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Old 05-12-2004, 07:22 AM   #1
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Question Colon Resection recovery Problems

Hi, My Mom-in-law had a mass removed from her colon, they removed the right part of the colon, all went well. She had the sergery on May 6th and came home a bit early on May 10th, She is 81 and has had cancer for 4 years now.

My concerns are this, since she has been home she has been thowing up off and on, seems whatever she takes in comes out on both ends. She is still on a soft food diet and drinking fluids, but is getting weak, she walks a little and trys to sleep, feels quezy most of the day. I hope soon she will get a brake, she is a very strong women(the strongest i have ever known). I would love to know if there is anything we could do for her...we have talked with her Dr, but I still feel things are not going as well.

I'm not sure what i am asking, but if anyone reading this has any good pointers please post a comment, I will check in here each day.

Thank you
~Linda

 
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Old 05-12-2004, 08:07 AM   #2
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Re: Colon Resection recovery Problems

Well, she is 81, and had cancer, and this is a tough surgery. It takes a while in the best of situations to smooth out after the surgery. She may actually be doing exceptionally well.

Nevertheless, you might look under a different stone. What medications is she on? I would go and have a consultation with as competent a pharmacist as I could find at a major chain. The computer systems at the major chains do a pretty good job of determining drug interactions and also listing off the side affects. Certainly, you should have the packet insert you can read as well as the reference book at your pharmacy. See if nausea and diarrhea are side effects of the medications individually. If nothing seems to be behind it, then see if there is a Pharm-D at your hospital.

The doctor could write additional prescriptions for the other two issues. Between the two, the throwing up is probably worse. There is no opportunity to gain nutrition and it must be very painful on the incision. It hurts to sneeze, I canít imagine throwing up.

The diarrhea might very well be related to the resection. It takes a while for the body to adjust. Unless your mother is losing weight at an alarming rate and is otherwise getting very weak, the diarrhea may just have to work itself out. Interferring with the healing process may just make it worse. The body has to work out the water absorbtion rates with the new length.

Good luck,

RS

Edit: My point to talking with the pharmacist would be perhaps a suggestion to change up the cocktail. It could be that simple. Losing it from both ends is a problem for sure. There are some quick dissolving anti-throw up drugs that are now available like Zofram. Talk to your pharmacist and then your doctor.

Last edited by resection; 05-12-2004 at 08:10 AM. Reason: My Point ...

 
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Old 05-12-2004, 08:45 AM   #3
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Re: Colon Resection recovery Problems

RS,

Thank you for your reply, at this time the only meds she is taking is ibuprofen for her lower back pain(cancer related) about once or twice a day. and then the Dr presribed Promethazine (suppository) for the nausea, it seems to work a little, it also causes drowsiness(which is good) but she is weak and I try and get her to walk, but she is so tired. I guess we will have to take it day by day and hope for the best, walking, eatting, fluids and rest....and hope for the best. Thank you again...and if anyone as I said before wants to tell me anything else to help my Mom please do. Thanks you!
~Linda

 
Old 05-12-2004, 09:27 AM   #4
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Re: Colon Resection recovery Problems

Promethazine is the generic name for Pheregan, which is stronger than Zofram, and has the benefit of drowsiness and minor pain suppression. It is good for the tummy. The obvious problem with a suppository is retention. That is why I suggested the Zofram.

There are Promethazine tablets too if she can hold them down long enough. It should really do good job of prevent the throwing up. There are a couple of threads in play right now from open resection surgeries that you might want to read and follow in the coming days. All three (including you are at about the same stage). Goody2shoes has one and PGTA5 has another.

RS

 
Old 05-12-2004, 10:35 AM   #5
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Re: Colon Resection recovery Problems

My wife suggested you might want to talk to the phamacist about moving from ibuprofen to tylenol. The ibuprofen can be harsh on the tummy, even cause bleeding. Is she at 1,500 mg or higher per day?

RS

 
Old 05-13-2004, 07:46 AM   #6
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Smile Re: Colon Resection recovery Problems

Hi RS, once again thank you for the advice and comments. Today mom is doing a little better(about 15%) she did not thow up yesterday(just once early in the morn) the Pheregan seems to be doing it's job, and again today so far she is doing good. She ate an egg and a slice of toast, it stayed in and she walked a little, even smiled for a moment. She is still very tired, so I will let her take the naps she needs and then get her up for food, drinks and walks. I feel today may be her best day, it's been 7 days since her surgery. I took her off the ibuprofen and gave her tylenol (thank you so much for that much needed info). Welll tha't it for now, I will check in here again tomorrow.

Take care and I wish you all the best of health and happiness!!!! ~Linda

 
Old 05-13-2004, 07:59 AM   #7
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Re: Colon Resection recovery Problems

Sure. I am actually surprised the docs didn't give your m-i-l something stronger than OTC pain relief.

Ibu can hard on the tummy and bowels, but it does a good job of reducing inflamation.

Don't exceed the label on the Tylenol !!! It can hurt you badly if you over dose. Just follow the label.

Glad to hear she is doing better.

RS

 
Old 05-13-2004, 11:12 AM   #8
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Re: Colon Resection recovery Problems

RS, Mom was given Vicaden(can't spell it) to go home with, Dr said to only take it if needed, she is really not in pain form the surgery, the back hurts do to a tumor on her lower spine . The Tylenol seems to be doing her good for the back pain.

I talked to her Dr today about the nausua and diarrhea(ever half hour) and she said Mom can take her IBS med (NuLev) and she also called in a prescription antibiotic med called Metronidazole 500mg for the diarrhea, and more of the suppositorys. So I think now we are set, time will tell and rest, meds, food, fluilds and of couse lots of love and patients.

Thanks again, I'm so happy I found this board.
~Linda

 
Old 05-13-2004, 01:40 PM   #9
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Re: Colon Resection recovery Problems

Linda,

I am by no means an expert, I just post like I am. Something strikes me as odd. Metronidazole (Flagyl ) is used to treat infections not diarrhea.

It is a pretty strong med. I spent most of January through April on it. In this case, the doc is probably prescribing as a preventative measure for intra-abdominal infections, including peritonitis, and/or intra-abdominal abscess. That is right out of the prescribing guidelines.

If he really believed she had such an infection, then I would think he would put her back in the hospital or at a minimum look at her Ö because Ö one source of the infection which could not easily be ruled out over the phone, is suture failure, or a leak at the resection. An infection of this nature could be a very big problem. It would be as dangerous as an intestinal rupture. Masking the infection while the suture line heals (if it were leaking) would not be a good idea in my opinion.

Flagyl is hard on the tummy. It kills pretty much all of the bacteria including the good ones, which in turn makes you nauseous and can produce additional diarrhea.

Is your m-i-l running a temp higher than say 100.9? Did the doctor run a blood test? If not, then he should confirm an infection before he prescribes such an antibiotic. And, she should be watched closely to ensure she does not develop a super-infection. If she does not have an infection, then she should not be on such an antibiotic. Resected people and divers in general do not want drug resistant bugs in their bellies.

Did the doctor perform a pressure (leak) test on your m-i-l before she was released to confirm the suture line? Those sorts of things should be done in my opinion. If her blood counts are normal and she is not running a temp, then I would not think Flagyl would be indicated.

I am a computer nerd, not a medical anything, so take everything I post with a GIANT grain of salt. It is just odd to me. I would question the doctor if I were her.

Also, the Vicodin can slow down the intestine somewhat. It can even be constipating. Since more time may be required to remove water from the pre-poop matter prior to elimination in the shortened large intestine, the Vicodin, may be a better alternative to the Tylenol. You cannot take both, as the Vicodin may also contain Tylenol (acetaminophen). Too much acetaminophen can cause liver damage. The Vicodin may give her a nice break and slow down her BMs.

The Vicodin should be a scored tablet, so you can crack them in half if they are too strong.

I canít comment on the NuLev. I have never heard of it.

Oh, drink plenty of water with the Flagyl. Plenty. It is a harsh antibiotic. You can run all of this past a pharmacist to get a real opinion prior to speaking with a doctor. Let me know.

Good luck,

RS

 
Old 05-13-2004, 07:19 PM   #10
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Smile Re: Colon Resection recovery Problems

RS, thanks again for the heads up, I talked to my bro-in-law he's a nurse, he said it's a med for fungus, and to just keep an eye on her, we see Mom's Dr on monday, but if before then there is any problems i will call her, she has been moms dr for a while and I do trust her, but one never knows.

I have a question for you concerning diet.

3 months ago I took care of my sister for a month after she had a colon resection (Divitic...) well I learned a lot and took very good care of her and today she is doing great. Her diet was different and I was very careful...I wonder about moms, I have been making her chicken dishes the last two days, and tomorrow i will make her fish, is there other meats she could have at this early stage? like beef, or should I wait...I will ask her Dr on monday, but since she is holding all down now and even going to the bathroom less i feel she could have more, The new meds are really helping and she is even a bit happier...I will take it day by day (just liek with my sis) but wanted to get your opinion . Thanks~Linda

 
Old 05-13-2004, 08:34 PM   #11
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Re: Colon Resection recovery Problems

When I came out, I was on a low residue diet (the opposite of high fiber) for a couple of weeks. There are two reasons. One is to give the gut a break and the other is to reduce the bloating and by extension the incisional pain. Gradually, you begin transitioning into a high fiber for life on a trial & error basis.

The nutritionist or dietician at the hospital should be able to provide you with a recommended menu according to your doctorís wishes. Assuming it is low residue like mine (I have been on it three times two coming off of bad infections and once after the surgery), it is not what you might think. Low residue is not necessarily liquids, Jell-O and baby food. Low residue is more like Rice Krispies, Hamburgers (no veggies), Light, mostly clear noodle soups with very limited veggies. American breakfasts and lean meats are OK. Many of the foods that are considered bad for you are actually on the list (much to the chagrin of my wife).

I am in my third week since resection, and I have reverted back to a relatively simple low residue diet. Today, I had a bagel for breakfast, Vietnamese for lunch, and breakfast for dinner at IHOP. Introduce variety and fiber slowly. This is probably way too soon for heavy meals. As always, follow your doctorís instructions. I want veggies, but I end up rolling in moderate pain. I think it just takes some time.

Back on the antibiotics, Flagyl is also for a variety of other bugs I would rather not tell you about. But, they are included below. That is really not my point. If she is in her fifth day and burning a high enough temp for Flagyl, (A) you should keep a very close eye on the situation, and be especially in tune to additional pain & tenderness in the resection area. That might be hard because it is already in pain or covered up by pain meds. And, (B) you should try to get a good idea if the infection is in the body cavity or related to a leak. You see the doc on Monday. That may go by quickly or it might be tough. Just be sensitive to infection. My guess is that 90% or better of the people on this board have been on Flagyl at some point in time. It is stout. I chopped (redacted) out the IV and Gel parts and few other parts to shorten the post. The Bold and Red texts are mine. Be sure to read the section on prophylactic use.

Metronidazole indications follow just for an FYI:

Oral Tablets
Symptomatic Trichomoniasis: Metronidazole is indicated for the treatment of symptomatic trichomoniasis in females and males when the presence of the trichomonad has been confirmed by appropriate laboratory procedures (wet smears and/or cultures).

Asymptomatic Trichomoniasis: Metronidazole is indicated in the treatment of asymptomatic females when the organism is associated with endocervicitis, cervicitis, or cervical erosion. Since there is evidence that presence of the trichomonad can interfere with accurate assessment of abnormal cytological smears, additional smears should be performed after eradication of the parasite.

Treatment of Asymptomatic Consorts: T. vaginalis infection is a venereal disease. Therefore, asymptomatic sexual partners of treated patients should be treated simultaneously if the organism has been found to be present, in the order to prevent reinfection of the partner. The decision as to whether to treat an asymptomatic male partner who has a negative culture or one for whom no culture has been attempted is an individual one. In making this decision, it should be noted that there is evidence that a woman may become reinfected if her consort is not treated. Also, since there can be considerable difficulty in isolating the organism from the asymptomatic male carrier, negative smears and cultures cannot be relied upon in this regard. In any event, the consort should be treated with Metronidazole in cases of reinfection.

Amebiasis: Metronidazole is indicated in the treatment of acute intestinal amebiasis (amebic dysentery and amebic liver abscess.

In amebic liver abscess. Metronidazole therapy does not obviate the need for aspiration or drainage of pus.

Anaerobic Bacterial Infections: Metronidazole is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Indicated surgical procedures should be performed in conjunction with Metronidazole therapy. In a mixed aerobic and anaerobic infection, antibiotics appropriate for the treatment of the aerobic infection should be used in addition to Metronidazole.

In the treatment of most serious anaerobic infections, Metronidazole IV RTU (metronidazole) is usually administered initially. This may be followed by oral therapy with Metronidazole at the discretion of the physician.

Intra-Abdominal Infections, including peritonitis, intra-abdominal abscess, and liver abscess, caused by Bacteroides species including the B. fragilis group (B. fragilis, B. distasonis, B. ovatus, B. thetaiotaomicron, B. vulgatus), Clostridium species,Eubacterium species, Peptococcus species, and Peptostreptococcus species.

Skin and Skin Structure Infections caused by Bacteroides species including the B. fragilis group, Clostridium species,Peptococcus species, Peptostreptococcus species, and Fusobacterium species.

Gynecological Infections, including endometritis, endomyometritis, tubo-ovarian abscess, and postsurgical vaginal cuff infection, caused byBacteroides species including the B. fragilis group,Clostridium species, Peptococcus species, and Peptostreptococcus species.

Bacterial Septicemia caused by Bacteroides species including theB. fragilis group, and Clostridium species.

Bone and Joint Infections, as adjunctive therapy, caused byBacteroides species including the B. fragilis group.

Central Nervous System (CNS) Infections, including meningitis and brain abscess, caused by Bacteroides species including the B. fragilis group.

Lower Respiratory Tract Infections, including pneumonia, empyema, and lung abscess, caused by Bacteroides species including the B. fragilis group.

Endocarditis caused by Bacteroides species including the B. fragilis group.

REDACT IV TO MAKE THE POST FIT

Prophylaxis

The prophylactic administration of Metronidazole IV preoperatively, intraoperatively, intraoperatively, and postoperatively may reduce the incidence of postoperative infection in patients undergoing elective colorectal surgery which is classified as contaminated or potentially contaminated.

Prophylactic use of Metronidazole IV should be discontinued within 12 hours after surgery. If there are signs of infection, specimens for cultures should be obtained for the identification of the causative organism(s) so that appropriate therapy may be given (See DOSAGE AND ADMINISTRATION).

REDACTED Topical Gel TO SHORTEN POST


DOSAGE AND ADMINISTRATION

Oral Tablets

In elderly patients the pharmacokinetics of metronidazole may be altered and therefore monitoring of serum levels may be necessary to adjust the metronidazole dosage accordingly.

REDACTED

Amebiasis

Adults: For acute intestinal amebiasis (acute amebic dysentery): 750 mg orally three times daily for 5 to 10 days.

For amebic liver abscess: 500 mg or 750 mg orally three times daily for 5 to 10 days.

Children: 36 to 50 mg/kg/24 hours, divided into three doses, orally for 10 days.

Anaerobic Bacterial Infections

In the treatment of most serious anaerobic infections, Metronidazole HCl IV or Metronidazole IV RTU is usually administered initially.

The usual adult oral dosage is 7.5 mg/kg every six hours (approx. 500 mg for a 70-kg adult). A maximum of 4 g should not be exceeded during a 24-hours period.

The usual duration of therapy is 7 to 10 days; however, infections of the bone and joint, lower respiratory tract, and endocardium may require longer treatment.

REDACTED

Prophylaxis

For surgical; prophylactic use, to prevent postoperative infection in contaminated or potentially contaminated colorectal surgery, the recommended dosage schedule for adults is:


REDACTED

It is important that (1) administration of the initial preoperative dose be completed approximately one hour before surgery so that adequate drug levels are present in the serum and tissues at the time of initial incision, and (2) Metronidazole IV be administered, if necessary, at 6- hours intervals to maintain effective drug levels. Prophylactic use of Metronidazole IV should be limited to the day of surgery only, following the above guidelines.

MISC. REDACTION

REFERENCES

1. Proposed standard: PSM-11-Proposed Reference Dilution Procedure for Antimicrobic Susceptibility Testing of Anaerobic Bacteria, National Committee for Clinical Laboratory Standards; and Sutter, et al.: Collaborative Evaluation of a Proposed Reference Dilution Method of Susceptibility Testing of Anaerobic Bacteria, Antimicrob. Agents Chemother. 16:495-502 (Oct.) 1979; and Tally, et al.: In VitroActivity of Thienamycin, Antimicrob. Agents Chemother.14:436-438 (Sept.) 1978.

2. Ralph, E.D., and Kirby, W.M.M.: Bioassay of Metronidazole With Either Anaerobic or Aerobic Incubation, J. Infect. Dis. 132:587-591 (Nov.) 1975; or Gulaid, et al.: Determination of Metronidazole and Its Major Metabolites in Biological Fluids by High Pressure Liquid Chromatography, Br. J. Clin. Pharmacol. 6:430-432, 1978.

 
Old 05-14-2004, 08:25 AM   #12
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Re: Colon Resection recovery Problems

Rs, I am very impressed with your knowledge on this subject. Some of the info sunk in very deep over here and some i don't fully understand, but the warning sign is up over here and I will be watching mom very closely! I will ask the dr why she put mon on this med, cause from what i am reading here she should have been seen by a dr before hand. Right now mom is feeling better, she has no pain, the incision looks excellent, this women was up and walking the second day, and not walking slow and sliding her feet, she was running, the nurses said they never saw that before, she walks around as if she never had surgery. I have asked her many times if she has any pain and each time she said no, only her lower back pain bothers her. She slept a little better last night, and has been eating very good. I push the fluids, and she listens for the most part. I think slowly her strength is coming back, and no more throwing up the is still diarrhea a problem, she is not going as frequently but it is still the same, perhaps mom does have a small bug....she has no fevor, no other signs of infection. I'm no where near a dr/nurse, but i am very aware of all around me... I do hope as the days go on mom doesn't have a problem with this new med....As for diet I will continue with the foods i have been giving her and then come monday ask. She ate french toast, some fruit cocktail, a little decaf coffee, juice, and a little of her yogurt smoothie, now mine you she only had a little of each, I think today will be a good day. I hope to put some weigh on her by the time the month is up.

I will post updates as the days go on, thank you again for all the information and I hope you stay on the healthy road, you sound as if your feeling great, take care~Linda

 
Old 05-14-2004, 10:10 AM   #13
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Re: Colon Resection recovery Problems

Thanks, I have taken a pretty active role in the management of my disease. If I was not so sick for so long, I would not have an opinion. So far, the best thing I did was find the very best doctor I could. After that, I have not added much to the management on my own disease. From all of my research, my doc appears to be at the top of the game.

All I really wanted you to do is watch for the slippery infection slope with mom, and for you to confirm my post with your pharmacist. It sounds like she has improved quite a bit. Keep taking the Flagyl until the doc orders otherwise. My guess is 3 500ís per day for 10 days. Once you start the prophylactic treatment plan, it is hard to stop for fear of a very ugly infection coming back in a merciless rage. About the 2nd or 3rd day after she stops the Flagyl, she should notice an improvement in the tummy. Try probiotics and keep the natural yogurt flowing in moderation, especially post Flagyl. For about 2 1/2 weeks after the Flagyl, continue checking for signs of infection (temperature mainly). Flagyl can suppress an infection for about two weeks after you stop taking them. If she has a leak or something in her cavity, it can come back.

Your mother-in-law appears to be recovering well. Although the throwing up has stopped, be sure and check her weight once or twice a day at the same time (dressed similarly).

No fever or chills is a good sign. Infection is really the big risk. Actually, infection caused by a leaky intestine is a bad one. Then there are just all of the nasty infections people get in hospitals period, particularly post-surgical elderly. Push lots of fluids to support the Flagyl, and watch for the temps. I am pretty encouraged by your post this AM. Unless things change, you should be able to go all the way into Monday with little concern. I just did not like the Rx for Flagyl without a look-see. If I am that sick coming out of this surgery, someone had better be looking at the cause before writing me up over the phone.

Your mom is lucky to have watching over her.

Good luck,

RS

 
Old 05-14-2004, 08:40 PM   #14
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Re: Colon Resection recovery Problems

I agree whole heartedly with RS on the flagyl...have been that route with hubby with diver surgery then emergency surgery 3 days later with parintinitis (sp?)...wish now I would have questioned why antibiodics were needed two days after 1st surgery. Flagyl is very, very potent and is for serious infections...would be all over doc with questions....don't take ANYTHING for granted...simple white blood count test when she goes to Dr. Monday would definitely be in order. Dr. probably prescribed flagyl as a precaution...but if Flagyl was indeed needed, there could have been something serious going on. One thing I learned with hubby's first surgery, you have every right to question, question, question!!!!...and you should! Hubby was sent to emergency surgery on that third day...he had been telling the nurses he was having trouble breathing and they kept telling him he was just anxious. Finally, that afternoon, I had enough and pressed the nurses call button and gave them a piece of my mind. They came in the room...then called the doctor...doctor came in and sent him directly to surgery...had a leak from the colon resection...lungs were filling up with fluid because of the infection...almost lost him..stayed on ventilator in ICU for 11 days...is doing great now and will have colon reconnection in August (colostomy was in November). ICU doctor told us that hubby would have died if he had stayed in his room for 2 more hours.

Imaginee, keep close watch on MIL...sounds like she is doing better...will keep her in our prayers....but DON'T HESITATE to bring her to emergency room over the weekend if she starts running a temp, etc. Don't mean to scare you or anyone else...just wish I had more knowledge when hubby had his surgery.

RS, you mentioned a pressure (leak) test....I would love to know more about that when you have time. You have been a Godsend to me and a lot of others I know. Will get husband to read your complete thread of surgery before he goes back in August. Thank you!

Cathy

 
Old 05-15-2004, 09:00 AM   #15
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Re: Colon Resection recovery Problems

Cathy, reading your comment made me cry....I'm so sorry for what your hubby had to go through, THANK GOD you got him help, spoke up and were HEARD. I have no problem speaking up either, I have been taking moms temp, checking her incision and asking her questions on how she feels etc, if there are any changes I will get her help right away. I was very upset to see her thowing up the first few days at home, and seeing her get so weak, The Flagyl has been a help, she is feeling so much better, and if there is any infection that med will do the trick...but i still plan Monday to ask her Dr questions and make sure mom gets blood tests and all. I will stay with her for weeks and watch her very carefully, I need to go right now, but I will post updates....

RS thank you again for all your help, you are an angel!!

~Linda

 
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