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How do you decide when to have the hospitalized/committed?


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For those who don't know about oru 16 yos, he has been experiencing mental/emotional problems for 4 yrs now. We have been all over the map in diagnoses and treatment (bipolar, Aspergers with aggression, OCD with anxiety, and on and on)

 

Anyway, he has had several meltdowns over the last 6 weeks. They are fairly short lived (under an hour) and he is remorseful and fairly calm and "normal" afterward (other than not understanding why everyone else hasn't simply gotten over it and moved on)

 

Yesterday, he stepped into a new realm of behavior that he hasn't done before. He is currently restricted from the computer and has to go with me when I leave the house (b/c I can't trust him to not hack on to the computers). He refused to go with me, so I tried to disconnect the modem and take it with me.

 

He became physically abusive toward me. It was like experiencing an episode on tv. As he was shoving me around he was saying things like......look at what you've done. Why are you making me do this? etc. He didn't harm me (as in bruising, etc). But he did have me cornered with me on the ground crying and asking him to stop.

 

My dh has spent the last 4 months working on a project that was presented yesterday. I could not interrupt him. I finally gave ds the modem and took the little ones and left. By the time we got back, he was apologetic and saying things like he was sorry and that it will never happen again, etc. He has been calm since.

 

Dh and I have been talking all morning about what to do. We are waiting for a return call from his psy, but I am so confused. Is this the type of behavior that justifies having him hospitalized hoping that the can get his meds stabilized there?

 

I personally spent the night looking at boarding schools. :ack2:

 

I am so tired of dealing with the episodes and his obsessions. I am worried about the impact on the younger kids as they keep witnessing his melt downs.

 

I would love to know how you decide to have them committed.

 

THanks!

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I helped a friend with a very difficult son for many years. While he was never formally adopted, my friend took him in with the blessings of his chronically drug-addicted, homeless mother. My friend then spent the next several years trying desperately to save his life.

 

There were many stages to this difficult journey. He started with all the advantages she could give him. He progressively shut down his options with his behavior.

 

I am really sorry. A very, very important line has been crossed by your son, and it does not appear that he has the resources to form better habits. It's not just a matter of stabilizing his meds--it is also a matter of teaching him to cope with his condition appropriately. That means forming behavioral habits that will prevent him from hurting those around him.

 

From the little bit of information you have given here, I think it is probably time to consider a therapeutic setting of some sort for him. A boarding school may really help.

 

Do it now while he still has remorse, and while you still have a good emotional connection with him. He needs that emotional connection to provide the motivation to learn a better way to live.

 

:grouphug:

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It's not just a matter of stabilizing his meds--it is also a matter of teaching him to cope with his condition appropriately. That means forming behavioral habits that will prevent him from hurting those around him.

 

From the little bit of information you have given here, I think it is probably time to consider a therapeutic setting of some sort for him. A boarding school may really help.

 

Do it now while he still has remorse, and while you still have a good emotional connection with him. He needs that emotional connection to provide the motivation to learn a better way to live.

 

:grouphug:

:iagree: And I'm *so* so sorry you are going through this. We hospitalized our dd when she was 12, for only five days, and that was hard enough. I pray you and your dh will have wisdom for what's best for you and your ds.

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We looked into therapeutic boarding schools last yr. There is no way we can afford one. They average $5800 per MONTH.

 

When we investigated the option, we were told we could turn over custody of him to the state and the state would fund his care.

 

It is absolutely insane. We have been on a waiting list for cognitive behavioral therapy for several months (since we moved to VA).......but his likely appointment is probably AUGUST!!! His old psy and np never even suggested that as a form of treatment. We have been told his care will be paid for if we give up custody!! We have been going in for bi-weekly or monthly appointments for over 2 yrs and 6 months of bi-weekly therapy off and on for the 2 yrs before that!!

 

I am so frustrated. What does it take to get real treatment for kids with mental/emotional problems.

 

The dr still hasn't returned our call, so dh is currently talking directly to the psy department with our insurance company.

 

:banghead: (except with tears rolling down my face!!)

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What meds is he on? Is he taking them regularly? Do you think they are the right meds/doses, etc?

 

If this happens again, you could always call 911 and tell them you have a MENTAL HEALTH emergency and send an officer and ambulance. They can then transport him to the nearest ER that has psychiatric care available.

 

You do need to make sure that you and the younger children are safe.

 

Have they evaluated him for seizures as well? Complex-partial seizures can cause a lot of behavioral issues and can go along with bipolar as well.

 

Also, are you sure your son is TAKING his medication as directed? At 16, many kids skip doses or try other ways to avoid taking meds.

 

Hope your doctor gets back to you soon. We have not reached that point yet but my 12dd has bipolar and is on meds.

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Right now he is on lamictal and cymbalta. Yes, he takes them correctly b/c I am the one administering them.

 

I am so frustrated. They thought he might have adrenal tumors a couple of months ago b/c he has high blood pressure. (They also made him go off of abilify) You should have seen the tests they ran. Ultrasounds, xrays, several days worth of urinalysis, tons of blood work.......all for it to be unclassified high blood pressure.

 

Take him in b/c he is punching holes in walls and kicking holes in doors, spending 20 hrs drawing the same picture over and over and over......told to come back next week for another session (of talking) and try this med for a month and see what happens.

 

It is absolutely insane.

 

I really wanted to call 911 yesterday but I just couldn't make myself do it. Why??? And why can't I get the dr to call me back when we are in the middle of a crisis?? (We were told when we decided to go with this dr that he took emergencies before scheduled appointments. But, today he is in the psych ward and unavailable!!)

 

I don't think his meds are stable. THe beginning of June he had 2 psychotic episodes on one med trial (lexapro)

 

I really think he needs to be seen in a treatment facility, but my concern is that he is very controlled around everyone else except us. Would they see this side? I am not sure.

 

DH has our new insurance company with this new company seeing if they will cover therapeutic boarding school in place of in hospital treatment. I think being somewhere 24/7 for a week+ will push him to his self-control limits and his outbursts will begin.

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I don't know much about Cymbalta but it does have an AD in it and that can trigger manic and agressive behavior in kids/teens with bipolar.

 

On the Lamictal, have you had a blood test done at all? Draw it 12 hours after his last dose and before the next one. My girls are both on Lamictal and one takes 50am/37.5pm and the other takes 325am/300pm and they are only 14 months apart in age and 4 pounds difference in size. They just metabolize it VERY differently. For one, the target dose (according to the charts) would make her toxic while for the other one, it would not do ANYTHING for her.

 

I LOVE Lamictal but it does need to be at the right dose.

 

Have you tried Risperdal or another anti-psychotic for the anger/aggression and manic stuff?

 

We do a combo of Risperdal/Tegretol/Lamictal for 12dd and Risperdal/Lamictal for 11dd. This combo has been highly effective here.

 

I hope you can get some help. We have found that if the meds aren't right all the talk therapy in the world won't help.

 

I do think that if he were somewhere 24/7 for more than a few days they would see what you see. The problem is getting them IN somewhere that is good and will effectively treat them.

 

The general rule for admission is if they are a danger to themselves or other (and sometimes property).

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The psychiatrist here specifically told us he did not need to monitor ds's blood work for the lamictal (we asked for it!!)

 

I do not believe he has been on risperdal. Honestly, I am getting a little leery of all the drug trials at home b/c some of the side effects have been serious.

 

Dh and I have decided to push for ds to be committed. I hope the dr calls in the morning.

 

Thanks for all your info. I really think it is the instability of the meds that is the biggest problem.

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It is not a blood test that psychiatrist order nearly as frequently as neurologists---Lamictal is approved as a seizure med first. I would still ask for it.

 

I can understand you being leery of drug trials at home, esp. if your pdoc is not available for you in emergencies.

 

If anything else happens, either call 911 or if you can SAFELY drive him, to go ER and tell them you have a mental health emergency.

 

Yes, the instability of meds is very hard, esp. during puberty. Now that we have the meds stable here, life is SO much better.

 

Are there other psychiatrists that your insurance will pay for? I worry about the pdoc not calling you back or having a crisis number or someone else on call.

 

In preperation for any possible admissions, I would try to write down all of the meds he has been on, the doses, what combinations of meds have been tried, the side effects, the positives, etc. The more information for the doctors the better.

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I sincerely hope that you are able to get the dr to commit your son, at least as a temporary measure. I'm so sorry this is so difficult, and I agree with the posters who state that your safety and the safety of your children come first.

 

As a former mental health social worker (and former juvenile probation officer) who also has a mentally ill relative, I do have a couple of thoughts for you. First, the very next time this happens (hopefully never, but assuming it will), you MUST call 911. Don't hesitate, don't feel guilty, don't wait. Your son has made terroristic threats (a legal designation) against you...his mental illness is obviously a contributing factor, but nonetheless there is a crime there. The police will be obligated (so long as you don't back down) to press charges. This is a good thing. If he has threatened your safety (or his own), in every state I know they will be obligated under the law to take him either to a psych ward for evaluation (best option!) or straight to a juvenile detention center.

 

If a juvenile facility is the end result, don't freak. This can also be a good thing. So long as you continue to press charges, your child will most likely end up on probation. The probation officer, once notified that he has a mental illness, will most likely need to include tx for your son in the probation requirements. If it is required by the p.o. and you can't pay, the state MUST pay for it. This can and does often include residential tx. They will need to pay w/o requiring that you relinquish custody. Depending upon your insurance and ability to pay, you might have to pay a portion.

 

Obviously, if you could afford the tx, it would be best to put him in a residential program w/o going through all this. If your doctor will cooperate with hospitalization, you can also avoid all this. However, if you run out of options, I highly recommend the legal route. Use the option while you have it. Once your son turns 18, you will be completely at his mercy in terms of consent for tx. Believe me, that is NOT where you want to be. You have so much more ability to help him at this stage than you will in the future, so don't hesitate to get tough now rather than later. If he is threatening you and it works, he WILL do it again.

 

:grouphug: :grouphug: I've BTDT with both a child (my DSS) and my BIL, and I know how much it hurts. I am so very sorry.

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You know, what you just presented was the other route we were told we could take other than giving up custody.

 

This is way out of my realm of reference. I have never had any contact with any sort of legal system. I am so scared for his future. It isn't for lack of trying. I blame the medical system for what is currently happening.

 

For now, our insurance company has agreed to the commitment as long as the psy signs off on it. We had a serious episode 2 weeks ago, an emergency call into him last week, and now this. I am sure the dr will agree (if only he will call us back)

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I would call them again if there are any more problems tonight. There is NO reason you can't get a pdoc or someone on call to call you back when there is a medical emergency.

 

Glad to hear your insurance will pay. It is SO hard to see your kids suffer when help is out there, it is just so hard to access for mental health issues.

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We have been in a similar position. My daughter, who is 15 now, has had bouts of anger for about 5 years. we have had to call 911. Most of the time the police come out and tell her that she must do what we say until she is 18. Once she had hit my husband and then refused to do what he said. After the police came they took her to Juve for not doing what we asked. She appeared before the judge. The judge requested a psychologist evaluation. Even after all this she still had problems with her anger.

It came to a point where we had to do something.

Last October, we looked into and then sent her to Teen Challenge. It is a 15 month program and is Faith Based. I would suggest looking into it.

Tammi

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You know, what you just presented was the other route we were told we could take other than giving up custody.

 

This is way out of my realm of reference. I have never had any contact with any sort of legal system. I am so scared for his future. It isn't for lack of trying. I blame the medical system for what is currently happening.

 

For now, our insurance company has agreed to the commitment as long as the psy signs off on it. We had a serious episode 2 weeks ago, an emergency call into him last week, and now this. I am sure the dr will agree (if only he will call us back)

 

Anything happen yet? Update when you can!

 

:grouphug: and prayers here...

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I'm so sorry you are dealing with this. The safety in your home - and for your other children- should not be compromised.

 

 

:iagree:. For us, it would be time for him to go. I am so sorry you are dealing with this and I can"t imagine how hard this descsion is. :grouphug:

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:iagree: And I'm *so* so sorry you are going through this. We hospitalized our dd when she was 12, for only five days, and that was hard enough.

 

My dh just called me. Our ds is finally admitted. He told me it was a very good thing that I hadn't gone or I would have grabbed our ds and walked out. He said some of the things they witnessed before they got to the pediatric area were gruesome and horrid.

 

It is incredibly hard. Our ds isn't uncontrollable all the time. During his calm moments, he is awesome young man. But during his uncontrolled moments, well, it isn't pleasant.

 

I know we have to stay focused on the whys behind why he is there, but listening to how deflated my dh sounded on the phone is making me 2nd guess all of our decisions. Ds was great today. When we actually told him he was going, he started crying. When we talked to him about the fact that this is what we had been talking to him about for the last 2 days, he said he didn't believe we would actually follow through with it.

 

I asked the dr specifically if he thought this would help with diagnosis and treatment and he said he couldn't say. He said they can't just do a blood test and get an answer it is a world of gray. That is where we have been treading for 4 yrs......a world of gray.

 

I want to just go to bed and wake up tomorrow finding it was all a bad dream.

 

I really hope that if nothing else, seeing what could happen to him will alarm him enough to take his treatment plan seriously instead of blaming everyone other than himself (his current pov).

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My dh just called me. Our ds is finally admitted. He told me it was a very good thing that I hadn't gone or I would have grabbed our ds and walked out. He said some of the things they witnessed before they got to the pediatric area were gruesome and horrid.

 

It is incredibly hard. Our ds isn't uncontrollable all the time. During his calm moments, he is awesome young man. But during his uncontrolled moments, well, it isn't pleasant.

 

I know we have to stay focused on the whys behind why he is there, but listening to how deflated my dh sounded on the phone is making me 2nd guess all of our decisions. Ds was great today. When we actually told him he was going, he started crying. When we talked to him about the fact that this is what we had been talking to him about for the last 2 days, he said he didn't believe we would actually follow through with it.

 

I asked the dr specifically if he thought this would help with diagnosis and treatment and he said he couldn't say. He said they can't just do a blood test and get an answer it is a world of gray. That is where we have been treading for 4 yrs......a world of gray.

 

I want to just go to bed and wake up tomorrow finding it was all a bad dream.

 

I really hope that if nothing else, seeing what could happen to him will alarm him enough to take his treatment plan seriously instead of blaming everyone other than himself (his current pov).

 

I am so very, very sorry about how hard this is. I pray you get some answers, and your son gets the help he needs and is able to embrace his diagnosis and treatment plan as his own.

 

:grouphug:

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My dh just called me. Our ds is finally admitted. He told me it was a very good thing that I hadn't gone or I would have grabbed our ds and walked out. He said some of the things they witnessed before they got to the pediatric area were gruesome and horrid.

 

It is incredibly hard. Our ds isn't uncontrollable all the time. During his calm moments, he is awesome young man. But during his uncontrolled moments, well, it isn't pleasant.

 

I know we have to stay focused on the whys behind why he is there, but listening to how deflated my dh sounded on the phone is making me 2nd guess all of our decisions. Ds was great today. When we actually told him he was going, he started crying. When we talked to him about the fact that this is what we had been talking to him about for the last 2 days, he said he didn't believe we would actually follow through with it.

 

I asked the dr specifically if he thought this would help with diagnosis and treatment and he said he couldn't say. He said they can't just do a blood test and get an answer it is a world of gray. That is where we have been treading for 4 yrs......a world of gray.

 

I want to just go to bed and wake up tomorrow finding it was all a bad dream.

 

I really hope that if nothing else, seeing what could happen to him will alarm him enough to take his treatment plan seriously instead of blaming everyone other than himself (his current pov).

 

 

Mo words, just :grouphug: . I will be praying for you all.

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I just want to add that commiting your son could be said differently you could say you were putting him into treatment, if he had a drug addiction he would be placed in a inpatient adolecent rehap facility. This is no different except the illness that you are treating. I think if he qualified that it would be better to be treated now then having something VERY bad happen and it NOT be your choice anymore such as court orders and such as of now you do have control. Your son sounds like he is not able to help himself and sadly then you have to step in and do it. With that being said I am IN NOWAY telling you what to do or trying to be an expert. I am just a mom with special needs of her own much like what you have described but with younger kids. This was just from my heart and reflecting on what I think about more often then I want to admit.

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I really hope that if nothing else, seeing what could happen to him will alarm him enough to take his treatment plan seriously instead of blaming everyone other than himself (his current pov).

 

What you've said in the quote above is so very true. Your DS will see some people who are much, much worse off than he is. He will be forced to look at what he can become if he does not face his illness head on. He will realize that you mean what you say, and that threatening you results in bad things happening to him. He will be faced with dealing with people who don't love him like a son and offer him a parent's grace, but rather who will expect him to cooperate, act civil and follow his tx plan in order to get what he wants. He will have a heady dose of real life and what it means to be mentally ill and not follow a tx plan. In other words, he is in absolutely the BEST place for him right now.

 

Having been in many a psych unit, half way house and the like myself (as a professional and as a family member), I know how hard it is to see your son enter a unit that is housing people who are much worse off than he is. I can also say with confidence that for both my DSS and my BIL, these were the best, most life-changing moments for them. Looking around and seeing what you DON'T want to become, or even just where your own choices have lead you, is eye-opening for the mentally ill and can help them have the clarity to see their illness and want to get better. My BIL managed to work himself into jail, onto a homeless shelter for the mentally ill and finally into the hospital at one point...there was nothing more horrifying for him, and nothing that made him want to change more. He is now doing everything he can to take care of himself, is appreciating and acting lovingly towards his parents (whom he lives with and formerly abused), and is getting his life back on track. Without seeing what he saw, I firmly believe he'd have never gotten better.

 

There is so much truth to what your doctor said about gray areas, but I know that it is SO very difficult for family members. Mental illness is all about trying to put a label on things that don't fit the mold. Everyone is different, diagnoses are just human constructs, meds work differently for some than for others...it's a tough business for everyone. Hang in there, and lean on God for help if you are a Christian. Your doctor may not easily know what's going on with DS, but God does...every single bit of it.

 

I'll be praying for you that He helps your doctors to see what your DS needs and find just the right tx plan for him. I'll be praying, too, that God comforts you, gives you peace and shows you that He loves your DS more than even His own life, and that He will help you all get through this.

 

Many :grouphug:s...

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I just want to add that commiting your son could be said differently you could say you were putting him into treatment, if he had a drug addiction he would be placed in a inpatient adolecent rehap facility. This is no different except the illness that you are treating. I think if he qualified that it would be better to be treated now then having something VERY bad happen and it NOT be your choice anymore such as court orders and such as of now you do have control. Your son sounds like he is not able to help himself and sadly then you have to step in and do it. With that being said I am IN NOWAY telling you what to do or trying to be an expert. I am just a mom with special needs of her own much like what you have described but with younger kids. This was just from my heart and reflecting on what I think about more often then I want to admit.

 

I definitely agree with this.

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I have no words that are adequate for all of you. Thank you for all your concern and your posts. I haven't written any more before now b/c I have been processing everything.

 

The first time I went to visit our ds, I was impressed by the unit and extremely thankful that he was in a pediatric area. I am pretty certain that an adult area would not resemble what I have seen in the ped unit (though, I am basing that off unrealistic tv versions of what I expected to see. ;) )

 

Ds is very calm and seems to learning a lot of techniques to help him shift gears (which is his biggest problem.....which is where I believe the Aspie part plays a role.) We have established a firm rule that if he starts to get confrontational to start asking a series of "Do you remember how to give yourself a time out and come back and discuss this later" scenerios. If he doesn't (which is the root of the problem), I am to immediately disengage and go to my room. If he follows me to my room, blocks my way, or continues in any fashion, I am immediately to call 911 and say (I had to ask the dr what to say b/c otherwise I know I won't do it......we've taught it to the other kids as well).......we have an uncontrollable teenager who is prone to violence and need immediate assistance. After they arrive and have the situation under control, we can tell them he is mentally ill and ask to have them take him to the psy unit.

 

Which leads me to where I am now.......at last night's visit he was upped to a level 2 which means he was allowed to leave the ward and walk on the hospital grounds with us. He started talking about how much worse off everyone else is in there and how he has totally managed to deal with his issues. I told him that right now being in the unit is sort of like being at school (he went to school last semester and had all 9 and 10s in conduct (10 being the best). I told him that the things that frustrate him and are the source of his obsessive behaviors don't exist in those environments and that when he gets home it is going to be hard work.

 

He got upset with me and started saying that I don't believe he can change, etc. I am concerned b/c the environment is so unrealistic. I pray he is right. I want to believe he is right. But I am scared that it is all a bubble. However, the other kids and I are firmly resolved to call 911 immediately. I think we have to make sure we do it at the first sign so that he can recognize that the controlled behavior he is having in the ward is the only option here. I feel like I have some control over the situation for the first time in almost 4 yrs. I really wish that we had done this yrs ago.

 

They have adjusted his meds. They increased his Lamictal.

 

We are going to take the kids with us tonight to have flurries with him at the McDs there. We go back for another family meeting Wed morning.

 

Thanks again for all your support. I am so glad I have a place to share this experience.

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It sounds like good progress is being made for all of you.

 

I remember having that same conversation with someone who was close to me. She was in drug rehab.

 

It's good that your son is working hard at the hospital. There are likely to be more ups and downs with this, but it is really good that all of you have some tools you can work with to come to a better way of living.

 

:grouphug:

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:)I am glad to hear yr working on things and being completely realistic as well. I have personally been in situations like these and it takes a lot of work and you may take steps backwards and end up calling 911 a time or 2. But it can get better and it will with work and for me lots of prayer:001_smile:

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He started talking about how much worse off everyone else is in there and how he has totally managed to deal with his issues.

 

I am so glad that things are working out! I'm so happy to hear that he is doing better. It sounds like he is in a great place and that you have terrific professionals on your side! I think that the script your doctor has given you is right on...really perfect. It will get you the results you need should this ever happen again.

 

I quoted his comment above because I want you to know how typical this to hear when people first enter a hospital. Basically, it is bargaining behavior that is used to get out earlier. Don't fall for it. He is probably getting better, but he ain't there yet! ;) You are right about it being an artificial environment and that it is easier for him to control himself there. It is also not a residential tx center and he won't be able to stay forever...they will likely stabilize and release with conditions. However, I hope that you will continue to stay as strong as you obviously are and not allow DS to push for an early release. He stays until you and the doctor decide he gets out, not when HE thinks he should get out.

 

You are doing great! :grouphug: and hang in there. It looks like a corner is being turned!!!

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Having dealt with this on a personal and professional basis, it is crucial to get several professional opinions regarding this specific incident. It sounds as if you have spent much time getting advice so far, and that can be frustrating, discouraging, and confusing at times.

Pray about open and closed doors, and that God would make clear which professional opinion to follow.

I know it is so painful, but try to remember good things from God during this trying time.

sarah

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:grouphug: And I will be praying. I'm so sorry for all this pain, but I think you did the right thing. The fact that he's still a bit angry and argumentative does show that he needs to keep working on these issues you see.

 

Praying he sees all this and takes advantage of his opportunity to learn how to better cope with his feelings. :grouphug: again. :)

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Momof7,

 

I just saw. I'm praying for you, dh, your ds, the doctors, and all your children. For wisdom and peace and comfort and healing, and that these ashes will be made beautiful very soon! I *wish* there was something more I could do.

 

Rhondabee

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