It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Pain Management Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 10-03-2004, 02:33 PM   #1
Member
(male)
 
Join Date: Mar 2004
Posts: 71
bcruth5 HB User
Doctor Is Mad Because I Ran Out Early

My body is intolerant of NSAID's and aspirin. I won't waste time explaing why. The only pain relief drugs I can take include Tylenol and opiods. For the past few years my PCP has given me 20 Lortab 5's each month for various pain problems. He makes me call him for refills each month rather than writing refillable Rx's. I sometimes refill at 30 days, sometimes as few as 25. Last month I asked for a refill at 14 days because I had several pain problems that month. I was not abusing the medication. I would not have asked for an early refill if I was trying to pull a fast one.

When I requested the refill he chewed me out over the phone and said he would not refill the Rx until I come in to see him. He said he had nothing else to say to me and transerred me to the appointment desk. I couldn't get an appointment for over a month. That means I will go about 7 weeks with no pain relief.

We have always had an excellent relationship and I was shocked when he shouted at me. What should I expect at my appointment? Will he dump me as his patient? Have you guys been through this?

 
Sponsors Lightbulb
   
Old 10-03-2004, 03:13 PM   #2
Senior Veteran
(male)
 
Join Date: Jun 2003
Posts: 3,483
Shoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB User
Re: Doctor Is Mad Because I Ran Out Early

Obviouly your GP has the same archiac idea about opaites that most non pain management docs do.

Not that a PM doc wouldn't dismiss you for running out early. But if your in enough pain to need opiates every month, than he needs to understand that one pill last you 4 hours, does a minimal job, and you basically have to choose what 60-80 hours a month you don't have to suffer as bad. .

I say a Pm would do the same thing because he has protocols and self medicating and adjusting your own dose can't be tolerated or explained if the docis ever auditied. If your meds are not working you call , I leave a message with the triage nurse and she calls me back. I've yet not to be seen with 24 hours of making a call. So there isn't a need to self medicate. Just honest comunication and absolute compliance with your PM docs instructions. It's just the oposite of many peoples phylosophy to do what they want and then beg forgivenes, In PM you have to ask and wait before you act and don't expect forgiveness.

Every script Ireciev is a 30 day script, not a 29, not a 28 or 25 day supply. If I called 3 days early and said I had extra pain and took extra meds, the meds would not be refilled and I would be discharged and go through cold turkey wthdrawal.

I know this beause I sign a new and more comprehensive contract every year that covers evey scenario plus a copy is posted in each exam room. Absolute complaince is absulute, There isn't an excuse they haven't heard and the docs can't defend themselves against early refills when there is no documentation of the new pain issues. PM docs are under a spotlight and if they don't cover their hiney, they won't be open next month when you show up for your next apt.


Gp's are not trained in pain management, have no understanding of the benefit of opiates and also have nothing else to offer other than opiates. he can't do trigger point injections, nerve blocks, medication infusions, he's not implanting and managing pumps and all he learned in school was that opiates are addictive and should be limited.

There is also a fear of being prosecuted fro over prescribing but I doubt abyone would consider 20 Vicodin a month over prescribing.

It tryily sounds like unless you were content with 20 vicodin a week, and can go on living with the relief they give, It's time to ask to be referrred to a PM doc. Not all PM docs use opiates, some will teach coping techniques, some will do ots of injections, some think acupuncture is the way to manage pain. It's just a matter of finding what works for you.

Sure opiates work and are the quick solution to pain. But can he offer any other pain reliving modality to help you. Does he understand tolerance and the difference between addction and simple physical dependnece.

If you have an HMNO, I bet he would be more than willing to pass the buck to a PM doc and willing to do it without seeing you again, so you may be able to find a doc that actrualy treats chronic pain al day long, 5 days a week. Whatever youmay learn or try, It's no worse than going without any method to manage pain for the next 6 weeks.

The AAPM or the APS, american acadamy of pain mangement physicians and the american pain society have lists of PM docs they can provide nin your area. So finding one shouldn't be that hard. It's finding one that is capable of manageing your pan that is the trcky part. I can't remeber how many PM docs and surgeons told me I would just have to learn t live with it. That's somewhat of a mojority decsion amongs BP's and surgeons. However PM docs are out there to help you deal with pain and manage it to the point it improves the quality of life rather than it being hindered by pain or the wrong medication. There is lots of trial and eror andinvolved in fnding the right doc, but they are out there. Opiates are just one tool in a PM docs bag. If that's his only tool I would be concerned that he thinks everyone will respond to the one therapy he offers. You really want to find a group or clinic that can offer a multifaceted aproach to PM.

Personally I would shoot for a PM doc before you have to listen to a lecture how your going to become horriably addicted and in the gutter from 20 vicodin a month? You may have to se several dPM docs before one has the ability tomange your pan or one tha doesn't try to slam every patient through the same whole and say this should work, It's what I do for all my patients.

How can alla docs practice benefit from one modaility or one class of meds. You want a doc with the abilty to manage chronic pain patients that fall all along the bell curve of pain and tolerance to meds.

I think we have all heard the evils of opiates speach or been called a drug seeker or sugested the pain is in our head. A true PM doc is going to continue to work with you untill he's found what's right for you. Even the best of the best PM docs can't look and listen and decide that x and y meds plus some PT will manage your pain. Every patients response to meds and different modailties is different. It may or may not include opiates, but at least someone is trying.
God luck, Dave

Last edited by Shoreline; 10-03-2004 at 03:32 PM.

 
Sponsors Lightbulb
   
Old 10-03-2004, 06:54 PM   #3
Inactive
 
Join Date: Aug 2004
Posts: 168
atibbert HB User
Re: Doctor Is Mad Because I Ran Out Early

well shoreline, that post really helped me out. I am having trouble finding a pain doc to see me. I have severe TMJ and many of these pain docs don't want to treat us, they don't do facial pain. I have tried to see 6 different ones and can't get one to see me. I currently take 3 to 4 vicodin ES daily with valium (10mg) nightly. I suffer endless pain and the vicodin ES barely touches the pain. I have tried PT, bite guards, trigger point injections, licoderm patches on my face, tramadol, vioxx, celebrex, nuerontin, zanaflex, flexeril, robaxin and skelaxin, 600mg ibuprofen, have endured 4 surgeries and still am in pain. My GP absolutely refuses to give me anything (except an antidepressant) because all this pain makes me depressed. My oral surgeon who did these 4 surgeries has given up on me and I am seeing a new one on the 14th of this month with high hopes. Every week I have to go through what I call the doctor dance, that is when I ask for a refill, get the run around, stress out whether or not he will refill it and spend most of my days stuck to a heating pad. What do you think? You seem to know quite a bit. I don't over medicate even when I am tempted because the pain is unbearable. I will take a 200 to 400 mg ibuprofen chaser with the vicodin, but it seems to help little. I am at my wits end trying to find a pain doctor to do facial pain.
Amy

 
Old 10-05-2004, 07:23 AM   #4
Inactive
(male)
 
Join Date: Nov 2003
Posts: 152
Phlox HB User
Re: Doctor Is Mad Because I Ran Out Early

Attibert, just a quick comment, and maybe Shoreline can clear this up: I too, have been in a situation the last few months where I am in almost constant pain. At one point, I too, was taking pills that had Ibuprofen and Tylenol (acetaminophen) in them, simultaneously. Once my doctor realized this, however, my medication was changed. I was told that taking Ibuprofen and Tylenol at the same time is not good for your body in the long term. Since youre taking Vicodin and Ibuprofen, that is what youre doing, also(Vicodin, in its different forms, contains anything from 325-800mgs of Tylenol/APAP/Acetaminophen). So you might want to double check with your doctor about taking the Tylenol and Ibuprofen at the same time, since my doctor wasnt too crazy about the idea.

 
Old 10-05-2004, 08:06 AM   #5
Inactive
 
Join Date: Aug 2004
Posts: 168
atibbert HB User
Re: Doctor Is Mad Because I Ran Out Early

My pharmacist is actually the one who suggested I do this. She was alarmed at the amount of tylenol I was taking and I told her that I was also taking additional tylenol because the pain was so bad. She said take Ibuprofen with it instead. Also on another not, when my doctor refilled my prescription for Vicodin yesterday, instead of the Vicodin ES (7.5/750) he gave me plain vicodin (5/500) This will be useless and I am at my wits end about it. The Vicodin ES was barely working. Why would he do this? He did not even discuss it with me, I found out when I picked it up from the pharmacy. My pain is constant and unrelenting. I cannot eat because it just causes too much pain and my stomach is in a constant state of upset from the meds. My husband told me last night I look like a skeleton. I was not a big person to begin with and this cannot be healthy. I am crying as I am writing this because the pain is bad and I am so frustrated.
Amy

 
Old 10-05-2004, 12:34 PM   #6
Inactive
 
Join Date: Sep 2004
Location: Oklahoma
Posts: 183
goddessdana HB User
Re: Doctor Is Mad Because I Ran Out Early

Quote:
Originally Posted by bcruth5
My body is intolerant of NSAID's and aspirin. I won't waste time explaing why. The only pain relief drugs I can take include Tylenol and opiods. For the past few years my PCP has given me 20 Lortab 5's each month for various pain problems. He makes me call him for refills each month rather than writing refillable Rx's. I sometimes refill at 30 days, sometimes as few as 25. Last month I asked for a refill at 14 days because I had several pain problems that month. I was not abusing the medication. I would not have asked for an early refill if I was trying to pull a fast one.

When I requested the refill he chewed me out over the phone and said he would not refill the Rx until I come in to see him. He said he had nothing else to say to me and transerred me to the appointment desk. I couldn't get an appointment for over a month. That means I will go about 7 weeks with no pain relief.

We have always had an excellent relationship and I was shocked when he shouted at me. What should I expect at my appointment? Will he dump me as his patient? Have you guys been through this?
I alway's alway's take my pill's as directed!! If I'm having a REALLY BAD DAY, I call my doc and ask if I can take an extra pill. If you have been on these awhile he may need to switch to another medication. Maybe something a little stronger obviously that pain med's not working if your having to take more of it. You need to see him. You need to say can we try another pain med? This isn't helping. Our doc usually switches our's bout every 6 mo's. But with what I'm taking right now don't mess with my ulcers as bad as the other one's. Sounds like it's time for a different pain med.

 
Old 10-05-2004, 12:45 PM   #7
Inactive
 
Join Date: Sep 2004
Location: Oklahoma
Posts: 183
goddessdana HB User
Exclamation Re: Doctor Is Mad Because I Ran Out Early

Quote:
Originally Posted by atibbert
well shoreline, that post really helped me out. I am having trouble finding a pain doc to see me. I have severe TMJ and many of these pain docs don't want to treat us, they don't do facial pain. I have tried to see 6 different ones and can't get one to see me. I currently take 3 to 4 vicodin ES daily with valium (10mg) nightly. I suffer endless pain and the vicodin ES barely touches the pain. I have tried PT, bite guards, trigger point injections, licoderm patches on my face, tramadol, vioxx, celebrex, nuerontin, zanaflex, flexeril, robaxin and skelaxin, 600mg ibuprofen, have endured 4 surgeries and still am in pain. My GP absolutely refuses to give me anything (except an antidepressant) because all this pain makes me depressed. My oral surgeon who did these 4 surgeries has given up on me and I am seeing a new one on the 14th of this month with high hopes. Every week I have to go through what I call the doctor dance, that is when I ask for a refill, get the run around, stress out whether or not he will refill it and spend most of my days stuck to a heating pad. What do you think? You seem to know quite a bit. I don't over medicate even when I am tempted because the pain is unbearable. I will take a 200 to 400 mg ibuprofen chaser with the vicodin, but it seems to help little. I am at my wits end trying to find a pain doctor to do facial pain.
Amy
Amy just a note be careful of taking a lot of ibuprofen. I have TMJ too from an accident i was in I dislocated and sprained my jaw. It was very diffacult for me to eat. I only ate soups (through a straw!!) Oatmeals, malt O Meals etc. I was eating aleve's like nut's. Now from all that not eating or eating very little at the time (from being in pain) and being on pain med's I have problems with ulcer's. They are not fun especially when they flare!!! And a dislocated jaw is not fun they say it's worse them breaking it. My hubby had to be my voice. I couldn't even talk. The pain was horrindous. And listen to shoreline. He is very wise.........

 
Old 10-14-2004, 06:17 PM   #8
Junior Member
(male)
 
Join Date: Jul 2004
Posts: 48
bigtuna HB User
Re: Doctor Is Mad Because I Ran Out Early

Wow your doc expects 20es vicodin to last a month?? I am soo sorry you are having to go through this my doc and I probably talk at least 5-10 minutes a month just about meds I currently am taking vicodin 5/500 1-2 every 4 hours as needed I fill once per month this month I have had trouble and had to see him 2 weeks before my fill day I let him know that my problem had been late night spasaming and aching and was only one day short he didnt even bat an eye he gave me 25mg amitriptoline (spelling??) to take before bed and I have not had late night problems I do have a question though I have now been on my vicodin for a year and have progressed to 240 tablets a month 8 per day how long will a doc keep someone on a med like vicodin before going to a longer lasting med we talked about my tolerance level and he said he wasnt surprised that my tolerance was getting higher any advice???

 
Old 10-15-2004, 11:06 AM   #9
Senior Veteran
(male)
 
Join Date: Jun 2003
Posts: 3,483
Shoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB User
Re: Doctor Is Mad Because I Ran Out Early

Hey Guys, I did want to clear a couple things up,. Taking tylenol and Ibuprofen at the same time is often recomended by docs because the route of elimination is different. It's not a good thing in the long run, tylenol can damage your liver and Ibuprofen can damage the kidneys. But there isn't an interaction betwen the two drugs. Just limits that your body can process either through the liver or kidneys.

240 5/500 vicodin a month for over a year is obviously not an effective way to manage pain Tuna. After a year, you have become physically dependent not addicted. Physical dependence is inevatable and with short acting meds tolerance is inevatable with the ups and downs. Clock watching, trying to cram activity during the peak of each dose is not the greatest way to manage pain.

Is this your GP or a pain management doc. 8 regular Vicodin a day maxes you out every day on the recomended safe dose of Tylenol which is 1000mgs per dose and 4000mgs per day. But if you use these meds everyday those numbers should be cut in half. You should probably have a liver panel done and that alone may be enough to say it's time to do away with the apap and use pure opiates.

The Norco product line of hydro and apap comes in 10/325, 7.5/325 and 5/325. It's available in generic versions and would reduce your intake by at least 25%. However LA meds are truely the way to go if you need round the clock PM. Tolerance tends to develop slower in LA meds, It somewhat reduce the risk of abuse because you don't really feel each dose start working or wear off If the LA med can maintain smooth coverage which requires proper dosing.

Pure opiates, Oxy, morphine, Dilaudid, fentanyl and methadone don't do any organ damage and don't contain apap. There is no ceiling on the dose you can take. You become just as dependent on 300 mgs of morphine a day as you do 600, so if 300 isn't working, what harm is caused by increasing the dose. As long as the meds themselve improve function rather than hinder it.

Some docs think tolerance is an inevatble and on going thing which scares them, they think you will reach a dose and there will be nowhere to go from there. But that's not true. Some folks consideer morphine the big un, which isn't true either, It's actually minimally stronger than Hydrocodone when compared mg to mg and the weakest of all the pure opiates. It's just the gold standard to which other opiates are compared in strength.

I've read this theory, my doc believes it and I found it to be true, that once you replace the natural pain relieving endorphiins that are not abundent enough to manage your pain, you can stay on the same dose for years, I spent years on the same dose of Methadone an a year on the same dose of kadina dn flipped right back to the same dose of meth. It was what some would consider higher than most, 600 mgs a day but my needs didn't nincrease. Another way to reduce tolerance is by rotating meds and BT meds. Using a different BT med from your Long acting med will cover more and different opiate receptors than a single opiate alone can.

Some people require combining long acting meds, The more receptors you cover the more anelgesia you can create. The other side effects like the inital warm fuzzy feelning you may feel is quick to deminish, so are side effects like itching and nausea or they can be managed. But the anelgesia is the last to deminish.
This doesn't hold true in every case, sometimes the nausea or sedation is just intolerable. Different people respond to different opiates better than others. Different pain can respond to different opiates better than other. All opiates are not alike, so just because you reached your present docs comfort level with a dose doesn't mean you won't find relief from a different med at a dose he is comfy with.

I've seen people make the mistake of relating a feeeling opiates may cause with pain relief which sets them up to need ever increasing doses t maintain a feeling. Anelgesia is really deminished feeling of pain rather than increased feelings or altered feelings. You don't need to actually feel the meds for them to work on pain. Ideally all you need is the anelgesic effect. The only time you actually may feel something is at a dose change or med change but that deminishes quickly along with other bothersome side effects.

I'm trying not to ramble on, but it does seem it would make more sense for tuna to be on a long acting med to maintain smooth coverage and avoid the apap and liver damage. There isn't a reason to be afraid of the LA meds, they are no more addicting and cause no more dependence than taking SA meds around the clock, Dependence will occur anyway,
but dependnence does not = addiction.

Addiction is destructive and likely hinders function and quality of life where dependence is just a physiological response and if the meds improve function and quality of life that hardly represents addictive behavior or signs of addiction.

Dependence is something we all have to deal with and be willing to accept in order to benefit from opiates. Some folks have a harder time dealing with just knowing they are dependnet and all that's involved, dependent on the doc to keep prescribing, dependent on the pharmnacy to keep your meds in stock, worrying abut Snow or hurricanes causing them to miss apts. It is a trade and each person has to decide if the trade is worth the benefit.
Take care, Dave

Last edited by Shoreline; 10-15-2004 at 11:15 AM.

 
Old 10-15-2004, 11:14 AM   #10
Senior Member
(male)
 
Join Date: Aug 2004
Location: Reno, NV
Posts: 244
Streetcar HB User
Re: Doctor Is Mad Because I Ran Out Early

Hi BigTuna,

You should definately be on a LA by this time. You'd be getting more consistant pain relief if you were, not to mention the fact that with 8 viodin @ day you're right on the line for max dose of APAP (4000mg). If your dr is uncomfortable with LA meds, see if he'll switch you over to NORCO 10/325 4 daily. That would really be doing your liver a favor.

That was the same dose of vicodins that I was taking before my PM dr switched me to MScontin 15Mg x3 and my relief was so much smoother. Ihad been taking the 8 Vic during the day only, nothing before bed or during the night and the swicth to MScontin taken every 8 hours gave me good nights sleep for the first time in years. I hadn't realized how poorly I'd been sleeping until the switch.LOL
__________________
GOD bless and be Comfortable!!

Ken

Neuromas, Diverticulosus, IBS-C/P, Esophageal Spasms

 
Old 10-17-2004, 06:15 PM   #11
Senior Member
(male)
 
Join Date: Nov 2003
Location: Lititz, PA US
Posts: 209
boogabear HB Userboogabear HB Userboogabear HB User
Re: Doctor Is Mad Because I Ran Out Early

[QUOTE=atibbert]My pharmacist is actually the one who suggested I do this. She was alarmed at the amount of tylenol I was taking and I told her that I was also taking additional tylenol because the pain was so bad. She said take Ibuprofen with it instead. Also on another not, when my doctor refilled my prescription for Vicodin yesterday, instead of the Vicodin ES (7.5/750) he gave me plain vicodin (5/500) This will be useless and I am at my wits end about it. The Vicodin ES was barely working. Why would he do this? He did not even discuss it with me, I found out when I picked it up from the pharmacy. My pain is constant and unrelenting. I cannot eat because it just causes too much pain and my stomach is in a constant state of upset from the meds. My husband told me last night I look like a skeleton. I was not a big person to begin with and this cannot be healthy. I am crying as I am writing this because the pain is bad and I am so frustrated.
Amy

Amy this could have been done inadvertently. Don't be too hard on him. Call the office and ask if he could call the phcy and change the 500 mg to 750s. Suggest that it was an oversight and that the 500s won't do it. Docs make mistakes too.

My wife has FMS and is in some level of pain all the time. We have been thru it all. Good luck

Last edited by boogabear; 10-17-2004 at 06:16 PM.

 
Old 10-19-2004, 12:24 AM   #12
Junior Member
(male)
 
Join Date: Jul 2004
Posts: 48
bigtuna HB User
Re: Doctor Is Mad Because I Ran Out Early

Shoreline,

Thanks for your input my doc is just a family doc he isnt a PM?? which im guessing is some type of pain doc forgive me Im not up on terminology what would you suggest I ask too be switched too the 5/325 at the same dosage or the 10/325 4 per day? Im sure he wont have a problem with it if I just exspress my concern with the tylenol he is one of the few good guys we have talked about longer lasting meds but unfortunantly I was hurt on the job despite retaining a lawyer my states labor and insustries pays for nada and I lost my job 2 days later and have been in a lot of agony ever since my wife works and makes minimum wage and of course has no bennies I have applied for welfare assitance we are young and have no kids so we dont qualify for medical as of now Im paying about $80/month out of pocket for meds doesnt seem like much but in my current posistion it is.

So what do you suggest I bring up med wise and do you have any other Ideas on help with scripts I am checking out the info on this board any you would or could reccomend im not sure what the mods will and will not allow on the board

Thanks

 
Old 10-19-2004, 01:58 PM   #13
Senior Member
(female)
 
Join Date: Sep 2003
Posts: 125
pain research HB User
Re: Doctor Is Mad Because I Ran Out Early

Amy , you say that "instead of the Vicodin ES (7.5/750) he gave me plain vicodin (5/500)" ...

You never should have left the pharmacy! You should check the meds at the counter, and then tell them there has been a mistake. Have them call the doctor from there, and refuse to take the meds home with you. Once you have them, they're yours, and it is harder to get a prescription changed.

Just assume your doctor made a mistake and refuse to take any meds which are not correct. Even if your doctor made the change on purpose, you are stuck with meds which are not what you want. I know it takes guts, but it's better than going a whole month in pain.

 
Old 10-21-2004, 07:32 AM   #14
Newbie
 
Join Date: Oct 2004
Location: bedfordshire
Posts: 2
angel-of-fear HB User
Re: Doctor Is Mad Because I Ran Out Early

ok so u got a Dr Martin aswell then? ( sorry i no it's no laughing matter but i couldnt resist it!) my Dr, does the same to me i'm not nitolerant to NSAIDS but i need extra stregnth ones so i see my Dr but i get the same reply when i ask for more than one prescription a month. My Dr wont give me anymore high strength tablets for some time and i've just been to the dentist and im in pain but he dont care. i've complained and complained but he wont listern so i got my social worker on to it he now jumps when i ask fro repeat perscriptioons. PS i dont miss use my medication i just try to stay away from dentists when i can.
__________________
undefined

so the angel of fear has returned

 
Old 10-25-2004, 09:44 AM   #15
Inactive
 
Join Date: Oct 2004
Posts: 43
desired1 HB User
Re: Doctor Is Mad Because I Ran Out Early

A quick note to atibbert your doctor is lowering your dosage for vicodin because he/or she is probably going a little overboard with your prescriptions, doctors almost always lower higher mg pain meds if they are giving them to you on a monthly basis because most pains that people have usually heals sometime or another so he/or she is just testing your tolerance to see if you are satified with a lower dosage, if your pain is still severe (tell your doctor) that the 5/500 mg are'nt working, one other note try taking one and a half that equals 750 mg.

 
Closed Thread

Similar Threads
Thread Thread Starter Board Replies Last Post
At what point do you call your pain management doctor? reallywant Pain Management 7 03-29-2010 03:46 PM
Insurance company knows more than the doctor?? butrfligirl28 Pain Management 19 05-24-2008 09:23 AM
Rash for one week, went to doctor. drs Lyme Disease 5 08-16-2007 11:35 AM
Insurance wrote letter, now doctor wont write scripts letthatsinkin Pain Management 45 06-10-2007 02:23 PM
advice for my mom (afraid of the doctor) libbie6 General Health 6 03-05-2007 06:35 PM




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Sign Up Today!

Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

I want my free account

All times are GMT -7. The time now is 11:41 AM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!