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LMV

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Everything posted by LMV

  1. For purely financial reasons, it is much better for him if he is paying you alimony rather than child support. I'm a bit surprised to see him take this approach. I'm guessing there are other personality issues at play. I hope you get it worked out soon.
  2. EBV serology (with additional immunoblotting if necessary) should be able to identify acute infection. CBC will not be helpful unless you are concerned about viral mediated bone marrow suppression.
  3. Ah the Hosta thief guy returns, I remember him. See everyone has at least a few redeeming qualities.
  4. I have a fellow physician friend who uses the hospital address she works at as "home". I initially thought it was a joke--she definitely has weeks she feels like she lives here. Of course they also do live within walking distance of the hospital and it was her husband's idea of a security measure.
  5. Hi Rose, I'm glad you had that happier moment with your son. He may never know how much you have always had his back but that will never change what you know in your heart. Blessings to you and your husband. Be kind and gentle to yourselves.
  6. You may find that when he sees baby brother or sister in the stroller it reminds him that strollers are kind of nice. Our little girls are a little closer in age than yours will be (currently 1, 4, just turned 7, and 8) so I've always liked to have the option of a double stroller. We've done dueling double strollers at times as well. My recommendation would be the Double Britax B-Agile but that is probably outside of your price range unless you find a really good sale. It also is probably most useful if you're using it with the travel system and I seem to recall you are not a fan of Britax models so you may want to just ignore me.
  7. We kind of did everything but legally divorce (mainly because our main home and the state we should have filed for divorce in was a state which really didn't believe in joint legal custody and that was a bit of a non-negotiable for us for our children). In our case there wasn't any abuse it was just a really awful time after our daughter died and we didn't grieve well together. We also weren't really living together as I and our surviving daughter were living in one place where I could do some of my additional medical training and DH and the boys were staying in our main home where they were going to school and DH was a county proscecutor. In our case civility, compassion, and kindness were just reality (honestly we both really loved each other through all of this and I think perhaps because we loved each other so much that it was so hard for us to grieve together). All of my friendly acquaintance type friends just presumed we were in a phase of our lives where our careers were geographically incompatible. Which I suppose was true but I also could have probably found some very workable training opportunities much closer to our main home, and a few which wouldn't have required a family split. I did have a few very close friends who knew about our daughter and knew that as much as I loved DH and he was a really good guy (and an even more amazing dad) it was just hard living with him. Living without him was hard too and in many ways life was just hard. That was just our reality. Ultimately after our surviving daughter was seriously injured I realized that the right thing for her was moving back to where we had lived before. Technically we were still married so this shouldn't have been difficult but in many ways it was. I really felt like our daughter needed us both kind of 24-7 so I just moved back into our main home. Over the years of our separation I had been back there to bring our daughter to visit or for holidays but it was different. We did have separate spaces for awhile but in time we rekindled our relationship and brought six more children into our family, My husband was extremely patient and caring which helped a lot.
  8. Is the left leg flexed and somewhat rotated? Is she moving the left leg normally? To be fair your daughter's pediatrician did an exam and if he/she is really comfortable that this could not possibly be a septic joint then I hesitate to question any of that because I haven't examined her. I think in EM we do sometimes have a pretty low threshold to proceed to joint aspiration especially in kids because the consequences of missing this can be significant for the patient. If you have a really low but not completely absent suspicion then sometimes proceeding with blood work (Blood Cx, CBC, and CRP) and imaging (ultrasound is often more sensitive for septic arthritis than plain x-ray but can be tech dependent---our department does use ultrasound with a joint protocol and that can be helpful) and if everything looks great then, although you can't 100% exclude the septic joint without an aspiration, it might be reasonable to watch. Does this help? If she gets worse over night or if you have further concerns now going to the ED for this would not be unreasonable or an inappropriate use of health care resources.
  9. I'm so sorry your daughter is going through this. I presume she is being treated at a Children's hospital. The arguments for surgery are symptoms due to the mass, the risk of bleeding/rebleeding, and the potential for seizures. Bleeding risk and seizure risk are generally higher in kids so resections is more commonly the plan for symptomatic children (as opposed ot adults). A second opinion is always reasonable of course and your neurosurgeon generally will even set that up for you. Good Luck!
  10. Is she lying on her back comfortably and seeming to move both legs well? Or is she holding one leg in flexion and external rotation? Has she had any preceding URI symptoms? I completely agree with no chiro please! Fracture is in the differential although without a history of trauma and with the presentation shared it would not be at the top of my list. A septic joint or a toxic synovitis would be higher on my list (although a three or five year old little boy would fit the demographics of this better than a 10 month old little girl). With these concerns I would probably push more in the direction of ED/Pediatric ED over urgent care. Some of this depends on how the differential settles out. If there is concern for a septic joint then you need to aspirate the joint both to make or exclude the diagnosis and for therapeutic reasons. [Delay in joint aspiration can lead to joint destruction.] If you need a joint aspiration many pediatricians do not do this procedure and some EM physicians do not do all joints. I'm the only physician in our group who will aspirate hips in kids. So that may be where orthopedics comes in if that is needed. Good Luck! I'm praying you get answers and it all works out.
  11. Honestly, the way you have described this property doesn't appeal to me so I would probably keep looking. However, if we presume that I was interested in the property then I would determine what I felt was fair market value [DH and I have bought multiple homes both for our family [the joys of life as it is we have always had a second home and often have been splitting time between three] and for rental purposes so unless we're looking an unfamiliar area we're often quite able to pull our own comps and run some informal appraisals---if you don't have this experience then this is where your real estate agent should be helpful], then I would offer fair market value (or possibly slightly above depending on if we really wanted the property or perhaps we sensed that this was a situation where we could/should give a little on the deal in the interest of humanity), contingent on the inspection/title process being clear. Personally we've never done contingencies for our house selling because we've never needed that (we're usually purchasing an additional home or a rental property so selling is not part of the plan) and we've never done financing contingencies because we're usually not planning on financing. I think you need to figure out what the fair market value is and offer that plus something extra if you are asking them to accept any contingencies.
  12. Our children's pediatrician does not accept insurance so we pay for the entire visit upfront and then submit to my husband's insurance for reimbursement for an out of network provider. Generally depending on the visit we pay somewhere between ten and thirty five dollars once we deduct what the insurance reimburses us. If you're more interested in insurance specifics we have our family covered under two different plans: Plan A [Purchased by DH's law firm covers our family, his associates/family, and their staff (secretary/paralegals)/family.] *Primary Care Copay 25 *Sub-Specialist Copay 50 *Emergency Department Copay 100 *Individual Deductible 500 Family Deductible 1000 We have 10% Coinsurance after the deductible. This is technically for in network providers but we have yet to find anyone who takes commercial insurance and is not in network. Our children have had subspecialty care at four different children's hospitals in three different states which have all been in network. They also reimburse quite well for out of network as you see above. This is actually good insurance because when my husband started back at his firm and wanted to offer insurance to his employees and families he wanted to offer something they could use. You pay for what you get to an extent though and if ACA holds up he will likely be hit with the cadillac tax so I'm not sure how that will change what they do for 2018. Plan B [My hospital provides this to all employed physicians (and other employees) and their families. It is kind of a self insured plan with a catastrophic rider but all insurance costs are born by the hospital so perhaps I completely concede/accept a little bit of you get what you pay for] *In network Family Medicine 10 *In network Specialty (Including Ob, IM, Pediatrics and all subspecialty) 30 *In network ED Copay 100 (but waived for admission) *Individual In network Deductible 200 Family In network Deductible 500. No coinsurance. This is actually great for anything which can be covered by our hospital and to be fair we do have 24 hour cardiac cath/CV surgery. are a stroke center, a trauma center, have PICU/NICU etc. If we didn't have children that see some pediatric subspecialists I might be ok with just covering the whole family on this plan. But we do.
  13. Just to clarify, murmurs are heard on auscultation of the chest. They are not something which would be picked up on EKG. Now there are some valvular conditions and or congenital heart anomalies that may present with murmur on auscultation and certain EKG findings (ie seeing right ventricular hypertrophy and right axis deviation on the EKG of a child with a large VSD who presented with holosystolic murmur on exam, however you can also see those EKG findings with for other reasons in patients with completely intact ventricular septums). I can't completely fault one for saying that an EKG is subjective because in I suppose that anything we have to evaluate is subjective but I wouldn't say that EKGs are more subjective than other tests (like a chest x-ray or an echocardiogram). I do think some physicians are better at reading EKGs than others but that is probably true in all areas of diagnostic tests where human interpretation is required.
  14. I have a former colleague and friend who married her husband in the middle of a Sunday church service so obviously their wedding was open invite as far as their church family. They did send wedding invitations to out of town guests and people who did not attend their church. They had a pretty simple brunch type reception which was pretty much completely coordinated by the women of the church who considered it their gift to the couple. They ordered their wedding cake (and oodles of cupcakes for the children of the church) from a local bakery and I know they paid for that. I think they also made a generous donation both to the church and to the women's fellowship group after their wedding. Their wedding was very simple in some ways but beautiful in many other ways. I will admit it was the first wedding I had been to in the middle of a church service (where the bride sang in the choir and played handbells with a choir robe over her wedding dress) but all in all it came together and came off well.
  15. I must have missed your original thread, Aimee, but I'm glad they are doing the MRI. I hope everything goes well and the MRI is clean.
  16. If she is suicidal then, unless the parents are able to be within direct sight and arms reach of her continuously, they need to seek emergent professional help. I'm sorry, I know that isn't what people want to hear but it is really the only safe way to proceed.
  17. I've had bruises on my face twice in the past five years. In both cases I was assaulted by a patient and or family member of a patient in our ED. In both cases I did cover the bruises with makeup when I needed to work subsequent shifts as an EM physician because I just didn't want to explain what had happened.
  18. Does this "bruise" ever completely go away? Is it possible that it is a Mongolian Spot? They can change in appearance at times.
  19. EMTALA requires that all patients who present be evaluated for an emergency medical condition. If a condition exists then stablization and treatment must be provided. I'm curious as to how you knew that the family was only waiting for tylenol. Our triage nurses will usually ask if they can give tylenol in triage for documented fever and if it is indicated we order it. Now tylenol isn't always indicated for fever and is truly contraindicated in some patients and clinical scenarios so we do handle this on a case by case basis but I don't think we've ever had kids in our waiting room just waiting for tylenol.
  20. Facilities which do this need to be very careful in how they are doing this or they will run afoul of EMTALA. My guess based on what you shared is that they have a fast track area of their ED which resembles an urgent care to you but is actually just another area of their ED. We considered doing something like this but ultimately decided we didn't want to add midlevel providers into our mix and currently don't have the volume to support adding another physician. We will re-evaluate in six months. If they are truly diverting from the ED to urgent care (even if that urgent care is on their hospital campus) then they will need to be in compliance with EMTALA as they do this.
  21. I think it is great if you want to look into breast milk donation. There is evidence that preemies who receive breast milk do have a lower risk of Necrotizing Enterocolitis (NEC) and many NICUs purchase donor milk (which has been screened and pasteurized) through breast milk banks for infants who do not have access to their own mother's milk for various reasons. I personally have donated the freezer stash after weaning DD4 and am in the process of weaning DD1 and plan to donate what we have left over. I would strongly discourage anyone from purchasing or selling milk over the internet. There have been cases of babies who have died from infections from contaminated breast milk purchased from a private seller. Also if you're reading this thread and having problems with supply issues or latch issues or anything else which is interfering with your baby being adequately nourished at the breast or with your breast milk please remember that the most important thing is that the baby is nourished. Formula is not poison and can be lifesaving if the other option is inadequate nutrition. I say this as mom and as an EM physician who has resuscitated neonates with hypovolemic shock and kernicterus in the last six months.
  22. Our youngest is at the age where they go every few months so the next visit is scheduled at the end of the current visit scenario. We usually schedule at the end of visit for appointments for chronic conditions followed by the pediatrician with our older kids as well (and generally our pediatrician will embed the annual preventive care into one of the chronic visits so I don't have to schedule it separately). I believe their pediatrician's policy is that patients should allow at least two weeks to schedule a non urgent appointment like a well child (and it may take a little longer if you try to schedule at a popular time). Their office does freeze urgent slots and I've never not been able to get a same day appointment if it was really needed providing the office is open. I've also had scenarios where we have gone to the ED either because it was a call EMS now kind of emergency or not quite that urgent but a definitely needs to be seen by a physician before the office will be open next scenario and the kid has been stabilized in the ED and then the pediatrician has come in and done the admission. Our kids' pediatrician is in a physician only (no PAs or NPs) practice so all appointments are with a pediatrician.
  23. Our soon to be son in law tells us that at least at his school they have a record number of applications. Our daughter got into his school, and two others which do rolling admissions. Most of her other schools will hold their acceptances until April and then announce so we're not sure where she will end up. I think Creekland's son submitted mostly MSTP applications which can be competitive. Our daughter only submitted at her undergraduate university because staying there and continuing in her current lab is something she would do otherwise she is going to just go straight MD. I'm probably a bad mom because I think that straight MD may fit better with her other life goals but I'll support her whatever she actually decides. Creekland good luck to your son!
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