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Old 10-17-2008, 07:57 AM   #1
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Healthy Male 35 yrs old, high psa and low free psa, is it prostatitis or cancer

Hi Folks,

I am a healthy 35 yr old male.
On a recent physical my GP asked for my PSA tested after a Normal DRE.
Total PSA was 4.01 and free PSA was 9.7%. This was my first ever PSA test.
He suggested that I take Cipro for 10days and retest after another week. Did exactly that and now the Total PSA is 3.53 and free PSA is 8.2%.
I have now hooked up with an urologist and he says that based on the percentages there is a 56% chance that it could be prostate cancer.
He also said it could be nothing more than prostatitis.

I never had any symptoms of prostatitis or cancer prior to starting my Cipro.
Since I started taking Cipro and completed the doze, I notice that I have been running to the restroom very frequently especially in the night time (4-5 times) in the last 3 weeks.

Urologist has scheduled a biopsy next week. The whole month has been very stressful and I am very worried. Got a wife and 2 young girls.
Had anybody been in a similar situation at my age, I did not seem to find any body in their 30's having prostate issues. Any thoughts people?

 
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Old 10-17-2008, 06:21 PM   #2
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Re: Healthy Male 35 yrs old, high psa and low free psa, is it prostatitis or cancer

Quote:
Originally Posted by givemehope123 View Post
Hi Folks,

I am a healthy 35 yr old male.
On a recent physical my GP asked for my PSA tested after a Normal DRE.
Total PSA was 4.01 and free PSA was 9.7%. This was my first ever PSA test.
He suggested that I take Cipro for 10days and retest after another week. Did exactly that and now the Total PSA is 3.53 and free PSA is 8.2%.
I have now hooked up with an urologist and he says that based on the percentages there is a 56% chance that it could be prostate cancer.
He also said it could be nothing more than prostatitis.
...
Hello Hope,

The urologist is being reasonably conservative in checking for prostate cancer, which can occur even in a man younger than 40, from what I've read and hear experts say, but cancer is still unlikely in my layman's opinion. That 56% chance of cancer strikes me as an excessively high estimate of the odds, probably based on statistics for PSA, age and cancer, and/or free PSA and cancer, without allowance for prostatitis. It seems to me the odds are hard to estimate until you have first at least tried to assess whether there is prostatitis. I very much doubt that you can use published odds when prostatitis is present. (The bad news here is that your doctor has an expensive medical education in his resume, and I have had no enrolled medical education, expensive or otherwise.

Prostatitis can drive PSA up (and 4.0 is up at your age), and at the same time it tends to drive the free PSA down, which makes those diagnostic clues confusing. (The book "A Primer on Prostate Cancer - The Empowered Patient's Guide," says that in the section that talks about PSA and free PSA; you can probably find a copy in the library. Are you sure the urologist is aware of your PSA change after completing the dose of Cipro that the other doctor ordered? You might want to call your urologist and find out tactfully whether he is aware that prostatitis drives down the free PSA %. If he isn't aware, you could call back a few days later and quote from the Primer about it, then ask if that could make a difference in the 56% figure he gave you. Is it reasonable to take another course of Cipro and see what happens? (There may be a limit on the amount of Cipro that is wise to take. If so, you could ask if there is some other medication that often acts like Cipro, but is more tolerable.) I recall reading that some experts favor long-term use (several months) of milder medication to combat prostatitis. I hope you get some other replies about this.

In fact, prostatitis can drive PSA up much higher than 4.0, with 50 not unheard of. I heard of one case where prostatitis eventually drove the PSA to over 200, before dropping to normal when a successful treatment for prostatitis was finally found - often not easy.

You have a couple of strong clues that you have prostatitis, as I understand it as a layman without any enrolled medical education, but from what you have said, the clues are not conclusive. The clues are that you have to urinate a lot, especially at night - a symptom of prostatitis (and also, less frequently, of prostate cancer), and that your PSA dropped a lot - by half a point, as a result of short-term use of Cipro, a medication frequently used in the trial-and-error process of trying to pin down prostatitis. I'm fairly sure that Cipro would not affect prostate cancer, and if I were facing your circumstances, I would be absolutely delighted with that news. (If anyone knows that's not so, please chime in! It is certainly true that Cipro is not on the treatment list for prostate cancer, even as a supportive medication!) Also, your age makes it a lot more likely you have prostatitis rather than prostate cancer. However, it is still important to figure out what is happening; it is clear that something is going on.

There is one other test that could help, and it could be done before the biopsy. It is known as the PCA3Plus test; if it is strongly positive, it is almost certain that prostate cancer is present. There have been several posts about it on this board, and you could check the archive. A biopsy is not that big a deal, but this additional test could provide an additional indication whether a biopsy at this time would be likely to have positive results.

Prostatitis has many causes. For instance, I've heard that habitually holding back urine can cause it, though for me that's more in the hearsay than knowledge category. (Can anyone help with that one?)

I hope this has helped. I would be very concerned too, but it's too early to hit the panic button. Even if it turns out to be cancer, which I think is unlikely, there is a lot that can be done.

Jim

 
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Old 10-18-2008, 06:55 AM   #3
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Re: Healthy Male 35 yrs old, high psa and low free psa, is it prostatitis or cancer

Hi Jim,

Wow, I am blown by your detailed account and analysis as a layman. Very much appreciate it indeed!
Will enquire aboout the new PCA3 test as you have suggested, it was not discussed with me. After I had posted this note, I got a new set of odds based on the combined score of 3.5 total psa and 8.2% free psa from the urologist which he put it as greater than 30%, (per abbot guidelines apparently, ie if total psa between 2.5 and 4 and free psa less than 10 then there is a greater than 30% chance that it is cancer. There is no upper limit however). Sounds better than the originally suggested 56%.

I did ask the uro about more antibiotics and a retest of psa before a biopsy, he did not like the idea of extending the antibiotics dosage. I am seeing another uro on monday for a 2nd opinion.

Based on all the archives here, I understand that sometimes more than one biopsy will be needed to find cancer, but is it possible to find out prostatitis based on 1 biopsy? In other words based on 1 biospy is it possibel to conclude if it is a case of prostatitis or cancer?

This whole waiting game is turning out to be very stressful, a repeat biopsy may just prolong this waiting game, but I guess a repeat biopsy should not be my concern now (1st things 1st) However I feel good after reading your post and offering hope. Thanks very much Jim.

I will keep updating. God Bless!

 
Old 10-18-2008, 08:13 AM   #4
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Re: Healthy Male 35 yrs old, high psa and low free psa, is it prostatitis or cancer

Quote:
Originally Posted by givemehope123 View Post
Hi Jim,

... I got a new set of odds based on the combined score of 3.5 total psa and 8.2% free psa from the urologist which he put it as greater than 30%, (per abbot guidelines apparently, ie if total psa between 2.5 and 4 and free psa less than 10 then there is a greater than 30% chance that it is cancer. There is no upper limit however). Sounds better than the originally suggested 56%.
Your, welcome! I'm glad I could help, and I hope you get some other replies.

Going for another opinion is wise as prostate cancer is such a complex field and doctors tend to be strong in some parts but not others, unless they specialize in it and are unusually tallented.

Thanks for the details behind the prediction, and I'm glad you now have a lower number. However, even that lower number does not allow for prostatitis, so your true odds of prostate cancer are probably even lower.

Check out the recent post by drswc. He has had a similar experience, but had a biopsy that found minimal cancer. By the way, in checking spelling of Dr. Babian's name for my reply, I learned he is a co-author of a 2008 paper published on using the PCA3Plus test to assess the risk of prostate cancer.

Biopsies can yield information on prostatitis, but I don't know if using the extracted tissue can help pin down exactly which of the bacteria caused it. As a layman, it appears conclusive to me that prostatitis is causing at least a substantial amount of the PSA elevation if not almost all or all of it. A biopsy often will not rule either prostatitis or cancer either in or out, but it may find that either is present. As with drswc's case, both can be present.

Take care, and keep your spirits up,

Jim

Last edited by IADT3since2000; 10-19-2008 at 07:21 AM. Reason: Grammar

 
Old 10-19-2008, 04:48 PM   #5
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Re: Healthy Male 35 yrs old, high psa and low free psa, is it prostatitis or cancer

Quote:
Originally Posted by givemehope123 View Post
Hi Folks,

I am a healthy 35 yr old male.
On a recent physical my GP asked for my PSA tested after a Normal DRE.
Total PSA was 4.01 and free PSA was 9.7%. This was my first ever PSA test.
He suggested that I take Cipro for 10days and retest after another week. Did exactly that and now the Total PSA is 3.53 and free PSA is 8.2%.
I have now hooked up with an urologist and he says that based on the percentages there is a 56% chance that it could be prostate cancer.
He also said it could be nothing more than prostatitis.

I never had any symptoms of prostatitis or cancer prior to starting my Cipro.
Since I started taking Cipro and completed the doze, I notice that I have been running to the restroom very frequently especially in the night time (4-5 times) in the last 3 weeks.

Urologist has scheduled a biopsy next week. The whole month has been very stressful and I am very worried. Got a wife and 2 young girls.
Had anybody been in a similar situation at my age, I did not seem to find any body in their 30's having prostate issues. Any thoughts people?

 
Old 10-19-2008, 04:50 PM   #6
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Re: Healthy Male 35 yrs old, high psa and low free psa, is it prostatitis or cancer

My Urologist told me it takes 3 weeks of Cipro to get rid of a Prostate Infection of Prostritis. My first doctor had me on 10 days. This he says is because antibiotics have a hard time getting into the prostate tissue. The fact that your PSA went down after just 10 days of Cipro is a positive sign.

Last edited by builder; 10-19-2008 at 04:51 PM.

 
Old 10-20-2008, 10:22 AM   #7
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Re: Healthy Male 35 yrs old, high psa and low free psa, is it prostatitis or cancer

It is your free PSA value behind your urologist's assessment of 56%change of cancer. Also, a value of 3.5 of 4 total PSA is high for one your age.I had a PSA about same as your's and my free was 10%. I had a biopsy and found to have a small focus of cancer. For sure you should get your biospy. Good Luck

 
Old 10-20-2008, 02:37 PM   #8
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Re: Healthy Male 35 yrs old, high psa and low free psa, is it prostatitis or cancer

Hi All,

Had been to seek a second opinion this morning with another urologist.
He performed a DRE and said the right side of the prostate appeared to be slightly harder than what it should be. This suggested to him that it could either be a cancer or inflamation. He said a biopsy was imp to find out any signs of cancer. Prostate size was determined to be 19 cc (1cc smaller than normal, but apparently not a concern)

He did perform a 12 core biospy, it did pain a bit and I am bleeding quite a bit. The ultrasound also apprently revealed a suspicsious portion of the prostate. He said based on that it could be 30% cancer, 30% inflamation and 40% just nothing. Again Biopsy to reveal more information.

Results to be expected in 1 week. Crossing my fingers and praying.

Jim, thanks again for your input !

Builder, how high was your psa pre-cipro? and how low did it go to after 3 weeks of taking cipro? Were you ever deteced with PCA?

Mark, can you tell us how old you were when they detected it and what was your course of action?

Thanks and God Bless!

 
Old 10-26-2008, 08:55 AM   #9
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Re: Healthy Male 35 yrs old, high psa and low free psa, is it prostatitis or cancer

I have a somewhat similar story. I am male in my younger 30's and in pretty good physical shape. Overall, I feel in great health and workout daily.

My story starts with an intestinal infection treated with antibiotics, then a battle with C-Diff this past summer which was treated and supposedly beaten with antibiotics.

Here we are now a few months later and I now have lower abdominal discomfort with gas, especially in the AM. Throughout the day this goes mostly un-noticed, as this is a very mild discomfort. The pain is not debilitating by any means.

As of the last two weeks I now am urinating more frequently (especially at night), the urine appears to have a cloudy and somewhat more yellow tint on occassion (no blood noticed). At other times my urine looks fairly clear and normal to what I'm used to. My wife says I am a hypochondriac.

I am visiting my GP this week to inquire with him about my latest symptoms.

 
Old 10-26-2008, 09:11 AM   #10
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Re: Healthy Male 35 yrs old, high psa and low free psa, is it prostatitis or cancer

Quote:
Originally Posted by gent1 View Post

...My wife says I am a hypochondriac.
...
I am visiting my GP this week to inquire with him about my latest symptoms.
Certainly takes courage to check things out- many of us go in denial when
somethings's not feeling right, so I think you're wise to have a doctor look you over. In my non-medical opinion, what you're writing about does not seem to be an indication for prostate cancer if that's any consolation.

 
Old 10-26-2008, 09:38 AM   #11
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Re: Healthy Male 35 yrs old, high psa and low free psa, is it prostatitis or cancer

Quote:
Originally Posted by daff View Post
Certainly takes courage to check things out- many of us go in denial when
somethings's not feeling right, so I think you're wise to have a doctor look you over. In my non-medical opinion, what you're writing about does not seem to be an indication for prostate cancer if that's any consolation.
daff,

Thanks for the comment. I just don't operate well when I think there is something wrong, in fact I am somewhat cranky due to the stress.

I hope your correct on the prostate opinion you gave me. I guess I wouldn't really know what the first signs are. I just know within the last 3 weeks my urine color appears to have changed at times. I also have a need to go more often and especially at night.

 
Old 10-26-2008, 01:46 PM   #12
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Re: Healthy Male 35 yrs old, high psa and low free psa, is it prostatitis or cancer

Quote:
Originally Posted by gent1 View Post

...I guess I wouldn't really know what the first signs are. I just know within the last 3 weeks my urine color appears to have changed at times. I also have a need to go more often and especially at night.
You'd be pretty young to be facing prostate cancer- and needing to go more often at night is a change most of us experience as we get older (although I think you're too young to be facing that). Might very well be an infection that antibiotics can cure- so your trip to the doctor is worth it.

It can never hurt to gain some knowledge about prostate cancer- so you might want to get a general book such as one by Dr. Patrick Walsh of Johns Hopkins. There's usually no particular signal that one has prostate cancer- it's usually found by a biopsy and that's not called for unless there is an overly high PSA reading or a rate of increase that is too high. Unless you have an incidence of prostate cancer in your family, you're probably not even ready to get started on the annual PSA test.

 
Old 10-27-2008, 04:57 PM   #13
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Re: Healthy Male 35 yrs old, high psa and low free psa, is it prostatitis or cancer

Hi All,

Got back my biopsy results today.
Thankfully the 12-core biopsy did not reveal cancer and apparently all tissues sampled looked normal. No evidence of prostatitis was found either.

I am yet to meet the doc in person to discuss the results in detail. So I dont know how to explain the high total psa and low free psa if it is not cancer or prostatitis. Can anybody explain this? I just think that perhaps they may monitor my PSA every 3-4 months and then decide on a repeat biopsy. Will keep you guys posted.

Can anybody suggest ways to decrease total psa and increase free psa?
I dont eat any red meat eat chicken and fish maybe once a week. My main diet is composed of veggies and fruits. Any supplements and nutritional available out there? I am planning on starting to drink pomogranite juice as seems to be heavily favored by this message board.

Thanks for the prayers everybody and I will keep in mind to pray for all of us out there. I am also determined to spread the awareness to others in their mid 30's to track their PSA's and DRE's.

 
Old 10-27-2008, 06:47 PM   #14
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Re: Healthy Male 35 yrs old, high psa and low free psa, is it prostatitis or cancer

Quote:
Originally Posted by givemehope123 View Post
Hi All,

Got back my biopsy results today.
Thankfully the 12-core biopsy did not reveal cancer and apparently all tissues sampled looked normal. No evidence of prostatitis was found either.

I am yet to meet the doc in person to discuss the results in detail. So I dont know how to explain the high total psa and low free psa if it is not cancer or prostatitis. Can anybody explain this? I just think that perhaps they may monitor my PSA every 3-4 months and then decide on a repeat biopsy. Will keep you guys posted.

Can anybody suggest ways to decrease total psa and increase free psa?
I dont eat any red meat eat chicken and fish maybe once a week. My main diet is composed of veggies and fruits. Any supplements and nutritional available out there? I am planning on starting to drink pomogranite juice as seems to be heavily favored by this message board.

Thanks for the prayers everybody and I will keep in mind to pray for all of us out there. I am also determined to spread the awareness to others in their mid 30's to track their PSA's and DRE's.
Are you still urinating frequently in the night? Or has that subsided back to normal.

 
Old 10-28-2008, 08:10 AM   #15
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Re: Healthy Male 35 yrs old, high psa and low free psa, is it prostatitis or cancer

Quote:
Originally Posted by givemehope123 View Post
Hi All,

Got back my biopsy results today.
Thankfully the 12-core biopsy did not reveal cancer and apparently all tissues sampled looked normal. No evidence of prostatitis was found either.

Hearty congratulations!!! While the negative biopsy is not a guarantee there is no cancer, it is a good sign!

Regarding prostatitis, my impression is that often no biopsy evidence will be found even if there is prostatitis, unless the biopsy happens to hit the right area of the prostate in one or more of areas sampled by the probes.


I am yet to meet the doc in person to discuss the results in detail. So I dont know how to explain the high total psa and low free psa if it is not cancer or prostatitis.

Can anybody explain this?

Could still be prostatitis, which would explain both findings. There is some possibility, fairly low I think, that there could be cancer.

I just think that perhaps they may monitor my PSA every 3-4 months and then decide on a repeat biopsy. Will keep you guys posted.

That's a common approach, but if it were me, now that we have the PCA3Plus test available, that would sure be my choice!

Can anybody suggest ways to decrease total psa and increase free psa?

Either of the mild drugs finasteride or Avodart would do that, and finasteride has been proven to have a preventive effect, safely decreasing the incidence of prostate cancer by 30%, as I understand it as a non-medically trained layman survivor. (That's up from 25%, based on more detailed analysis and longer follow-up from the original clinical trial.) Avodart probably has the same effect, in fact it appears to be even more effective, but trial results are still a year or more off. However, your main problem may well be a stealthy form of prostatitis, and that may raise the PSA and lower the free PSA until it is effectively countered, which can be very difficult.

I dont eat any red meat eat chicken and fish maybe once a week. My main diet is composed of veggies and fruits.

Avoiding red meat (including pork) appears sound because of its arachidonic acid problem (and saturated fat, etc.), so that's good. Chicken appears to be okay, with fairly low arachidonic acid and some apparent offsetting benefits for us. Fish that are low on the food chain appear to be a wise choice, and eating them several times a week is advised by a number of experts. I do that and also consume 4,000 IU of good fish oil daily, following the advice of Dr. Charles "Snuffy" Myers and other experts.


Any supplements and nutritional available out there? I am planning on starting to drink pomogranite juice as seems to be heavily favored by this message board.

Lycopene (mainly from cooked or processed tomatoes) appears to help us prostate cancer patients, as does good quality vitamin D3. (Ideally, we should be tested for 25-hydroxy vitamin D and strive for a level from 50 to 80 ng/ml, staying below 100, as I understand it. Dr. Myers says that 95% of his new prostate cancer patients are deficient in vitamin D.

High quality pomogranate juice or a high quality pomogranate extract capsule look like a wise choices. Light and heat apparently destroy much of the key elements in the juice, so the value of some of the unrefrigerated juices on the store shelves is questionable. The key study that generated enthusiasm was done using POM Wonderful brand juice, a juice that is sold refrigerated. Material for extract pills and possibly also foods made with elements carefully studied by the same research team and at least partially validated is marketed by the Pomela Corp. One brand of extract capsule using their material is distributed by Life Extension Foundation. That's the one I use, but there are probably others. I like the extract because I don't get the normal amount of sugar that is a constituent of the fruit juice.

Yesterday I would have recommended selenium and vitamin E, especially E with gamma tocopherol, but today I'm not so sure since the NIH just suspended the SELECT trial for those two supplements. I just launched a new thread about that.

There are several books that are good about diet, nutrition, supplements, exercise and stress reduction for prostate cancer patients. The one I especially like is the recent one by Dr. Myers, "Beating Prostate Cancer: Hormonal Therapy & Diet." You do not have to be on hormonal therapy to get a lot out of the diet sections of the book.

You did not mention exercise or stress reduction. Both appear to be helpful for prostate cancer patients. Strength building resistance exercise appears particularly helpful. I'm thinking both would be important in trying to avoid prostate cancer as well as for those of us who have been diagnosed.


Thanks for the prayers everybody and I will keep in mind to pray for all of us out there. I am also determined to spread the awareness to others in their mid 30's to track their PSA's and DRE's.
Amen! I have attended church almost every Sunday through almost all of my life, and I'm convinced our spiritual investments really pay off when you are diagnosed with cancer or are trying to avoid it.

Congratulations again, and good luck in tracking down the cause of that PSA and free-PSA!

Jim

 
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