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Old 05-24-2007, 01:47 PM   #1
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Urethral Stricture - Buccal Mucosa Graft Surgery

After a urethrotomy, 4-5 dilations, and years of self-dilation failed to fix my urethral stricture--scar tissue from hypospadius surgery--three weeks ago I had first stage buccal mucosa graft surgery. It's a major surgery, though the success rate is in the 90s. The 2nd stage procedure is 6-9 months later.

If anyone has been frustrated as I have over long-term urethral stricture issues, and other minimally-invasive procedures have failed, post here and I'll be glad to fill you in with more detail.

I found a world-renowned surgeon who performs exclusive surgery for urologic reconstruction. This particular procedure was introduced, according to my surgeon, around 1995 and has showed very promising results.

I had been depressed for many years because of my problem, and after much thought, and multiple opinions, decided this was for me, physically, mentally.

 
Old 05-24-2007, 04:42 PM   #2
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Re: Urethral Stricture - Buccal Mucosa Graft Surgery

Hi,

The surgeon I saw is Dr. Leonard Zinman at the Lahey Clinic in Burlington, MA.

He performed the buccal graft surgery 3 weeks ago. A year ago, he did a diliation for me--cystoscopy I believe--under anesthesia. He injected a dye that tracked the flow of dye, and took an X-ray to show exactly there the stricture was.

The dilitation worked for a few months, but the stricture came back. Again. I told him I had a urethrotomy in the past as well as other diliations, that the scar tissue from hypospadius surgery I had when I was 4 always came back. It was then he recommended the buccal graft surgery as a permanent solution.

I got several other opinions from urologists at different hospitals in the Boston area, and they all heard of Zinman and said he's the best for reconstructive issues.

If you decide to see him, my suggestion is to visit him sooner than later. He books out surgeries ONE YEAR in advance. That's how in demand he is.

 
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Old 05-29-2007, 06:20 PM   #3
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Re: Urethral Stricture - Buccal Mucosa Graft Surgery

Hi,

I have an appointment with a specialist here in Chicago at the end of June. Like your surgeon, he specialized in urethoplasty.

Two years ago, after many urologists and years of pain, I found a urologist who diagnosed me within minutes as having strictures. Two weeks later I was in the operating room undergoing urethrotomy. Since then I have been dilated twice for limited results. The stricture always comes back after several months.

I was excited to hear that there is a permanent solution with much better success rates then dilation and urethrotomy.

My first apointment with the specialist at the end of June. I would be interested in hearing more about your operation and what has been involved.

 
Old 05-29-2007, 08:47 PM   #4
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Re: Urethral Stricture - Buccal Mucosa Graft Surgery

Quote:
Originally Posted by Gritz78 View Post
Hi,

I have an appointment with a specialist here in Chicago at the end of June. Like your surgeon, he specialized in urethoplasty.

Two years ago, after many urologists and years of pain, I found a urologist who diagnosed me within minutes as having strictures. Two weeks later I was in the operating room undergoing urethrotomy. Since then I have been dilated twice for limited results. The stricture always comes back after several months.

I was excited to hear that there is a permanent solution with much better success rates then dilation and urethrotomy.

My first apointment with the specialist at the end of June. I would be interested in hearing more about your operation and what has been involved.
Sorry to hear your strictures keep coming back. Believe me, I've had the same frustrations, and it makes it worse considering how much pain you feel after the dilations and especially the urethroplasty. You'd like to think that going through that kind of pain would at least be worth it!

Here's what I can tell you about the buccal mucosa graft. I'm going to give you a truckload of info, so I apologize if it's long-winded; as a fellow sufferer of urethral stricture, I can empathize and would rather give you more than less.

From what I gather, there are variations on the technique depending on where your stricture(s) is, how large they are, etc. I'll just tell you my case to have something to go off of...

In my case, it's a two-stage process, meaning two surgeries, the second occurring 6-9 months after the first. However, my doc said in some cases it can be done in one stage, one surgery. No idea what the parameters are, but just to let you know for informational purposes it can be done in one fell swoop.

My recurrent, persistent stricture was in my urethra, about an inch from the opening. When I had the first graft surgery a month ago, what the surgeon does, at least as far as I understand it in layman's terms, is "open up" the underside of your urethra where the stricture is so it's kind of wide-open from the stricture to the opening at the end.

He removed the stricture, then took a graft from the inside of my cheek and lined the inside of the wide-opening with it. Then he put a "temporary" end to the urethra on the underside before the new wide-opening so that I pee out of there (until the 2nd surgery). You essentially get a new urethra.

The surgery, again for first-stage, took about 6-7 hours, so I was under anasthesia for quite a while. When I woke up, I had a catheter out the "temporary" urethra end, and dressing over the wide opening on the underside where the graft went.

I was in the hospital from Monday-Sunday, standard procedure for this surgery. They keep you that long not because you'll be sick, but because you need to stay relatively immobile so the graft stays in place.

If it sounds like a big deal, well, it is a big deal. I thought long and hard about doing this, and because I had so many years of pain, so many other options tried and failed, and considering the success rate of the surgery is higher than 90% and my surgeon is a leading authority and practitioner of this procedure, I decided to do it.

For the second surgery, and I don't know enough detail at this point, just some small tidbits, under anasthesia, the wide-opening is closed as well as the temporary end to the urethra. A catheter is inserted into the newly lined channel (from the cheek graft), and one wakes up peeing through the catheter out the "normal" end of your urethra. My doc said after the hospital stay (not sure how long on stage 2), you go home with the catheter for several days so that everything heals, then go back to have it removed, and finally pee "normally." Cosmetically, I was told the results are excellent.

Things to keep in mind: I had my surgery a month ago, and have just in the last few days started to get my energy back. I was told it takes 4-6 weeks to feel like your old self again, because of 1) the long period of anasthesia, and 2) being bedridden for 5 days. I was also told it takes about the same amount of time to have normal erections after surgery. Erections are a bit stinging right now, though not excruciating.

This is just my own personal scenario to use as a benchmark. If you investigate further with your doc regarding this procedure, he may approach it differently.

If there's anything else you'd like to know on this, post again and I'll be glad to help. I have my first follow-up soon and will update this thread with any significant changes.

 
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Old 06-06-2007, 04:48 PM   #5
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Re: Urethral Stricture - Buccal Mucosa Graft Surgery

Hi Ennio,

I'm glad I found your post on this website. I hope you can help me or give me some info. I was diagnosed with a small stricture about 1/2 to 1 inch from the tip. I have moderate burning, maybe a 5 in intensity on a scale from 1 to 10. Burning happens after urination and lasts about 30 minutes. I would not say it is affecting my life too much but it gets annoying at times and I have learned to live with it. I will be seeing a specialist at UCLA for it. I went for a second opinion with a general urologist and he said he would not recommend surgery as it "was like hitting an ant with a sledgehammer"...no pun intened! He just though the stricture was not siginficant enough to do that surgery and ig I could live with the burning then stay away from surgery. Then again he is not a stricture expert so that is why I am going to UCLA. My only concern is that I am not emptying my bladder enough and I will have that tested. I was sad to read that you had some depression symptoms but hopefully after the surgery you are doing better emotionally. I sympathize with you on that. I was wondering if I could ask you some questions?

1. How long was your stricture?
2. Did you have the surgery because of the pain?
3. Where you having any voiding problems? Was urine flow normal?
4. Could you have not done surgery and just "lived" with the symptoms?
5. What kind of diagnostic tests were done previous to surgery to determines the stricture length and location?

Any info you could give would be so helpful. I am really worried that I will eventually have to do surgery but I can definately live with the moderate burning.

Thanks,
Alex

 
Old 06-08-2007, 04:43 PM   #6
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Re: Urethral Stricture - Buccal Mucosa Graft Surgery

Quote:
Originally Posted by almok View Post
Hi Ennio,

I'm glad I found your post on this website. I hope you can help me or give me some info. I was diagnosed with a small stricture about 1/2 to 1 inch from the tip. I have moderate burning, maybe a 5 in intensity on a scale from 1 to 10. Burning happens after urination and lasts about 30 minutes. I would not say it is affecting my life too much but it gets annoying at times and I have learned to live with it. I will be seeing a specialist at UCLA for it. I went for a second opinion with a general urologist and he said he would not recommend surgery as it "was like hitting an ant with a sledgehammer"...no pun intened! He just though the stricture was not siginficant enough to do that surgery and ig I could live with the burning then stay away from surgery. Then again he is not a stricture expert so that is why I am going to UCLA. My only concern is that I am not emptying my bladder enough and I will have that tested. I was sad to read that you had some depression symptoms but hopefully after the surgery you are doing better emotionally. I sympathize with you on that. I was wondering if I could ask you some questions?

1. How long was your stricture?
2. Did you have the surgery because of the pain?
3. Where you having any voiding problems? Was urine flow normal?
4. Could you have not done surgery and just "lived" with the symptoms?
5. What kind of diagnostic tests were done previous to surgery to determines the stricture length and location?

Any info you could give would be so helpful. I am really worried that I will eventually have to do surgery but I can definately live with the moderate burning.

Thanks,
Alex

Hey Alex,

Glad this post was helpful to you...

When I first had my stricture cause me pain voiding in my teens (now am 35), my urologist said I would need to self-dilate every week for the rest of my life. I did that for a while, and the pain would come and go, but when it was bad, it was REALLY bad, more like an 8 on a scale of 1 to 10.

Over the years I went through a multitude of other procedures listed in this thread. The problem always came back. For me, it not only caused pain with urination and ejaculation, but with relationships. For long stretches I couldn't have sex with my then girlfriends because of the pain, and it put a strain on the relationship.

I say this only because I had a long history wrestling with this problem before I decided to get the buccal graft surgery. And even when the prospect was mentioned to me, I balked at first. I had a long "introspection-fest" before deciding to get it done, believe me.

How long have you had this problem? Is it fairly recent? If so, then for right now, I honestly wouldn't worry about having the surgery. It's good to know that this procedure exists if your stricture, over a long period of time and other procedures fail, won't go away and becomes a major intrusion on your life, but it sounds like your urologist hasn't even suggested self-dilating yet, so if I were you, I would put the graft surgery out of your head. I only did it after a series of other procedures failed to correct it.

Good idea to get that second opinion!! Based on my own experience, I'm guessing that the options given to you at this beginning stage may be either self-dilatation, a dilation by the urologist (either in-office or under anasthesia), or to do nothing and see if you can live with it.

To answer your questions above:

1. How long was your stricture?

I'm not sure how long the actual stricture was, but it was roughly in the same location as yours.

2. Did you have the surgery because of the pain?

I had surgery because the pain was a major life-intrusion and because my urologist said that over time, I could potentially see kidney problems because of the urine retention issue. Also, my bladder was becoming increasingly sensitive and irritated. Lots of frequent trips to the john.

3. Where you having any voiding problems? Was urine flow normal?

Had voiding problems where my bladder never felt completely emptied. Lots of starting and stopping. Also, my urine was spraying all over the place so I would have to sit down to urinate. I had taken tests on a "uroflow" machine that showed my urine flow was equivalent to that of an old man.

4. Could you have not done surgery and just "lived" with the symptoms?

Yes, this was certainly an option, but I had become so frustrated physically and emotionally (I didn't--or better yet couldn't--date for many years because of this problem) that I decided to do it. I also had 2 other opinions. Both said they thought I should have it.

5. What kind of diagnostic tests were done previous to surgery to determines the stricture length and location?

I've had a few cystoscopies done by different doctors to determine where the stricture is. One I had in-office, others I had under anasthesia. I would definitely recommend not being awake during this procedure!

A year prior to surgery, my surgeon dilated my urethra with a balloon under anasthesia, and inserted a dye from my penis through the bladder. He took an x-ray so he could see where the stricture was. At my follow-up, he showed me the picture so I could see exactly where the stricture was. In my case, the flow of dye was significantly blocked at the point of the stricture.

Hope this helps. Let me know if you think of any other qs. Good luck with the UCLA doc. Let me know how that goes...

 
Old 06-12-2007, 07:21 PM   #7
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Re: Urethral Stricture - Buccal Mucosa Graft Surgery

Gritz78, is your doctor Chris Gonzolez at Northwestern?

 
Old 06-14-2007, 12:31 PM   #8
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Re: Urethral Stricture - Buccal Mucosa Graft Surgery

Hi everybody, I'm an 18 year old male from Michigan, and I just got done with my surgery and recovery for a urethral stricture. I had a very long stricture, which I believe was the result of many bad procedures.

I first had an internal urethrotemy done, but even with self-catheterization there was recurrence of the stricture. I then was unable to void a year ago and had to go to the ER and undergo a dilation so that I could urinate. The stricture recurred this winter, and I decided to take care of it.

On May 10th I had a buccal mucosa graft to repair my long stricture, I believe the doctor said somewhere between 7 and 8 cm. I had a catheter in for a little over a month after the surgery, and just had it removed yesterday.

So far I feel fine, I have began living a relatively normal life again, I am just a little sluggish in terms of my energy level but feel much better now. I still have two problems however.

1. Penile Discharge. I urinate with a very strong stream now and very little pain. The doctor said that there would be discharge for a couple weeks, so I'm not that concerned about that.

2. Erections. I have gotten erections since the catheter has been removed, and they have been slightly painful, but the most noticable difference is that they are much shorter than they were before. Also, when erect my penis can't move nearly as much as it could before the surgery. I'm not sure if these are temporary and will get better as recovery time passes or if these are permanent side effects from the surgery.

 
Old 06-14-2007, 01:07 PM   #9
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Re: Urethral Stricture - Buccal Mucosa Graft Surgery

Quote:
Originally Posted by Brian41 View Post
Hi everybody, I'm an 18 year old male from Michigan, and I just got done with my surgery and recovery for a urethral stricture. I had a very long stricture, which I believe was the result of many bad procedures.

I first had an internal urethrotemy done, but even with self-catheterization there was recurrence of the stricture. I then was unable to void a year ago and had to go to the ER and undergo a dilation so that I could urinate. The stricture recurred this winter, and I decided to take care of it.

On May 10th I had a buccal mucosa graft to repair my long stricture, I believe the doctor said somewhere between 7 and 8 cm. I had a catheter in for a little over a month after the surgery, and just had it removed yesterday.

So far I feel fine, I have began living a relatively normal life again, I am just a little sluggish in terms of my energy level but feel much better now. I still have two problems however.

1. Penile Discharge. I urinate with a very strong stream now and very little pain. The doctor said that there would be discharge for a couple weeks, so I'm not that concerned about that.

2. Erections. I have gotten erections since the catheter has been removed, and they have been slightly painful, but the most noticable difference is that they are much shorter than they were before. Also, when erect my penis can't move nearly as much as it could before the surgery. I'm not sure if these are temporary and will get better as recovery time passes or if these are permanent side effects from the surgery.

Thanks for posting this Brian...

I certainly hope your situation improves.

I, too, have been having burning with erections. I was told the pain would pass at some point, but my doctor has been very vague about that.

I had my surgery on April 30th and it was just last week that I started to get my energy back. Being under anesthesia for a long time and the subsequent 5-day bed-in had a profound impact on my energy level. I tend to be more sensitive to anesthesia than most though.

I'm having pain at one specific point in the urethra where the catheter was inserted during my hospital stay. (They took it out before I went home.) The pain was only there with erections before, but the past week or so, the pain is there all day. Urinating doesn't burn, but the stream isn't fluid and is still spraying. It feels like there is a stricture. The nurse gave me Peridium for the burning, but it didn't help after 3 days.

My doctor said he didn't know why I'm having pain at this point, which is of grave concern for me, so I'm getting another opinion from his colleague tomorrow morning.

I'm hoping the pain will go away and everything will be fine, but right now I'm very worried, especially since the doc didn't give me any reason to hope it will improve.

 
Old 06-14-2007, 01:13 PM   #10
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Re: Urethral Stricture - Buccal Mucosa Graft Surgery

Quote:
Originally Posted by ennio View Post
Thanks for posting this Brian...

I certainly hope your situation improves.

I, too, have been having burning with erections. I was told the pain would pass at some point, but my doctor has been very vague about that.

I had my surgery on April 30th and it was just last week that I started to get my energy back. Being under anesthesia for a long time and the subsequent 5-day bed-in had a profound impact on my energy level. I tend to be more sensitive to anesthesia than most though.

I'm having pain at one specific point in the urethra where the catheter was inserted during my hospital stay. (They took it out before I went home.) The pain was only there with erections before, but the past week or so, the pain is there all day. Urinating doesn't burn, but the stream isn't fluid and is still spraying. It feels like there is a stricture. The nurse gave me Peridium for the burning, but it didn't help after 3 days.

My doctor said he didn't know why I'm having pain at this point, which is of grave concern for me, so I'm getting another opinion from his colleague tomorrow morning.

I'm hoping the pain will go away and everything will be fine, but right now I'm very worried, especially since the doc didn't give me any reason to hope it will improve.
That's unfortunate. I guess my doctor took a bit of a different approach to recovery, I was only in the hospital for one night and I was encouraged to move around as much as I could. My stream doesn't spray much anymore, and is mostly pain-free. The main region where I have pain during erections is right at the spot where the penis and testicles meet. This was a spot that hurt when I had the stricture, and I'm fairly sure that spot took the longest to heal with the catheter in, so I hope this is just temporary.

I hope your situation improves. Best of luck to you.

 
Old 06-20-2007, 09:40 AM   #11
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Re: Urethral Stricture - Buccal Mucosa Graft Surgery

I guess I figured I should post an update in here.

It's been a week since the catheter came out, I have noticed improvement in almost every category. There is now only a very slight burning sensation when I urinate. Stream seems to have calmed down a little lately. I seem to be going more frequently than usual still, but I'm expecting that to persist for a while.

The only real problem I'm having is that there is still a good amount of dribbling after I urinate. My urologist said that could persist for up to a few weeks, so I guess I'm not that concerned.

Erections have returned to normal for the most part, it is tough to move the penis when erect, and ejaculations seem low and weak, but that's about it right now. Much improved over a week ago.

 
Old 06-21-2007, 08:40 PM   #12
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Re: Urethral Stricture - Buccal Mucosa Graft Surgery

Thanks for the update Brian, and I'm glad that you are steadily improving.

It doesn't hurt for me to urinate, but oddly enough, after it does. And the pain is, for the most part, constant all day. Erection pain is no worse than the pain I have during the day. Had one ejaculation which was extremely painful though.

After I had my first surgical follow-up a few weeks ago, I was very concerned and downright depressed that my surgeon did not provide any explanation to why I was having any pain at all 4 weeks after surgery.

However, at present, I do feel better psychologically. While my surgeon was away, I saw a collegue of his, also familiar with this procedure. He looked at the graft, said it looked great, then explained to me that there are internal sutures that can take several months to dissolve and that before they completely go away, it's possible to feel pain during the day. He said there are tiny holes in the urethra the urine is flowing over that cause irritation. He likened it to spilling alcohol on an open wound on your arm. So he said there's no reason to be alarmed, that it will get better. He said for some people it can just take longer.

That's one thing I've been frustrated about is the lack of explanation on what to expect after the procedure. Seems like it wouldn't be hard to make a standard one-pager for patients so 1) the patients can feel more at ease, and 2) the nurses and doctors themselves won't get frequent post-op calls from patients. Anyway, if anyone else is researching the net for this surgery, hopefully some will find this thread.

Even though the pain is there, I'm not freaking out anymore about living like this for good. I can deal with the pain having the assurance that it will go away. The surgeon's colleague also put me on Urosed which is helping a tad.

 
Old 06-26-2007, 07:32 PM   #13
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Re: Urethral Stricture - Buccal Mucosa Graft Surgery

I guess it seems like this is a relatively new procedure, so there really isn't a set expectation of exactly how patients will respond after surgery. It does seem logical that the stitches could cause some discomfort.

It's been around 3 weeks since I got the catheter out. My stream is still healthy/normal with very little pain. Erections are getting better all the time and ejaculations are returning to normal. I drank 3 nights in a row over the weekend, and had no problems with alcohol, which was a major problem for me when I had the stricture. I don't have a follow-up appointment until September, but I'll be fine as long as I don't have any major problems.

I guess the problems for me right now are still frequent dribbling after urination and increased soreness after ejaculation. Other than that I'm doing fine. I hope you continue to get better ennio.

 
Old 06-27-2007, 06:02 PM   #14
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Re: Urethral Stricture - Buccal Mucosa Graft Surgery

Great thread!

Wow...I must say, I commend you guys on your ability to go through with such a difficult procedure. I'm looking into stricture surgical options myself as I developed a stricture during a urodynamics test where I had a severe muscle spasm which caused the catheter to jerk very violently. A few days following the test, my stream began to get much much weaker and my penis was obviously bruised. This was about a year ago, and the underside of my penis still looks bruised. My stream is very weak, and I feel it stop for a few seconds as it tries to make it's way through the obstruction.

One question I have is when you say you had "failed" uretrhrotomies(sp?), how long did they help? When all was said and done and the urethra closed back up, would you say it closed up but was still somewhat better than it was before the procedure, the same, or even worse? I know these procedures have extremely low success rates but that's what my urologist suggests at the moment. I figure even if it closes back up some, but is better than what I have now, it would be worth it.

I don't really know what to do since I am still capable of emptying my bladder, and I don't experience pain other than a very mild but not bothersome sting during urination on occasion. It has definately affected my life, and mental state, but I know it could be much worse. I'm basically just worried about making a mountain out of a mole hill so to speak by going into surgery.

 
Old 06-27-2007, 06:47 PM   #15
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Re: Urethral Stricture - Buccal Mucosa Graft Surgery

Quote:
Originally Posted by allie_2448 View Post
ennio

I have a few questions for you if you'd rather not answer I'd understand as they may be to personal..as I mentioned my son also had hypospadius..
Did you experience urinary incontinence before this surgery?
When did you start noticing problems?

I want to talk to my son about things to watch for...it's a not something you bring up at the dinner table...I have told him about scar tissue and a little of what to watch out for...decrease in urine, weak stream.
Should he have a test done by a urologist? He had a few operation before he was 4 to correct this..

They did say he may have a harder time conceiving a child due to the hypospadius and reconstruction of the ureter tube..

I thought I'd ask here first before I bring this up to him.
Thanks in advance..

Hi allie,

I never had incontinence problems; the first problem I had was pain in my urethra when urinating. This first happened in my mid teens (had hypospadius at 4 years). Later in life I also developed bladder sensitivity because of urine retention due to the stricture from hypospadius. So from my perspective, those are a few things to look out for....

 
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