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Old 12-07-2010, 12:25 AM   #1
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Question New here, and confused with my splint and doctor

Hello everyone,

Let me begin with my questions, which might not make much sense until you read the rest of the situation, but... well, I know this is long, but I'm really at a loss and wondering if my experiences either sound familiar or raise red flags.

So I guess here are my questions:
1) How is my bite supposed to not drift when the top of the splint is relatively smooth hard plastic?
2) Why do I need to wear the splint for a year before I see an orthodontist to correct my bite? Why don't I just go to the orthodontist now?
3) When I wear the splint, it significantly decreases real estate in the bottom of my mouth, which is already small, so that my tongue cannot rest comfortably in my mouth when it's closed and so that I lisp when I try to talk. The doctor says I'll just get used to it in time, but it's been weeks and it's just not happening. In the interim I'm supposed to be a mouth-breathing (with yuck, dry mouth) lisper while I'm trying to have professional conversations with my clients at work? Not to mention that the splint is also thick and actually makes my lower lip stick out visibly?
4) When do I get to open my mouth as much as I used to after I popped my jaw "open", so I can yawn and sing and eat big hamburgers with wild abandon?

Sound familiar? Want to know more? Happy to oblige.

So, here's my situation: I started having problems with TMJ shortly after having my wisdom teeth removed, at which time the orthodontist had to dislocate my jaw to extract. Over 10 years later, and I've just been dealing with the popping and clicking, with moderate bruxism at night. A couple of months ago, the popping and clicking got worse and quite painful for no reason that I'm aware of, until finally one night when I tried to pop my jaw the muscles just completely locked on one side and I was in excruciating pain. I managed to get it to let go, but I haven't been able to open my mouth to what I feel is normal for me ever since then.

I went to see a doctor my dentist recommended, Dr. A, who is an oral/facial surgeon. He gave me Flexeril and anti-inflammatories and told me to come back in 2 weeks to make a cast for a hard splint.

The medication helped, but only negligibly, I was unimpressed. We made the hard splint which I picked up a couple weeks later, and it fits on my bottom teeth. It's molded to the shape of my bottom teeth, but the top of it is pretty much just flat. He uses a burr to grind down bits of the splint here and there so that when I tap my teeth together, there's no point that feels like it's getting most of the pressure. I've had two adjustment appointments now, 2 weeks apart, where he has me tap and/or lightly grind my top and bottom teeth together (ow?) on a dye strip that leaves marks on the splint where my top teeth are touching it, has me take it out, grinds it down, puts it back in, etc. When I get really picky toward the end, he tells me that my bite is just drifting (um, duh?) and I need to wear the splint and get used to it.

I know the reason for this is an improper bite - when my back teeth come together, my jaw is in what I consider the "closed" position... when I used to pop my jaw into the "open" position, it dropped and moved forward and I could open my mouth all the way, but my back teeth didn't touch at all. Now that I have it in the "closed" position all the time, which the doctor tells me is normal, I have to hold my chin when I yawn to keep my mouth from opening too far (it used to just pop open when I did this with little resistance, but now the joint just seizes up and hurts like hell) and I can feel it wanting to pop open when I try to, say, eat a big hamburger... like it's straining against the muscles or the joint or something. The doctor pretty much told me that it would never be in the "open" position again and I'd just have to get used to it. I thought I was going to cry. I'm a singer, not to mention a yawner and a hamburger enthusiast, and I cannot live the rest of my life with this not being able to open my mouth all the way ever again thing.

He told me I'd need to wear the splint for about a year, at first he told me just at night but now he wants me to wear it all the time, and he said after that he'd probably need to refer me to an orthodontist.


Thanks for your time!
--Hollybelle, the thirsty, mouth-breathing, lisping, holding-chin-up-when-yawning, big-hamburger-loving fellow TMJ sufferer.

 
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Old 12-07-2010, 08:59 AM   #2
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Re: New here, and confused with my splint and doctor

Hey there......Your story is so typical....but the good news is that there is help out there...I think you need to get another consult with someone who does Neuromuscular TMD treatments...and functional Jaw orthodontics. Surgeons try their best...to their abilities to help patients with muscular issues...but they are so lacking the proper diagnostic tests...and knowledge on the subject....frankly, I think they should just stick with surgery... Anyway...to answer some of your questions...
Flat plane splints DO NOT hold the jaw into a new position at all.....they are like a skating rink for your mandible to slide over ....constantly...putting more muscular dysfunction into the mix. Although he gave you a lower splint....it should be indexed.."bumpy" to hold the jaw into it's new resting place. It should also be worn 24/7, even while eating. The reason that you are not hitting on your back teeth are that the vertical dimension is lacking in your bite...meaning that your back molars need to be higher, to compensate for the space missing. This is done in phase 2....AFTER the orthodic has got you out of pain...and limited, or eliminated the popping...which by the way, is your disks dislocating...and causing you joint pain, etc. I highly disagree with his statement that you will have to live with this limited opening...that is simply NOT true. My doctor always treats closed bites, and successfullly I might add. I have been in phase 1 Neuromuscular TMD treatment for a little over a year now...My popping is gone...my muscles have adapted to my new jaw position...and I am almost ready for phase 2, which will be functional orthodontics and expanders to widen my arches...becasue I am so narrow. Also, I need more room for my tongue to function. Please consider consulting with someone who does NM dentistry, and FJO. Look on the great tmj doctors thread at the top of this page...maybe there is someone in your state...or surrounding states that is listed there. Consults are worth their weight in gold....I went through all the bad splints, dentistry...like you have...and finally got with someone who knows what the heck they are doing. Good luck to you.... J.

 
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Old 12-07-2010, 12:19 PM   #3
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Re: New here, and confused with my splint and doctor

Quote:
Originally Posted by Jill 227 View Post
Hey there......Your story is so typical....but the good news is that there is help out there...I think you need to get another consult with someone who does Neuromuscular TMD treatments...and functional Jaw orthodontics. Surgeons try their best...to their abilities to help patients with muscular issues...but they are so lacking the proper diagnostic tests...and knowledge on the subject....frankly, I think they should just stick with surgery... Anyway...to answer some of your questions...
Flat plane splints DO NOT hold the jaw into a new position at all.....they are like a skating rink for your mandible to slide over ....constantly...putting more muscular dysfunction into the mix. Although he gave you a lower splint....it should be indexed.."bumpy" to hold the jaw into it's new resting place. It should also be worn 24/7, even while eating. The reason that you are not hitting on your back teeth are that the vertical dimension is lacking in your bite...meaning that your back molars need to be higher, to compensate for the space missing. This is done in phase 2....AFTER the orthodic has got you out of pain...and limited, or eliminated the popping...which by the way, is your disks dislocating...and causing you joint pain, etc. I highly disagree with his statement that you will have to live with this limited opening...that is simply NOT true. My doctor always treats closed bites, and successfullly I might add. I have been in phase 1 Neuromuscular TMD treatment for a little over a year now...My popping is gone...my muscles have adapted to my new jaw position...and I am almost ready for phase 2, which will be functional orthodontics and expanders to widen my arches...becasue I am so narrow. Also, I need more room for my tongue to function. Please consider consulting with someone who does NM dentistry, and FJO. Look on the great tmj doctors thread at the top of this page...maybe there is someone in your state...or surrounding states that is listed there. Consults are worth their weight in gold....I went through all the bad splints, dentistry...like you have...and finally got with someone who knows what the heck they are doing. Good luck to you.... J.
How does a NM dentist heighten the back molars in phase II? My back two molars on the bottom on both sides are about half the height they should be from bruxing for the last decade. I believe this is probably the reason that my TMD came about.

 
Old 12-07-2010, 12:31 PM   #4
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Re: New here, and confused with my splint and doctor

Hi there.....you can either have crown work done, to add the vertical...or depending on how bad the loss of height is...you could have functional jaw orthodontics done to "pull" up the back molars to the proper posiitons. Some people have worn away too much though..and may need crowns done. OR....you could have a permanent orthodic made...such as the ones they make out of gold...it can be removed to clean..but it is another alternative. It is made again with all the NM diagnostic testing...so that you can keep the good jaw position going.

 
Old 12-07-2010, 01:14 PM   #5
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Re: New here, and confused with my splint and doctor

Quote:
Originally Posted by Jill 227 View Post
Hi there.....you can either have crown work done, to add the vertical...or depending on how bad the loss of height is...you could have functional jaw orthodontics done to "pull" up the back molars to the proper posiitons. Some people have worn away too much though..and may need crowns done. OR....you could have a permanent orthodic made...such as the ones they make out of gold...it can be removed to clean..but it is another alternative. It is made again with all the NM diagnostic testing...so that you can keep the good jaw position going.
Assuming one does get crowns to replace their molars, won't you just grind those down like you did your original teeth?

 
Old 12-07-2010, 01:59 PM   #6
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Re: New here, and confused with my splint and doctor

If your jaw was placed in the proper neuromuscular position, and your posture is addressed as well, the bruxism should get much better. I know, as far as my doctor...he gives all his patients with TMD a NM nightguard, that is made so that the back teeth do not touch...and it is fabricated with all the usual NM diagnostic tests. You can see something like he makes if you look up a mini-bionator appliance. There are also more designs that you can have made...but you get the idea.

 
Old 12-07-2010, 04:38 PM   #7
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Re: New here, and confused with my splint and doctor

Quote:
Originally Posted by Jill 227 View Post
If your jaw was placed in the proper neuromuscular position, and your posture is addressed as well, the bruxism should get much better. I know, as far as my doctor...he gives all his patients with TMD a NM nightguard, that is made so that the back teeth do not touch...and it is fabricated with all the usual NM diagnostic tests. You can see something like he makes if you look up a mini-bionator appliance. There are also more designs that you can have made...but you get the idea.
How much have you spent undergoing treatment?

I recently quit going to my current TMJ Dentist due to his lack of knowledge.

I had an evaluation from a neuromuscular dentist today to see what he had to say. He basically confirmed everything that I already knew about my teeth and condition and hooked me up to his K7 EMG to get some readings of my masseter muscle activity as well as the temporalis muscle. The EMG readings showed minimal activity in the massaters (about 1.5 (units?)) and right temporalis was 11 while left temporalis was ~4.5.
He quoted me $3,900 for phase I treatment of an orthotic and said I would need full mouth reconstruction for phase II.

Insurance coverage - 0%.

 
Old 12-07-2010, 04:52 PM   #8
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Re: New here, and confused with my splint and doctor

Question for you....does he belong to the associations that I listed on the great tmj doctors thread at the top of this page...? Does he do Functional Jaw ortho.? While I agree with his findings of the EMG tests....before spending over 30K on a FMR....get another opinion from a doctor that does Functional Jaw ortho..and NM dentistry. There are other options than going into a total reconstruction. I wish I could post more specifics on this forum...but they don't let you post names, or associations at all. I have 2 friends that are going through tmj treatment right now with a doctor in the mid west...He is one of the top tmj specialists in the country..and he gives a patient at least 2 options for phase 2. Before I chose my dentist...I must have done at least 5 phone consults with other NM dentists...and in the end..chose mine for various reasons. I have probably...to date....on just myself...spent about 10K, and I'm almost ready to start phase 2. The alternative therapies are what really add up. Especially if you are in them weekly. I hope that helps. BTW--I also have no tmj coverage...and my daughter is also in treatment...talk about a double whammy!!

 
Old 12-07-2010, 05:58 PM   #9
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Re: New here, and confused with my splint and doctor

Quote:
Originally Posted by Jill 227 View Post
Question for you....does he belong to the associations that I listed on the great tmj doctors thread at the top of this page...? Does he do Functional Jaw ortho.? While I agree with his findings of the EMG tests....before spending over 30K on a FMR....get another opinion from a doctor that does Functional Jaw ortho..and NM dentistry. There are other options than going into a total reconstruction. I wish I could post more specifics on this forum...but they don't let you post names, or associations at all. I have 2 friends that are going through tmj treatment right now with a doctor in the mid west...He is one of the top tmj specialists in the country..and he gives a patient at least 2 options for phase 2. Before I chose my dentist...I must have done at least 5 phone consults with other NM dentists...and in the end..chose mine for various reasons. I have probably...to date....on just myself...spent about 10K, and I'm almost ready to start phase 2. The alternative therapies are what really add up. Especially if you are in them weekly. I hope that helps. BTW--I also have no tmj coverage...and my daughter is also in treatment...talk about a double whammy!!
I am sorry to hear about your situation... I wish the best to you and your daughter and friends.

This particular dentist is member of the American Dental Association, The Arizona State Dental Association and Summit Dental Study Club. I am afraid that I cannot find any functional jaw orthodontics here... (Arizona).

I have been to two NMD's for consultations, the first quoted me $1250 for first TENS and orthotic, and this one for $3900 which included all of phase I treatment.

 
Old 12-07-2010, 06:55 PM   #10
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Re: New here, and confused with my splint and doctor

Well....the most honest answer to you would be..please don't limit yourself to travelling to get help. I know that may sound incredibly hard to do..but I know many people that travel to see their specialist. Mine actually treats someone from Alaska...and he is located in Wi. Do you know where your doctor learned NM dentistry? Was it from the Las Vegas Institute? Or another clinician? Just curious. He does not have the usual credentials that the NM guys have. The prices for both doctors are VERY reasonable....but first off, when I look at a doctor...I do not necesarily look at the price...I look for major experience. Who did they study under? What are the associations that they belong to? How long specifically have they done NM (TMD) treatment? (hopefully more than 10yrs.). Ask for patient referrals...see if they will give out numbers so you can contact these people..What are their success rates in TMD cases.....specifically the tough ones, with long standing TMD? These are some of the questions that need to be addressed in my opinion when consulting with someone. THere is too much at stake..too much can go wrong....and as you know....it's very expensive. You may try getting phase 1 covered under "Myofascial pain disorder..." (MPD) , or Craniofacial Pain of unknown origin. Your health ins. may take these diagnosis so you can get some financial help with this. Don't rush into anything real quickly...maybe there is someone in a surrounding state that you could also consult with. Did you look on the thread for another referral?

 
Old 12-07-2010, 09:37 PM   #11
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Re: New here, and confused with my splint and doctor

Quote:
Originally Posted by Jill 227 View Post
If your jaw was placed in the proper neuromuscular position, and your posture is addressed as well, the bruxism should get much better. I know, as far as my doctor...he gives all his patients with TMD a NM nightguard, that is made so that the back teeth do not touch...and it is fabricated with all the usual NM diagnostic tests. You can see something like he makes if you look up a mini-bionator appliance. There are also more designs that you can have made...but you get the idea.
I have NO idea whether my jaw was placed in the proper neuromuscular position. I really don't understand what the hard splint he has me wearing is meant to accomplish. I feel like I'm missing something here... I haven't had any of these tests other people are talking about or anything. All he did was measure how far my mouth would open at the very beginning and now it's apparently "within normal range" and so my insistence that my mouth isn't opening as far as it normally does (I still have to hold my chin up when yawning to keep my jaw from trying to pop, hello...) is falling on deaf ears. And he spent a couple minutes looking vaguely at the gaps between my back teeth when I bite down. I don't remember if he even touched the muscles in my jaw. After the first 5 minutes I spent with him in my initial appointment 2.5 months ago, all of my time with him since then has been 100% about adjusting the splint.

 
Old 12-08-2010, 06:10 AM   #12
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Re: New here, and confused with my splint and doctor

HEy Holly.....The tests that need to be done to properly fabricate a NM orthodic are:
1. EMG testing...to determine how and what muscles are functioning....with, and without the orthodic. This can also be used when determining WHERE to adjust the appliance.
2. CMS...to record the delicate sounds within the joints
3. K-7 jaw tracking...
4. Tomographic x-rays...before AND after to check the condyle placement within the joints. Very important.
5. The use of the tens...before attempting to do the EMG testing...and K-7 testing.

If these were not done Holly...IMO, I would get another opinion on your case. There can be NO guesswork in repositioning someone's jaw. If the dentist follows this protocol....he or she can get the jaw position within an accuracy to the nearest 10 of a mm.
Look on the great tmj doctors thread and see if there is someone near you that can hook you up to the EMG, and K-7 to "check" your dentists's work.

 
Old 12-08-2010, 08:18 AM   #13
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Re: New here, and confused with my splint and doctor

Quote:
Originally Posted by Jill 227 View Post
Well....the most honest answer to you would be..please don't limit yourself to travelling to get help. I know that may sound incredibly hard to do..but I know many people that travel to see their specialist. Mine actually treats someone from Alaska...and he is located in Wi. Do you know where your doctor learned NM dentistry? Was it from the Las Vegas Institute? Or another clinician? Just curious. He does not have the usual credentials that the NM guys have. The prices for both doctors are VERY reasonable....but first off, when I look at a doctor...I do not necesarily look at the price...I look for major experience. Who did they study under? What are the associations that they belong to? How long specifically have they done NM (TMD) treatment? (hopefully more than 10yrs.). Ask for patient referrals...see if they will give out numbers so you can contact these people..What are their success rates in TMD cases.....specifically the tough ones, with long standing TMD? These are some of the questions that need to be addressed in my opinion when consulting with someone. THere is too much at stake..too much can go wrong....and as you know....it's very expensive. You may try getting phase 1 covered under "Myofascial pain disorder..." (MPD) , or Craniofacial Pain of unknown origin. Your health ins. may take these diagnosis so you can get some financial help with this. Don't rush into anything real quickly...maybe there is someone in a surrounding state that you could also consult with. Did you look on the thread for another referral?
Thanks very much for the information. I will certainly add those questions to my list when consulting with NMD's in the future. There are still a couple more that I would like to check out here in Phoenix before I explore going out of state (It's not so much the traveling part that is difficult, it is getting off work that is difficult). All of the NMD's that I have visited so far I have pulled off of LVI's website-- taking anywhere from 8-16 classes at LVI.
Have other people had success with having their dentist bill someones MEDICAL insurance for MPD or CFP? Do you need a note from a doctor to be able to diagnose you with this?

 
Old 12-08-2010, 11:12 AM   #14
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Re: New here, and confused with my splint and doctor

You usually have to get diagnosed with MPD by your general practitioner..and then see if your dentist will even use the codes. I guess you could call ahead to a dentist and simply ask them how they help patients get ins. coverage, and if they use the MPD diagnosis, or the other one I mentioned. I've also heard of people getting coverage under migraines. Yes, I do know people who have done this. Also, one thing about LVI. There are also dentists that are at the Master level at LVI...you can also check to see if someone has that status around you. Also, like I said...look on the great tmj doctors thread for the other associations that they also can belong to. My dentist has been around before LVI came into fruition. He is a Functional Jaw Orthodontist...as well as a NM dentist. He also does sleep disorders. Being an FJO is crucial...IMO...to finding a good tmj specialist. Some LVI guys are not FJo's....check into that...good luck to you...

 
Old 12-08-2010, 12:23 PM   #15
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Re: New here, and confused with my splint and doctor

Quote:
Originally Posted by Jill 227 View Post
You usually have to get diagnosed with MPD by your general practitioner..and then see if your dentist will even use the codes. I guess you could call ahead to a dentist and simply ask them how they help patients get ins. coverage, and if they use the MPD diagnosis, or the other one I mentioned. I've also heard of people getting coverage under migraines. Yes, I do know people who have done this. Also, one thing about LVI. There are also dentists that are at the Master level at LVI...you can also check to see if someone has that status around you. Also, like I said...look on the great tmj doctors thread for the other associations that they also can belong to. My dentist has been around before LVI came into fruition. He is a Functional Jaw Orthodontist...as well as a NM dentist. He also does sleep disorders. Being an FJO is crucial...IMO...to finding a good tmj specialist. Some LVI guys are not FJo's....check into that...good luck to you...
I checked with my medical insurance and those things are not covered. However, TMJ IS covered under my medical insurance. The problem is that it is HMO and there is only one dentist in my network...(the one that I have previously gone to after receiving my lower permissive splints (which did not help)). The only good thing about it was I received both splints ($1200 each) for my small copay.

Last edited by saltyk9; 12-08-2010 at 12:24 PM.

 
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