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TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??


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Old 02-05-2018, 12:09 PM   #1
gabrialo
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TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Hello
I have 2 older threads regarding conditions before my TLIF on L4-5 in early November 2017 done at UCSF. Teterri has provided invaluable advices for last 18 months before my surgery. THANK YOU Teterri!

I woke up from surgery with numbness from knee down to toes on left leg. I was told I'd dura tear during the operation and surgery took 8.5 hours instead of 3 due to soft bone to secure the pedicle screw. I also cannot dosiflex and heel walk on left leg. I have severe thigh pain on left leg and numbness did not improve. Started PT in mid-December to strengthen the leg muscle.
About 2 weeks ago, I started having electric shock on my left shin, foot and toes. At my 3 months post-op last week, surgeon said the nerve might be awakening....be patient and wait for another 3 months. Then the electric shocks intensified to pain level of 8-10. also the frequency and duration are longer. I also have sensations of water dripping down and ants crawling on my leg. I found out these are symptoms of anarchnoiditis and it can be caused by dura tear during fusion surgery. I called the surgeon office today to see if they could order a MRI with contrast to rule out the possibility of arachnoiditis but refused....:0(
I'm at a loss and not sure what to do! Please help and advice

thanks,
glo

 
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Old 02-06-2018, 06:46 PM   #2
teteri66
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Sounds like things are pretty much the same as they were in the early weeks post surgery. Has the level of pain increased?

I had my surgery about a month prior to yours and am still dealing with the residual effects...in my case some nerve-related issues I didn't have prior to surgery. It is very standard practice to make the patient wait at least six months before the surgeon may begin to examine some "options." Also, with the symptoms you describe, I don't believe arachnoiditis (ARC) is the first thing that the surgeon would think to contemplate! While it is more common than doctors used to believe, it is still fairly rare, especially considering how many people have invasive spine surgeries.

Hopefully it is a matter of the nerves being traumatized by surgery and the subsequent healing.

I'm in a similar situation...waiting several more months to see what healing occurs before my surgeon will order an EMG. It is frustrating but I suppose collected data has shown that many issues resolve with time.

Also, it isn't all that unusual for PT to aggravate the healing process. Try to be patient and try not to panic while you are waiting.

 
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Old 02-09-2018, 04:13 PM   #3
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Hello teterri
Thanks for your reply and support
Yes my pain level has increased since surgery.
The first 2 months were numbness from knee to toes but the last 3 weeks I have more electric shocks pain on the numbed area and they were painful and long
If nerve is handling too much should it be lesser pain over time? That's why I am so scared of getting ARC and I was told a MRI with contrast will show nerve clumping for arc.
Is the contrast dye safe and will NOT cause arc like depo-medol?
I'm sorry to hear that you are also living through post surgery pains! I regret going through this surgery even though I thought I picked the best surgeon for the job! I don't understand how the doctors keep telling me "you are still early in your recovery stage" at each post op visits!
When will they acknowledge that something is wrong and need medical attention!
I'm sorry I got so frustrated but they seemed to be so insensitive in delaying proper treatment to the real issue!
Hope you feel better and I really appreciate your advice and support

Take care and I will pray for both of us

Have a nice weekend
Glo

 
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Old 02-09-2018, 06:38 PM   #4
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

I share your frustrations...but in most cases spine surgeons don't consider much of anything for the first six months. Some will not order a MRI until a year has passed.

I've found that with each of my four lumbar surgeries, there has been a specific turning point where I became aware that things were a little different and my energy improved. Of course it varied from surgery to surgery but was usually somewhere between 4-6 months. The exception was my multi-level fusion which was more like 12 months.

This is the first time I have had nerve pain that was something other than either causing numbness, pain or tingling. (And the occasional electric stabs). They are mostly annoying symptoms rather than horrendous pain...but they come and go randomly.

Are you doing any therapy yet? Perhaps the surgeon doesn't feel that PT would make any difference with the drop foot.

The gadolinium that is used to provide "contrast" is injected into a vein in the arm. It can be hard on the kidneys if the kidneys aren't working well and sometimes people with diabetes have some reaction, but for the most part, it is well-tolerated. As far as can be determined now, it doesn't cause arachnoiditis ...probably because it is no where near the spinal canal.

 
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Old 02-09-2018, 07:14 PM   #5
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Thanks so much for your reply.
Iím doing PT exercises at home and try to walk 20 min daily and lap swim if my pain is not horrible as I love to sit in he hot tub afterward.

Iím frustrated because the first 2 months were just numbness from knee to toes but recently the spasms, pain & electric stabs were taking a toll on me.
I still have thigh aching pain since a week after surgery.

Does nerve recover with all these pain symptoms? I read that dura tear can cause arc so thatís why I am so scared And depressed, i read some posts from the arc forum and their symptoms match to my new ones! I prayed that I donít have arc! 🙏

Like you said before my single level fusion is simple and itís done mis but it took 8 long hours, so Iím not sure if there were other complications but I was told only dura tear and soft bone based on the operation notes from The surgeon. My surgeon has ordered ct to check for bone fusion but wonít order emg or mri with contrast until 6 mos post op. Would ct show any nerve clumping like mri would?

From your experience, how was your recovery from fusion surgery? Does it take 4-6 months to see nerve healing?
Does it come with pain or worst symptoms before it resolved?
Thanks so much for listening and giving me advice... youíre guardian angel of the forum!🧚‍♀️
Glo
Glo

 
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Old 02-10-2018, 08:03 AM   #6
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Things have been a little slow on the board. 5here used to be more "regulars" who hung around.

The name "Minimally invasive" surgery can be a bit misleading because people tend to get the impression that it will be lots easier than open surgery. It doesn't change too much what happens once the surgeon gets inside the body. He still has a major carpentry project facing him. It just doesn't result in cut muscle tissue, etc. However, the fact remains that things have to be moved out of the way to access what the surgeon needs to reach.

My most recent surgery was a laminectomy to decompress the central canal at L2-3. If I had needed the surgery five years ago, it would have been an open surgery that would have required adding on to my L3-S1 fusion...which might have required removing old hardware, installing all new and adding on rods and screws at L2-3 to tie it all together. But now technology is such that I ended up with three small incisions...and no fusion at that level. However I woke up numb from knee to hip, both legs,and intense front-of-thigh pain. The very intense pain gradually got better after several days, leaving behind pain that is gradually going away...but also intense itching and sometimes burning.

About ten days ago I realized that I felt the veil lifting -- my body has recovered from the general anesthetic, hormonal changes, etc. As far as the medical people are concerned, I am healed from the surgery. Now it is a matter of working through the things that take longer ...regaining strength, stamina and gradually hopefully, losing the "new" nerve pain.

In my case, in order to clean out all the stenosis, the surgeon had to push the thecal sac and everything contained within it, off to the side. This is what creates the nerve pain. Also, the bits of blood that form as the surgery is being completed, apparently form little adhesions that tend to constrict the spinal nerves. As the person becomes more active, these adhesions stretch and break apart which can cause that electrical zinger sensation. So, in a way, as time goes by and you get a little more active, these sensations may occur more frequently.

 
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Old 02-10-2018, 08:50 AM   #7
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

More....

Not to discourage you further, but it took about 18 months to recover from my three level fusion! Probably from 12-18months it was just sort of subtle improvement in nerve issues...but after 18 months, I stopped paying so much attention to what was going on.

You should expect to see change for the first twelve months...as that is how long it takes for the new bone to form and set up so it is hard and durable.

Other than indulging your own curiosity, there is no urgency to finding out if you have nerve clumping. While some of your symptoms may be similar to those who have been diagnosed with arachnoiditis, they are also the same as some more garden-variety nerve issues...ie., the trauma from the fusion surgery is enough to cause these same symptoms (without any nerve clumping!).

I don't believe CT scan will show nerve clumping...but could be wrong about that. It is better for envisioning bone but MR is better for soft tissue/nerve stuff.

The very best advice I can give you is to develop patience and a positive outlook. I found with my long recovery after my multilevel fusion that it was helpful to just take it one day at a time. There is no point in looking back or wishing you hadn't had the surgery. You did. There is no going back. So don't waste your time and energy thinking about it for one more second. You don't know how much worse your situation could have become without the surgery!

Keep doing all the exercises. Did your surgeon OK the lap swimming? I wasn't allowed to swim after any of my spine surgeries...but it may have been due to the nature of the open surgery or for another reason! Shouldn't try to compare experiences! I walked in the pool and did a whole series of exercises but wasn't allowed to swim any strokes where my back was in extension.

 
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Old 02-12-2018, 09:24 AM   #8
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Hello Teteri,

Thank you for your support and encouragement!
Yes I try to to take one day at a time and not to be so worry about ARC.
I do my PT exercises daily and swim 1/2 times a week. Yes I asked my surgeon at my first post-op and he approves as long as my incision is sealed. So I have been swimming for about a month now. I tried not to extend my back when I came up for air by turning either to the sides. Yes backstroke is the best but I do all strokes except butterfly. I also do dog pedal too. I have been lap swim daily for the last 20 years.

I am sorry you'd another surgery even though it's not a fusion a few months ago. Was it in October last year? And you also have numbness and pain on your leg and foot? Have it been resolved or improved? I was worry because of the pain symptoms that started last month. I was hoping the numbness will resolve over time but was totally taken when I have these painful electric shocks couple weeks ago.

I will try to be patience on my leg and hope for the best! My surgeon ordered the CT for the bone fusion and will see him end of April for my 6 months post-op.

I hope your pain and numbness will resolve soon. Please keep me posted so I know you are doing better and will be a great support to my case.

best of luck to all of us who suffer!

thanks
glo

 
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Old 02-12-2018, 07:34 PM   #9
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

I have numbness in both feet and have had it since around 2010...I kind of lose track! My surgeon was hoping the last surgery (Sept.22, 2017) would alleviate at least some of the numbness, but I think, if anything, it is worse. The thigh pain that developed post surgery (woke up from surgery with it) is changing and I believe, getting better...slowly.

You are lucky you can swim. With my fusion the way it is, I am not supposed to swim other than backstroke and then not to kick much. I tried swimming with a snorkel but haven't gotten the knack of it well enough that it is enjoyable or indeed, tolerable!

 
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Old 02-13-2018, 10:09 AM   #10
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

I am sorry that your numbness lasted so so long! Did it also include nerve pain along the numbed area?
I think I can put up with numbness which I had for the first 2 months, but the random localized nerve pain is the worst pain I'd experienced. If it hit while I was walking, I will collapse and fall!
I also have thigh pain 2 weeks after surgery for couple months and it has somewhat come and go now.

This is my 4th months post op but I am having more pain on my numbed leg than before. I have not gone walking or swimming these couple weeks as I am depressed and tired. The pains I have are so similar to those with ARC but you said it can be just random stabbing pain from surgery? They are stabbing, stinging, electric shocking pain. I have intense pain even when my pant just barely brushing on my leg! Are all these still normal and expected?

Are you still on pain med such as norco or percocet? I was off Norco 1 month post op but still on gabapentin and baclofen. I try to ease off gabapentin and just stay on baclofen. Is baclofen a better drug than gabapentin on pain and addiction? Do I need to wean myself off slowly? any long-term side effects. I read from GMAK that baclofen is a neuropathic drug that works on CNS.

Would you advice trying acupuncture? would it make it worse?
any other modalities to alleviate the random stabbing nerve pain?
please advice.

I praying I could feel better around 4-6 months timeframe as you'd mentioned. So far it has been a downhill battle! But I really appreciate talking to you and all your advices.

thanks
glo

 
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Old 02-13-2018, 09:19 PM   #11
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Try to do a moderate amount of some sort of exercise. It is helpful to healing in general.

I don't have much pain along with the numbness. I've had varying degrees of numbness for fifteen years. I don't take any medications. Every symptom or character of pain that you describe as typical of ARC is also common with regular healing. Can't say "how common". I have had a variety of reactions after each of my surgeries...no experience like the previous one.

Baclofen is a muscle relaxer which I haven't used. Sorry. Can't help you there. I used to take gabapentin and then Lyrica, but haven't used either since about 2011. Baclofen and gabapentin are not given for the same purpose. You could take both.

I went through a period with this surgery where I could barely stand to wear clothing. Anything touching my thighs really was unpleasant. Luckily, that is mostly gone. Some days it feels sensitive, like my laundry detergent is causing itching, or something.

I really don't know what to say about acupuncture. I currently go to someone who I believe helps me a lot...but he also does bodywork and keeps me structurally aligned so I don't know which helps the most. It really all depends on the quality of the acupuncturist. Some are more symptom-oriented than others!

 
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Old 02-16-2018, 11:47 AM   #12
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Hello Teteri66,

thanks for your post.

I have some new symptoms this week:
- super sensitive to light touch by pant or hand and caused burning pain, is this allodynia?? When I woke up from surgery, my foot was numbed and when they touched my top of my toes, they were extremely painful when touch gently. But then it eased off in a few days.
- aching pain on my left buttock when sitting for 5 minutes or so, I will need to get up to ease the pain.

are these symptoms normal during recovery in your opinion? Seems to me that I have more and more symptoms/issues and none of them have improved over time. I am very worry!
I just have my CT-Scan done to check for bone fusion and am waiting for the radiologist report.
I will post the report once it's out.
thanks for listening and allow me to vent.

glo

 
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Old 02-19-2018, 09:50 AM   #13
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Hello Teteri66,

thanks for your post.

I have some new symptoms these 2 weeks:
- super sensitive to light touch by pant or hand and caused burning pain, is this allodynia?? When I woke up from surgery, my foot was numbed and when they touched my top of my toes, they were extremely painful when touch gently. I'd had this when I woke up from surgery but it eased off after a few days. Now it's coming back again!
- aching pain on my left buttock(sit bone) to left calf when sitting for 5 minutes or so, I will need to lay down to ease the pain.

are these symptoms normal during recovery in your opinion? Seems to me that I have more and more symptoms/issues and none of them have improved over time. I am very worry!

I just got my CT scan on lumbar and here is the findings:
Interval surgery with interbody fusion elements at L4-5 level
and bilateral L4 and L5 pedicle screws. No pedicle cortex is seen
inferior to the left L4 pedicle screw. Pedicle screws do not
extend into the lateral recesses or the foramina. There appears
to be focal bony continuity across the L4-5 disc space. Slight
anterolisthesis of L4 on L5. No acute vertebral body compression
fractures. Pseudoarticulation of right L5 transverse process with
S1 as before
T12-L1 (focal posterior left of center disc protrusion with
annular calcification noted without high-grade bony spinal canal
or foraminal narrowing)
L1-L2 (disc bulge and facet joint degenerative changes. No
high-grade bony spinal canal or foraminal narrowing)
L2-L3 (disc bulge and facet joint degenerative changes. No
high-grade bony spinal canal or foraminal narrowing)
L3-L4 (disc bulge, facet joint degenerative changes and
ligamentum flavum hypertrophy with mild spinal stenosis. Right
posterior lateral disc protrusion might abut the extraforaminal
portion of right L3 nerve sleeve as before)
L4-L5 (postsurgical level. Left foraminotomy. No high-grade bony
spinal canal or high-grade bony foraminal narrowing.
L5-S1 (facet joint degenerative changes and spondylosis without
high-grade bony spinal stenosis. Bony elements encroach upon the
right foramen possibly affecting the exiting L5 nerve sleeve.
Mild to moderate bony narrowing of left foramen also noted.
Bilateral SI joint spurring)
Paraspinal Soft Tissues: Mural vascular calcifications.

I also consulted with another ortho.spine surgeon remotely and he believed I had nerve root damage/injury during surgery on L4 & L5. Probably caused by dural tear on L4 and difficulty to secure the L4 pedicle screw.

please comment and provide your advices. this is ordered to check on bone growth. Do you see any nerve root damages or bone growth. Thanks a lot for your help

thanks,
glo

Last edited by gabrialo; 02-19-2018 at 11:23 AM.

 
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Old 02-20-2018, 07:58 AM   #14
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

I assume the ortho spine surgeon you consulted with remotely was looking at the actual images and not the report? I don't see that the report answers any of your questions. There is not much specific info about bone growth, but it does say " there appears to be bony focal continuity across the L4-5 disc space." I believe that indicates some growth! You'd have to look at the images to see it.

Again, the CT scan isn't able to provide much info about soft tissue, nerves, etc. But you should be able to tell that the screws are properly located, etc. If a screw is penetrating a nerve, it can be extremely difficult to visualize.

Regarding your return of symptoms...it is not unusual with nerve pain to have symptoms feel worse as things are healing. As feeling begins to return, or as the nerve "wakes up" it can be painful for many months before things begin to improve. When this happens, it is hard to know if it is a healing or something getting worse! Sometimes it is hard to kno if it is time to panic or if you are better off trusting to nature, relaxing and going with the flow, as it were!

 
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Old 02-20-2018, 01:13 PM   #15
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Hello Teteri,
thanks for your reply as always.
No the comments from the ortho.spine surgeon I consulted remotely was based on the radiology findings you read and the symptoms I provided. I was kind of desperate and concerns on my growing symptoms so I posted my situation to his online portal for advices, just like I did on the Healthboards.com site.

He said ARC can be the cause by mostly likely are the direct nerve injury on L4-L5. he also mentioned the missing inferior pedicle on Left L4 and assumed the surgeon removed it during surgery per the CT report-"No pedicle cortex is seen inferior to the left L4 pedicle screw. " I was not told post op so was a surprise to me from the CT report.

Here is the operative report from my surgeon:
We place a right iliac stealth pin and arc and did intraop oarm ct and registered stealth navigation system. We use stealth to localize the 2 MIS wiltse plane incisions and created a 1 inch incision over the bilateral L4-5 pedicales.(BUT MY FINAL INCISIONS ARE 2.5″ EACH SIDE). We used stealth as she had very abnormaly angulated L4-5 pedicales and we navigated with a cannulated drill and created L4-5 pilot holes and placed kwires and tapped and placed L4-5 pedicle screws bilaterally (left L4 screw we placed after the TLIF to avoid hindering the TLIF view). We used cannulated cortical fix expendium pedical screws as she is osteoporotic. The left L4 screw purchase was not as solid as the right L4 or bilateral L5 screws. The inferior L4 pedicle was weak and eroded when we placed that screw due to osteoporosis. However, we inspected the exiting nerve root and the screw was not touching it so we left the screw in place. We did a left L4-5 facetectomy and laminotomy and decompressed the exiting and traversing roots using microscope and microdissection techniques. We had a small dural tear on the left L4-5 lateral dura and repaired this with microsope and micro sulture w 6-0 prolene and a small muscle autograft. We placed duraseal over this repair. We did L4-5 discectomy from left and interbody arthrodesis and cage placement with globus cage and placed local autograft and iliac bone marrow aspirate autograft and mosaic graft extender into L4-5 disc space to complete the transforaminal interbody fusion. We expanded the TLIF cage to get sold purchase. We connected rods to the screw heads and locked the locking screws and placed right sided posterolateral arthrodesis w local bone graft into the L4-5 facet. Hemostasis was achieved with bipolar. The wound was closed in a layered fashion. I was present for all key portions of the procedure. I did the decompression via microscope and hardware placement w navigation myself. The sponge and needle counts were correct per the nursing staff.

sorry it's a bit long. Please advice and comment if any issues during surgery that could result in direct nerve damage. As always your time and support are greatly appreciated.

Thanks,
glo

 
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