be beneficial) in the Northeast so I do understand some of where you are coming from. Outside of the Northeast, I do think that graduate and professional schools, employers, and the general populace may be just as impressed with solid Stanford, U Chicago, Duke, or Hopkins grads as your preferred Ivy schools. Or perhaps I am just showing my own biases as a scholar athlete from a non Ivy top 10 school who had no problem obtaining entrance to medical school, residency, or fellowship sans vines. For the record I have not shared our daughter's choices and experiences to argue that others should use her approach or follow her path. I do firmly believe that she has made the choices that have been right for her so, as her mom, I'm thrilled to see her having the confidence, self worth, and integrity to make that happen. I would like to think that her dad and I did something right or at least didn't impede too much of her forward progress. To answer your other question, no, basketball is not her sport.

http://pediatrics.aappublications.org/content/130/4/774.full

I tried to vote but it requires me to login to Facebook. I do not use Facebook so that is a bit of an impediment.

I like this! It sounds very similar to what we helped facilitate for our oldest daughter. We're trying to provide similar [yet very different because she is a different child] opportunities for our fourteen year old now. She is taking some courses at a local four year school and I suspect that she could handle enrolling for a full load but I don't think she would get as much out of that now as she will in another three years.

Definitely count us in! We can actually ride from the farm in DH's family and connect with a larger trail network so we do a fair amount. We've been doing less trail riding lately because DFD10 is working really hard on dressage patterns as she wants to test in November.

Our daughter took mostly sophomore and a few typically junior level courses in math and science her first year of university because she was able to get credit for her AP coursework and some of her DE courses. She was well prepared to start at the level and she did well with her courses. She will now be in a position to take more advanced and graduate courses in molecular biology and biochemistry as an undergraduate and I think this will benefit her. She is currently not sure if she wishes to pursue MD or MD/PhD so I think having more opportunity to really get into the field as an undergraduate will help her make a much more educated decision. I would imagine that this would have a similar advantage for your son.

I'm confused as to why getting a job would not be an issue. Even if the child comes from a very wealthy family, in my experience, most of those family patriarchs and matriarchs have enough of a work ethic that they feel subsidizing their unemployed grandchildren through their twenties and thirties would be doing them a large disservice. I actually don't see how early college will pave the way into top US schools because usually these schools do not have transfer agreements and the community college often is not viewed as favorable. To answer your question, our daughter did get 800 on the mathematics section of the SAT I and came close on the critical reading and writing portions. She also achieved 800 scores on several of her SAT II subject tests.