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  • Please explain the various ADD meds

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    Old 06-30-2007, 07:49 AM   #1
    frazzledparent
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    Please explain the various ADD meds

    What do all of you know about the different medications? I'm assuming that some are more directed toward the hyperactivity, some toward the concentration issues, some toward the impulsivity, etc. Is that true and, if so, what can you tell me about them? I'd like to have some information, first hand, before this appointment on the 5th.

    Karen

    Last edited by mod-anon; 07-01-2007 at 05:44 AM. Reason: starting a new thread with this post.

     
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    Old 07-01-2007, 11:50 AM   #2
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    Re: Please explain the various ADD meds

    Karen,

    A complex question indeed and one that I am not qualified to answer authoritatively.

    Heck, that never stopped me before so here goes:

    There are a couple schools of thought on ADD/ADHD. I'm in class at the "they are the same disorder being manifested differently because of many other variables not fully understood" school.

    A couple of real authorities including Dr. Daniel Amen, a psychiatrist who has my highest respect, disagree. Another preeminent figure in the field is Dr. Russel Barkley, a psychologist. He is currently teaching at my school but may jump ship if future research results put ADD in its own category.

    Whatever the case, ADD and ADHD respond to nearly identical therapies with the variance to the best of my knowledge being ADD responds better to a lower dose of a stimulant class med than ADHD. Keep in mind that not all with ADHD respond to stimulants. About 25 to 30 percent do not respond at all, that is, to stimulants focus enhancing, implusivity and hyperactivity suppressing properties. Other meds not classed as stimulants nor having stimulating properties can be used to suppress hyperactivity and impulsivity because of their sedative effects.

    Both your daughter and Goody2Shuz's daughter have lots of Hyperactivity so forget the ADD. Your psychologist ruled out bipolar but just in case watch daughter carefully if stimulants are prescribed. Stimulant intoxication is mania. They are capable of sending bipolar suffers into the most dangerous mania imaginable.

    Stimulants are first line meds except when abuse may be a problem. The stimulant meds are Ritalin (methylphenidate), Foculin (l-methylphenidate), Adderall (a mix of d-amphetamine and l-amphetamine – their molecules mirror each other if you are a chemistry buff), Dexedrine (d-amphetamine) and rarely Desoxyn (methamphetamine).

    I got to tell you since I've been there and done that, that Dexedrine and methamphetamine are as addictive as hell IF ABUSED. Anything that can make us suffering humans feel that good is difficult to resist unless a good deal of mental, emotional and moral stability is firmly in place. By moral stability I mean the cognition that abusing drugs is wrong.

    Ritalin and Adderall can also be abused but because their "high" isn't as "high" as meth or dex amphetamine they are much better choices for the teen years when roller-coaster emotions are the normal.

    Down side is more possible side effects and higher doses may be required to achieve efficacy. Extended release formulas are less likely to be abused because the release mechanism prevents the full dose from slamming into the CNS. That slam action is why dope-fiends use needles.

    Barring the potential for abuse (other than that Mrs. Lincoln, how did-cha enjoy the show?), the stimulants are remarkably free from serious side effects given a healthy heart. Stimulants generally slow heart rate but raise blood pressure. They cause the heart to pump harder hence less need for frequency. As long as heart is healthy, not a problem.

    There is a slew of other meds if stimulants don't work, can't be used because of drug/alcohol abuse history or commorbidies such as bipolar indications.

    Sometimes a combination of meds is needed.

    Do you want your question answered?

    Stimulant class meds are first line choice for inattention, implusivity and hyperactivety symptoms.
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    Old 07-01-2007, 01:58 PM   #3
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    Re: Please explain the various ADD meds

    Addprogramer....thanks for your very informative post. Like Frazzled, I would like to educate myself about the varying meds so that IF the doctor diagnosis our daughter we will be well informed as parents to make a final decision with him. We have an evaluation set for July 20th for my 18 year old daughter and since we are somewhat concerned about her susceptibility to Bipolar (being that her younger sister has been diagnosed with both ADD inattentive & Bipolar), I am of course very concerned about the induced mania issue especially since my younger daughter experienced that when put on Zoloft, a SSRI which poses the same risks of triggering mania in an undiagnosed BPer. However, in my younger daughter's situation it made it much easier for the doctor to diagnose BP. I will of course see what the psychiatrist recommends and will of course share my concerns with him regarding this.

    I am also concerned about my daughter's susceptibility to drug abuse, first because alcoholism and addictions run on both sides of our family and second, my daughter has been using alcohol and pot since the age of 14. I am pretty sure she is self medicating but am not going to bury my head in the sand and make excuses but that is my motherly instinct.

    So.....with that being said I think I would be more comfortable with a non-stimulant medication such as Strattera. What are your thoughts about that one??? And are there any others that you would suggest with what I have shared with you concerning my daughter's predisposition to Bipolar as well as addictive problems.

    I appreciate your advice and look forward to anything you or anybody else has to share regarding medication choices.

    Frazzled....I am glad that I am not the only one here standing in LIMBO and hope that both of us will see some positiver results once our daughters are porperly diagnosed and treated.

    Hope things have calmed down and that you get your answers soon. I am only a few steps behind you.

    (((((HUGS))))) ~ Goody

     
    Old 07-01-2007, 02:07 PM   #4
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    Re: Please explain the various ADD meds

    Sorry that I have not replied to you in the other thread. Programmer said it nicely, I'll add a few thoughts. Disclaimer: Layperson talking...I welcome any corrections.

    Here is simile that may give you some understanding. Keep in mind, this is a gross simplification, but it partially explains the goal of medication. The idea of using stimulants to treat ADD/ADHD sounds like a misnomer.

    Picture this ...with medication, a basic goal is to stimulate the frontal (cerebral) cortex. With ADD/ADHD the frontel lobe is lacking stimulation---for various reasons...The frontal lobe is likened to the executive command center over the rest of the brain...the other lobes and structures deeper in the brain. ...so while the boss is taking a nap, the other lobes of the brain are having a party. The effects could be hyperactivity, inattention, both. In some cases, the person deals with overstimulation, but the same person can also be understimulated in other cases. As you can imagine, the person may resort to destructive habits and behavior to get the stimulation. This can be anywhere from mere arguments, caffeine to drug abuse. Of course, understimulation has it's problems.

    Random question to Frazzled parent, Goody (or any ADD'er), have you noticed a tendency to want to cut tags out of shirts...or pickiness on material texture, etc??....One of those authors mentioned that it was common with ADD due to hypersensitivity. I've always been picky about scratchy clothes, but I would have never connected it!
    I encourage you to read some of Daniel Amen's books. I may have mentioned this in the other link but Daniel Amen has a section dealing with social and family dynamics. There is a chapter called "The Games ADD people play," which gives great advice on how to deal with them.

    Also, Driven to Distraction (forgetting author) is wonderful for the parent and the child.

    [removed]

    Last edited by mod-anon; 07-01-2007 at 10:21 PM. Reason: Please read and follow posting rules. Private emails are not allowed.

     
    Old 07-01-2007, 05:08 PM   #5
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    Re: Please explain the various ADD meds

    Quote:
    Originally Posted by kjrunner View Post
    The frontal lobe is likened to the executive command center over the rest of the brain...the other lobes and structures deeper in the brain. ...so while the boss is taking a nap, the other lobes of the brain are having a party.

    Also, Driven to Distraction (forgetting author) is wonderful for the parent and the child.
    Yep, "them other lobes having a wild bash" - an apt ADHD description. Ed Hallowell is author.

    Strattera is effective. Fact is, some adults swear by it. Better than stimulants they say. My experience: I, like many males, found the sexual side effects intolerable. Both genders usually find the first few weeks intolerable. After that the side effects seem to moderate for most but not all. So like all other psychotropic meds, works for many but not all.
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    Old 07-01-2007, 06:42 PM   #6
    addprogrammer
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    Re: Please explain the various ADD meds

    Quote:
    Originally Posted by kjrunner View Post
    I encourage you to read some of Daniel Amen's books. I may have mentioned this in the other link but Daniel Amen has a section dealing with social and family dynamics. There is a chapter called "The Games ADD people play," which gives great advice on how to deal with them.

    Also, Driven to Distraction (forgetting author) is wonderful for the parent and the child.
    I want to ditto kjrunner's book recommendations.

    Also read her post at [url]http://www.healthboards.com/boards/showthread.php?t=512267[/url]. It has very valuable info. I hope I didn't minimize its value by musing over our shared OCD traits.

    Set aside a few hours for it and enjoy.

    Sorry, still trying to conquer my TID.

    Bob

     
    Old 07-01-2007, 08:00 PM   #7
    frazzledparent
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    Re: Please explain the various ADD meds

    Thank you all very much for the information. I'll look into those books, kjrunner. I think they'll be very helpful. As far as your question regarding sensitivity to clothing/material and/or tags...I haven't experienced that with my daughter. She is, however, very sensitive to the NAME on the tag I needed that bit of levity. So, again thanks for the information. I now can discuss, with a teensy bit of knowledge, the drug therapy and can possibly ask some good questions as well. Thursday is just around the corner!

    Karen

    Last edited by frazzledparent; 07-01-2007 at 08:01 PM.

     
    Old 07-04-2007, 06:47 AM   #8
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    Re: Please explain the various ADD meds

    Karen,

    I had Foculin/Ritalin bass-ackwards. Foculin is dexmethylphenidate hydrochloride or d-methylphenidate NOT l-methylphenidate. Evidently methylphenidate (Ritalin) is the left sided molecule.

    This is more than a geeky curiosity. Brains love right sided molecules. That means considerably less Foculin is needed to achieve ADHD symptom relief efficacy.

    Another member posted that Foculin is maxed at 20mg per day. I questioned that statements veracity (in my own mind). I looked up the Norvatis prescribing info sheet and 20mg is in fact max recommended dose.

    There may be good reason for a shrink to go over max, but generally the more over max, the more likely adverse serious side effects become.

    Bob

    PS I got to beef up my "I'm no doctor" caveat to a black box skull and cross bones warning.

    Last edited by addprogrammer; 07-04-2007 at 06:49 AM. Reason: typo

     
    Old 07-05-2007, 05:15 PM   #9
    frazzledparent
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    Re: Please explain the various ADD meds

    Hey everyone:

    On to the next step. The meeting with the psychologist went fairly well. He is going to send his findings to our general practioner so she can prescribe something. What that will be is to be determined. I questioned whether a pyschiatrist would be the preferable way to go for medication. He said "yes", but in our area there are only three...seems they are lacking in the field...and the three around here are booked solid with more severe cases (psychosis, bipolar, etc.). He knows our family practioner and has confidence in her ability to prescribe something that will work. He was concerned about my daughter's "experimentation" with alcohol and pot. Yes, seems she has been using the weed! Says it helps her concentration. Hmmmmm. Therefore he thought that a non stimulant drug, like Strattera, would be the first step in combatting her ADHD. She, of course, wants Adderall because so many of her college friends are on it and it works for them. She seems to have her mind made up that Strattera won't work because she knows of one girl at school who uses it and it doesn't work for her. My guess would be that she doesn't take it regularly. Anyway, on to the family doc next week for another discussion and then hopefully on to some kind of medication so we can take the next step in finding something that will help her. Meanwhile, she's doing a great job with her summer English class!
    Karen

     
    Old 07-05-2007, 06:55 PM   #10
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    Re: Please explain the various ADD meds

    Frazzled ~ I am glad that you are on your next step of the process. I hope you won't be upset by what I am about to say but a little RED flag went up when I read your post. Your doctor is absolutely right about avoiding the stimulant meds if your daughter has admitted to alcohol/drug use. And I believe that I already forewarned you about my concerns in regard to that with my own daughter. It is the case of which came first the chicken or the egg....are our daughters using the alcohol/weed to self medicate because of undiagnosed ADD/ADHD or are they abusing drugs wanting to get something more accessible????

    Listen to me for a minute. My daughter is very aware of what is out there and what kids are doing (as I am sure yours is as well) and could be quite manipulative which is another thing that is part of her behavior. We use to say that she could be a lawyer because she could convince you that the sky is really purple instead of blue!!

    Anyway....when she was IMing with somebody recently (one of her college suitemates) the girl stated that she needed an "Adderall Rush". My daughter has requested to be tested for ADD and I have been concerned about her behavior since she was 14 so her asking for help was a really big thing for us. She seems genuine, however, since seeing that IM and knowing that she is into experimentation I couldn't help but question her motives here.

    I did some research and it seems that alot of the ADD stimulants are a big thing with college students. They are a perscription that they can get rather cheaply through perscription plans ( a copay of $10 isn't bad) and they can crush it and inhale it and get themselves a nice high. Also, if kids are hard up for cash I hear that they can get $5/pill and if we have a month's supply that would be $150 or more depending on how it is perscribed!!! And believe me...I can see my daughter fitting into both of these scenarios the struggling college student who never seems to have enough money!!

    From what I have read, Stattera is a good med of choice if addictions are of concern. I would guess that if it were my daughter's or your's motive to get their hands on something to experiment with or sell that they wouldn't be too happy being perscribed Strattera and would make a stink about taking it with an excuse similar to what your daughter is using. I would tell her that everybody responds to meds differently and that what works for one may not for another visa versa. And take it from there.

    As I shared with you, my plan is to make my daughter's doctor aware of her alcohol and weed use and REQUEST that he keep that in mind when perscribing anything for her. WE certainly do not want to encourage an addiction here but I cannot dismiss the reality that we have something going on here especially since her sister has Bipolar/ADD.

    I just wanted to throw in my 2 cents worth and let you know that I am still a little bit behind you on the road but wanted to share my concerns with you since you seem to be going through the same situation as I am.

    Again, I hope that I haven't offended you in anyway....the way I see it we're on the same team here and could use every set of eyes available to us to help us see what lies ahead.

    Keep us posted with how things are going.

    (((HUGS))) ~ Goody

    Last edited by goody2shuz; 07-05-2007 at 07:01 PM.

     
    Old 07-05-2007, 07:53 PM   #11
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    Re: Please explain the various ADD meds

    Goody:

    I agree with you 100%. A problem that is making this whole situation worse is that my husband is giving our daughter EVERY benefit of the doubt. I think she's using that trust and running with it...often. He even scrutinized the psychologist's report, bringing up little points to him at the meeting regarding her drug "abuse". He didn't want our family physician thinking that our daughter was some kind of drug addict. Even though the pyschologist explained that the term "abuse" was the decided upon term for those who use...even recreationally...illegal substances. My husband wants our daughter to get the best medication she can and thinks that if the doc thinks she's prone to addiction then the stimulants will not be prescribed. We just had another fall out over this. I was talking to our daughter about Strattera and what I'd found on the net as well as what feedback I've gotten on this site. I was also told, months ago, by my older daughter, that the "'ADD daughter" had taken someone's medication (Adderall, I'm guessing) to complete a project. I didn't say anything at the time, not wanting to get the older daughter in trouble. But, tonight I did say something to the effect of "Just because you've tried Adderall doesn't mean that other things won't work". Well, that blew up...she denied it and stormed out of the house. Husband got extremely mad at me and left as well. Lots of relationship problems centered around this disorder. If I can't talk about it openly then what am I to do???????

    Karen

     
    Old 07-05-2007, 08:18 PM   #12
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    Re: Please explain the various ADD meds

    Karen and Goody,

    You ladies have a tough, tough problem on your hands. Too bad you didn't have it when I was 18 and had all the answers.

    Best I can do is say you both are good parents excersing good judgement.

    Strattera works. If you opt for it, you'll have to sell it well. Not everyone experiences side-effects. Nevertheless, Strattera can be brutal first couple weeks for many if not most users. That in itself can be cause for failure.

    Another option you can very cautiously consider is Concerta. A methyphenidate high "sucks" to start with. Concerta's slow release makes it suck even more. I'm talking like a teen because that is how they think. It is not as abuseable as Adderall. Hence its "market" value is much lower especially if Adderall is available. And Concerta is not snort friendly.

    Why risk it? A lot less possibility of nasty upfront side effects. Us ADHDers want action NOW. We certainly don't want things getting worse before they get better.

    Additionally, if Concerta has no (zero) efficacy neither will Adderall. It blows the "it ain't working for me" con out of the water. Tell a doctor Concerta doesn't work at all, and you are out of the running for stimulants altogether.

    Even so, don't do Concerta unless you can police your daughters meds. Is there any way to do that? Can you or someone you trust hold the bottle and dispense preferrably on a daily basis? It not daily, weekly?

    Honestly, I never took so long to post. I've thought and rethought. I'm nervous about Concerta. I'm nervous about Strattera. Sometimes all options suck. Which one sucks less?

    Bob
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    Old 07-05-2007, 09:02 PM   #13
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    Re: Please explain the various ADD meds

    Well, you can tell this is bothering me. It's 11:00pm and I'm not feeling the least bit tired. When I'm upset I get the adrenalin rush, unike hubbie who crashes. I have a feeling I'll be up for hours to come. But, I did want to comment on Addprogrammer's post. My daughter did quite loudly say that she didn't want to mess around with finding a drug that works...she wanted it to work NOW! She wants to be "fixed" before she heads back to college in 6 weeks. The doc couldn't guarantee that. It's terrible to say but I just can't be certain of what is going on here. I can't or maybe won't give that absolute benefit of the doubt to her. Too many lies in the past, too much manipulation, etc. If she's really hurting then I can't understand why she won't try what the professionals suggest. She thinks she knows better, always has. Her very strong personality makes it extremely difficult to reason with her and discuss this situation sanely! Hey Goody...how does this affect the relationships in your household? How do your daughters interact? Any tension. Are you and your husband on the same page when it comes to the behaviors?

    Karen

     
    Old 07-05-2007, 09:05 PM   #14
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    Re: Please explain the various ADD meds

    Addprogrammer....I could use a crash course in ADD meds 101!!! You seem to extremely knowledgeable and I am sure that Frazzled is in need of this as well. If you could give us a basic rundown with the pros and cons I would appreciate it.

    Also...what if I opted NOT to medicate my daughter if she were diagnosed with ADD/ADHD??? I do not advocate that for everyone but my daughter is quite functional....she works a full-time job during the summer and has held jobs since she was 14 years old balancing that with her studies and still getting GREAT grades. Alot of her dorm mates were on academic probation whereas she made the Dean's List. Her employers seem to love her....the problem I see with her is her impulsivity, lack of good judgement that often land her in trouble. As a matter of fact, we just got a letter from the court out of state after her arrest for underage drinking while living with my brother (that she said wouldn't be a problem and would most likely be dropped) asking for a signature waiving a court hearing before a jury of her peers and a deposition will be asigned to her by the court to be followed. Granted this was over a year ago and she hasn't had any problems with the law since we still do worry. And as I have shared, she does drink and party more than we see as normal....she never comes home drunk or trashed but I have seen pictures she has downloaded on our computer with her passed out on the floor, in a bathtub, or in a closet. So these things do concern me. My gut instinct tells me that it is secondary to something else whether it be ADD or Bipolar....that she is self-medicating or acting on impulsivity.

    I so appreciate your input as well as others here. I just would like to well prepared as a mom when it comes time that the doctor discusses the various options and am sure Frazzled wants that too.

    Frazzled....I am sorry that your daughter is acting the way that she did....my daughter does the same when confronted or caught in the wrong. She doesn't face up to it and twists it around to make me or my husband to be in the wrong and not taking responsibility for her wrongdoing. I have a feeling that your daughter does the same. With all that we have been through with our younger daughter, my hubby and I learned that the worse thing is to not be united as a front thus allowing them a loophole to get through and not face up to what they have to do in order to accept the help that they need. Your husband MUST stand united with you in order to best help your daughter.....bailing her out is not going to help. If she does something wrong she must be held accountable....ADD or not there is not excuse. When it comes to the law she will not be able to use ADD as an excuse nor should she within your household.

    Hang in there....men handle stress so much differently than we do. Sounds like your hubby is having a difficult time with all of this and probably needs time to digest everything and then work on realizing as parents you need to stick together in order to do your best.

    Sending you lots of ((((HUGS))) ~ Goody

     
    Old 07-05-2007, 09:09 PM   #15
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    Re: Please explain the various ADD meds

    One more comment about policing the medication. I guess if the doc does actually prescribe Concerta we would dispense the pills for the next six weeks. Of course we'd be accused of treating her like a baby, not trusting her, etc. I really think that won't be necessary because I'm pretty sure that Strattera will be the first choice of meds. I was so hopeful yesterday...now I'm starting to feel helpless again, thinking that we've got yet another fight on our hands regarding treatment. Ugh.

    Karen

     
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