A family we know is going through this now. Ultimately the judge suspended required visitation for the eldest child with dad but also changed sole custody of the two younger children to dad. Because of the custody shift, child support was significantly reduced so mom is not happy (to put it mildly). Apparently the order also spells out that child support will end on the eldest's eighteenth birthday and while dad is free to provide financial support for college etc beyond this he has no legal obligation to do so. The mom has said she will be appealing the decision because she doesn't feel the support is sufficient. With the caveat that I do not really know what truly happened behind closed doors during their marriage and beyond and I am sure that some on this board will insist that dad is clearly NPD and gas lighting mom (that is not my impression from various interactions with both of them during their marriage and now), I tend to think that the support payment is reasonable just not excessive (and probably not enough to support mom and her new SO in addition to the teen) and some judges would have assigned support payments to mom since dad has custody of more children and children with likely higher support needs (ie childcare expenses etc).

I'm so sorry Caden is going through this! We will definitely keep him in our prayers. I am a little confused by this though. I presume this means he is already at least intubated on conventional ventilator (although reading your posts it sounds like this might not be the case). [if not, why not, that would be the question I would be asking the physicians if he was my child. Persistent saturations in the 80s can cause damage to the brain and other organs. There would need to be some good explanation for why I should be willing to take this risk with my child.] Does the PICU he is currently in have HFOV and ECMO capabilities? What is the timeframe and criteria for considering these interventions? If his current PICU doesn't have these options what facility is their transfer facility and has his case been discussed with the PICU attending or Ped's Pulmonologist/Cardiologists at that facility? I wish you and Caden all of the best. I pray he is in good hands.

It sounds like perhaps they are doing some variation on FBT without good medical support. FBT actually relies on parents selecting appropriate meals and ensuring that they are eaten during the first stage of treatment. This is currently the best evidenced and most successful approach so I wouldn't want people to think that a parent ensuring that nutritional restoration happens at home with the support and monitoring of their medical team would be making things worse. Of course, I want to underscore that parents should not be going into this without professional support and that medical monitoring is an important essential piece and I personally wouldn't advise any one to refeed at home without physician oversight. I also think it is very important that parents don't use physical force to ensure that food is eaten. Some children shouldn't/can't be refed at home for these reasons. Other children shouldn't be refed at home initially because they need closer medical monitoring during the initial period. Refeeding syndrome can and does happen and can be very dangerous. As far as stopping ballet until the malnutrition is corrected, that I could absolutely get behind. I see that as just basic safety (because exercise can and does damage malnourished bodies) not as punishment.

Harriet's book really shows the parent perspective and also gives a pretty good overview of FBT. Parents could also consider reading Help Your Teen Beat an Eating Disorder by Lock & Legrange.

Anorexia nervosa is a biological brain disorder. Unfortunately it may be very difficult (perhaps even impossible) for someone to recover while their brain is still malnourished and the anosognosic aspect of the eating disorder will make it even more difficult. For this reason, the first priority has to be on stopping the weight loss and starting the process of nutritional restoration. Sometimes that can happen at home (but if you are going that route you do need regular physician visits and daily lab monitoring initially to assess for refeeding syndrome and associated complications), sometimes it is safer to start in the hospital, and for some patients that will only happen in the hospital. It is also critical to have a competent physician evaluate for complications of malnutrition. These can cause problems but also can sometimes interfere with optimizing nutrition. A good physical exam along with vitals with orthostatics and temperature plus some basic nutritional screening labs is probably a reasonable bare minimum. They also need to identify some approach to monitoring for refeeding syndrome when you start the nutritional restoration process. Some clinicians will not do this outpatient and prefer to admit for this reason. Ideally this child's parents could discuss options with her doctor and come up with a plan. Continuing with any plan that leaves her malnourished or leads to more weight loss is not something I would advocate. Some more general thoughts: -There is a lot of variation on what is a healthy weight. The best guide is often to look at your child's own growth curve over time. Is where she is now where you would expect from looking at her historic curve? Puberty is a peak time for developing a energy mismatch because kids are growing and expending energy in that direction, so it is easy to fall into a cycle where intake isn't really adequate. I think we see a lot of eating disorders, female athlete triad, etc in this age group for this reason. -Malnutrition is a medical issue whether it caused by the social situation(including food scarcity, and abusive food withholding), a psychiatric illness, or an underlying medical/organic illness. Addressing the malnutrition promptly and effectively, screening for possible complications, and monitoring for refeeding syndrome need to be priorities regardless of the etiology. -I would never delay medical evaluation. -I would not proceed with a treatment plan that didn't incorporate nutritional restoration as the top priority. -If you're looking at evidence based treatment for eating disorders the unfortunate reality is that we're probably still a few decades away from having a good evidence base. Of the literature that exists the strongest evidence seems to be for FBT (at least in children 12-18 with anorexia nervosa) but unfortunately there just isn't the evidence base we have for some other conditions. -Depression, anxiety, and or, OCD can all co-exist with eating disorders. Exactly whether these are further complications of malnutrition or predisposing factors for ED seems to vary in different clinical situations. Further these comorbid conditions can interfere with achieving full nutrition so generally they should be addressed in the context of full nutrition. In some cases it may be reasonable to withhold formal diagnosis or consider medication withdrawal after recovery from the ED. -CBT and SSRI therapy are evidence based strategies OCD, anxiety, and depression. CBT protocols and medication dosing will vary. -Independent of comorbid conditions, there is not great evidence for pharmacologic therapy for anorexia nervosa although there is some softer evidence for benefit for atypical antipsychotics. High dose fluoxetine has been shown to be beneficial with bulimia.

Generally with molar pregnancy we will see something in the uterus (sometimes it is called a "snowstorm pattern" because of all of the projections from the mass). Molar pregnancies also generally have high HCG levels.

I'm sorry for your losses. Hugs. :grouphug: Yes, generally if the HCG >1,500 then if there is a viable IUP we should be able to see it with a transvaginal approach. In contrast, it can often be difficult to visualize an ectopic. Careful doppler scanning in the adnexae can be helpful for this, however, ectopics can be hard to visualize so we generally err on the side of caution and presume that these are ectopic and proceed accordingly. I presume they are recommending you take Methotrexate. In your case, I suppose given that you had passage of tissue you could have had an incomplete miscarriage. You can use Methotrexate with missed/incomplete miscarriages so that wouldn't necessarily be a bad option. Did your doctor do an internal exam? Is your cervix open?

What are you planning on him taking for math? Perhaps I am overthinking this because our kids have done DE at the local four year university and have done that because they had surpassed a rigorous high school level in the subject matter (i.e. they had already taken math through Calculus BC, were ready for upper level science courses for majors etc). I realize that community colleges probably offer many classes at the high school level but I think if he was my child I would feel he might be better served by taking his high school courses in a class with other capable high schoolers rather than older students who likely struggled with the material and are now trying to get through it. I think that the goals and content between the two courses would likely vary significantly and the former would likely be more beneficial to a student who is planning to go on to a four year university. I guess for these reasons I might be more inclined to go with the Catholic High School.

If I was a parent of one of the older children, I would tell them I expected them to be kind (and in the event of some emergency help to the best of their ability) but I would not expect them to play with or entertain the six year old. I would also have no problem calling one of the parents of the six year old if she showed up on our property without supervision and or an invitation. My expectation would be that the parent come and collect their child. Now if the six year old is technically on her family's property then I would encourage my children to just ignore her. They can get involved in their basketball game and focus on that. If she wants to watch their game from her driveway or lawn well that seems fine. If she was my child I would probably offer her something a bit more active to engage in but that may be my bias and I am thinking of a child in the extended family who would just sit and watch his older cousins play pick up soccer and he was apparently really taking it in and learning. It worked for him, he is playing in college now. I actually do have a daughter who recently turned six. I don't allow her to just wander the neighborhood. She does play with some of the neighbors' children but these are generally arranged ahead of time play dates. We do have some spontaneous play if we meet up with kids at the playground in the park within our neighborhood but then I, her dad, and or one of her older siblings are around supervising at least within line of sight and if it appeared she was bothering others we would step in and redirect. Our daughter does have a few older at least quasi-friends because they are involved in sports with her but I think that dynamic is a bit different (also these kids are older in the sense of being eight or nine not teenagers). Additionally, since she has several significantly older sisters (who are currently twenty, sixteen, and eleven) sometimes she will be included in an activity with them and their older friends but this is because she is their sister and they are choosing to intentionally adapt a bit to allow inclusion of younger siblings (and sometimes little cousins we have a pretty close knit extended family). I think it is great when I see my kids do this because I love to see the connection and bond they have, however, I do not expect them to do this all the time and have no problem reminding their little siblings that they can't join into all activities.

I think your concerns about the abrupt jump to three DE courses are valid. I know he has been taking computer/programming classes at the CC but it sounds like these are his favored courses and in 2016-2017 you will be wanting him to take his less favored courses as well. What courses are you planning on having him take? Is there a way to make the transition a little smoother (i.e. continue another favored/interest course and also add a more academic core course)?

Hugs! Definitely address the PTSD aggressively. It will be difficult, if not impossible, to address the attachment issues until you have effectively treated the PTSD. Additionally, parsing out what is due to PTSD and what is due to RAD can be difficult (and really not necessary) so you may find that once the PTSD is treated the RAD is much less severe (or in some cases not actually diagnosable).

Myelodysplastic Syndrome is what you're thinking of. Some variations can present with or progress to AML or CMML.

I have come to love our main home. It took awhile (and perhaps some of that was petty). Our main home is a house that DH bought when he was engaged to his first wife. It was the house they lived all of their married life in and the house that they brought their wonderful son home to. It was a huge house for a family of three but I'm sure that had DH's first wife not been killed when their son was four they would have brought his younger siblings home to that same house. When I married DH, it only seemed reasonable that we should not uproot his son from his house but it took awhile for the house to really feel like my home (or even our home). To his credit, I think DH kind of got this (which in some ways reinforced that he was a sensitive and caring guy and in other ways just made me feel like I needed to get over it already). That was probably the best explanation for our second home/lake home. This was a home that we designed together and for that reason it will always be a special place for us and our family. Over time as we did some more remodeling (and I tried to be sensitive in what we did so that I wasn't completely overhauling my stepson's home) our main home also came to feel more like our home. It was the home where we brought both of our oldest daughters home to and I really thought we had arrived. Then our younger daughter died and the struggle returned in much different fashion. That brought us to house number three, the house purchased when we did a geographic separation for some of my medical training (and because honestly we needed the space because we couldn't grieve together for a child we had both loved). Ultimately, we came back together geographically and emotionally. We've done some more remodeling, and our family has grown further. I gave birth to our fifth biological daughter (and tenth child) this past August and we brought her home to a house I do now truly love. Things I appreciate about our house: -Renewable energy -Our kitchen is huge, but also very functional. We're a very cook together kind of family so we spend a lot of time hanging out here. We also have a great pantry set up and an eating area that transitions into the solarium extension. -We have enough space for all of our children to have their own room. -Our dining room and formal living have managed to retain the historic charm of our home in spite of several remodels. -We have two laundry rooms so there is a lot less lugging laundry all over. -We've added in storage and niche build ins with each remodel. We have a place for everything so there really isn't an excuse for clutter. -We have an amazing and comfortable library. The book shelves kind of make the room along two different window book nooks, a fireplace, and two couches I fell in love with at an estate sale. Yes, a few friends have told us that libraries are really so last century but I don't care! I love our library! There are also a lot of tranquil escape nooks in our home (as worded by one of DD16's friends). -Our attic has skylights (so one can stargaze without risking frostbite even this winter). -Fireplaces did I mention fireplaces? Beyond our home I love: -The rose arbor around our outdoor pool -Our cute guesthouse which is great for out of state guests with a family and also was where DH and I have snuck away to for a night when my mom or MIL was staying with the kids but we were afraid to go too far. -Our backyard which has an English Garden feel with paths and benches -Our greenhouse (which does not cost us an arm thanks to a solar/geothermal system) -Our four bay detached garage which looks like the former carriage house it once was.

I completely agree that communication is key! I also think that as we go forward we will see less and less physicians with hybrid practices. The hospital I work at will not credential GPs for inpatient admitting privileges. The large Internal Medicine group does still use a rotating schedule [one of their doctors does hospital each week] and they will cover all of their patients in the hospital. Most of the smaller IM groups and most of the FM groups/individuals have now ceded admissions to the hospitalists. DH and I are established with the large IM group so we do have the benefit of being admitted by them in the event of need, but at this point I'm not sure if I would have switched away from one of the other groups just because they stopped admitting. Our kids' pediatrician does have a hybrid practice and this is more important to us. Our local hospital does not have pediatric hospitalists so kids who see FM or pediatricians who do not admit are generally admitted by whichever pediatrician is on call for unassigned admissions.

Is the probation actually through an ABMS board? That would seem unlikely, I've never heard of that for any of the ABMS boards I'm certified through. My guess would be that the probation was of the medical license. In that case you can check with the state medical board that applied the sanction. Some state boards provide disciplinary actions online. Some states provide only via completion of a formal request in writing. Additionally the detailed disclosure regarding the case do vary from state to state.

Congratulations!

For parents looking for help, I think the best idea is to look at the CPST locator [and, yes, I realize that there are some areas with a dearth of CPSTs]. Many are affiliated with Fire Departments, EMS organizations, Police Departments, and Hospital EDs but not all of these facilities will have CPSTs or have them available at all times. Several of our trauma nurses are also CPSTs in the ED I work in. They do community outreach but also will do installs if you arrange ahead of time. Our hospital is actually looking at sending several of the mother-baby nurses through the CPST course and staffing in such a way to allow them to do safety checks prior to newborn discharge.

Oh, wow, Cat! I knew this was somewhere on the horizon but I didn't realize it had just happened. Prayers for your husband's medical team and his recovery. I hope you're finally getting some well deserved rest.

I just have to say that I really don't understand this mindset. Of course maybe that is because I'm an EM Physician and I see what the downside of this approach at least once every day I work in the ED.

I do have an automatic car starter. However, if I didn't I would just let the kids use a blanket while the car warmed up (or stay in their coats while the car warmed up and then remove coats and buckle up right before we start driving).

I have had two different patients just this winter alone with significant injuries from being improperly restrained due to winter coats. I suppose on the positive side both children did survive but not without significant disabilities in either case. This same concept also applies to older children and adults with lap belts. Everyone should remove coats before they buckle up.

I'm sorry. Hugs :grouphug:

My parents (mom/dad then mom/stepdad after dad died and mom subsequently remarried) always gave/give Christmas and Birthday gifts to my husband's son. They started including my husband's godson/our foster son once he started living with us. These gifts were different from what our daughters have received but I think that is due to the fact that there were age, gender, and just different kid preferences at play. The gifts were always chosen and extended with love and there was never an idea of less than. DH and I certainly would have never tolerated that. My husband's parents (technically mom and stepdad but although DH has some very early memories of his own dad who died when he was very young none of our kids have ever known is stepfather as anything other than Grandpa) have always give gifts to all of our children. I suppose that all of the biological children are technically MIL's "blood" but I also suppose none of them are really related to FIL at all and he has never been anything but awesome to and with any of them. My husband's first set of inlaws (and DSS biological maternal grandparents) have always sent Christmas gifts to our other kids when sending them to their grandson. They would come visit their grandson a few times a year (and stay in our guest house while visiting) so they got to know his sisters and were able to send meaningful gifts. In more recent years as we have had more foster children (one of whom we have adopted and two more we will finally adopt in early 2016) they have always been included in gifts by both of our parents. The first Christmas that DFD11 was with us (when she was eight) my MIL had gotten to know her quite well because we she had been with us a lot for respite before coming full time as a foster child. She had no problem with meaningful gifts, my own mom did request that I give her some ideas. Now three years later my mom has no problem knowing all of our girls well enough to get amazing gifts. (Ok our three, almost four month old is still working on developing her personality but she likes sparkly paper so anything wrapped in that for her to rip off will be a hit.) DFD11 and DFD7's biological maternal grandfather gives them heritage gifts (something related to their mom's childhood or life) not necessarily at Christmas throughout the year. At Christmas he gives several gifts for all of our children (usually separated by age groupings). He has come to care about our kids and is very supportive of his granddaughters seeing them as siblings. He sees them as their siblings. DSS and his wife now have two children. Their son is actually his wife's nephew that they adopted after his parents' unexpected death.Their now eighteen month old daughter is their biological child. We do not consider their daughter more our grandchild than their son and although none of our daughters have children yet I could never consider these precious children any less precious than any child one of our daughters might have. DFS/DGS and his wife have a son who we cherish just as much as DSS's children above. Although we never formally adopted his father we have continued to be the parental figures in his life and while my husband was never "dad", DGS taught his son to call my husband "Papa". In many ways when DH watches DSS and DGS with their boys he is reminded of his own friendship with DFS's dad when they both had their own young sons. Families come together in unique ways. Sometimes new relationships come together out of tragedy as we all extend grace and compassion as we heal.

Ok I think I have responded to all messages--sorry for the delay I ended up needing to go back into the hospital to do a consult so I was gone most of the day not just two hours as I had planned. If you requested help I have got that mostly arranged. You should get a message from me tomorrow or Wednesday letting you know what to expect (in a general sense ie expect packages from Amazon, expect cards in mail, etc). On that note my wonderful husband says dinner is ready!

If you messaged me earlier with needs or offers of assistance please check your messages. If we have any other members who would like to contribute please message me. I think we are mostly set but we have a few families who need assistance with food or gas and additional amounts could certainly be sent to those families.