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    Old 07-03-2008, 08:42 AM   #16
    katlin09
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    Re: New medication...need information and advice

    Oh yeah I forgot to mention that I have both a Psychiatrist who handles my BP meds, as well as a Psychologist for therapy, a PCP that handles my Migraine and general meds, and a PM doc that handles my Pain Meds. None of these docs cross into each others fields, but they do communicate with each other to make sure they're all on the same page medication wise.

     
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    Old 07-03-2008, 02:58 PM   #17
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    Re: New medication...need information and advice

    Hi, I have some experience with the Duragesic patch. I have been on it for about 2 years now. It has helped me with pain so much. I was in so much pain before I was in the hospital for a week for just pain. BUT I had already tried everything else but it! I had left the hospital previously with the only thing that helped being morphine drip. When I was released they put me on liquid morphine to take at home. After about a week I was back in the hospital for the week I am talking about. Intraveniously it helped a lot but by liquid or pill it didn't. So they put me on everything I can think of to the highest possible dosage and then put me on dilaudid (IV). It was fabulous. But you can only take it in the hospital I guess. They finally put me on the patch to go home with and it has been great. First I was on 25mcg. then went to 50. Then to 75. I went back into the hospital for more surgery and the people there almost killed me by giving me xanax (so I wouldn't move in MRI machine) ontop of the patch and dilaudid and tramadol, and muscle relaxers. If my husband and daughter hadn't been there to see I wasn't breathing but 6 time a minute I would have died. Actually I told them to let me die. I was so comfortable finally. I didn't want them to bother me.

    I tell you this so you will know how serious to take this med. I feel like I am normal in every way instead of dopey like the other meds. But I am really not. I do function better but I realize I do things I am not aware I have done later. I have a terrible memory. I don't drive because I can fall asleep instantly, even standing up. This is getting better now, but like I said I have been on it for 2 years. I had to drop from 75 back to 50 because I get real mean on 75. I was fighting with everyone in the hospital, and with family too. It helped the pain better but was ruining my life at the same time.

    You can't just quit taking it. I went on a trip and the airlines lost my patch meds. I had to go into withdrawals for 3 days before I got home and it was terrible. NOOOO sleep for 3 days and terrible shivering and pain. Back to great with patch in about 6-8 hours. This med RX has to be hand delivered to the pharmacy. Just for a note: The Mylan brand of Fentanyl sticks better and is much smaller than other brands. The name brand is real big and won't stick as good. Funny huh?

    Please be careful if he just jumps to putting you on it. IT WILL MAKE YOU QUIT BREATHING IF YOU HAVEN'T BEEN BROUGHT SLOWLY INTO BEING ABLE TO HANDLE IT! I don't take all my other pain drugs anymore except in dire need. I can't tell that Tramadol helps at all anymore. Flexeril doesn't either. None of the pain meds ie: hydroco, oxyco, percocet, etc. I have to take Zanaflex 4mcg. 2 of those knock me out if I am real bad pain. PS I have Lupus and have some liver and kidney damage and my Dr. still has me on it. I don't think it hurts them at all, or he would be telling me to get off it.

    I hope this helps. If you can think of anything I can help you with just ask. Good Luck! I know what you are going through!
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    Old 07-03-2008, 08:01 PM   #18
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    Re: New medication...need information and advice

    I'll throw my 2 cents in again for what it's worth..I started the patch on the 25mcg/72 hrs, then after 2 months went to 50mcg/72 hrs, then after 1 more month went to 50mcg/48 hrs which is where I'm at now and I've never really had any side effects from the fentanyl patch...but with all the other meds I'm on, my tolerance is pretty high also I think the titrating up at the right speed/interval plays a big part in tolerance...if you go to fast then the adverse effects seem to be higher.

     
    Old 07-04-2008, 02:30 AM   #19
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    Re: New medication...need information and advice

    Good morning everyone!

    I think after all your helpful post I am definitely leaning toward not getting the patch, but something has to be worked out concerning my pain medication.

    I think my biggest fear about the patch is that I keep hearing that you build up a tolerance. Could someone who is on the patch please tell me how long does it take for that tolerance to happen. Are we talking days, weeks, months., If someone could get back to me that would be greatly appreciated.

    Thanks

    Richard

     
    Old 07-04-2008, 03:05 AM   #20
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    Re: New medication...need information and advice

    Hi Richard,

    I have been on the patch for about 2 years. I started on 25mcg. I went to 50 then 75. There was about 2-3 months between increasing it. After being on 75 for about a month, I asked to go back to 50. I have been on 50 for about a 1 1/2 years. I know when I am supposed to change it because I start to feel more pain but it is almost exactly 72 hours later. Like I said previously, since my Drs. have talked to me about my concerns on taking it for the rest of my life, I have decided I will stay on it. The difference for me being on it or off is dramatic. FOR ME...it was the answer I needed. If I can help anymore let me know. I wish you all the best on finding your answer.
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    Old 07-04-2008, 11:23 AM   #21
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    Re: New medication...need information and advice

    Richard,

    Tolerance is highly individual. There's so much that builds into how quickly one develops tolerance to opioids.

    When I was on the patch I developed tolerance fairly quickly. You may be different.

    Folks that have been on strong opioids for a long time tend to develop tolerance to fentanyl quickly. But, again, it's highly individualized.

    Fentanyl is in reality a very, very short acting opioid. It just happens to be packaged in a delivery system that deals out small amounts each hour over a 48-72 hour period. It originated in anesthesia and the beauty of it is that it takes effect quickly, and when stopped, leaves the system like lightning. This is helpful in surgery when trying to wake patients, because the effects are so short. Folks develop tolerance to short acting (SA) meds much more quickly then they do to long acting (LA) opioids. So, with fentanyl being so short acting, tolerance can develop fast.

    Your mileage may vary.

    But this doesn't have to be a show stopper when considering the patch. If you are in need and it seems to be the best choice, then it's worth a trial. You can ask the doc to consider it a trial. Ask him how long it should take to know if it's working well for you. Ask him how long it should take to know how quickly you are developing tolerance. Then see if he's willing to consider it's use as a trial, for a time period you both agree to. If it turns out that it doesn't help as you had hoped, or your tolerance skyrockets, then you and your doc can consider switching to another med.

    steve

    steve

     
    Old 07-05-2008, 05:39 AM   #22
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    Re: New medication...need information and advice

    I agree with Marcia,Ex & everyone else. To many other options in between. Less is better. I wonder why this doc. would want to by pass trying other pain meds in between. I would think that he would want to save something stronger in case it is needed in the future. Unless its something to do with any other health issues you may have. I am not as knowledgable as others about these meds but I believe my sister in law was put on the patch because of somthing to do with the other meds & her liver. Sammy

    Last edited by sammyo1; 07-05-2008 at 05:45 AM.

     
    Old 07-05-2008, 11:58 AM   #23
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    Re: New medication...need information and advice

    Quote:
    Originally Posted by Executor View Post
    I would agree. I don't mean to be repetitive, but I think moving from 40 Percs per month to the patch is too big a jump. It's really not necessary @ this point. In PM, you have to leave room in the playbook for future regimens. While the patch is a great med (Steve will attest that I'm one of its biggest supporters), it's not appropriate @ this time. Additionally, with the heat of the summer @ full swing and nearing it's peak, now is not the time to start. As the adage goes "timing is everything" and now is not the time.

    Just my .02. Good luck.

    Regards,

    Ex
    You know something, you are probably right. I have never been truly convinced that the patch was right for me, but after reading more of your posts I am starting to lean the other way. You keep bringing up the 40 percocets a month. Matter of fact you said in one of your posts that going from 40 percocets a month to the patch is like going from a pistol to a rocket launcher. If you are going to use comparisons when referring to my situation at least get it right. I think it more like going from a water pistol to a rocket launcher. As you may remember or not I stated in one of my post that my primary care physician was prescribing me 60 Norco(but not to be used on the same day as the percocet), with the instruction of taking 2 every 4 hours. I wouldn't said that dosage makes me pain free, but it does feel better than before the medicine. Okay, that's 8 pills a day, that will take care of 7 and one half days. So I am back to what my psychiatrist prescribes for me...40 percocets a month. Remember the distribution schedule...2 on Monday, 1 on Tuesday, none on Wednesday, 2 on Thursday, none on Friday, 2 on Saturday and 2 on Sunday. So we are back to the water pistol. You stated that the patch was too big of a jump. So according to your logic, what in your opinion would be the best next step. Do we increase the percocet to 200 - 240 a month, let's not forget the medicines I am on for my bipolar disorder and some other minor problems...Albuterol--two puffs every 4 hours, Amitriptyline--1 tablet every Monday and Thursday, Aspirin--1...81mg daily(my PCP thought it would be good for my heart), Clonazepam--1mg @ 8:00am, 1mg @ 2:00 pm, 2mg @ bedtime(my psychiatrist is going to change this to something stronger and once I start taking it, I will have to have a blood test every week for the next six months), Crestor 40mg @ bedtime, Depakote Sprinkles--125mg @ 8:00, 125mg @2:00 pm, 500mg @ bedtime, Folic Acid--1mg daily, Nadolol--20mg daily, Percocet--9 weekly, Promethazine--25mg three times daily, Seroquel--400mg @ 8:00 am, 400mg @ 2:00pm, 800mg @ bedtime. If you would increase the percocet to 200 - 240 a month, bye, bye liver. That would be good thinking. Let's start another problem, a possible irreversible prolem with my liver. Executor you stated "as the adage goes, timing is everything", here is another one for you..."I feel so bad, I would have to get better to die".

    Have you considered that what I have been through with my headaches, my bipolar disorder and especially over the last 8 to 10 months with arthritis popping up all over by body(especially my knees, my primary care physician told me that I couldn't even take a walk for exercise because of my knees that it would probably cause me to have some painful shin splints and that exactly what happened when I went for a short walk), that maybe I have missed my opportunity to work my way up the medicine chain because my pain management was so screwed up from the beginning that maybe my only option is to go straight to the rocket launcher.

    I know this is very harsh and I apologize, but I have been up since 4:00am and my body feels like a giant nerve and someone is stepping all over it. I know I probably sound angry but it's just frustration and once again I apologize for venting on this board. I really hurt and I have no percocet. Why?, because there was a mix up at my doctor's office. He was on vacation last month and I didn't have a appointment with him, so no script. I called his office on Tuesday and informed them I would need more pain meds by the end of the week. His secretary informed me that they knew and that my doctor had already wrote the prescription and they would put it in the mail. When it didn't come Thursday I called his office again and was informed it was put in the mail on Thursday...can you believe that?

    I have vented to much and I hope that my new found friends are not upset with me. By the way the big meeting is set for Thursday. My psychiatrist will be there, so will my therapist along with my sister, deciding my future in pain management.

    Any advice or options you guys think I should try to push on Thursday would be greatly appreciated!!! I probably will not post anymore because I made such a fool of myself. So thank you for all your help.

    Thanks!

    Richard

     
    Old 07-05-2008, 01:12 PM   #24
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    Re: New medication...need information and advice

    Richard,
    Dont feel so bad about your post. I DO understand where you are at. I too felt like life would never get better. I too got so frustrated and didn't think ANYONE understood. I don't think people on this forum would be here though if they didn't know and didn't want to help you and everyone else on here. You just don't get on one of these lightly. At least I don't. If you just hang in there and trust your Dr.s (If you don't then get new ones!) they will help you eventually. It sounds like you have a LOT going on. I did too. I had soooo many Drs. trying to figure out just one problem each. Then to try to figure out all the other stuff they weren't in touch with, which was going on, was extremely hard for them. BUT..your PCP should know all that is going on and know enough about all of it to decide correctly what you are ready for. I KNOW how strong this med is and I did have a lot of other meds first. BUT I was in the hospital for week and they (in that 1 week time) got me up to the point to be able to accept it. They can do the same thing to get you off it. I don't take that lightly! I didn't plan on being in the hospital but when I went in IN so much pain, they admitted me.

    I'm not saying you have to go in the hospital like I did. I had no choice! I hadn't slept for days and was in screaming mode. Why don't you just go Thursday and talk with them. THEY know about this med. They know about you. Ask your questions and then make your decision based on what they say. Get all the info on here you can and get the questions you need answered written down. Take it with you and just ask. Please let me know how you do. I think I know how hard this is for you. Like I said before I hate pain meds! I didn't want on them! I also wanted to be able to live a quality of life which I wasn't getting. Good Luck and hang in there!
    __________________
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    Old 07-05-2008, 01:48 PM   #25
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    Re: New medication...need information and advice

    ((((((((((((((((((Rich)))))))))))))))))

    Hang in there. I still think the lowest dose patch might be ideal for you, Its a very safe way to make sure you always have pain meds on board, and if like you said the percocets are doing nothing for you, I agree you have suffered through a few steps. as long as the doctor doesnt think the dose increase is dangerous, it wont hurt to try it, you can always back off if need be.

    I would not suggest this for everyone, but living with someone with bipolar, I know about all the meds you are on already, the memory problems, the sleeping issues, and how fast things can get really bad if you are suffering and unable to sleep and all your other meds get out of wack.

    You can come here and vent anytime, we all do it, its one of the great things about this board, when we say we understand, we really do.

    ~Fabby

     
    Old 07-05-2008, 02:14 PM   #26
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    Re: New medication...need information and advice

    Rich....I'm just trying to help. I've been in PM for 10+ years and take as much, if not more meds, than most. In addition, I've tried just about everything, except Methadone. I can only offer assistance and support...Do with it what you may. Many others on this board also have a wide array of experiences.

    My point is this....Going from 40 percs a month to the patch is a very big jump. Not only in potency, but consistency. Fentanyl (patch) is 100 x stronger than morphine. Oxycodone is 2 X stronger than Morphine. Thus, the patch is about 50 X stronger than Perocet.

    The second issue is consistency. The patch is 24/7 and significantly increases your tolerance. Conversely, you aren't taking very many Percs on a per day average, which doesn't lead to physical dependance. 40 Percs per month is only 1.3 per day on average. I'm aware of your schedule and have no idea why it was imposed. Doesn't make sense to me, but I'm not a Doc. Pain should be treated as needed, not on a day schedule. But, that's a different issue.

    It sounds as if the 40 Percs per month isn't enough. However, the active ingredient in Percs, Oxycodone, does work for you, so I would stay with it. If you need more coverage, I would look into either getting more Percs per month, or go to Oxycontin, which is 2 per day. How many extra Percs you need....Not sure as I'm not fully aware of your condition & etc. Personally, I would try to stay away from any 24/7 med because as I posted originally, once you go that route, you are almost always tied to meds forever. There is nothing like 24hr per day dependance. Fentanyl is usually reserved for pain that hasn't responded to other meds, or for those who have built up a large tolerance. You don't fit into either category.

    Good luck in whatever you choose. I would describe your pain to your Doc and let him/her decide as this person is the most qualified.

    Regards,

    Ex

     
    Old 07-05-2008, 08:28 PM   #27
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    Re: New medication...need information and advice

    Quote:
    Originally Posted by rich57 View Post
    Thanks steve! I know you said that it varies from person to person, but can you give me a ballpark figure on what you think the average is. empressorofq13 stated that she has been on the 50 for about 1 1/2 years. Do you think that this is a typical result or do you think someone like me would not even come close to that amount of time. I know you can't predict exactly, but just give me your honest opinion...
    Richard,

    You can assume that however quickly you developed tolerance to the pain killing effect of previous opioids (hydrocodone/vicodin, oxycodone/ percocet), you will develop tolerance to the patch in a similar amount of time. Notice I underlined "pain killing effect." This is wholly different from the "kicking in" feeling, as I explained in an earlier post. I have a concern that you have been considering them as being the same thing, as many do. They are not the same. So, when thinking about how long it took you to develop tolerance to previous opioids, I'm talking about only their pain killing effects. And that's how long I'd expect it to take you to develop tolerance to the patch's pain killing effects.

    Quote:
    Originally Posted by rich57 View Post
    Steve, you also mentioned that fentanyl was a short acting opioid and people that have been on strong opioids tend to develop a tolerance to fentanyl quickly. I have been on percocet(is percocet a opioid, I hate to be so stupid, but I really don't know)in excess of three years. Does that mean that the chances of me developing a tolerance to fentanyl quickly is pretty much in the cards for me... Also you mentioned long acting opioids. Once again I don't mean to be so stupid, but what are some of the long acting opioids you are talking about. Maybe that is the road I should take.
    Percocet is not that strong, as "strong opioids go." Mainly because they are limited to 10mg per tablet, max. Some people take the main ingredient, oxycodone, without the tylenol, and at much higher doses - now that's strong opioids. So, no, I do not think it is automatically in the cards that you will develop tolerance real quickly just because you took Percocet.

    Methadone, OxyContin and MS Contin are long acting (LA) opioids. Methadone is naturally long acting. OxyContin and MS Contin are short acting meds formulated to release the med over a long period of time, similar to how fentanyl is short acting but formulated to release the med over a long period of time (the patch), making the Patch a LA opioid.

    Should you take OxyContin or MS Contin or Methadone? Only your docs can make that judgment. I think there is probably a bias in your part of the country against OxyContin, so I doubt they'd prescribe that. Maybe MS Contin. Probably not methadone, because it's usually reserved for when nothing else works.

    I think because of your various painful conditions a long acting med is appropriate. I also think that making your schedule for taking meds as simple as possible demands that LA opioids are considered. With LA opioid you take the meds much less often, and there's usually less pills to take. Now the patch happens to be the easiest of all. And it comes in a 12.5mcg/hour formulation, which is what they usually start beginners at.

    Because of your unique profile, I think the 12.5mcg/hour patch is the best choice, one every 72 hours. This would be very easy to remember for either you or your sister, making the whole thing much simpler. If not the patch, then I'd recommend OxyContin. It's the active ingredient in your Percocet without the tylenol. You could be started at 10mg twice per day and see how that works. If that isn't strong enough then three times per day might be appropriate. But I think, given your med history to date, that twice per day is appropriate.

    So, first the 12.5mcg/hour patch, then if that's not acceptable to the docs, 10mg OxyContin twice per day. There are differences in potency between these two meds, but I think the need for simplicity in schedule trumps any potency issues.

    Good Luck to You Richard.

    steve

     
    Old 07-05-2008, 09:14 PM   #28
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    Re: New medication...need information and advice

    Quote:
    Originally Posted by Executor View Post
    ...I'm gonna bow out of this one because it's so a typical...
    Same here.

    I can't add to anything I've already written. Like you, I feel out of my element here. The last thing I want to do is complicate things or make things worse. The more I write the greater the chance of that happening I'm afraid.

    steve

     
    Old 07-06-2008, 02:09 AM   #29
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    Re: New medication...need information and advice

    I said that I wasn't going to post again, but felt that I must because of my behavior from yesterday. First, my biggest apologize goes out to Executor. I had no right to say the things I did. I was extremely rude and very sarcastic. I can say I am frustrated, in pain or just tried of the whole situation, but Executor did not deserve it and I hope you will accept my deepest apologize!, and please don't bow out of this. Everything yesterday was my fault and I do value your advice!

    To my other friends, I also ask for your forgiveness. My actions were inexcusable and please believe me, also out of character. I promise to never act like that again. I appreciate everyone participation and advice and will continue to do so.

    Please keep your fingers crossed for me on Thursday!

    Thanks!

    Richard

     
    Old 07-06-2008, 07:05 AM   #30
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    Re: New medication...need information and advice

    Believe me Richard, we understand. each of us has been there. there are few things more depressing or frusterating than chronic pain. we all have times when the meds arent working, or we havent slept, where we say things we normally wouldnt.

    You are not only among friends here, you are among others who really do understand what its like to be in never ending pain. Its enough to make a saint kick a kitten through a fan, and very few of us are saints, I certainly am not.

    I hope everyone keeps posting, its so great to see the different opinions and it can only help make better decisions when you know your problem has been looked at from all angles.

    Hang in there my friend!

    ~Fabby

     
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