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hydrangea
Regular Member


Date Joined Mar 2007
Total Posts : 190
   Posted 9/6/2010 6:34 AM (GMT -7)   
This has only happend once before years ago...................PM Dr. wrote scipt for my Noco on my last visit. Told me he wanted me taking no more than 5 a day. (.75mg) He said I would always be in pain, and to only take them when I absolutely need them. (easy for him to say) well I told him that I always thought it was best to "stay ahead" of the pain and take them at a scheduled time. Well.....I have been in soooo much pain this week, problem is that I will be out of my meds a few days before my next appt. Should I call the office and tell them that I have been in more pain than usual, and took "one" more a day that was prescibed, or should I just grin and bear it till my visit? I will only be ably to take three a day till my next visit. Why Why Why should I be worried about this? This is My body and it is my choice not to live in this pain on a daily basis.  UGGGG I HATE THS!!!!!

grainofsalt
Regular Member


Date Joined Aug 2010
Total Posts : 215
   Posted 9/6/2010 7:13 AM (GMT -7)   
Hydra,

I can really sympathize with your situation. I have had times in the past where I used less than the prescribed amount daily amount on the bottle was, and come back for refills just to be told "You really should have only used them for emergencies so NO, you're not getting a refill". Even worse, at one point I was told I had a "ghost" pain condition and that is was immaginary, which is when I was cut off from pain meds and I was listed by the VA as an abuser and it was documented on my VA records as "pain medication restricted". The medication I had requested to have them refill and denied (which is what I think caused the ball to start rolling) was T#3, which has only a mild risk for dependency and abuse.

Anyways, you have an unsympathetic doctor who appears to be poorly educated in his field. He would understand that medication maint is very safe and low risk if the patient is seeing him on a montly basis. He would realize that under treated pain IS what causes people to overuse medications that are too weak for their conditions. He obviously doesn't understand tolerance very well, know that there are systematic approaches, such as rotating medications on a bi yearly basis. He would also understand (and my PM agrees with this), that for people that experience moderate to severe levels of chronic pain and it is has been shown that OTCs are not effective enough alone, that taking prescription pain medications at the first sign of pain, is the most effective way to treat pain. You are absolutely right in your mindset: Stay ahead of the pain. Medications work less effectively if taken after the pain is severe. While the pain levels will eventually come down, it can take 2 hours to finally become tolerable, instead of the 30 minutes it would have taken if your doctor implemented a stay ahead of the pain strategy. Its unfortunate, but your doctor will probably not be understanding of your predicament. It doesn't appear hes doing anything to adjuvant the medication either (adding things like muscle relaxants, TENS units, ect).

Its a tough call. You are hoping your doctor will finally see the light, but at the same time, you are affraid your doctor will consider you a "risk" and cut you off from medication. I hate to say this but its probably best to tough this out. When you see your doctor, tell him that with the amount you were prescribed, the situation was not bearable, and that your qaulity of life was very low. Explain that your pain interfered with your daily activities because you didn't have enough medication (or the right medication, as I'm thinking he should have given you something stronger if this medication isn't cutting it). If you've kept a pain journal, bring it with you. Your best hope with this doctor is to prove to him that his lack of proper actions are causing a negative effect on your life.

Again, you really need to find a new PM. PMs are supposed to be pain SPECIALIST. You are seeing a PM because your pain care needs are beyond that of a PC. Its like needing to goto an x-ray tech with your PC requesting 5 x-rays, but the tech saying "you know what, you can really do without the last 2 x-rays, you'll just need to get by on the results from these 3."
MRI revealed a bulging disc w/gel lost at L5 and showed the bulge touching nerves, causing sciatica. Diagnosed w/ Arthritis which is responsible for joint inflamation pain. Treatment: Nucynta 50-150 mgs every 6 hours (schedule II narcotic, Mu Opoid agonist and NE reuptake inhibitor), Celebrex 100 mgs, Klonopin .5, Epidurals, Radio Freq nuerotomy (sept 8th, 2010)

yankee girl
Regular Member


Date Joined Nov 2008
Total Posts : 125
   Posted 9/6/2010 7:37 AM (GMT -7)   
Hydra,

I totally agree with grainofsalt. I wouldn't put myself at risk of being denied my next script.

Had you signed a pain contract?

I am in a similar situation. My pm doc changed my meds from 15 mg. roxys to 10 mg. percocets ( 5/day each) ---a 33% decrease ...I hadn't seen this coming at all...I've been the perfect patient, passed my drug tests, etc....reason he did this is the current crackdown on pain clinics.

Anyway, withdrawal was horrific, and I took more than what he prescribed. I'm also down to 3/day until I pick up my next script. It's awful.

I just know that he wouldn't be understanding, and I would forever be labeled a drug seeker if I call and tell them what happened. I'm going to see how it goes with the next script (since I won't be contending with withdrawal) and will discuss possible options on my next visit.

It shouldn't be like this. I'm so sorry you're hurting.

yankee girl
severe nerve damage/several surgeries on wrist, fibro, had jaw discs replaced due to TMJ, PTSD

Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 9/6/2010 8:03 AM (GMT -7)   
I wouldn't call the doctor and tell them you need to refill early because you were taking more than scripted. What you could do is call the office and ask if there is an opening sooner, saying that you have a scheduling conflict and if possible you would like to move your appointment up a few days if possible.

The one thing that seems to tick a doctor off faster than anything is a patient not taking medications as prescribed. It doesn't matter if it is a vitamin or a pain med, but when it comes to the latter they often feel that the patient violated a trust since these meds are often powerful and can be dangerous if not used correctly.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.

flower123
Veteran Member


Date Joined Apr 2009
Total Posts : 856
   Posted 9/6/2010 8:25 AM (GMT -7)   
Hi Hydrangea. I'm so sorry that you are going through this. I think that you've gotten great advice!

I do not think that you should call. I think that you should tell your doctor that your pain is not well-controlled on your next appointment.

As hard as it is to wait, it would be so much harder if you didn't have any pain control and since your doctor told you that you are not allowed to take more than five a day, he may think that you are not following the prescription rules and thus say that you are misusing your medication. You don't need the stress of having to deal with that.

Also, I think that many doctors want you to call before taking more breakthrough medication than they tell you to take. Are you under contract? Your doctor seems strict. What is your relationship like with him?

I feel so bad, because it sounds like your doctor doesn't listen to you. I know that it will be difficult to wait and only take three pills a day, but I think that's your only choice.

It's ashame that he doesn't let you have more control of your pain by prescribing more effective medication.

I think that our medication is a very important tool that we have in controlling our pain. It makes life so much easier and so much less stressful when we feel like we have control of our pain, even if it is just a small amount of control (b/c pain is often still high even with meds). I think that it helps us to live happier, more productive lives.

It frustrates me to no end that people have such trouble getting meds. for legitimate, painful conditions. It causes unneeded stress, worry, and anxiety. Sometimes I wish that they could be in our shoes for five minutes. I believe that five minutes is all that it would take for them to realize how we feel.

Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2284
   Posted 9/6/2010 9:59 AM (GMT -7)   
I agree with the others. Asking for a script early is a bad plan. Also, you may want to cut back or skip a couple days ahead of time b/c you could always get tested at the visit & if you show no medicine in your system that's going to be a problem.

In the future, if you're still in a lot of pain even with the medication, call your PM's office & let them know. Then they can be involved with deciding whether you may need more meds, shots, or whatever.

I will say that I've been in your position so I do understand it. My first PM told me that I should try to "get ahead" of the pain by not waiting until I was totally incapacitated before taking any meds. At that point, your emotions are involved & the pain medicine is less effective.

My new PM has been good about clarifying that a bit more for me. So I understand that pain is cyclical & waiting a bit (in my case, 30-45 minutes) to see if the pain will either stay the same or slightly lessen can mean avoiding an unneeded dose of medicine. The exception to that is that sometimes I get sudden extremely sharp pain. If that stays with me for 5 minutes, I can take a fast-acting medicine. It's not easy. Taking meds on a schedule seems less stressful b/c it means the pain doesn't get so bad as often. But following the current policy means that I don't run out of meds. I'm switching to a new med now, but before that my PM said that if I had saved up meds from a prior day & was in bad pain I could take 2 doses at once. That's really made things easier on me. Some days are just really bad. And no amount of "getting ahead" of it makes a difference. I just need more meds on those days. But for some reason -- something to do with how the body processes it, I think -- there are meds that cannot be taken more than 4x/day. I was on one of those. I could take a higher dose one of those times, but 5x/day was a no-no. Just so tricky.

take care & hope your pain lessens a bit!
frances

Retired Mom
Veteran Member


Date Joined Feb 2010
Total Posts : 1753
   Posted 9/6/2010 10:14 AM (GMT -7)   
Hello,

I'm in agreement about not calling and about making sure you have the correct amount of meds in your system when you go in. I know that my last call to PM prompted a requirement that I now list every med I take and bring that list with me to my next appointment. I was just letting them know that I couldn't take the regular dose for a few days because my xanax had been increased and there was an adjustment period where the meds were really sort of making me loopy. I would never have made that call, but I was afraid I was going to be tested when I went in to pick up my script and I didn't want to show up with less meds than prescribed. That is a really bad thing and looks like you are a dealer or don't really need the meds. I do need my meds badly and didn't want to come across as anything other than completely honest.

The only really good think about it is that I have had a much easier time keeping up with what I took when and I think I will continue this approach even if I don't have to after this next appointment.

Perhaps (and please don't get angry for my suggestion) you could suplement with OTC (Tylanol or Advil....or something like that) to help keep your pain in check. I know that sounds like using nothing at all, but some times the addition of these simple OTC's can help enough to keep you from going crazy with the pain. I don't know much about the meds you take, so I don't know if there is already Tylanol in it....please be especially careful if there is).

Good luck with this appointment and please be careful!
Retired Mom

grainofsalt
Regular Member


Date Joined Aug 2010
Total Posts : 215
   Posted 9/6/2010 10:54 AM (GMT -7)   
@Retired Mom and Hydra,

Norco has 325 mgs of tylenol (acetametaphine) in it, and usually 10 mgs of hydrocodone (although I think some preps have 7.5). IF you should take any tylenol to supplement, please be sure that your total acetametaphine dose does not exceed 1000mgs total every 6 hours of 4000 mgs per day. Also, even though 4000mgs of acetametaphine is allowable in a day and is the maximum safe dosage, taking 4000mgs over several days can put your a risk for liver damage. If acetametaphine containing products are used daily, the dosage should not exceed 3000 mgs a day. Honestly, it best to avoid supplementing your Norco with Tylenol if you can avoid it, but if you decide to supplement it, remember 4000mgs max for a single day, and no more than 3000 mgs a day for multi day use. Please don't take my word for it though, this is best discussed with a professional, particularly a pharmacist. :)

You can DEFINATELY supplement your pain medication with Alieve though (Naproxen Sodium) at up to 600mgs a day on your own accord. Under a doctors care, more can be used. Keep in mind that high doses of anti inflamatories like alieve or advil can cause damage to stomach lining, so with anti inflamatories, its best to use lower doses when possible. Again, please talk to your pharmacist about this issue.

Narcotics, when used properly for pain management are very safe. The biggest risk of narcotics comes from overusing them, as then tolerance builds more quickly; or taking to much at one time, which causes a risk for breathing depression and blood pressure drop.
MRI revealed a bulging disc w/gel lost at L5 and showed the bulge touching nerves, causing sciatica. Diagnosed w/ Arthritis which is responsible for joint inflamation pain. Treatment: Nucynta 50-150 mgs every 6 hours (schedule II narcotic, Mu Opoid agonist and NE reuptake inhibitor), Celebrex 100 mgs, Klonopin .5, Epidurals, Radio Freq nuerotomy (sept 8th, 2010)

Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 5005
   Posted 9/6/2010 12:25 PM (GMT -7)   
Good afternoon Hydrangea!

Hey!...sounds like you and I are clipping along at about the same pace with our recovery problems and pain. I too am suffering more than usual pain at the moment. It seems to come and go, teasing me, but lately it has seemed to have gotten worse on the bad days.

At the moment I'm taking Percocet #7.5 325mg X3, way down from before my surgery. However; my pain has been persistent, and the meds just aren't cutting it, although, it is taking the edge off a little. eyes
Part of the pain management program requires discipline on you're part, and I must admit can be hard to do, especially when one is being scripted at the lower end of the requirements to keep their pain at bay.

Lets remember, that you are still in the recovery phase, from your fusion, and that you may have a ways to go before you will know where the pain cycle will settle. You're PM should know this and expect to make adjustments to you're scripts, as needed.
If he is not willing to give you the type of comfort, to allow you to live some sort of quality of life, then he is leaving you under medicated. It is one thing to be treating patients for unseen problems and worrying about the government crack down, and quite another to have a mile long well documented medical history, which includes MRI's, CT scans, back fusion surgery, and the such, and leave you under treated. nono

Since you're in a PM program, I fear that you are going to have to suck it up for the time being, but when that day comes and he makes no adjustments, then I would start the process of looking for a new PM. There is absolutely no need for a person to have to suffer this way, with the type of meds out there, unless you have an extremely high tolerance to all of them.

I will not deviate from my medication orders, and this is how I built up a good trusting relationship with my PCD, but I will also not sit here and not make an effort to call him, when a problem arises. If, and when you have your next appointment, please discuss this with him, to see what his policy is on this. I'm willing to bet, that the contract you signed actually states this.
I have a call in to my PCD, and still have a half a bottle of meds left at this time, so I have allowed myself a little wiggle room in case I need to seek another PCD and or a PM

From your statement, you said that you will be a few days without, so it looks like this condition has been going on for a while if you have been adding a 4th pill each day. From the time you take the 4th pill, you are adding mental stress to yourself, because of guilt. Stress can be a factor in your level of pain as well, so take note, and avoid this at all cost the next time.

Yes, it is easy to preach this, and quite another to be the one dealing with the pain, but I am going through the same problem as you right now. Not fun at all, so I do sympathize with you.
It will be up to you to communicate this problem with your PM and seek answers while you are there for the appointment. You may need to be earnest, in either you're plea, or demand, but not to the point that you offend you're service provider. If he is a total idiot and arrogant about it and declares that he is the PM God of all, then you will have your answer.

Thank You so much for posting here, as you well know, that I do follow your progress here.

Take care my friend, and lets hope you and I both have a successful outcome in the end.

SE:)

Post Edited (Screaming Eagle) : 9/6/2010 2:18:21 PM (GMT-6)


Blessedx8
Veteran Member


Date Joined Aug 2008
Total Posts : 3193
   Posted 9/6/2010 12:43 PM (GMT -7)   
Hydrangea,

Hey... I've been there before, and I am sorry you have to stress about this. I agree that staying on top of the pain is important... Trying to "catch up" when you are already in lots of pain is a vicious cycle.

Anyway, the others have said basically everything I would say. As horrible as it is...I would probably just suffer through until my appointment...Should it be this way? Absolutely not...

But I would absolutely tell your doctor that your meds aren't working. There's so many options out there... The fact that he would tell you that you are always going to be in pain bothers me. Yes, maybe your pain won't ever be "gone" but there are too many things out there that can improve your quality of life. Please remember to advocate for yourself and really tell your doctor this isn't working.

I'm sorry you are going through this :(
--Tina

White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3611
   Posted 9/6/2010 1:20 PM (GMT -7)   
Hydrangea
You have gotten yourself some very good advice, hindsite is always 20/20 but we have all done things that we wish we hadn't or we wish  we could go back and change but we can't! But we can learn from the things that we do. I think like the others have told you that it probably would be best to try and not to call your pain doctor and request more meds, but instead try to find other ways of helping yourself deal with your pain till your next refill appointment. Bio-feedback, Guide Imagery, massage therapy, aternating heat and ice, and the use of ibuprofen, or even aspirn, I would avoid using tylenol since it is in my pain meds. There are a host of things that you might be able to try to help you with your pain, and keep it at a tolerable level . You know you might even want to cut back more now so you will have more later on if you absolutely need it. and especially for the day before and the day of your appointment. Does your Doctor require a urine sample the day of your visit? I know for me, every refill appointment day, the first thing I am given, ( as all my Doctors patients are given)  is a  brown paper lunch bag with special cup in it with a thermometer thing on the side of the cup. and then we go to the bathroom and fill it, and then they call us back and we give them our bag with the filled cup in it, and the nurse asked when I had my last scheduled pain med and when I took my last percocet for break through. and then I date and sign and initial the form in several different places, and while I am doing that she takes the cup and puts my printed label on it, and I have to verify that, that is my name and information on that label . Then it is back to the waiting room to wait to be called back to see the Doctor. I know that one of the things they check is to see that you are taking your meds. There has been one person that ranted and raved on the waiting room because the Doctor would not refill his meds, and he was really making a scene. Well the Doctor finally came out and tried to calm him down, but he would not do that, and then the Doctor said that he did not need the pain meds because the last two urine test showed he was not taking them, as there was no trace of the meds in his system, and then asked the individual what he was doing with the medications if he was not taking them. The guy shut-up really quickly and left the premises right away! So at least my Doctor is not only checking if your abusing your medications, but also if you are taking them! That is just another reason to take the meds as prescribed.
 
  You know Hydrangea,  I know this is difficult, and allot of Doctors are not as caring and compassionate nor up to speed with treating pain as they should be. But with that said you do have to be responsible in making sure you follow your doctors orders, and if you find that you just have more pain than what you can tolerate, then that is when you need to call his office, and explain your situtation, telling him that your pain is intolerable, and you do not want to violate his orders on taking the pain meds, but you feel that  something needs to be done to better controll your pain! Don't ask him to increase the dosage or anything you, afte all you are paying him to treat your pain, so let him decide on what to do! You just let him know that your pain is intolerable and you would want him to help you get it back under control!  Kind of look at it as a team effort, you hire him to treat your pain, so let him do that, but if it is not working, then it is up to you to let him know that, and then let him  decide on how he wants to procede. If he continues to not give you adequate treatment or pain control, then it is up to you  to find another doctor that will!  Most Doctors are funny about being told or second guessed, they usually have huge egoes, and you have to work around that, so don't try and do their job for them,  but in the end they do work for you, just as a plumber or a mechanic does. and if your not happy with  what they are doing then you should certainly let them know, and of course you do have the option of firing them and getting some one else.  You do not need to feel bad  about doing that either, after all you hired them so they are your employee, and you are their employer, ( You are their BOSS!)
 
Try to get through this period of time the best you can, and  when you see your pain doctor, talk with him about your expectations, he is right in a sense that you will always be in pain, but the pain should be tolerable, and it should not be so great that it completely keeps you from being able to do any of your daily things of living!. Sure you might have to change your life style, chronic pain does require life changes. But there is no excuse for him to not adequately treat you either! I know that this is a trite statement but do "try and hang in there!", you do have all our support!
 
Good Luck to You!
 
White Beard
Moderator Chronic Pain
After spending nearly 22 1/2 years in the USAF, I retired in Sept, 1991. I then went back to school and became a licensed RN in 1994, and I worked on Oncology and then a Med Surg Unit, I became disabled in late 1999 and was approved SSD in early 2002!-- DDD, With herniated Disk at T-12 and L4-5. C5-C6 ACDF in Sep 2009, C6-C7 ACDF in Mar 1985, Osteoarthritis, Ulcerative colitis, Chronic Pain, Fibromyalgia, Complex Sleep Apnea, and host of other things to spice up my life!(NOT!) Medications:Oxycontin, Percocet, Baclofen, Sulfasalazine, Metoprolol, Folic Acid, Supplemental O2 at 3lpm with VPAP Adapt SV I am White Beard with a White Beard!

hydrangea
Regular Member


Date Joined Mar 2007
Total Posts : 190
   Posted 9/7/2010 10:02 AM (GMT -7)   
First of all, let me say thank you to everyone for helping me keep my head on straight.

I do know that it is up to me to "help" the doctors keep my pain under control. But your right, every time I take that "one" extra pill a day it sure puts a lot more stress on me emotionally. I think to my self....Is this one pill really going to help?.....Now, I will have one less tomorrow, oh heck my pain won't be bad tomorrow so I will just take one less pill. It sure is a viscous circle!!!

I did sign a contract but to be honest I guess I really did not pay that close attention to it, because I thought for sure I would not have chronic pain. I thought for sure I would not even need "meds" for any length of time. Boy was I wrong! many of you recommended that i make sure that I have meds in my system when I go in. This has never even crossed my mind, that my Dr. would think that I was selling my drugs. I guess they see all kinds of people. I for one just want my pain controlled.

I did go to the book store this weekend and bought a book on controlling pain. It think it is called "the mindful solution to controlling Chronic pain". I will be reading it this week.

I do have an appointment on monday with my PM Dr. for another epidural. I am going to discuss the procedure at lenghth with him before I have it. It only helpss for a couple of days, and then right back to the same level of pain. I will also make sure I discuss my medication with him as well. I have asked my husband to come with so that I can make sure i get all my questions answered. I also have an appointment with another surgeon for a second oppinion on the 23 at Rush

Thank you all for your words of wisdom, and for helping me through this (for lack of a better phrase) painful time.

Hope all is good with everyone.
Hydrangea
"lIFE IS NOT WAITNG FOR THE STORM TO PASS.....IT IS about LEARNING TO DANCE IN THE RAIN"
Diagnosed crohns Disease, Bladder tumor and inflammation, Herniated disc, spinal stenosis, facet arthritis, degenerative disc disease, siatica, Three laparoscopis, hysterectomy, physical therapy, trigger point injections, spinal epidurals,
Meds lyrica, norco, amrix,metanx,pentasa.
Spinal Fusion 3/20

White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3611
   Posted 9/7/2010 7:12 PM (GMT -7)   
hydrangea
I do not get much relief from epidurals either, maybe a bit more than you, mine averages aroung 3 weeks after my third one in the same area,( C-3) I am told I need to see a surgeon again, as my Pain Doc is convinced that it is the only thing that will fix the pain. I do wish you well with your appointment with your surgeon at Rush, I have been up there at there movement disorder clinic and they do have quite a facility! I can't imagine going to a place with better Doctors! Good Luck to You!
 
White Beard
Moderator Chronic Pain
After spending nearly 22 1/2 years in the USAF, I retired in Sept, 1991. I then went back to school and became a licensed RN in 1994, and I worked on Oncology and then a Med Surg Unit, I became disabled in late 1999 and was approved SSD in early 2002!-- DDD, With herniated Disk at T-12 and L4-5. C5-C6 ACDF in Sep 2009, C6-C7 ACDF in Mar 1985, Osteoarthritis, Ulcerative colitis, Chronic Pain, Fibromyalgia, Complex Sleep Apnea, and host of other things to spice up my life!(NOT!) Medications:Oxycontin, Percocet, Baclofen, Sulfasalazine, Metoprolol, Folic Acid, Supplemental O2 at 3lpm with VPAP Adapt SV I am White Beard with a White Beard!

Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 5005
   Posted 9/7/2010 7:31 PM (GMT -7)   
Hydrangea, I'm encouraged to see that you are trying to work you're way through this, with a level thought process. I do feel for you, and fully understand some of your thoughts of hope.

It has been quite a challenging road hasn't it! I'm glad to see White Beard posting here with you, and he really does have good advice for those of us dealing with this type of problem.

I also take my wife with me to my appointments, as I think it helps to confirm what I'm telling my PCD. Of course she has much better ears than I do, as I'm a little slow to digest what he is telling me at times.

Please don't get too discouraged at your recovery rate. It can take quite a bit of time to heal properly, and don't take to heart if someone may try to lay blame for your recovery problems. I really don't think there is anyone here who will do such a thing, but I have had family members try this. I let the Big guy in the sky take care of such problems, and have seen personally a spanking if you will of those who do such.

You may have to also come to terms, with some sort of reality that you will suffer some sort of pain for a very long time, and maybe for the rest of you're life. Lets hope this is not the case. Please protect your back at all cost while you're recovering, and I give you my promise I will do the same. We will get through this! Maybe not in the fashion and outcome that we are hoping for, but lets travel down this road with a positive attitude.

Hang in there and do keep in touch with us. Feel free to email me anytime is you want to talk.

You're friend SE wink
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