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  • Vicodin...My doc is afraid to prescribe a dose that is effective for me.

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    Old 03-18-2008, 11:02 PM   #1
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    Question Vicodin...My doc is afraid to prescribe a dose that is effective for me.

    I have had awful, chronic pain in my foot since 2003 that has interfered with my life. No over-the-counter pain relievers ever helped reduce the pain. In 2007, my primary care doc prescribed Vicodin 5/500 mg 3 pills per day. When I took my very first pill, it made me really tired, nauseous, and I had to lay down for a few hours. And in the beginning, I only took one pill per day right before bedtime so that I wouldn't have to experience the side effects. Unfortunately, one pill did not help to relieve my pain. So an hour before bedtime, I took two pills at once to find out if that dose would help, and it gave some pain relief, but not enough so that I could walk without pain. I then tried 2-1/2 pills an hour before bedtime, and that dose was more helpful. So that is the dose I found worked for me, and I never took more than that amount at one time. However, given the fact that my doc only prescribed 3 pills per day, and I was taking 2-1/2 pills before bedtime, that only left me with 1/2 pill for daytime, and I never bothered taking it because 1/2 pill is useless. So I basically had nothing to relieve my pain during the day. But I did try the 2-1/2 pill dose once during the day, and it relieved my pain for 4 hours, and I was able to function better on my feet and get things done around the house that I couldn't do otherwise.

    Anyway, at my last visit with that doc, I told him that 2-1/2 pills of 5/500 mg is very helpful, but it only leaves me with 1/2 pill for daytime, so I have nothing to relieve my pain during the day. I asked him to please prescribe enough pills so that if I needed pain relief during the day, that I would have enough pills. I told him that I have no desire for Vicodin, that my only desire is to be able to walk without intese pain. I mentioned that I was concerned about the stigma attached to people taking Vicodin, that some people are wrongly labeled as addicted or abusers of Vicodin. So he looked up some info about Vicodin doses, and told me he was giving me a higher dose to be taken 3 times per day. My new prescription was for 7.5/650 mg 3 pills per day. I tried the new prescription, but did not experience much pain relief.

    So I phoned my doc and told him that the dose he prescribed was not helping my pain, that the previous 5/500 mg prescription was helping a lot when I took 2-1/2 pills at one time, but since he prescribed 3 pills per day, I had only 1/2 pill left over to take during the day. I said that he can prescribe up to 8 pills of the 5/500 mg per day (that would not go above 4,000 mg of acetaminophen per day). He told me that he will NOT prescribe 8 pills per day, and that he felt uncomfortable prescribing even 6 pills per day.

    My doc stated in this conversation that I'm "already addicted to Vicodin." I didn't respond, but when I spoke to him by phone again recently, I asked him what exactly he meant by saying that I'm "already addicted to Vicodin." He responded that "[my] body is addicted to Vicodin." I then told him that I have no desire for Vicodin, but it happens to help with pain. I also told him that when I was sick the prior weekend with a fever, I didn't take any Vicodin for 4 days and didn't experience any withdrawal. I told him that I've never been addicted to anything in my life, and I hate medicine and have no desire for Vicodin, that I hate having to take it, but it helps my pain. I also reminded him that I don't smoke or drink alcohol. However, his response was that other people thought they wouldn't get addicted to Vicodin, yet it happened to them, so he's worried it will happen to me, that I'll end up taking much more Vicodin than would relieve my pain. I assured him that will not happen to me.

    I'm trying to figure out if what my doctor said about my body being addicted to Vicodin is accurate. I'm not psychologically addicted in any way. So is every person who takes Vicodin every day for longer than a month addicted to it? Is my doctor correct in saying my body is addicted to Vicodin? How would he know whether or not my body is addicted to it? I wouldn't want him writing something in my medical records that isn't accurate.

    Is 8 pills per day of 5/500 mg Vicodin excessive being that 2-1/2 pills at a time relieve my pain? This amount of pills would allow me to take a dose 3 times a day if needed. Not that I would take all 8 pills per day because I HATE taking this med, but it would be there if I really needed it. But my doc will NOT prescribe 8 pills, maybe 6 at most. What do you think about my doc being reluctant to prescribe even 6 pills per day? He hasn't changed my prescription yet, and I have to call him again in a week and try to convince him again to prescribe the 5/500 mg and at the very least allow 6 pills per day.

    Sorry this was so long. Thanks for any comments and advice.

     
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    Old 03-18-2008, 11:14 PM   #2
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    Re: Vicodin...My doc is afraid to prescribe a dose that is effective for me.

    To me vicoden is not mech more than tylenol I do under stand why he does not give you something more at bed time and then the vicoden during the day maybe you can ask him of this.
    Kimmie-Kat

     
    Old 03-18-2008, 11:28 PM   #3
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    Re: Vicodin...My doc is afraid to prescribe a dose that is effective for me.

    Just want to add...

    In the past, I've tried Lyrica, but it did nothing for my pain. I tried Ultram (non-narcotic pain reliever), though every time I took it, I vomited. I recently have been trying Cymbalta, yet it's done nothing for my foot pain, and I'm slowly weaning myself off it because you can't stop it cold turkey.

    I just read that for long-term use of Vicodin, you shouldn't go above 3,000 mg of acetaminophen per day to avoid liver damage, so I will make sure not to go over that amount. I don't want to damage my liver in any way. Unfortunately, Vicodin has been the only med that has helped with my pain so far...and I don't get the euphoria feelings that some people have with taking Vicodin, yet I do get a little nauseated & tired still...not a good feeling. When am late taking my dose before bedtime or don't take a dose for 24 hours, I don't experience any withdrawal symptoms...when I was sick I didn't take any Vicodin for 4 days and didn't have withdrawal that I could sense (I was just in a lot of pain with my foot).

    Last edited by sealover; 03-18-2008 at 11:35 PM.

     
    Old 03-19-2008, 12:32 AM   #4
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    Re: Vicodin...My doc is afraid to prescribe a dose that is effective for me.

    Hi Sealover: I think I can explain the reason he used the word addiction. I am assuming he is a family practice physician, please correct me if I'm wrong.

    When taking vicodin or any other opiate/opioid, on a daily basis, longterm, there is a physical dependency that occurs. This should not be confused with psychological addiction. (too many gen doc's are not educated about this) The difference is that with phys. dependency your body's pain receptors become used to the medication, blocking out the messages that the pain is sending to the brain. Psych addiction occurs when you start taking a narcotic more often than prescribed, purely to achieve a high.

    People with chronic pain are very unlikely to develop an addiction, because the meds go to the pain and are used up by it. Your pain sounds chronic to me. Many family docs see addicts and drug seekers, because they prescribe for an acute injury and because the patient likes the way it makes them feel, they want more even after the pain is gone. So they seek out more, just to get the euphoria.

    From everything you wrote, this does not sound like you have this problem at all. You sound chronic and I would recommend seeking out a Pain Management Specialist for your care. There are all kinds of medications, both narcotic and others that work on a long acting or time released basis. I'd say most of us who post here are on one form or another of these meds. From a pharmaceutical perspective, these types of long acting (LA) meds work best for chronic or long term pain.

    I probably wouldn't even bring this up with your current doc, as he seems to have a very dim view of narcotics in general. I would just ask him if he could refer you to a Pain Management specialist as you feel you are "stuck" with this pain and would like to find out what is available out there for chronic conditions. If he truly cares about your medical issues, he should be more than willing to do this for you. I know there are many others who can explain this better than I can, and I'm sure they will reply to your request as well.

    Please don't let this man discourage you or make you feel ashamed. He obviously doesn't know all of the facts. God Bless you and please hang in there. You deserve to get the relief you need. cmpgirl

     
    Old 03-19-2008, 01:16 AM   #5
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    Re: Vicodin...My doc is afraid to prescribe a dose that is effective for me.

    Yes, my foot pain is chronic and hard for me to deal with...I have had it almost every single day since 2003, and the pain has gotten worse through the years. The pain is in an area of my foot that is hard to treat for pain, since I bear most of my weight into that area.

    I agree that my primary care doctor must be uneducated about using narcotics for pain management. And his worry about me becoming hooked on Vicodin is rediculous...I have no desire for drugs, no desire to get high. If something like accupuncture would stop my pain, that's the type of treatment I would seek, rather than medication.

    It's just frustrating when my doctor says that my body is addicted to Vicodin, yet I've never had any withdrawals when I stopped taking it for 4 days, and I don't feel any desire to take Vicodin at all.

    I'm starting to think that doc is an idiot. At my last appointment, I told him that part of my foot turns purple when I take a shower and put more of my weight into that foot as I wash up. I asked him what's causing the purplish discolorations, and he said "I don't know." So I asked him what kind of test I should have or what kind of doctor I should see to find out about the discolorations, and he replied "I don't know." What the heck? I know that if your primary care doc is unable to diagnose and treat a problem, that it is his/her duty to refer a patient to a doctor who is able to do so. I've been taking Klonopin to help me sleep, and a year ago I asked him how I can wean myself off of it, and he said that I must deal with getting off one thing at a time, since I was weaning myself off Lyrica then. But just a few weeks ago, I asked him again how I can go about weaning myself off Klonopin because I don't want to take it, and his reply was that it's going to take me a LONG time to get off it. That's all he said, and then he changed the subject. So frustrating dealing with him. I am still trying to find a new primary care doc near me.

    Going to a pain management clinic is a great idea, and I'm going to look into it.

    Last edited by sealover; 03-19-2008 at 01:22 AM.

     
    Old 03-19-2008, 03:18 AM   #6
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    Re: Vicodin...My doc is afraid to prescribe a dose that is effective for me.

    Your Doc is incorrect.
    All CP'ers on narcotics will become dependent. All that means is that when you stop taking them abruptly, you will suffer withdrawal.

    Withdrawal has nothing to do with addiction.

    Addiction is a psychological event.

    Addicts take pain mess for the high, not for pain relief.
    Addicts doctor shop and take more than directed.
    Addicts buy their meds on the street.

    You are dependent-not addicted.

    Alan

    Last edited by erfan; 03-19-2008 at 03:20 AM.

     
    Old 03-19-2008, 06:48 AM   #7
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    Re: Vicodin...My doc is afraid to prescribe a dose that is effective for me.

    Sealover,

    Do you know the source of your pain (e.g. diabetes, neuropathy, etc)? What other modes of treatment have you tried besides oral medications?

    If you go to a pain specialist you can (hopefully) expect diagnostic tests and possibly procedures to isolate the cause and such before settling on narcotics. If your GP knows you are willing to undergo such treatment he should be more willing to give you a referral to a PM specialist (in case he's reluctant).

    In anticipation of a referral you might begin keeping a pain diary where you daily enter your pain scores, what may have caused the pain, and what you did to relieve the pain. Use a 0-10 pain scale where 0=no pain and 10=the worst pain you can imagine. My PM specialist and I have agreed that level 5 is what we are shooting for. I can't imagine any medical professional that would accept a higher score for quality of life. You might even mention to your GP what your average score is and ask him if living with that is reasonable to him. The more you educate him the more likely he may treat you and those down the line with a little more respect and understanding. A PM specialist will certainly want to see a pain diary.

    Best of Luck to you,

    steve

     
    Old 03-19-2008, 07:38 AM   #8
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    Re: Vicodin...My doc is afraid to prescribe a dose that is effective for me.

    It's very clear by your post that your Doc is inexperienced in pain mgt. First, he had to "look something up" re: how much Vicoden to take. Secondly, he made those inappropriate comments to you.

    I agree with the others that you need a referral to a pain mgt specialist. There is too much new research available today for you to suffer. I would recommend that you scroll through much of this board and read other threads to learn as much as you can about PM. There have been some really good dialogues over the past week or so.

    Good luck.

    Ex

     
    Old 03-19-2008, 10:40 AM   #9
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    Re: Vicodin...My doc is afraid to prescribe a dose that is effective for me.

    Ex is correct...And why couldnt he prescribe Norco [vicodin 10/325] if hes worried about the aceto. level. I hope you can find someone soon. The guy sounds like he got his diploma from the back of a Cracker Jack box.
    Keep us posted!

    P.S. if you leave him, get a copy of your records. That way you can see if hes written anything inappropriate. My guess is that if hes been that way to you face to face, then the records could have something that could get you started off in the wrong way with a new doc.

    xoxoxoxx,
    IZZY'SMOM

     
    Old 03-19-2008, 02:33 PM   #10
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    Re: Vicodin...My doc is afraid to prescribe a dose that is effective for me.

    Quote:
    Originally Posted by sealover View Post
    Yes, my foot pain is chronic and hard for me to deal with...I have had it almost every single day since 2003, and the pain has gotten worse through the years. The pain is in an area of my foot that is hard to treat for pain, since I bear most of my weight into that area.
    You sound EXACTLY LIKE ME. I have been enduring chronic pain since May 2003 in both feet. I started out seeing my family doctor, then I was referred to a podiatrist, and then after having multiple surgeries and other treatments I was referred to a PM doctor. If you have not seen a podiatrist, I would suggest doing that. Of course they are probably not going to prescribe meds (especially narcotics). Do you know exactly what is wrong with your foot? Have you had it looked at by a podiatrist? Is it nerve pain or other type of pain. I had what is called "neuromas" in the ball of my foot. I had many kinds of treatments and lastly surgery. However, the surgeries were not successful and now I am left with chronic pain for life.

    Trust me I KNOW HOW FRUSTRATING FOOT PAIN CAN BE. Most people do not realize how debilitating foot pain can be since you put pressure on your feet all of the time. I have been where you are and I was just about ready to chop off my feet (well maybe not literally) but there were times I felt like it. I was willing to try or do anything to stop the pain and I have gone through nearly every treatment option and medications. Here are the meds that I currently take:

    fentanyl patch
    Lyrica
    Ultram
    Triletpal
    Percocet
    Ambien

    Please respond back and I will try to help out as much as possible especially since we both have chronic foot pain. You probalby will need a PM doc to prescribe more potent narcotic meds.

    Brian

     
    Old 03-19-2008, 03:38 PM   #11
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    Re: Vicodin...My doc is afraid to prescribe a dose that is effective for me.

    Sealover:

    First of all, I feel for you. It is totally maddening for a doctor to give you a script, but not one that is adequate in addressing your issue. If the doctor will not either (1) give enough medication to treat your pain, or (b) refer you to someone who can help you better, I don't know why he/she even gives you any vicodin at all. Before I had surgery, I was prescribed 5/500 vicodin with enough for about 2 a day. I may as well have been taking m&ms, because there was not even a small dent in my pain level with one, and if I took both at once, then I could only do it once a day, and I'd be screwed for the rest of the day. I felt like why did the doctor even give me anything at all, then? By what you have wrote, you are not asking for that much medication compared to a lot of people. If you were an addict, you'd be asking for much more than that. I think I read that this is your GP that you are working with. Any chance of getting a referral to a specialist who might be more in touch with what you are dealing with?

     
    Old 03-20-2008, 12:49 AM   #12
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    Re: Vicodin...My doc is afraid to prescribe a dose that is effective for me.

    Hi everyone. Thanks so much for all the responses! Thanks for explaining to me that I'm not addicted to Vicodin, but that there's a physical dependency. I'll be sure to tell my doc about this so he doesn't write in my records that I have an addiction. Even with many non-narcotic meds, you can have a physical dependency to the med in that you have to wean off the drug or else you'll suffer withdrawals, so physical dependency is nothing to be ashamed of, it just naturally happens to your body.

    I'll try to answer the questions everyone asked...

    My pain is related to accidentally banging my foot on metal and then receiving a couple of cortisone injections for my foot injury that ended up causing fat pad atrophy and possible muscle atrophy and weakening of the tendons in my foot. The podiatrist who injected my foot with Kenalog never bothered to inform me of any risks of steroid injections. It feels like I'm walking on just bones. My forth toe concerns me a lot now because it has become weak and thinner so that when I stand, it is on its side. My other toes on this foot are a little thinner than normal...maybe some nerves are damaged in my foot which caused my toes to lose bone mass and muscle mass. My good foot is as normal as can be.

    For treatment other than oral medicine, I was in physical therapy. I give myself warm foot baths with epsom salt and I apply a cream that has capsaicin in it (it depletes substance P). I've used Lidoderm patches. I tried TENS. I've made sure to wear only comfortable shoes...I can't imagine wearing heels, as I think I would pass out from the pain in my foot.

    A daily pain diary is a great idea...I have notes on my pain levels through the years. I have had to tell doctors and physical therapists what my pain is like on a scale from 1 to 10.

    I've been to podiatrists, orthopedic surgeons, a neurologist, a pain specialist (he was only interested in doing sympathetic nerve blocks, and he's ready to retire anyway). I've had x-rays, mri's, bone scans, a nerve conduction test, a bone density test. I've met my share of very rude doctors. I've been brushed off by some specialists and told there is nothing they can do for me, that my foot doesn't require surgery, and they closed the door on me.

    I've had my primary care doc for at least 15 years, however, it's time to change doctors. The last straw was when an orthopedic surgeon sent him a letter in 2007 for him to send me to physical therapy for my foot. My doc never brought up the subject of physical therapy to me when I saw him in 2007/08, and I only found out about the ortho's recommendation for PT when I received a copy of that letter from the ortho's office. When I recently mentioned to my doc that the ortho's letter to him states that I be put into PT, his reply was, "I didn't think you wanted to go back to physical therapy."...so my doc is covering his lazy butt by blaming me, though HE KNEW I would jump at the opportunity to go back to PT.

    Regarding the Vicodin, my doc isn't afraid of the acetaminophen in it, rather, I'm the one who is concerned about my intake of acetaminophen because I don't want to damage my liver. Actually, my doc is afraid I'm going to become addicted to Vicodin and start taking too much of it, but his fears are unfounded. I've been suffering with this pain for about 4-1/2 years, and it was only last year that I first started on Vicodin. I chose to try non-narcotic pain relief measures first, leaving narcotic meds as my last resort. Even now, I'm still leaving my options open for pain relief that doesn't involve narcotic meds.

    Brainpain (Brian), I can relate to your foot pain as well. Mobility is so important, but when you have severe foot pain, it limits your ability to get around, and that can be so depressing and frustrating. I've had my moments where I thought I'd be better off having my foot amputated, but of course that's an unrealistic thought. When I see other people running and walking on their feet for a long time, I wish I could tell them how lucky they are. And as you mentioned, when you have pain in your feet, it doesn't help that you're putting the weight of your body into them, which leads to more pain. With the meds you take, are you able to be on your feet without bad pain?

    Take care for now.

     
    Old 03-20-2008, 02:02 AM   #13
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    Re: Vicodin...My doc is afraid to prescribe a dose that is effective for me.

    First of all what is wrong with your foot and why are you being treated with pain medication that isn't working. There are dozens of pain medications on the market that can be tried. There are also injections that can be given to alleviate foot pain. But first ...we need to know what is wrong with your foot/diagnosis and what has been tried then maybe someone could help you better?

     
    Old 03-20-2008, 05:21 AM   #14
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    Re: Vicodin...My doc is afraid to prescribe a dose that is effective for me.

    AnnD, I just wrote in my last post about all the treatments I've received, what the cause of my foot pain is, what tests I've had, and what types of doctors I've seen. In physical therapy, I've had phonophoresis, iontophoresis, whirlpool therapy, plus PT to be able to bear weight into the foot and move my toes again.

    At first, a doctor thought I may have RSD, but other doctors have said that I don't have it. I don't suffer from burning pain in my foot, which is characteristic of RSD. I've been diagnosed with fat pad atrophy due to cortisone injections (the fat pad on the ball of my foot is thin), metatarsalgia (this is a general term for pain in the ball of the foot) and possible nerve damage. Doctors have not come up with a reason why my toes have become thinner or why my arch has dropped a little, but I hope to find a doctor who has some answers. All of this stuff going wrong with my foot is causing me awful pain. I wake up with no pain, but as soon as I start walking, the pain begins and gets worse through the day, and the level of pain depends on how much I'm on my feet. If this pain was somewhere else in my body, I could deal with it, but foot pain is horrible because I have to bear the majority of my weight into the bad area of my foot.

    You wrote that there are injections to alleviate foot pain. What are these injections, and are they given in the foot? I already received two cortisone (steroid) injections in my foot, and soon after receiving them, I started to get fat pad atrophy. The steriod I received is known to cause muscle atrophy and fat pad atrophy, and if it can atrophy muscles, it can likely damage nerve tissue. Some people receive these injections in their arms or hip area for allergies, and several people have developed deep indendations through to the muscle tissue which is disfiguring and painful. So I cannot get any more injections in my foot...a doctor warned me that it is possible for my big toe to dislocate because of the damage the steroid has caused.

    The Vicodin is helping when I take 2-1/2 pills of 5/500 mg at one time, but I cannot imagine going out in public when I'm on this dose because it makes me nauseated and tired. My doctor is giving me a hard time because all he wants to prescribe is 3 pills total per day. Well, if I take 2-1/2 pills in the evening, that only leaves me with 1/2 pill for during the day, and 1/2 pill is useless. When I get into Pain Management, I will find out what options are available for treating my pain...I am open to something that causes less side effects than Vicodin.

    Hope I answered your questions.

     
    Old 03-20-2008, 05:09 PM   #15
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    Re: Vicodin...My doc is afraid to prescribe a dose that is effective for me.

    Quote:
    Originally Posted by sealover View Post
    At first, a doctor thought I may have RSD, but other doctors have said that I don't have it. I don't suffer from burning pain in my foot, which is characteristic of RSD. I've been diagnosed with fat pad atrophy due to cortisone injections (the fat pad on the ball of my foot is thin), metatarsalgia (this is a general term for pain in the ball of the foot) and possible nerve damage. I wake up with no pain, but as soon as I start walking, the pain begins and gets worse through the day, and the level of pain depends on how much I'm on my feet. If this pain was somewhere else in my body, I could deal with it, but foot pain is horrible because I have to bear the majority of my weight into the bad area of my foot.
    Oh my I am so glad to see that someone is nearly exactly like me I mean not glad that you are in pain but someone who has been through all of the crap that I have been through with my feet, endured all of the injections, therapy, pain and everything associated with it. I have not written my story at the top of the board but when I do it is going to be a 20 page novel. I have also had multiple cortisone injections in each foot, alcohol slerosing injections, chryo surgical procedure (6x in each foot). 1 neuroma surgery in my left foot, 3 surgeries in my right foot. I have seen 3 podiatrist, an orthopedic surgeon, neurologist, chiropractor. I have also had metatarsal pads, inserts, arch supports, 2 sets of custom orthotics, blah, blah, blah.

    Before I started on the fentanyl patch I was able to tolerate about 1 hour of walking per day and 15-20 minutes at a time. Now I am up to 3-4 hours of walking per day and 45-90 minutes at a time. I am just like you considering I wake up with nearly no pain and then as the day goes on it gets worse and worse and worse. I can totally empathize with you although it is from a different condition. My podiatrist screwed up on my left foot and the tendon did not heal right so my 2nd toe droops down, causing pressure and inflammation in the joint, called capsulitis. But the majority is chronic nerve damage (neuralgia). Let me know if you have any other questions ok?

    Brian

    p.s the podiatrist thought that I had RSD or CRPS as it is called now. I don't know about that but I do have chronic pain, which is mostly nerve related, and this is all that I need to know.

    Last edited by brianpain33; 03-20-2008 at 05:11 PM.

     
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