*I have seen Vaxxed and I suppose to be very diplomatic I found it less than credible. *We've vaccinated all of our biological children by the recommended CDC/ACIP/AAP schedule. Our sixteen year old was completely unimmunized when we met her (when she had just turned 10) so we did work through the catchup schedule with her. At the time we met her, her physical health was horrible but I'm not in any way blaming that solely on her lack of immunizations. Our pediatrician recommended a quite aggressive catch up schedule with the plan to check titers for some vaccines because her immune system was not in great shape at the time we started immunizing. Yes, we knew that she might not build good immunity to vaccines at the time but we also didn't feel comfortable leaving her completely unprotected either so we followed the pediatrician's recommendation. In the end I guess the immune response concern was needless because she had adequate titers when we were all done. *None of our children have been diagnosed with autism. In the course of practicing medicine, I can think of several children/adolescents with very low functioning autism who were completely unimmunized at the time I saw them.

This recommendation is about two years old. It recommends that the baby be alone in their own crib on their back, but in the parents room. We've always done this--our master suite was designed with a nursery alcove that led from the master bedroom into the nursery proper and the crib has always fit well there. I have also breast fed all of our biological daughters so neither DH or I wanted to be wandering too far in the middle of the night to retrieve a hungry baby.

That is too bad about the trundle bed. I'm pretty sure your middle kids are a son and daughter not both the same gender where it might work for them to just share a bed. When DD12 and DD8 were DFDthen8 and DFDthen4 they both shared what had originally been intended to be DFDthen8's bed. We weren't intending them to share a room but it was really the only thing which worked. Because of foster care regulations we had to move them both into a third room that was larger (and get permission from the CPS caseworker) and when we did that we put two full size beds in the room but they usually both ended up in the same bed by morning and never looked cramped. The blind concern is mostly the cords but there have been a few cases where kids got caught in the actual blind material so ideally I would have them completely out of reach.

I'm sorry you went through this. I have a fellow physician friend who was in a somewhat similar situation. She was doing frequent BPP/NSTs and her neonatologist husband was seriously praying for pre-term labor once she got to 35 weeks. She was hoping to (and actually did) deliver vaginally so she wasn't looking for an early scheduled c-section but I believe her OB had to do some hoop jumping to induce before 39 weeks even though there were very valid medical reasons to do just that.

How big is the room they are sharing? From the picture it looks like maybe 10' x 6'--is that close? My professional bias is against bunk beds---would you have room to do a trundle and still be able to get to and from the crib at night if you put the crib in the corner? Said very gently and with only concern for your children, if those are the cord blinds that kids can strangle in please consider replacing them (or if finances are an issue order the free retrofitting supplies).

Our adult children are recently turned 32, almost 30, and just turned 21. Our sons both have wonderful wives and their own children our daughter is engaged to her fabulous fiancé but if we invite them to do something we would pay for them and their families. We do have a large family ( we still have a 16, 12, 8, 6, almost 4, and 1 year old at home) so logistically we sometimes do things that are planned in parallel and then the "kids" may make their own arrangements and pay. If that scenario was a financial hardship for any of the "kids" though then we would certainly pay/reimburse.

I'm glad you're getting the MRI. I also really hope it is normal but if it is that will not negate that it was necessary.

CMS hasn't really taken over the pediatric world so they would not be penalized for that 30 day readmit.

As far as I understand she never had any action taken against her license she just took a big break from practice to raise her kids, let it lapse, and then had no need to try to reactivate as she had no intention of returning to clinical practice. Technically she has the right to use her MD unless it is rescinded and I can see that it is relevant to the context of her looking at OB EBM now. So I guess I understand why she does it. Now personally I have never not been licensed in some state since my initial licensure but I've also never taken any real time off completely from clinical practice since finishing residency either.

Cough syrup is generally a bad idea with pneumonia. Effective coughing helps in clearing secretions. Now if you're coughing because of bronchospasm then a bronchodilator inhaler would be helpful. I'm not sure why the PA couldn't prescribe that (perhaps it is restricted for him, many states do have some restrictions on midlevel prescribing although that seems odd). If it was a midlevel issue he should have discussed the case with his supervising/collaborating physician and got them to write it if they felt it was indicated. We're either of your pneumonias imaged? Were both in the same lobe/lobes? In the event they were did you have radio graphic resolution of the first pneumonias confirmed? If yes, yes, and no then at a minimum repeat imaging of some form to ensure resolution would be reasonable. A high resolution CT may be appropriate depending on the full clinical picture. I would think your internist should be able to do all of this. They should also be able to order a full set of PFTs with or without ABG if they feel that is warranted. If any of this initial work up is concerning or you are not improving then they should be able to get you in with a pulmonologist more quickly by calling and speaking to them directly. Good luck!

Prevnar is 13 strainsYou may be thinking of the Pneumovax which is 23 strains. Ideally high risk individuals and those over 65 should get both, Prevnar first and then Pneumovax one year later.

Hugs! Find a pediatrician or internist who is comfortable identifying malnutrition, and managing nutritional restoration and malnutrition potential complications. Keep an open mind on underlying diagnoses. Don't dismiss the ED possibility but also make sure that other etiologic explanations are also considered and confirmed/excluded as appropriate. Also keep an open mind on associated versus comorbid mental health diagnoses. Depression, anxiety etc can be a set up for malnutrition but also a consequence of malnutrition. This is yet another reason why it is so critical to make nutritional restoration priority #1.

I'm not sure if you read the link Epicurean posted, or just glanced quickly because you consider the author a "birth troll", but she actually discusses how the ban was misinterpreted by many as any births before 39 weeks being a problem not just elective inductions or c-sections in this period. So,yes, perhaps some of the problem is the concept and perhaps some of the problem is that the concept led to poor policies by some hospitals (as Murphy illustrates below). Our own hospital's current policy requires two physician consent on any induction or c-section before 39 weeks. Ideally the two physicians are the delivering OB and the pediatrician or neonatologist. There is a way to get around that with two OBS but they both have to have evaluated the patient and can't be in a group practice together.

This is one of the problems with the ACA in states that did not opt to expand Medicaid. Ideally this would have been envisioned and addressed during the legislative period.

:thumbup1: This was going to be my response. You saved me typing it.

I'm so sorry your daughter has been struggling for so long. I hope you get some answers soon. A few more thoughts: *Sadly, she really does need a MRI of the Brain. Unfortunately it can be hard to visualize all of the posterior fossa in children with a CT and statistically their brain tumors are more likely to hide there. While headache, visual changes, and vomiting can certainly be other things they all fit with a tumor and this needs to be ruled out. I can understand that they may not be able to get the MRI from the ED (I'm an EM physician if I want an MRI I need to have an emergent this MRI will change my management over the next hour kind of reason) but they can admit her overnight and get the MRI sometime in the next 24 hours. (Perhaps even overnight because often inpatients are brought down for outpatient scheduled cancellations or no shows. *I won't say this couldn't be some atypical migraine (perhaps with some superimposed cyclic vomiting syndrome) with this presentation but I think other things need to be excluded before that is the decided diagnosis. *If this has been going on for almost three weeks I would be really surprised if she wasn't at least mildly dehydrated. Sometimes dehydration can make it impossible to break the vomiting cycle (even if the underlying diagnosis really is viral (and usually self limited) gastritis/gastroenteritis. *It sounds like she has had three ED visits (or were there more) and a few outpatient PCP visits, you can make a pretty strong case for a "failed outpatient treatment" admission. (If it matters with your insurance whether it is a full admit or observation these words will usually make the full admit case.) *I presume they did a comprehensive metabolic panel at some point or are doing one now? Because looking for electrolyte derangements (either due to the vomiting or in a few cases causing the vomiting) and liver enzymes would be key. You could also add an amylase and lipase if that hasn't been done (and, yes, that is a rare zoloft association when the ED doctor asks again if you're a physician). Good Luck! I hope she feels better soon.

I'm sorry! So far we've avoided that. We do still have DDalmost4, and DDjustturned1 to go so I don't want to jinx us yet.

All of our children were baptized during a regular church service. In our congregation the typical approach is not to do more than one baptism at a time (unless there are special circumstances like twins or other siblings being baptized at the same time). I also can't imagine that a private baptism would be denied a child/family with any of the reasons Faith listed. We did opt to wait until two weeks after the second set of immunizations for immunity reasons so all of our children were baptized around four months (we vaccinate early because Mama and multiple family members are MDs).

Some thoughts: -Plain film x-ray images really do not show ligamentous damage/injury. -Subacute soft tissue/muscle strain injuries certainly can present symptomatically a week or beyond after trauma. Often this is a scenario where there is an overuse component or poor body mechanics component (or both) superimposed on the subacute process. If anyone I cared about was in this scenario and they had a decent PCP I would send them there to make sure that there weren't any red flags for something more sinister (malignancy, neurologic compromise, etc) and then a referral to PT +/- a short course of NSAIDs might be a reasonable expectation. -Chiropractic manipulation (especially in the neck) is not without risk.

For the record, I'm all for spouses deciding together what works for their family. Neither my husband or I have pursued our careers in a vacuum. We've both made some adaptations (perhaps sacrifices) as our lives, our family, and our children's needs have changed and evolved over time. We still have six children at home so we will likely make some further adaptations in the years to come. So if when you're talking about veto power in the context of a relationship built on mutual respect and the view that both parents can make meaningful contributions in all aspects then maybe we aren't even coming from a different place. For the record, even if we are coming from different places I completely respect that if it works for your family, it works, and it isn't really my place to have an opinion, well, unless someone asks WWYD? Perhaps we are in an atypical situation where I could make very close to, if not, what my husband does currently if I were to work full time. I don't work full time because we don't want to use outside childcare at this juncture and if we were both working full time and also working around each other's schedules we would have next to no time together as a couple or full family.

The negative predictive value of a D dimer <500 is not 100%. If you have a strong clinical suspicion of or patient with high risk for PE/DVT then you will need imaging even in the face of a reassuring D dimer. [This is why I don't order them on high risk patients and just go directly to Chest CTA or ultrasound.] So if your husband is still symptomatic then he needs further evaluation. The timing of this (your trip to NYC was a month ago right?) sounds less like the typical presentation of an acute PE but you can have acute on chronic and subacute presentations so at this point it may still make sense to do a CTA (especially if the PFTs don't explain the dyspnea---or if the pattern looks consistent with a PE). Ischemic cardiac disease, heart failure, and arrhythmias (which often cause heart structural damage/induce heart failure over time) could also present with persistent and progressive dyspnea. Additionally, if whatever explanation is eventually determined for the dyspnea doesn't also explain his prior syncopal episode it would be reasonable for that to be worked up. I hope your husband gets some answers soon. He really shouldn't be driving until he gets to the bottom of this and is feeling better.

I'm not sure how to respond to this because I do work part time and my husband steps up to the plate and parents while I work. Our youngest is about to turn one. So dads can help raise babies and can do it well. I completely grasp that all marriages are different and what works for one couple/family can be very different than what works for another but the idea that husband's decide whether their wives can work or not feels off to me. [To be fair, I'm getting more of this sense from some responses than the OP.] We've always been a bit blessed with financial security so we've always had significant cushion in one checking account that is essentially our emergency fund. We also have always had the ability to build replacement appliances, upgrades, and remodeling project into each upcoming annual budget after we decide what we want/need to do in the upcoming year. In this context, I think I'm probably more inclined to want to work to maintain that. At the same time, because I currently work in a profession where I could pick up two extra shifts and pay off a 5K repair, I suppose I'm also more immune to the panic over a 5K repair.

Echoing everyone who is adamant that the only safe place for a child in a moving car is safely restrained in an appropriate car seat. I do see a lot of posters chiming in with how they managed to nurse their baby in the moving car without moving them from the car seat. I completely get that you all meant well at the time but if you consider the impact of the gravitational force from the crash then you can see that this really is not safe. Very sadly children have died in accidents this way when crushed by their mother's chest.[There are also risks to mom (increased risk of head and neck injuries) and if mom unbuckles her own seat belt to accomplish this there is also the potential of her body becoming a projectile putting others in the car at further risk.] I hope no one takes offense at this part of my post, I'm mentioning it because it seems that there are a lot of misconceptions that this is safe and the consequences of this error could be deadly.

We've not been in your exact situation. Our eldest daughter went off to college on the other side of the country at seventeen. One of our boys did live at home and commute during his first two years of college more because my DH really felt he needed to still have that connection to home and not be completely fending for himself on a college campus (because he was considered an independent student I think he might have actually made out better financially if he lived on campus). Because we felt this was really what he needed, even if not what was going to be most appealing to him at almost nineteen, we sweetened the deal a bit and let him move into our guest house. In some ways he actually had a pretty sweet deal with free rent, dinner any time he was home at dinner time, and DH and I took care of a lot of things for him it just wouldn't have been practical for us to have taken care of for DH's son or our eldest daughter because both of them were nowhere near home. With this we did have some expectations (or perhaps conditions) for this arrangement and we laid those out and he kept up his end of the bargain. I think it is perfectly reasonable for you to work out some arrangement that your daughter is not disturbing her younger siblings (and perhaps other arrangements that involve certain responsibilities or other conduct expectations). So perhaps you say that if she is sleeping at home she needs to be home for the evening at whatever their lights out time is. Or maybe the compromise is that if she is coming home late she will need to sleep on the couch so as not to disturb siblings. Or maybe that doesn't work and maybe you just need to stand firm that she needs to be home by a certain time (perhaps there are few reasonable exceptions and of course some grace is extended for emergencies and situations beyond her control). Or maybe it just isn't realistic for her to commute and not disrupt the family and maybe she does need to live on campus or in a nearby apartment. If that is the case and you are in a financial situation to pay for or subsidize that then I think that is a nice thing you can do but I also understand if you aren't or if you feel that she is kind of thwarting making commuting work and don't feel you need to pay for this choice for her. Hang in there.

We'll keep your son (and your family) in our thoughts and prayers. I'm glad you're starting to get some answers.