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Old 11-26-2007, 11:25 AM   #1
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I have been diagnosed with a Cervical Myelopathy

I have been diagnosed with a Cervical Myelopathy. This apparently is caused by minimal posterior bulging at C3/4, and C4/5, a moderate right lateral extruded disc, causing moderate right lateral cord compression and severe right root impingement, at C5/6. Mild degenerative disc narrowing, and posterior osteophyte formation, and mild thecal sac compression at C6/7. My symptoms seem to baffle the Dr's ( I've seen 4 NSs, so far ) My symptoms are;. Muscle twitches (they called them "fasciculations").left side weakness/awkwardness, (diminished dexterity in lefthand), poor balance, stiff gait..cannot run at all, hyperreflexia, and hightened "startle response"--the slightest unexpected noise can make me jump....I have no pain. 3 of the NS's said surgery is necessary, the 4th ordered a CT scan of c-spine to check the bone spurs...will comment on possible surgery after test results are in... I'm sure I'll need surgery, the problem is, what type ??..I'm leaning toward artifical disc ( one NS said I was a good candidate for this )...But my main question to you is, do these symptoms/diagnosis make sense to you ?? I would appreciate your thoughts. Doug

Last edited by moderator2; 11-26-2007 at 11:32 AM. Reason: please do not post to specific members - write a relevant title line - topics are open to all members

 
Old 11-26-2007, 04:20 PM   #2
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Re: I have been diagnosed with a Cervical Myelopathy

YES - your symptoms sound similar to mine - check my older posts. I also had NO PAIN which meant I procrastinated on getting my walking (gait) issues checked out - by the time I was diagnosed (spinal stenosis) C4-C7 it was pretty much considered an emergency (I had surgery 3 weeks from diagnosis). I even saw a chiro who reviewed my MRI and said yes I needed surgery. At least two years ago artificial disk was not a choice and I was told the few sites doing it would only do one level. I opted for the "older" procedure of cervical laminectomy (they go in from the back, clear the bone spurs, etc and make more room for the cord to move) - its a little more difficult to recover from because the large muscles are cut but it really wasn't bad. Most posters on this board have had ACDF which is from the front and invovles removing the disks - my disks weren't removed. I thought at the time it was a more logical choice (doc said can always fuse later if needed) and I would make the same decision again - that said I am not 100% better 2 years later but I don't know if going ACDF would have made a difference or if I just waited so long that the spinal cord didn't totally decompress. I am significantly better than before suregery but I still have a gait issue and minor tremors on my right side. Hang in there while making a decision.

-Gloria

 
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Old 11-27-2007, 08:11 AM   #3
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Re: I have been diagnosed with a Cervical Myelopathy

wow,now thats a little insane.do you have numbness in that c 4 dermatome area?i would think considering the severe compression that you would have at least some level of actual numbness going on from just that alone?have they ever done an actual EMG and nerve conduction study just to see how much compression is actually there and how the nerve flow is with the other problem areas?in your particular case,this would be very highly reccomended just to see where you are at here with your actual nerve flow.
the one thing that makes your situation a bit more emergent,considering that you are not having pain here,is the myelopathy.your cord IS being affected to the point of it being damaged,and causing symptoms.that is what myelopathy is basically.i have myelopathy in my legs caused by the damage in my cord.if the area of your spinal compromoise has not gotten to the myelomalacia point yet,thats a good thing.this is a softening or granualizing of the cord that takes place when part of the cord tissue "dies' from constant contact or compression with usually part of a disc of some other fragment.you don't want to get to this point.while certain symptoms of myelopathy can be reversed to a degree,myelomalacia cannot.

i don't get the symptomology here either.your NSs must really be scratching their heads.your symptoms are pretty crazy when compared to the areas of affectation.the no pain thing?in that,considering how bad certain types of radiculopathy can be,you are a bit lucky there.it can get pretty ugly with severe compression of any nerve.i am wondering just how much actual flow that c 4 actually has in it?an EMG really IS needed to determine what is still being fed and what could be too 'closed off' at this point to even be sending signals.if none of your docs have actually done the EMG yet(which kind of shocks me if they haven't)you DO need to have this testing done just to see what still has flow and how much.

as far as using the disc replacements,i have never gone there myself and have heard both good and bad things about them,kind of like with alot of outside things being placed into our bodies,ya know?that decision is kind of up to you.the two things as far as what i read in your post that need the most attention right now?your cord compromise needs to be lifted,and that severe c 4 compression needs to be relieved soon before the nerve actually dies.but you definitely DO need that EMG just to see whats still flowing there.

if you could post the summary part of your MRI it would be a bit more clear as to what it saw.how long ago was your last MRI done,and was it done with contrast?

personally just having cord damage myself,reading some of the symptoms you are currently experiencing,it would appear you are actually having alot of just the 'cord' related symptoms going on.the myelopathy?hyperreflexia is a biggie as far as myelopathy goes.this also affects the startle reflex too.you could also have some level of sympathetic nervus system involvement going on to some degree as well just based on where your affectations are,lateral?this is where the SNS chain runs down the spine on the outside of the spinal column.but it comes out the lateral side of the cord first to get there,you know what i mean?have they said anything about you having "clonus' in either leg?let me know whether or not you have actually had the EMG run,if you haven't you NEED to have this done before any surgery gets contemplated.your docs just really need to know this info.this would just give them very specific info on the nerves themselves and what is okay and what ones are having problems just by testing the nerve flow itself,and the muscle innervation.i wish you lots of luck with this.please keep us posted on how things are going.marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 11-27-2007, 09:41 AM   #4
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Re: I have been diagnosed with a Cervical Myelopathy

Marcia--

Thanks for your detailed and caring response--I neglected to mention, that I DID have an EMG....the "IMPRESSION" from the report is as follows;
Prolonged left meian F wave, raise the possibility of left C7 radiculopathy.
Few fasciculations observed in the upper arms muscles, otherwise normal EMG including the tongue. There is no electrodiagnostic evidence of ALS at this time.
I also had a SEP done the IMPRESSION ;
This study is consistant with peripheral neuropathy or brachial plexopathy on the left. Central conduction velocities are within normal limits..
There you have it----I'm not sure what all of that means...the NS's seem to be confused that my weakness is on the left side.... I am scheduled to see the Neurologist again on Dec. 10th (tried to get it moved up, to no avail ) I will probably have another EMG. and SEP to compare to the first. In the mean time I am looking for a NS in NY or L.I., that takes BlueCross. Maybe I'm being too picky, but I want one with TONS of experience, at a major hospital.
This site has been extremely helpful, thanks to people like yourself that take the time to post, and share knowledge...so Thank-you very much...............Doug

PS--here is the summary of my MRI ;
Moderate right sided extruded disc, C5-6 moderate right lateral cord compression and severs right C6 root impingement is seen.
Mild posterior bulging disc annuli and bony productive change, C3-4 and C4-5. Mild bilateral foraminal encroachment is seen at both levels.
Mild posterior ridge, C6-7 slightly more right sided, causing mild right C7 root impingement.


Thanks again Marcia, and thanks to "Sunshine" for her response--you two have been very helpful...

Last edited by Braveheart07; 11-27-2007 at 10:53 AM. Reason: need to add more info.

 
Old 11-28-2007, 07:31 AM   #5
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Re: I have been diagnosed with a Cervical Myelopathy

that is just tooo wierd.i did expect more pertinent findings in that EMG.to have actual compression but no hard EMG back up findings is just crazy,or numbness?i am going to give you the best possible advice here consdidring how crazy your situation is?what i did,only becasue i had something in my cord that two other NSs really did not actually understand,was i went to the U of MN here in MN just to have a consult with the head of neurosurgery there,wow did i ever find out ALOT about this glob of blood vessels inside my cord that my other two NSs were just clueless about.if you live anywhere near,and i mean even within a few hours drive,of a good university type teaching hospital,that is where i would head to if iwere you.really.they just see so much more of the more 'off the wall' types of neuro problems there and KNOW what certain signs and symptoms actually indicate.i was just amazed at how much differently this head of neurosurgery treated me and my cavernoma over two other supposedly highly knowledgable NSs.the other two i had seen really didn't seem to get the overall gravity of my situation and it was kind of minimized by them?this doc also informed me that my cavernoma had actually bled,twice,and was now considered an 'active' bleeder.the other two NSs knew this but never actually told me that it had bled in my cord at all.go figure.that really ****** me off.i needed my cav out or the next bleed,which he said was going to be sooner vs later becasue it was just active now,would have paralyzed me as i was rapidly running out of just plain old cord space.the next bleed i had would have just completely cut off the rest of that space.kind of important things to leave out ya know?

but the overall difference in just plain experience and knowledge of my condition,well the U of MN was the place i was supposed to actually end up for the best possible consult.i really do think considring your situation,you really DO need this level of knowledge and expertise too ya know?the teaching hospitals are just soo much more on top of things since they are teaching all the brand new little future NS who will be roaming around one day.you get more of a team approach to your overall care which i really liked.the more opinions the better.you also have the benefit of many different NSs all looking at your particular case too.i just feel,based on my experience and some others at this same U i went to that this really would be your best bet as far as finding out what the hell is actually going on inside you right now.your symptoms are just so not normal as far as fitting your actual affected areas like they should be,thats just crazy really.

the thing about going to university type hospitals is most ins will cover a consult there since they are a different type of medical facility.the U was not in my ins plan but they did cover it after my primary called the ins co on my behalf.i was desperate at that point and needed the 'right" info.check around and see what options you have availiable top you in your area.this IS what i would do if i were in your shoes right now.hopefully you can find the right NS for your proper Dx and what to do about it.please keep me posted as to what you find out,K?good luck HM,marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 11-28-2007, 12:20 PM   #6
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Re: I have been diagnosed with a Cervical Myelopathy

Marcia--

Thanks again for your response...I really appreciate your time....I was leaning towards Columbia-Presbyterian Hospital in NYC....it is a teaching hosp. and ranked #3 in the country for NS....I can't find anyone to take my insurance there---yet. I will keep looking, and researching, and will get this all figured out, just have to be persistant, and positive. I don't know the full extent of your situation (I'm still a "newbie"), but I hope you are feeling well, and continue to do so.

Thanks again, very much.................................... ..Doug

 
Old 11-29-2007, 04:33 AM   #7
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Re: I have been diagnosed with a Cervical Myelopathy

Thanks HM.if this really is the place you feel you need to be going to then by all means,push it to the freaking wall with your primary doc.this type of situation is where you really do need your primary to try and work with your ins co (and your referral person at his office)in order to get you to where you will recieve the best possible care for your particular medical problem.this is just part of your primarys job.advocating for his patients.if you get the back up from your primary you would be really amazed at how far they can push things for you.mine has been amazing with all of the ongoing medical nightmares i have had to deal with.i really don;t know where i would be without his support thru all of this.just lay it all on the line with him and tell him if i cannot get there to get the 'right" help i don;t know what i am going to do here,which is kind of where you are at,you know what i mean?persistance in the medical world generally will pay off in the end.people just need to know what your true needs are.good luck and please keep me posted.Marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 11-29-2007, 11:51 AM   #8
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I need your advice..

Hi, I'm new to this (fantastic) board, but I've read some of your posts, and am impressed with your knowledge. Maybe you can shed some light on my situation that has baffled 4 NS's here in NY. Here goes: I am 46 years old, and a few months ago noticed muscle twitching(found out these are called fasciculations) in my left arm. A few days later I tried to run, and was shocked to find that my left leg wouldn't move as fast as my right..I was limping like I had hurt my leg...only I didn't, and had no pain, just a clumsy/awkward gait. I saw a Neurologist that diagnosed "Cervical Myelopathy", and I had MRI's of my C-Spine and Brain. The brain was normal but the MRI showed bulging/herniated disc(s)...the official "Impression" is;
MODERATE RIGHT SIDED EXTRUDED DISC,C5-6. MODERATE RIGHT LATERAL CORD COMPRESSION AND SEVERE RIGHT C6 ROOT IMPINGEMENT IS SEEN

MILD POSTERIOR BULGINGDISC ANNULI AND BONY PRODUCTIVE CHANGE,C3-4 AND C4-5. MILD BILATERAL FORAMINAL ENCROACHMENT IS SEEN AT BOTH LEVELS

MILD POSTERIOR RIDGE,C6-7, SLIGHTLY MORE RIGHT SIDED, CAUSING MILD RIGHT C7 ROOT IMPINGEMENT.

I was told to consult NS's about possible surgeries...so far I've seen 4..while they all think surgery is necessary, they are all confused as to why I am experiencing LEFT SIDED weakness, when the bulging/herniation is on the right. Also, I have NO pain, just a slight tighness when I turn my head all the way to the right. I also saw a 2nd Neuro, who was "puzzled", and said the symptoms don't match the MRI (this was at Columbia-Presbyterian Hosp, and he is the director of the ALS dept.--he so far ruled out ALS) the last NS I saw..has done over 3500 spine surgeries, and he to wasn't sure of the exact cause of my symptoms...he ordered a CT Scan to see if more bone spurs were present than the MRI showed.....The CT SCAN impression;

RIGHT PARACENTRAL DISC OSTEOPHYTE COMPLEX WITH MILD EFFACEMENT OF THE VENTRAL SUBARACHNOID SPACE AND MILD RIGHT NEURAL FORAMINAL STENOSIS AT C5-6

LARGE RIGHT PARACENTRAL DISC OSTEOPHYTE COMPLEX WITH MILD EFFACEMENT OF THE SPINAL CORD AND MILD RIGHT NEURAL FORAMINAL STENOSIS AT C6-7

RIGHT UNCOVERTEBRAL OSTEOARTHRITIC SPURRING WITH MILD RIGHT NEURAL STENOSIS AT C4-5

SMALL RIGHT PARACENTRAL DISC OSTEOPHYTE COMPLEX WITH EFFACEMENT OF THE VENTRAL SUBARACHNOID SPACE AND MILD RIGHT NEURAL FORAMINAL STENOSIS AT C3-4.

Give it to me straight NECK.....what is going on ???

Thank-you for your time----you've already been a great help with your previos posts. Hope you are feeling well...............Doug

Last edited by moderator2; 11-29-2007 at 05:07 PM.

 
Old 11-29-2007, 02:05 PM   #9
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Re: I need your advice..

Doesn't look like herniations, just arthritis and narrowing. Have they said the word, herination?

Last edited by moderator2; 11-29-2007 at 05:08 PM.

 
Old 11-29-2007, 05:00 PM   #10
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Re: I need your advice..

Hi Hittman, sorry you are having trouble. Before I give you my view, there is a person on this board called Back in the Saddle (we fondly call Bits) and if I remember correctly, she has an unexplained opposite side reaction as well. Read some of her old posts and maybe she will see this and chime in.


Those pesky MRIs, dr's try to correlate the symtpoms exactly, but remember they are taken with you lying down in a static state and that's not how we live day to day. The body in motion could actually present a different picture. Wouldn't it be great if they had ALL the answers!

From what I can tell in my layman understanding, you have

1. Lots of arthritic changes going on. They can do some surgery to open up space, but be aware that this doesn't stop arthritic changes from continuing, so best case is to stop any bad things from happening by cleaning this stuff up best they can.

2. Neural foramen, I assume you read about this, but this is common to be narrowed by bony growth or disc material pushing into that space. Usually though this kind of narrowing produces worse arm symptoms. Consider yourself lucky that you don't have bad arm pain.

3. That extruded disc could be a possible explanation for the opposite side symptoms. Sometimes they create disc fragments and they migrate to other places in your spinal canal. I had one that absolutely did not show up on the MRI. The term "extruded disc" is used to describe the situation where the nucleus pulposus actually moves outside of the disc into the spinal canal, even tiny little fragments can wreck havoc.

4. I would put money that C6 is causing those faciulations.

5. You have lots of places where the thecal sac is effaced and they say you have compression. I am guessing probably worst at the spot where C6 nerve root is connected to the cord. Creating double whammy, nerve root and cord compression at the same spot. Electrical signals gone haywire! Any time the cord has compression, you can expect some really odd symptoms. The lower roots cervical roots are most likely to also cause downstream problems. Pressure on the spinal cord at any location can cause problems with the bowels /bladder, changes in the way you walk, trouble with fine motor skills in the hands, etc..

You are seeing best dr. -- neuros are best for your case. Do tell what they are recommending for surgery. Because pain isn't your chief complaint and it is neurological, they might have difficulty nailing it down to the exact, but you have enough going on that if it were me, I would proceed and not take the risk of permanent damage.

I'll think on it and see if I can find more info for you. TTYL

Last edited by PNo; 11-29-2007 at 09:15 PM.

 
Old 11-30-2007, 07:05 AM   #11
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Re: I need your advice..

Neckpatient
Thank-you for your reply...I'll raise these thoughts with the Neuro..(I see him today)..This post was ogiginally addressed to you specifically, but I see that it was edited by the moderator..I guess that's not allowed....But thank-you again for sharing your knowledge.....I hope you are feeling better, I wish I could give you advice, but that would be like the student teaching the professor..........Regards, Doug

 
Old 11-30-2007, 07:52 AM   #12
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Re: I need your advice..

Quote:
Originally Posted by moonlight View Post
Doesn't look like herniations, just arthritis and narrowing. Have they said the word, herination?
Moonlight--- Thank-you for responding....I've seen 4 NS's, the last one said the disc was probably herniated...he was confused because the symptoms didn't reflect how badly I was affected...he ordered a CT Scan to see if there were any bone spurs that didn't show up on the MRI...

Thanks again for reponding

 
Old 11-30-2007, 08:15 AM   #13
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Re: I need your advice..

i just had some quick questions for HM.on the opposite side of the side you have weakness on?how is your feeling as far as hot or cold?do they feel normal to you or feel the same to you?when the cord is being affected you can develop certain types of syndromes depnding on what actual 'tracts' are involved.i am also wondering about your cortico tract within the cord since this is what kind of dictates or governs 'gait' if that were being affected it "could' possibly be casuing you the weak leg issues.just some thoughts here.you probably have the myelopathy in the weak leg(did they say whether or not this leg has clonus?it is a muscular type of reaction that happenes when they push on your foot a certain way.it indicates myelopathy).sometimes the symptoms of the actual side invovled can be on the opposite side of the body.that is one huge thing i found out with cord involvement,they(tracts) don;t actually "run' like the spinal nerves do,its a bit more up inthe air as far as what those tracts get affected by and how much and just where.but this could be some level of actual 'syndrome' you are now experiencing just becasue of the cord involvement.but i really would like to know your reaction to hot and cold on both sides?just let me know if they feel totally normal.marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 11-30-2007, 08:24 AM   #14
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Re: I have been diagnosed with a Cervical Myelopathy

Hittman, i will be looking for your post after dr. appointment. This is a great community of people here. All willing to share their experience and information that they have learned. Cummulatively, there is quite a body of knowledge here (and support).

The internet is like a medical school and every time I have a little bit of time where I feel good to be on the computer I read, read, read. I even review medical lectures on this stuff, because I keep looking for some question to ask that might spur a resolution or treatment to my problems. Besides basic anatomy and medical information, you can access most studies, trials, and medical research papers. We can't share how to do this but there is unlimited good stuff out there by world class experts.

I have good doctors that take a lot of time with me explaining but there is nothing like reading all the specifics about how it works yourself.

I hope you have a good day today, it's been raining here and I am a little worse today, so I think I 'll just stay in my "jammies" and rest.

 
Old 11-30-2007, 12:32 PM   #15
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Re: I need your advice..

Marcia--(feelbad) (hopefully you change that name soon....."formally known as feelbad", or"used to feel bad") Thanks for your reply.....All sensations are normal--hot/cold, dull/sharp pin *****s, movements up and down....the latest is that I am scheduled for another EMG (this time a 2 hour test--can't wait) and another MRI this time with contrast....I guess the more test results, the better...I was thinking that I would decide on a surgeon, and get on with the surgery, but the Neuro, said I could wait a little longer, and see what the tests reveal......I'll just have to be patient and positive (and keep checking the "boards")
Thanks again for the response---hope you're feeling well............Doug

 
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