I didn't see this before, but we will definitely add your son to our prayer list. Many healing mercies.

I have milk or some kind of protein enhanced homemade juice or smoothie with breakfast depending on what else I am eating for breakfast. I drink mostly water throughout the rest of the day. I don't drink coffee or soda and if I drink herbal tea it is usually an after dinner or before bed type of beverage.

-DD21 months is still rear facing and probably will for another year or two. -We turned DD4 around when she outgrew her convertible seat right around her fourth birthday. At that point we bought a new high backed booster with 5-point harness seat for her. -DD4 and DFD6 now have high backed boosters with 5-point harnesses (aka Britax combination seats). They will both be harnessed in these at least until they reach forty pounds. Their seats are theoretically ok to harness up to 90 pounds. I'm pretty sure we won't be harnessing to that weight (DFD10 is in booster only at below that weight now) but I do think that we will have some better data on the benefits (and possible risks) of harnessing beyond forty pounds coming in the next year so I'm waiting on the data to guide what we do. [Yes, I'm also doing a little praying that DFD6 gets to 40 pounds sometime in the next year.]

I'm glad your son is home and on the path to healing. I guess I missed where you shared about the surgery originally so I'm probably missing a lot. From what I can glean from your posts (and your responses to others), I'm guessing that your son had a pilonidal cyst resected and he has a very deep wound as a result. I don't get the impression from what you are describing of the home wound care you are doing that there is wound vacuum in place so that may be something to discuss with the surgeons. Obviously I only have the most superficial surface information and there may be very valid reasons why a wound vacc wouldn't be a good option for your son but from what you are describing it actually sounds like it might so that may be something to bring up if you haven't already. The reality is that physicians are human just like all other professions and some are just not very good with interpersonal interactions and/or are poor communicators. I have to say that really was probably what distinguished DH's uncle early on in his career (before it became very obvious that he was also a very technically skilled surgeon) was that he is very personable and has very strong communication skills. Patients/ parents understood clearly why he needed to do what he needed to do and what they needed to do to give them/their child the best shot at a good outcome. Obviously some of that good outcome was due to his technical ability as a surgeon as well. As an ED physician, I too often see patients in the ED with post-surgical complications that are likely much more attributable to aftercare adherence than the actual procedure. I realize that some patients will not follow through with what is recommended no matter who explains how important it is but in some of the cases I have seen it really was much more a case of ignorance or misunderstanding than willful non adherence. If you have questions about wound care or anything that is going to impact what you do between now and the next appointment then I would call/email and get all of that clarified. Otherwise, I think your idea to go with your son to appointments in the future and take notes is reasonable. Sometimes even after our kids reach "technical legal adult status" they can still benefit from our guidance and input. If your son is ok with you speaking with all of his physicians you may want complete privacy paperwork to that effect if this hasn't been done already. I will agree that it is a bit of a deviation for the surgeon to not have seen the patient before surgery. With the caveat that I don't know the whole situation this is not something I would have felt comfortable doing back in my original medical specialty (where I did quite a bit of surgery) or anything I see any of the surgeons at our institution do. Since you've mentioned you're an attorney I'm sure you understand that informed consent is really much more of a process than just a signature and generally I believe that whoever is doing the procedure should be leading that discussion. Obviously, in more emergent situations, these discussions can be somewhat time restricted and there are certainly times where for this reason the discussion should be started by someone else. There are also times where things are emergent enough that consent is just implied because the patient isn't really in a position to decide and the treatment is truly lifesaving, like with the three patients I intubated back to back while working an ED shift yesterday afternoon (yeah it was kind of a bad shift with a really bad hour right in the middle of it). As far as the percocet dosing, there is more concern with acetaminophen dosing toxicity (there was a lot of discussion that the FDA would actually lower the daily max to 2g from 4g which hasn't happened but many physicians believe that is appropriate and will prescribe accordingly) so perhaps that was the concern even if it wasn't worded well. I don't know what strength of Percocet your son is taking but with 8 pills a day he is going to be over that 2g limit at a minimum. We aren't supposed to be writing for the 500mg and 650mg combination products anymore so he shouldn't be over 4g unless that happened. Your point about stronger pain medicines is certainly something to discuss further. If your son has a low pain threshold to begin with, and then a bit of an opioid tolerance from prior exposures with prior surgeries, then he may need something stronger. I'm not clear if the PA or surgeon have now written a new prescription but I hope that you have come to some workable solution.

My husband's godson (who became our foster son after his dad died) has ADHD which escalated with puberty. His dad died in the line of duty when he was a young adolescent and his biological mom was not in any position to parent then (or really any time before or after sadly). My husband definitely earned his parenting stripes but they both came out on the other side healthy, reasonably happy, and with a very strong healthy "father"-son relationship. Things which helped/a few thoughts: -Effectively treating the ADHD (initially with stimulants now as an adult he is doing very well with a non-stimulant medication). Kids with ADHD often really struggle with impulse control and just can't hop off their wave well in other cases. [untreated ADHD also increases the risk of substance abuse in self medication attempts. It appears that these kids seem more genetically predisposed to addiction as well if they venture down the substance abuse path.] -Ensure underlying depression/ and or depression is identified and addressed as ADHD increases the risk for depression in children/adolescents and is often co-morbid with anxiety. -Adequate outlets for physical activity and exertion. DH, DSS, and DFS built many houses with habitat for humanity during the boys adolescent years. It was a physical outlet for them, an opportunity for service (DFS's eagle project developed out of this as well) and something that they all looked forward to doing together which was really important at that time. -Parental understanding of what was a reasonable expectation at what time. DH did very well with setting up for success but also holding accountable when appropriate. -CBT can be very effective at helping manage escalating anger issues. With younger children (or amenable adolescents) it can be helpful if the parents learn the skills/and techniques alongside the child because then they can model and encourage skills use at home between sessions. This definitely helps in terms of consolidation. DBT can also be helpful as an adjunct and with older adolescents. Our experience/bias is with DBT building on CBT which seems more successful but others may have a different experience. -The therapeutic foster program we worked through taught parents motivational interviewing skills and my husband believes this was what made the biggest difference at least in helping him parent the child in front of him the way that child needed to be parented. Am I correct that your son came into your lives as a foster child? We've always tried to acknowledge the developmental context of both attachment issues and grief. It also seems that sometimes kids will shelve grief when they aren't in a position/sphere to acknowledge and experience it. Often this comes back and can get in the way of securing the earlier attachments you may have worked very hard to develop and nurture. I'm not saying that either of these are relevant for your son but it may be something else to consider. Good Luck!

I didn't vote because we don't really spend a set amount per child. We also do gifts, toys, and experiences throughout the year and spend money on activities and equipment/supplies for those activities throughout the year. We often---but not always---do a big family gift but it isn't always at Christmas. We did put in an indoor lap pool last year at Christmas time so it was at least technically considered our big Christmas gift. A few years ago we got a new canoe and paddle boat and made some other improvements at our lake house throughout the spring and summer. We didn't do a big family gift at Christmas that year.

I am sorry for your loss of your dad, Jean. I know burying a parent is not easy. It is even more unfortunate that it sounds like there is additional family strife on top of your loss. I pray that everyone will manage to come together and support each other.

Hmm I'm a soccer mom, a gymmom-but not a CGM I promise ;), a swim mom, and a horse show/equestrian eventing mom. I guess one advantage of multiple children is diversity of interests.

This can be a bad idea if it prevents full chest excursion with deep breaths. In that case it makes patients at greater risk of post-injury pneumonia.

If you have fractured ribs without underlying injuries (like a pneumothorax, hemothorax, pulmonary contusions, etc) then usually pain control and time is the way to go. You do need to ensure that you continue to cough and take deep breaths to prevent atelectasis and pneumonia. If your pain is getting worse, you develop shortness of breath, fever, chills, or cough with productive sputum or blood then you definitely need to seek urgent/emergent medical attention. **No the above is not intended as true medical advice. That should only come from a physician who has had the opportunity to examine you and establish some degree of physician patient relationship.**

:grouphug: Hugs!

Breyer's has become a real disappointment over the past ten years. Gone are the days of four ingredient ice cream. Now most of what they sell is frozen dairy dessert and that half gallon you are suggesting has been reduced in size by 25%. I do still buy select flavors from Ben & Jerry's and I will take the kids to their local scoop shop but we've started making a lot of our own ice cream for quality reasons as well. We have an ice cream freezer so I usually make it in gallon size batches.

I rarely (perhaps never but I'm trying to stay away from absolutes) have found bribery a helpful parenting strategy. Having said that, I would have no problem telling my teenage daughter that she needs sufficient fuel to support her activities and if we can't figure out how to make that happen then the only option will be to cut back on activity while we pursue a better solution. Our fourteen year old is a L10 gymnast who trains around eighteen hours a week and accepts that if she wants to be mature enough to train L10 then she needs to be mature enough to address the nutritional requirements of that training (albeit with some support and guidance from her parents and pediatrician).

Our six year old daughter's epilepsy presented with prolonged status during a febrile illness. I was actually finishing up a physician shift in our local ED when the seizure started and she was home with my poor DH and some of her siblings. He handled things well but I know it was traumatic. I truly felt for him at the time and I feel for you now. :grouphug: I'm so sorry you and your daughter had to go through this. I hope you're able to get back in with her neurologist soon and adjust medications if needed.

Many advocate that you not consider a foster placement (or an actual adoption) with a child who is older than your youngest child. I think in some situations, and with some families and children, this advice is particularly relevant. In other situations, families, etc I think you can take children who disrupt birth order and make it work. It helps if you and your spouse can honestly and effectively assess your own strengths, limitations, and even particular challenges then evaluate on a case by case basis what works. This approach also requires that you can trust the information you're being given about the child you're considering bringing into the family. We've been fortunate that the program we've worked with has really competent caseworkers and we've always been given any information that was known. I would say that this is the norm in our area but I've heard quite disparate stories from others in other states so this may be a concern for your family. We are a family that have disrupted birth order several times over the years. Our foster son who we took guardianship of (because adoption was not what felt right to him in his teens) is older than any of our children. DD14 came into our family as DFD10 when our now DD4 was not quite two months old. Our current DFD10 originally met us as a medical respite child when she was seven and then stayed with us after her foster parents abandoned her in our home after a respite placement when she eight. Our youngest biological daughter was not quite a month old at that time. In both of the latter scenarios several well meaning people cautioned us that we were making a mistake. At the time, we weren't sure we weren't making a mistake but we firmly believed that we were both girls' best chance (and maybe their only chance---medically fragile kids can be hard to place but can also thrive in the right placement) so we felt we had to try with our eyes wide open. We were prepared to alter the plan if it wasn't working and we certainly did some adapting and reframing (but we've certainly done this with our biological children as well) but we managed to survive and even thrive as a family. Please understand that I am not sharing our experiences in any effort to discredit the advice you have been offered. I still think in many situations the advice to not disrupt birth order can be very sound. I just also think that each situation needs to be evaluated on individual merits. I must also offer the disclaimer that I don't believe any of the children we have adopted/accepted guardianship of have had RAD. I do think if there is a question of that then it is more important that the potentially RAD child be the youngest. I hope I haven't overwhelmed you with all of this information. We have found our experiences with this whole process challenging and difficult at times but we've also found them rewarding and renewing at other times. I wish you and your husband blessings on your own journey whatever that may be and wherever it may take you. Please reach out with more questions if you have them.

In full disclosure, I am Parent Z. I do truly believe that Parent A feels badly about what happened but I just could not deal with her in the moment when I was trying to calm and comfort our daughter. I do think that Parent A does seem to be operating from a view that both kids share responsibility for the incident and while it is unfortunate that our daughter was injured it is partially her fault that she was injured. I am not saying that the other child was trying to hurt her (I certainly hope that he/she was not) but I do believe that the incident happened completely due to his/her actions. I am trying to channel compassion for Parent A and Child B without that compromising my need to protect and advocate for our child. As for our daughter, initially I was concerned that she had possibly broken her ankle because she did not seem to be able to put weight on it and it seemed like she had landed with it in an odd angle. The X-rays (of her ankle and her wrist on the other side) didn’t show any fractures but even in the ED she still seemed to be in a lot of pain and had true point tenderness so the plan was to repeat the X-ray on Monday if she wasn’t feeling better. She is long since asleep now but she was putting some weight on it today and said it was better so hopefully tomorrow will bring even more healing. She has some activities she was really looking forward to coming up mid/late next week so I hope she will be up to participating. If she isn’t then we will deal with that and I will definitely come with something else fun that she can do even with the injuries but I hope she will be able to participate.

The rest of the story: -Parent Z picked up and removed Child Y from the situation. -The manager called 911 (perhaps a bit of an overreaction) -Parent A attempted to talk to Parent Z who was somewhat dismissive and stated they needed to attend to their injured child. -Police and EMS arrived. -Because EMS responded Child Y was taken by ambulance to the hospital (also probably more than truly medically necessary but once EMS gets on scene with minor children that is often the path of least resistance) -Child Y was treated (for several oral/tongue lacerations and a sprained wrist and ankle) and released from the local ED -Police investigation is ongoing.

Are all four of your kids girls? If so, then, with three bedrooms, I guess you can do parents, daughters, and fosters. That would require that any sibling pairs you take are of the same gender though. You may also run into guidelines on the size of room required to share. I'm not sure if that applies to all children in the house or just foster children. We are not allowed to put children together unless they are full biological siblings and then we need caseworker approval. We have enough bedrooms to separate DFD10 and DFD6 but they prefer to share a room [their caseworker is great and trusts us to do what is right for them so she had no problem] so we moved them both into a bigger room and that is working. If we want to put kids together we're supposed to have at least 100 square feet per child and technically DFD10's original room was a few square feet short of the requisite space. I hope it works. I do think that having the opportunity to foster before proceeding to adoption is a good thing.

Actually CLIA was ammended recently to allow laboratories to release completed lab results directly to patients (or their designated representatives). You do have to formally request the results be relased to you but there is no obligation to obtain them from the ordering physician or for the lab to have the ordering physician's permission to release the results. To clarify, if your local clinic merely has a phlebotomy station for a commercial lab (ie LabCorp, LabOne etc.) then you will need to go through the commercial lab not their satelite station if you want to obtain the results.

As I understand: -Child B is 14. He/she does not have a physical mobility impairment but has a physiologic issues which make walking long distances medically ill advised. -Child Y is 6. He/she was moderately injured. -The employee who responded was the manager. Reportedly they had already told Child B to disembark from and park the scooter earlier in the trip. The employee would probably also dispute that they were yelling at Child B (although I think both parents would disagree with that).

There is also this (relatively) recent thread: College Incidental Expenses

We have adopted through foster care but only in the context of adopting children who came into our lives as therapeutic foster care or medical respite placement children. In our case, we adopted/ are in the process of adopting children who had become our children so I'm not sure how helpful our experiences will be. I do think that going straight to adoption with children who have been in foster care can be problematic in some (perhaps many) situations and it may be hard to tell if the child/family are really a good fit without the fostering experience. Admittedly, there are some parents who do foster, then adopt thinking that things are going well, and then run into problems with attachment later on as well. I would just be concerned that would be even more likely in a straight to adoption scenario from foster care. Please don't take my words as discouragement. If you and your family are able to be the family for a child in need I think that would be great, I just want you to understand the journey you are embarking on. If you have any questions I would be happy to try to answer them.

I will admit that I've worked a few more physician ED shifts in the four days preceding this (Sunday 12 hour day shift, 8 hour overnight shift on Monday and then another lovely 6A-6P shift on Wednesday) than I would like, so perhaps I wasn't my best on Thursday afternoon when this happened. With that disclaimer, I really am interested in other perspectives. Scenario: Parent A and Child B are shopping in a local supermarket. Parent A is pushing a standard cart and loading it with groceries. Child B is riding/driving one of the scooters with an attached front basket. Parent Z and Child Y are also shopping in the same supermarket. Parent Z is pushing a standard cart and filling it with groceries. Child Y is walking/standing alongside the cart sometimes adding groceries to the cart. Child B comes around a corner into an aisle (without Parent A) and comes very close to child Y. Parent Z navigates Child Y out of the scooter path. Child B cruises on past on his/her way. Child Y affirms to Parent Z they are not hurt but asks Parent Z why Child B gets to play with the scooter they aren’t meant to be toys. Parent Z tells Child Y that indeed the shopping scooters are not toys but it is possible that Child B has a valid need to use the scooter and that isn’t really their concern. Parent Z and Child Y continue shopping. Parent Z briefly has his/her back to child Y while obtaining nuts from a bulk bin. Parent Z turns around in time to see Child B knock over Child Y with the shopping scooter. Parent Z goes to Child Y to comfort and assess the situation. A store employee who states that he witnessed the encounter comes over to check on Child Y and starts yelling at Child B. Parent A reaches the scene while the store employee is yelling at Child B but did not witness the encounter. How would you handle this if you were Parent A? How would you handle this if you were Parent Z?

To be fair to the OP's daughter, she may not be willing to pledge more than two or three of the GLOs on the list her mom posted. Perhaps she won't be willing to pledge any of the GLOs but is keeping an open mind and going through the process aware that she can withdraw at any time. I don't want to say her mother's title is misleading, because if all goes well her daughter will indeed be pledging one of the listed GLOs, but she is obtaining letters prior to her participation in rush (not pledging). To give further context to the situation, if the OP's daughter is participating in NPC formal rush in the first round she will have to visit all GLOs, even if she has already decided that she isn't interested in six of them at all, or even if she is a 5th generation legacy of a certain GLO and believes that her mother will die if she doesn't join that GLO. As she goes through the later rounds of rush and then accepts or declines her bid she will get to exercise selection.

You also have a daughter who is a gymnast right? Gymnastics gets so much bad press that I definitely run into the sentiment that I'm an irresponsible mom from acquaintances. I just take a deep breath and smile because I know that gymnastics is her sport. It is not the sport I would have picked for her but overall it has been a positive experience for her. To be fair, I have met some delusional sports parents. We have a (sometimes friendly) acquaintance who has invested thousands and thousands of dollars in private coaching time for her daughters. She and her husband have sacrificed a lot for their kids' softball at the expense of college funds, paying the mortgage, focus on academics etc. They have also done a lot of fundraising (some not in compliance with NCAA rules) and a lot of begging for funding from anyone and everyone. Ultimately both kids ended up going the junior college route and haven't made the transition to a four year school for various reasons.