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Old 09-02-2009, 08:38 PM   #1
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neck shoulder fatigue

I have been dealing with issues of headache, then neck problems for about 6 months steady now. They thought migraines, then finally did MRI. It said
left-sided disc herniation at C5-C6
-- another small one noted at C6-C7
-- a bulging disc also noted at C7-T1, this is a near lower neck area, and definitely could be contributing to her overall symptoms and headache

I have had a shot in my spine - which probably helped relieve the headaches, but now I am still left with fatigue of the shoulders and mid upper back and neck when I do much - not so much pain, unless I push too hard, then I get a headache. To complicate matters, I was also diagnosed recently with a torn rotator cuff, which I will wait until Christmas to have operated on. I am an art teacher in college, and of course my classes are long and require work with my arm. I am exhausted after one drawing class - my neck and shoulders feel like I have been pumping iron for two weeks. I am going to try pt again (although I don't think he believes there is much he can do until after I have my operation). I tried one muscle spasm pill and it made me feel terrible - exhausted. I wonder if the fatigue in my shoulders and neck is the spine, or is it the compensation my muscles do for using my left hand so much because of my rotator cuff? I have never dealt with spine issues before so I am not sure what is what.

 
Old 09-03-2009, 02:29 PM   #2
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Re: neck shoulder fatigue

Hello - I'm not sure if this will be helpful, but what the heck. I was diagnosed with disc herniation at C5/C6 with severe left forminal stenosis in July. For years, leading up to this, I had really annoying stiffness and pain in my left neck/shoulder. I thought this was a normal due to stress at work, working on a computer, bad posture, etc... Imagine my surprise when I had a horrible painful episode in the the middle of the night in July and needed to go to the emergency room. So since then, I've been out of work resting up my neck, and now recently going to physical therapy. The rest has definitely helped, but is not a long term solution since I need to return to work and life at some point. So it's definitely possible the neck and should symptoms are a result of your cervical issues. I do find myself now overcompensating with other muscles since I'm left handed and have lost some strength .

 
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Old 09-06-2009, 05:30 AM   #3
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Re: neck shoulder fatigue

Red, It sounds like you have alot going on & I imagine until you have that shoulder done its going to be hard to tell exactly whats causing what. I had both shoulder & cervical also, but had the decompression of the shoulder & not the rotator cuff. The shoulder definantly contributed to the pain & discomfort but the majority came from the cervical.

I did not know this till after the shoulder surgery was completed & the problems remained. It does sound like you may very well need a muscle relaxer & you need to know there are several out there to try. Like you I could not take the first couple the doctors prescribed. One made me to tired & one did nothing at all.

When we are in pain or discomfort we tense up & the muscles are already aggravated from the existing problems. I strapped on ice & moist heat nearly every morning driving to work, not comfortable. Some respond to one over the other. For me it was ice. I had the shoulder & neck surgery 11 months a part. Once you get the shoulder done & recovery you'll be better able to tell where you stand with the neck. I had the headaches on & off from the start & then daily right before surgery with no relief from anything. IMO the headaches were the toughest to deal with. These headaches were alot like migraines.

Have you spoke to a surgeon about your MRI report & does the the report mention nerve involvment?
I put the cervical surgery off for just under a month & did not expect it to get much worse, but it did. The headaches were so severe I ended up in ER & never thought it could get that bad. Its not my intention to scare you but I dont like the thought of anyone going through what I did. It was not worth it. knowing the herniations are there limit your activities. I imagine you already have with the shoulder involved but just in case try not to lift or do anything that may risk your cervical while waiting for the shoulder surgery. I went on with attempting to do everything with my one arm but at the time did not know about the cervical problems.
I tried to paint & do things around the house before my cervical fusion, anticipating not doing anything after for a long while. It was probably the dumbest thing I could have done.

Be careful putting surgery off & just to be on the safe side ask if cervical surgery was needed if there is a time frame to wait between the 2 surgeries. This is not to say you'll need the cerivcal but better to be safe then sorry. Usually doctors try everything possable before cervical surgery, hopefully you get lucky & get relief from another source of treatment. Since your waiting for the shoulder surgery perhaps you can start addressing the cervical. Good luck & take good care, Sammy

 
Old 09-06-2009, 08:39 AM   #4
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Re: neck shoulder fatigue

I have not been told exactly what the mri means, but here are what looks like the impt points.
Findings: There is straightening to miinimal reversal of the normal cervical lordosis apexed at the c5-6 level where there are degenerative endplate changes, narrowing of the disc space and mild disk dehydration Th bone marrow signal is otherwise unremarkable. There is maintenance of the vertebral body h=eights, the Craniocervical junction including tje c1-2 articulation is unremarkable. The cerebellar tonsils are in normal position The cervical spinal cord is normal in signal intensity but its caliber is indented upon ventrally at the c5-6 level secondary to disk disease described below.
at c5-6 there is a leftward mild disc herniation and endplate spurring which indents the spinal cord and effaces the ventral subarachnoid space. There is also moderate left neruoforaminal narrowing.
at c6-7 there is a mild central disk bulge and posterior annular tear
at c7-t1 there is a minimal bulging of the annulus and left neruoforminal nerve root sleeve cyst vs partial avulsion.

Impression
the c5-6 mild leftward disk herniation and osteophyte complex resulting in indentation of the ventral aspect of the spinal cord and moderate left neuroforaminal narrowing.
mild central disk bulge and posterior annular tear at c6-7
Minimal annular bulging and endplate spurring with possible partial left nerve root avulsion at c7-t1. The differential includes a neuroforminal nerve root sleeve root cyst.

I have NO idea what this all means, my reg doc saw this and said it could contribute to my headaches and sent me to pain doc. I have never seen an actual doctor about the spine. I also never had problems until a several months ago - is this something that took a while to develop? I was carrying around some heavy chairs at school for part of the quarter. Is there nerve impingement?

I do agree though, I need to see what happens after the shoulder. Of course I had headaches and weakness before the shoulder, but this had increased the fatigue. I have to wait to Christmas because of funds.

The muscle relaxer I took once was skelaxin and it made me feel like I was walking though mud - and mildly sick. Someone said I should give it another try, but I don't know.

Thanks

Last edited by redjb7; 09-06-2009 at 08:44 AM.

 
Old 09-07-2009, 02:14 PM   #5
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Re: neck shoulder fatigue

redjb7- I just wanted to share that I thought that I had rotator cuff injuries in both of my shoulders and had even been tested and treated for them by my PCP. Then, I had severe pain, numbness and radiculopathy in my left arm and after the MRI was sent to a neurosurgeon. I ended up having ACDF C5-C-7 surgery in April. Immediately after surgery the pain, numbness and radiculopathy was gone. Later, when I could sleep more comfortably, I realized the my shoulder pain was all gone. I hadn't been able to sleep with my arm above my head for probably 8 years (on either side.) Now I can sleep on either side and with my arms above my head. No more shoulder pain which we thought was rotator cuff!!!

I've been noticing on quite a few of the strings that people have many times mentioned both rotator cuff and ACDF surgeries in the same post. I'm not a doctor but it sure seems that some of the pain that is attributed to rotator cuff issues must instead be due to the C-spine problem.

Hope you don't mind me sharing my observation.

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Old 09-07-2009, 05:50 PM   #6
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Re: neck shoulder fatigue

Thanks for your replies. I do think it is probably a mixture of my neck and shoulder. They know that I have a tear in my rotator cuff which they need to operate on. I guess I will see what happens after that.

I couldn't tell whether my nerves are infringed in the mri of my neck- can anyone understand what was written in what I just posted?

 
Old 09-09-2009, 05:20 AM   #7
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Re: neck shoulder fatigue

You will be much better off with a good pain managment doctor. Hopefully with some diagnostic testing he will be able to determine what level is causing you the most pain, although your MRI report indicates pretty well where your problems are.
I'm not good at interpetting MRI reports but there are a couple people here that can explain things better I will bring your post to Feelbads (Marcia) attention, she can be extremely helpful with these things.
Yes it does indeed sound like there is nerve involvement. I am wondering from my own past experiance if its the spinal cord involvement thats causing the headaches.
When my problems first started I did not experiance alot of pain but had other symptoms. The pain came later & first appeared in the shoulder/chest area. It was extremely confusing to me the doctors.

I had cord involvment at the C5-6 level also & suffered awful headaches toward the end right before surgery. I had some nasty headaches but not near as bad as the ones that occurred at that time. Both my doctors did not think that level was causing my headaches until the cord involvement was found during surgery. The C6 was also causing problems to the C7 which already had some minor damage that did not appear on the MRIs. Once the C5-6 level was fused it took some pressure off the C7. It can indeed be confusing & IMHO I dont think any doctor can be completley sure of whats going on in there until surgery no matter what test is done. No test is 100% accurate. I can say once the pressure was off my cord the headaches improved greatly. I get some nagging ones at times but nothing like they were preop.
You can also look up dermatome charts & that may help you figure out what level is causing what. These are a huge help to me, as the charts show what level effects what part of your body.

Good luck with pain managment & god bless, Sammy

 
Old 09-09-2009, 07:38 AM   #8
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Re: neck shoulder fatigue

Thanks for your reply. Who should I go to about this? A doc just sent me immediately to the pain doc (who gave me the shot), but I wondered if I should have been evaluated by another kind of doctor. I don't know who treats spines. I went to one neurologist who just insisted I had migraines and handed me migraine meds - didn't do an mri of my neck. They didn't help.
I think maybe I should do my shoulder before I think of any operations on the neck. I am just waiting if I can stand it until Christmas, because I am an adjunct instructor - no time off no sick leave no insurance with them ( I PAY for my own). It is getting very difficult to cope with the back to back classes (six straight hours using my arm, et - art teacher). I need to figure out what doctor can help me get through til Dec. I have been going to PT - that helps a little maybe - but I am having trouble with good sleep - so I am exhausted all of the time.
I don't like pain pills, which all docs have offered me. Going to try the muscle relaxant the doc gave me tonight - I felt bad when I took it before, but something has got to work.

 
Old 09-09-2009, 12:38 PM   #9
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Re: neck shoulder fatigue

Hi redjb7

Just to let you know I also had the symptom of headaches in my case with C6/C7 bulge, again at the end when things were really bad just before surgery. I also had tingling and numbness in the left side of my face and was told that this was not on the nerve route. Funny how this miraculously disappeared also when I had the surgery!

I know there are a couple of different muscle relaxants that you can be prescribed that work in different ways. Some of them can make you sleepy which might be a short term help if you are exhausted from not sleeping.

Bobbyboo x

P.S. Why are you against painkillers? Your muscles are in spasm against the pain and injury and can relax out a lot if the pain is relieved.
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Last edited by Bobbyboo; 09-09-2009 at 12:43 PM. Reason: Adding PS

 
Old 09-09-2009, 02:59 PM   #10
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Re: neck shoulder fatigue

I guess I am afraid of pain killers. I have had a few narcotics in the past (for teeth and gum things) and they always made me sick. I use motrin, but that is it. What kind of pain killers are safe? AND what kind of pain killers can I use and keep my wits about me when I am teaching for six hours and have to drive before and after the class for a while? At this moment, though I am so tired from not resting well and the spasms that I am about ready to try anything. I am going to try Skelaxin the doctor gave me one more time.

I ran home from teaching this afternoon and hit my neck with ice! What a relief!

 
Old 09-10-2009, 11:23 AM   #11
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Re: neck shoulder fatigue

Bobbybo,
After you PS I thought about it and decided to try the Skelaxin before I went to bed last night. I slept more soundly than I have in some time - and I had no ill effects. I am still a little tired this morning, but I have some hope that the muscle relaxant will be of some help to get me through. Now I just have to try it during the day and see if it will make me too tired to function. Is it addictive? Thanks for giving me the incentive to give it a go- what you said made sense!

 
Old 09-11-2009, 12:57 AM   #12
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Re: neck shoulder fatigue

Thats great news - a night's sleep is so important to our functioning the next day. I don't know anything about Skelaxin - maybe someone on this board has tried it and can advise. I am/was on different muscle relaxants as the UK can sometimes prescribe differently than the US and there are different brand names so it can be confusing.

The only downside is, I don't think there are any drugs without some side effects and you often have to weigh up which is worst: the pain/incapacity or the fatigue and/or nausea etc. Hope you continue to get some relief with minimal/no side effects and are able to get through your nights and days with some comfort and relief in the meantime.

Take care,

Bobbyboo x
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Old 09-13-2009, 06:11 AM   #13
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Re: neck shoulder fatigue

I do the same & try to hold off & take the mucsle relaxer at night. At times I have to give in & take 1/2 during the day.

Lets back up here, as I wanted to ask what doctor ordered your MRI?

I would say & this is only my opinion, that your a little more complex, as you have the shoulder & the neck. I am also going to assume one could effect the other as the muscles could be effected by both the neck & the shoulder. When we are in pain we tense up & that alone brings on problems or can enhance existing pain.

Your PM should be directing you as far as your neck goes. Really the only doctors you could see would be ortho or nuero surgeons.
A good Pain managment doctor if theres no surgery or until your waiting to discover if surgery is needed. Your PM should be trying different things with you to see if any bring you relief. Pain meds are one option & there are non narcotic pain meds out there. All have side effects though & its really your decision. Some PMs dont deal with meds & some do. I fought meds & was scared to death to be on them. I really had no choice, as my vitals were being effected & I was vomiting due to the pain levels. I also was quickly loosing my quality of life. Although I strongly dislike taking any medication I know I would not make it without them.

The thing is you need that MRI gone over with your PM or a good surgeon, in detail to see what this may be causing & if your at risk for further damage.
If you think about it, the shoulder may not account for all the other symptoms & pain. Not every doctor takes the time to go over MRI reports with patients in great detail.

There may be other things you can try but as far as Muscle relaxers I believe skelaxin is on the mild side. I also think most will make you tired at first & this may not be as severe the longer you take them & your body adjusts. You could ask your doctor or pharmacist about trying 1/2 a dose. Some meds can be halfed & others cant.
Really it all depends on if this progresses or if your able to work through till surgery without trying other meds or procedures. Perhaps you can ask this PM what he can do in the meantime to help any symptoms or pain that may be coming from your cerivical.
My PM started with ESIs & nerve blocks to try to determine what was causing what. After attempting different methods of treatment he sent me off to a surgeon for a consult along with my MRI films & report. Im going through this again with different areas since my fusion.

I realize this is overwhelming & scary, trust me Ive been there. I had to go through the shoulder surgery to discover it was only a small contributer to my pain & problems.

A really good PM should be able to help you get through this or at least try.
If your worried about the neck & what it could be causing ask for a recommedation to a good surgeon just for a consult. Perhaps then you'll get a better understanding of what may be causing what & where you stand as far as your cervical. Its not saying you'll need surgery but gaining knowledge cant hurt.
As far as meds or muscle relaxers if you try any perhaps you can try them on the weekend when you dont have to worry about work so much.
Your situation takes me back to the beginning of my problems & I do feel for you. Your off to a good start as there are some knowledgable people here. Good luck, Sammy

Bobby, I wanted to say I have heard much of the same from others. Where your told your injuries are not causing certain pain or symptoms, but after surgery those problems are gone. Interesting, I think the spine is very complex & I am guessing doctors cant say 100% whats exactly causing what.

Last edited by sammyo1; 09-13-2009 at 06:18 AM.

 
Old 09-13-2009, 08:02 AM   #14
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Re: neck shoulder fatigue

hi red,sorry it has taken me a while to just get to this, i actually ahve been trying to really decipher that MRI report. mostly that one rather insane finding at the C 7 T 1 area? the ONE thing i do know about a true avulsion just working trauma for many years is that is is an actual, in almost every case, a traumatic 'pulling away from the body" type of an injury? or tearing away? this happens most often with teeth being knocked out by a traumatic blow to the face or jaw type of thing(a tooth avulsion)?

the finding you have within that one specific area of a 'possible nerve root avulsion? it would be VERY difficult to have that level of actual injury and not have the surrounding area just 'look' much worse than what you have as far as real traumatic type damage there too? its just the forces involved to EVEN avulse that type of structure would also show other types of tearing in SOME way, are ya with me so far here? i am thinking what the rad gave as the 'differential Dx of a possible 'cyst" in that nerve root sleeve may be much more accurate than the avulsion, just based upon what i mentioned above?

while i was wandering thru info on an nerve root avulsion, it DID state in most of the info that in order to really tell just what THAT particular finding actually is, it appears that having an MR myelogram type of test AT that particular site may be the best way to truely tell just what the heck that is. but on the other hand here, what EXACTING symptoms you are really feeling and experiencing within the hand/finger area in the affected side would seriously come into play here as far as telling whether or not that nerve root is actually pulled away at all? it would show itself in the symptoms you would mostly have in the hand and fingers. any loss of innervation is just shown that way. what are you experiencing in the hand and what specific fingers are actually involved? are you having ANY symptoms in your lower torso like in the legs or feet? you just DO have definitive cord compromise at c 5-6 that could present with lower types of symptoms that would not normally be there if you 'just" only had basic radiculopathy symptoms from stenosis or herniations without cord compromise. everything would just be within that upper neck, shoulder, arm, hand/finger areas.

it really sounds like you just have ALOT of excessive bone spurring, and for some reason alot on the endplates which is also a bit more rare? the c 5-6 spurring actually sounds much more significant than the herniation actually is. from what i got from that report, it IS that spurring that is impacting your cord(along with the nerve foramen) and NOT the actual herniation there that if i remember right they termed as 'mild'?

have you consulted with at the very least a good neurosurgeon about what he or she feels needs to be done and how soon yet? its just when you have something impacting the actual cord,espescially if they find that you have myeolpathy in either leg,just kind of 'ups' the need for intervention much sooner vs waiting on this. just having that overall eval and consult with a really good neurosrugweon woulkd really give you the best possible advice as to how to proceed here.

while you DO also have the rotator injury(what is actually involved there, what areas and or tendons damaged?) in most cases,it can be kind of put on 'hold' til that c spine gets straightend out first. believe me, i like sammy ahve had botht the c spine nightmare and the rotator too going on at the same time. but my c spine mess presented first a few years before my top tendon snapped one morning in that R cuff. you just really need to find out the overall significance of both areas that have the issue then prioritize based upon the NS eval, just what seriously just needs to be done first. personally i really do think getting that c spine done first would be the best way to go for alot of reasons. just my own opinion there. the spinal cord just IS more crucial overall to not have anything impacting the central nervous system which with cord compromise already present, could get much worse since the spurring will simply continue to grow like "bone scar tissue" or something? you just appear to have ALOT of excessive overgrowth within your c spine so i am kind of assuming it could grow more quickly? just a theory based on how that crap just works.

but DO get to a good NS just so you really KNOW what you are dealing with here and what the heck that 'avulsion/cyst" thing is really all about too. i am curious as to what an actual NS would see there not just a mere rad who is pretty much 'guessing'? it may not even be either one of what the rad stated either ya know? just my two little cents here. i do hope things can get fixed here soon for you, believe me i do know how ugly those two particular areas can get and also play off each other too. please keep us posted, Marcia
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Old 09-13-2009, 09:17 AM   #15
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Re: neck shoulder fatigue

Thanks for the replies! There is alot of information to digest here - and to understand.

As far as the doc who ordered the tests - I had finally had it with the neurologist insisting the my headaches and neckaches were migraines and handing me serious medication for migraine - tried to see my regular doc - who is too busy to get an appointment with for two months ahead - so I went to a doctor I had never been to before - told him my symtoms and he ordered the mri of the neck after I pretty much told him it was the neck.
He sent me a letter online after I bugged them about the results and said a few lines about the xray - simply this could be the cause of your headaches, here is the name of a pain doctor.
I went to the pain doctor who said that my spine is pretty straight and showed me where he would inject the pain med. NO ONE EVER told me what was going on with my spine - you are the first people to give me a clue.
I am not really feeling much problem with my legs - sometimes my feet get hot and a little buzzy - but I am pretty sure that is an effect of the low dose med for high blood pressure they put me on -My hands have really had no problem - sometimes my arms ache - shoulders ache often - and neck is the worst.
I have to reread what you have said. I didn't see the part about the bone spurs (because I don't understand the language). The reason my shoulder tore was for the same reason.
So from reading the xrays they ARE saying that this is impinging on my spinal chord? Is there a possibility that this is not so serious?
I agree - somehow in this horrible place for docs I have to fine one that is decent to give me the lowdown on what is going on.

What doesn't make sense is that this should all start at once! I did move chairs around in the classroom at school last semester - and they were heavy - could this have come from that, or is this something that has happened over a period of years?

Thanks so much for the information and time!
Jane

Last edited by redjb7; 09-13-2009 at 09:18 AM.

 
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