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Old 02-11-2013, 10:42 PM   #1
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Is 36 to young for basal joint arthroplasty surgery

I'm 36, but have had ongoing issues with my hands for years due to wear and tear from my job. Just last year I had 2 hand surgeries. On my left hand I had 2 trigger fingers released and an MCP joint arthrotomy to remove scar tissue. And on my right hand, just a few months ago, I had a deqervains release surgery.

After the deqervains surgery I was still having quite a bit of pain and I noticed that my thumb pops and cracks when I moved it. After additional testing my doctor diagnosed it as osteoarthritis with mild subluxation in the basal joint. He has recommended a 3rd hand surgery, basal joint arthroplasty.

You would think after having 2 hand surgeries already I'd not be concerned or worried about having surgery again. But I am, mostly because I've read how much bigger and badder this surgery is, with a much longer recovery. I can't afford to take that much time off work, and I can't help but wonder if I should even have this surgery. I'm 36, is arthritis surgery like this the best thing to do at my age? Removing bones and moving tendons, yikes!

I'm just not sure what I should do, and after having a not so good outcome from my second hand surgery I am really hesitant to have another, especially one that is so much bigger.

Any thoughts and advice is much appreciated. Thank you.

 
Old 02-12-2013, 12:56 PM   #2
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Re: Is 36 to young for basal joint arthroplasty surgery

Sorry to hear you are facing the surgery decision at such a young age. I had my thumb surgery on Dec. 20th. At 5 days post-surgery I had less pain than before, at 7 days none. I went back to teaching after Christmas break. I have been in therapy for 3 1/2 weeks now and have back 100% ROM on the tip of my thumb, almost all on the second joint, full flexion and almost full wrist extension, and will be starting to mobilize the joint that was operated on this week. I will be taking the brace off for two hours on Thursday and increasing that time by two hours each day until I go all day without. I will start to use my thumb for very light activity. In another month I will start strengthening and then I'm done.

While the cast and brace have been inconvenient, it really hasn't been a serious problem. Since it was not my dominant hand I went back to driving at 2 weeks when I got the cast on. Elastic shoe laces took care of the only problem with getting dressed. I have basically done everything I normally do except scrub floors and fold laundry(because my other hand has taken a beating with the extra work).

Right now I am seriously considering having the other thumb done in summer. It is getting to be a problem, and as a teacher I really can't manage without my dominant hand during the school year, so its this summer or wait another year.

You would be extremely foolish if you didn't worry about each and every surgery. I certainly have for every one-and mine have all been successful. In your case, I would expect that having the surgery would mean the end of your current job since you would lose some strength and don't want more hand surgeries in the future. That is a scary proposition I am sure.

No surgery is a piece of cake, but don't be afraid that this is really horrible. It is time consuming to wait as long as the protocol says for each step of recovery, but the delay is to make sure that everything is rock solid, not that it is 12 weeks of misery.

Good luck in your decision making.

Margarita

 
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Old 02-12-2013, 11:21 PM   #3
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Re: Is 36 to young for basal joint arthroplasty surgery

Thank you for your reply. Hearing from others who have had this surgery really does help, and I appreciate you taking the time to share.

I know arthritis can happen at any age, but when I first read about this surgery I read an article from an orthopedic doctor who said he excluded patients under 40 from having this surgery. Which caused me to wonder why my doctor thinks this is a good idea for me.

And what complicates my situation even more is that all of this is attached to a workers compensation claim. Which basically prevents me from getting a second opinion because once you have a treating surgeon (and this one most definitely is since he's already done 2 surgeries on me) you have to stay with that doctor. They will not pay for me to see another doctor. And after having a not so good outcome from my last surgery, I am very hesitant to do another, especially one that may or may not be right for me. I also have a limited amount of time to decide too. If too much time goes by and no progress is made, then they will close my workers comp claim. If it weren't for this factor I would probably wait, because while my pain is uncomfortable I could live with it for a while longer. I would prefer to wait until I was older, until things were worse, but if I did that my claim will be closed and my means to pay for this would be gone. So I am essentially being forced into making a decision I'm not ready to make.

Anyway, that is why I'm seeking advice. This surgery would be on my dominant hand, and I'm not sure if it would prevent me from doing my job, it could. So I just need to know what I can expect. If I have to do this now, I've at least got to be more informed on what I'm getting into.

Thank you again for responding.

 
Old 02-13-2013, 04:56 AM   #4
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Re: Is 36 to young for basal joint arthroplasty surgery

Hello! So sorry you are going through this. I was diagnosed with this last year in both my thumbs and I'm in my early thirties. I don't even have a job or do anything that would have caused this so early in my life. I understand it can happen to anybody, but I feel that most cases are b'c of their jobs, etc...I also was told about the surgery, it was the first time I heard I had this, and I was like what are the other options. I was not going to just jump into surgery without other opinions. Anyway, another ortho. said to wait. SO now it's a year later, and I'm not any worse, but I defintiely have limitations, and they do hurt a lot at times.
I feel like worker's comp. is so unfair. So if you decide not to have the surgery now, and wait your insurance then won't pay for it?
Also there are many people on this board that has have the surgery, with some very helpful info.

 
Old 02-25-2013, 09:48 AM   #5
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Re: Is 36 to young for basal joint arthroplasty surgery

I could have written this post!!!! I am 37, and am on my 3rd surgery as well. I also feel like I am WAAAY to young for this. I have had two Tendon Release surgeries on my left hand and now the arthritis in my thumb is sooo bad that the doc suggested the CMC Arthroplasty. Just like you, I am much more nervous this time around because of what I believe will be a MUCH harder recover with MUCH more pain. It's like I know what to expect because of the other two surgeries and those sucked. Knowing the pain and knowing that it will be worse is causing lots of anxiety over here. When is your surgery scheduled? Mine is set for March 19th. Maybe we will be recovering together?

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Old 02-28-2013, 12:29 PM   #6
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Re: Is 36 to young for basal joint arthroplasty surgery

Quote:
Originally Posted by mschloe View Post
I could have written this post!!!! I am 37, and am on my 3rd surgery as well. I also feel like I am WAAAY to young for this. I have had two Tendon Release surgeries on my left hand and now the arthritis in my thumb is sooo bad that the doc suggested the CMC Arthroplasty. Just like you, I am much more nervous this time around because of what I believe will be a MUCH harder recover with MUCH more pain. It's like I know what to expect because of the other two surgeries and those sucked. Knowing the pain and knowing that it will be worse is causing lots of anxiety over here. When is your surgery scheduled? Mine is set for March 19th. Maybe we will be recovering together?
I'm probably not getting my surgery until April, so it look like you'll be doing it before me. I'm just trying to give my right hand more time to heal from the last surgery. It was 5 months ago (for DeQuervain's release) but it left me with quite a bit of numbness and a rather painful neuroma on my radial nerve. So I am even more nervous about getting basal joint surgery which is even more invasive on the same hand that still feels painful from the last surgery.

After the bad outcome of my second surgery I am much more worried this time around. I have learned the hard way there are no guarantees from surgery. But I did have one good surgery. My first hand surgery on my left hand (2 trigger finger releases) was overall successful. It's a little stiff, but the pain is so much improved. So I have had one good surgery and one not good one...makes this decision so much easier lol.

And here's another nice little aspect for me, a few months ago I was also diagnosed with Crohn's disease. Which explains the arthritis since many people with Crohn's have arthritis too. It's just there are days when just the Crohn's is overwhelming, I'm still learning how to manage and live with that. Then add to it a lengthy and probably painful recovery from joint reconstruction. Can I handle both at the same time?

IDK, I mean basal joint arthroplasty is just so much more involved then a simple tendon release surgery and getting joint replacement surgery in your 30s? It's just not something I thought I'd ever have to face at this age. I think maybe I should just go for it sooner rather than later now that I think about it, the more I wait the more worried I get lol! I suppose I should just be strong and have faith it will work out.

Do keep in touch on how you're doing. I'd me curious to hear from you. I'm glad to have found someone in the same situation!

Last edited by Greengal04; 02-28-2013 at 11:15 PM. Reason: Just wanted to add more

 
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Old 03-05-2013, 09:42 AM   #7
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Re: Is 36 to young for basal joint arthroplasty surgery

IDK, I mean basal joint arthroplasty is just so much more involved then a simple tendon release surgery and getting joint replacement surgery in your 30s? It's just not something I thought I'd ever have to face at this age. I think maybe I should just go for it sooner rather than later now that I think about it, the more I wait the more worried I get lol! I suppose I should just be strong and have faith it will work out.

Do keep in touch on how you're doing. I'd me curious to hear from you. I'm glad to have found someone in the same situation![/QUOTE]



Yeah, I never thought I'd be in this situation either. I am not looking forward to it. I have been waiting 6 weeks and have another 2 to go. The longer the wait, the more anxiety I have. I wonder how long it will take before I can use my fingers? As long as my fingers can move, it's not THAT big of a deal. I am just getting the impression that it will take a while before I have finger strength. I remember with my Tendon releases I could use my fingers within a week or so. I assume it won't be anywhere near the same. sigh...

I am also going to ask the surgeon to use a scope to see what is going on on the ulnar side of my wrist as I have pain there too. I figured that since I will be under anesthesia, it can't hurt for him to poke around and see if there is more to this. I am sooo tired of this left hand of mine. I wish I could do a hand transplant. I seem to go from one thing to the next. according to my doc, they are all unrelated. I think it's just too cooincidental that over the past 3 years I have had to have 3 different surgeries. I have also had extensive bloodwork to see if I have other medical issues that could cause all of this inflamation, arthritis, etc.. So far everything is negative.

 
Old 03-06-2013, 02:25 PM   #8
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Re: Is 36 to young for basal joint arthroplasty surgery

Well, after agonizing ove whether I should do it for well over a month, I gave the go ahead for the surgery to my doc yesterday. I know there are no guarantees, I learned that the hard way from my last surgery, but I had a good chat with him where he addressed most of my concerns. He said while its not common for people my age to have this, he had done it on patients my age. He also said he's done this surgery often and for the vast majority it has good results.

I just have to figure out how I'm going to manage being without the use of my right hand for a while since I'm right handed. My job involved a lot of writing which I am worried how long I'll be unable to write. But I'll have to figure out a way to accommodate that until I'm healed.

I'm about as anxious and nervous as I can be, mostly because due to my Crohn's disease I can't take ibuprofen and NSAIDs. So hopefully the pain won't be too bad. My last 2 surgeries weren't to bad pain wise after, but I know this surgery is much bigger. So hopefully the pain will be manageable. The problem isn't getting better if I don't do this, it will only get worse. So I just have to take the risk, trust my doc (and I do because he's been a hand surgeon for over 20 years) and hope for the best.

Let me know how your surgery goes, we are very similar in age and circumstances so it'll be good to hear from you before I do mine. My surgery will be in April. I'll try not to stress to much bout it til then!

 
Old 03-13-2013, 02:09 PM   #9
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Re: Is 36 to young for basal joint arthroplasty surgery

Thank you for your calm and reassuring replies. I made the mistake of watching a video of this surgery and its been giving me mini panic attacks lol. You'd think having 2 previous hand surgeries already this one wouldn't bug me at all. But dang, this is just so much bigger than the other 2 I've had and its been freaking me out!

What worries me the most is the pain after. You see, I have Crohn's disease also and my GI doc has warned me to avoid ibuprofen and other NSAIDs as they can bring on a flare since they're bad for your gut. And I haven't taken anything for pain except Tylenol in at least 6 months now due to that. So I'm concerned about how I'll manage the pain, which is bound to be worse than my prior surgeries since this is bigger. I know they give you the good stuff right after, but I've always avoided taking narcotics if at all possible because they make me nauseated and I'm always paranoid about becoming an addict since my father was. What will I do if the pain is bad?

I know this surgery is needed, even at 36. My hand is only getting worse and my hand doc says I now have "demonstrable subluxation and instability." So I know this is it for me. But wow am I scared lol. So I do appreciate the encouraging replies!

Last edited by Administrator; 03-14-2013 at 04:43 PM.

 
Old 03-14-2013, 09:36 AM   #10
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Re: Is 36 to young for basal joint arthroplasty surgery

When you take oxydocone or other medications for pain they don't have the same effect on your pleasure centers as they would if you were taking them recreationally. Your obvious concern and fear of addiction is your best protection from ever having a problem with them. Your doctor will only give you enough for a few days, not enough to lead you into dependency. I would talk to your doctor about your concerns, but you should know that being in pain can slow your healing, so I think you are safe to take them for a few days. I used them for 5, but on days 4 and 5 it was just at night. Your tylenol at top dosage should take care of the rest. Do not take your tylenol with the pain meds unless your doctor says so. Some of them have tylenol included and you don't want to take too much.

I finished up my hand therapy this week and my hand feels great. I wish you the same success.

Margarita

 
Old 03-14-2013, 03:22 PM   #11
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Re: Is 36 to young for basal joint arthroplasty surgery

Hello Greengal,

Before I had the first surgery 2 years ago on my left hand for arthroplasty CM1
for the basal joint, I found a video of this surgery. I refused point blank to watch it! I did'nt want it to freak me out. The best advice you can obtain is from your surgeon/doctor.

Remember it's your body, your hand & you have the right to get all the information you want. Don't be shy Greengal. Write down all your questions beforehand & take them with you when you see him next.

Your hand will not improve without the surgery & you will be relieved of the awful grinding pain that you are experiencing now. Steroids btw do not help in the long run!

For pain management ice is your best friend. Get yourself several ice-packs, keep them in the freezer, not the fridge & use them as often as you need to.
Remembering to re-store them in the freezer when they go ''limp''
Some people find 7 minutes of ice then 7 minutes of heat works for them.
Meaning ice-pack then hot water bottle or the ice-pack can be heated up in the microwave. I used only ice-packs from my freezer.

After your surgery you will need to raise your entire arm above your heart when you sleep. It is very helpful to keep your arm raised as much as possible as this will help reduce the swelling & pump the blood back to your heart.

There is a homeopathic ointment called Traumeel. I suggest you order at least 4 small tubes or 2 large ones & rub it liberally into your fingers & thumb. If you are allowed to remove your brace/splint after the first 2 weeks, use Traumeel as often as you feel the need. It is non-toxic & I swear by this product.

As for your concern about meds, I fully understand. (My sister has Crohns)
As Margeritta suggested correctly, taking Tylenol will help you. Your doctor will give you meds during & after your surgery & you need to discuss what meds you can & cannot take, with him beforehand.

The first week is the hardest. 4.February my right hand was operated on, I am still in a micro-plastic splint, without any pain. (If you have a look at my thread you will be able to read about my surgery & the meds etc)

Any questions you may wish to ask me, please do as I have loads of info that
I'd be happy to pass onto you.

I wish you good luck for your surgery.
All the best to you Greengal.

Haydena.

PS. I am also right-handed, I have been writing with my left hand since 5.February. At first my writing looked like it was from a 5 year old! today my writing is quite acceptable.
Greengal, when push comes to shove & we women have to improvise, we manage well. The thought of brushing my teeth with my left hand gave me the chills, surprisingly I manage. I am able to make a meal, even if it takes me much longer. The only thing I miss is not being allowed to drive. I am not insured with a splint on! We will give you all the moral support you need. Feel free to ask, vent & moan as much as you want. You are going to be OK.

Last edited by Administrator; 03-14-2013 at 04:45 PM. Reason: needed to add some advice

 
Old 03-15-2013, 11:00 AM   #12
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Re: Is 36 to young for basal joint arthroplasty surgery

Thank you Margarita and Haydena for your detailed and encouraging responses. Who would have thought I'd be facing joint reconstruction surgery in my 30s but I here I am!

I do have some questions regarding the actual procedure if you don't mind. I have talked to my hand ortho doc several times, and he's done his best to answer those questions. I know exactly what he wants to do, but I also know there are variations on this surgery. So I was curious what you both had done. My doc has said he will be removing the entire trapezium bone and taking and entire 10 cm section of the FCR tendon to replace it. But from my own reading I know the surgery can also be done with partial excision of the trapezium and just taking half of the FCR tendon. What version did you have done? Have you found any change in your wrist function without that tendon?

When your symptoms were at their worst, did you ever feel a sharp, stabbing kind of ache in your wrist where the thumb meets the wrist? That's my worst pain, and then it just radiates up the thumb. My thumb also pops and cracks when I use it. I really hope this surgery will resolve that.

Until I get authorization from L&I I cannot schedule it. But I'm hoping it will be next month, the sooner the better because the longer I wait the more paranoid I get lol.

Last edited by Greengal04; 03-15-2013 at 12:04 PM. Reason: Added some things

 
Old 03-15-2013, 12:42 PM   #13
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Re: Is 36 to young for basal joint arthroplasty surgery

Hi again!
My surgeon removed the entire trapezium and used half of the tendon to stabilize everything. That is the common version, although there are several different tendons that can be used. If you google CMC thumb surgery research there are several studies that all say whatever version is used the results come out the same. Usually the entire trapezium is removed because both sides of it are damaged by the arthritis. I think you are thinking of a different surgery that is for very early problems where they reshape the trapezium so that the angles in the joint are changed and the wear is slowed.

Before my surgery sometimes the pain when my sleeve brushed the base of my thumb was enough to cause me to tear up. It was really awkward when a student noticed that I was in pain and asked if they could help somehow. And it wasn't just feeling the crunch-other people could hear it! I am now dealing with the same pain level with the left as well as some minor numbness in the fingers due to wrist swelling. I am hoping that the numbness stops soon or I will have nerve conduction tests done and possibly a carpal tunnel release when the thumb is done.

I have just done 2 weeks of strengthening so far, but the wrist strength is coming back really well. I can lift a large kettle of soup without a problem and lift a stack of glass serving bowls up over my head, so I think that is pretty good progress. Until I have full strength back my therapist want me to limit to 10 lbs, but for me that is plenty to be able to do all my normal lifting. With a bad back and partially replaced knees, I am only to lift under 30 lbs. total anyway. The cracking and noise is completely gone.

Hang in there gal, this is going to be okay. I did watch the video and I thought it was really interesting. There are also a number of good websites that just use diagrams which are a little easier to look at for most people. Send me a message if you want me to give you a list of the best ones. I think I looked at 30-40 before I had my surgery in December. I am one to research everything and began checking into it when my thumb started to have problems over 2 years earlier.

Have a good weekend.

Margarita

 
Old 03-16-2013, 12:09 PM   #14
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Re: Is 36 to young for basal joint arthroplasty surgery

Thank you again for your reply!

When my surgeon described the procedure he was going to do with me he said he would remove the entire trapezium and not half but all of the FCR tendon. But when I asked him if losing that whole tendon in my wrist would affect wrist function he said no. And I'd like to think that since he's been a hand surgeon for 20+ years and probably done this procedure countless times, he knows what he's talking about.

I still have some numbness and a small neuroma from my last hand surgery in the same hand, so I hope this surgery won't make that worse. I just now that awful stabbing pain and popping/cracking is only getting worse so I know this surgery is really the option I have. I just hope I get authorization for it soon because the longer I wait to do it the more anxious I get!

Thanks again for replying and giving your tips and advice. I look forward to hearing how the surgery went for the other poster who is my age and getting it as well.

 
Old 03-17-2013, 11:53 PM   #15
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Re: Is 36 to young for basal joint arthroplasty surgery

Quote:
Originally Posted by Greengal04 View Post
I'm 36, but have had ongoing issues with my hands for years due to wear and tear from my job. Just last year I had 2 hand surgeries. On my left hand I had 2 trigger fingers released and an MCP joint arthrotomy to remove scar tissue. And on my right hand, just a few months ago, I had a deqervains release surgery.

After the deqervains surgery I was still having quite a bit of pain and I noticed that my thumb pops and cracks when I moved it. After additional testing my doctor diagnosed it as osteoarthritis with mild subluxation in the basal joint. He has recommended a 3rd hand surgery, basal joint arthroplasty.

You would think after having 2 hand surgeries already I'd not be concerned or worried about having surgery again. But I am, mostly because I've read how much bigger and badder this surgery is, with a much longer recovery. I can't afford to take that much time off work, and I can't help but wonder if I should even have this surgery. I'm 36, is arthritis surgery like this the best thing to do at my age? Removing bones and moving tendons, yikes!

I'm just not sure what I should do, and after having a not so good outcome from my second hand surgery I am really hesitant to have another, especially one that is so much bigger.

Any thoughts and advice is much appreciated. Thank you.
I had CMC joint Trapezium removed and Flexor Carpi Radialis tendon arthroplasty at 38. Now 7 years later it has failed. I am a physical therapist. Initially it seemed good the first couple years but as time went on it became weaker, muscle atrophy, even though I work with it daily. I work with patients in pt and out pt 7 days a week. I am very busy. the pain initially went away but the pain causing rom restricted before surgery same after the surgery due to the weakness in the structure missing the tendon and the bone. In Seattle talking with hand therapists, the word is that this atrophy is expected and it is expected to fail. a tendon can not replace a bone! My tendon was absorbed by my body by the 5th year. and my thumb has recessed and is weak as well is my grip, my pinch, and my hand is now physically smaller looking. I have pain in mult areas of my left hand and forearm due to compensation. I wish I would not have had this surgery. I had followed up 2 years ago with a different hand surgeon. He said my arthroplasty had failed. He said I was very young for this surgery usually over 65 years old. Young people are too active for this surgery. He wanted to move more tendons. I said no. I went to Seattle last year and another hand surgeon said not much to do now. I was looking for cadaver tissue replacement for bone and tendon for my hand... He is still considering but not sure. There is 3D printing in North Carolina. Maybe they can replicate cartilage for the bone or reproduce a new bone. DONT HARVEST YOUR TENDONS! IT IS ONLY A TEMPORARY FIX. Sincerely, Monica

 
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