What I was afraid of happening may have happened : (

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bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 9/14/2008 2:48 PM (GMT -6)   

Background: I was dx'd with UC in 05/07 and I'm sure I've have had it 2-3 years before, as my first GI doc kept telling me it was IBS; he performed a colonoscopy with NO biopsies and said my colon was healthy 3 weeks after I ended a very bad flair go figure???. In 05/07 I was bleeding with D and very bad pain, so I checked myself into the local hospital where I had a second colonoscopy with biopsies and it came back as pan colitis; the doc said it looked mild but the pathology came back moderate to severe in two of the three places. I questioned my GI doc on the discrepancy and he said in his 20 years of practice he relies on his visual assessment. I was started on the typical routine of UC treatment; 6 asacol and when that stopped working in about 6 months he added rowasa to the mix which really helped until recently when I was advised to try canasa which I was using  2x's per day; I was also up to 4 Lialda per day. Well what I was afraid of finally may have happened; it appears that mesalamine is only working to a point, as I have been in a stubborn mini flair for 3 months and up until today I was doing pretty well considering...just some very minor blood specks but on formed stool and with some pain/spasms following my morning BM on some days...I have only been having 1 BM per day.

 

 

Current Condition: This Thursday I went to the University Of Miami Miller School Of Medicine and saw Dr Maria Abreu who is the newly appointed Chief of Gastroenterology. I asked her a myriad of questions etc and I was feeling pretty good that day with the pain only being about a 3 (1-10)...to sum things up she said she felt my UC could be contained with meds and she advised I switch from Lialda (2-2xs per day) to Pentasa (4 2x's per day) as it has a better release system...she also wanted me to try cortifoam which I was very excited about...I tried the cortifoam last night and started the Pentasa today. Yesterday started off with a nice formed a.m. BM but moderate pain/spasms developed about an hour after my BM which would come and go throughout the day getting pretty bad around 8 pm so I was very anxious to start the cortifoam last night. This morning I woke up and did not have the moderate but pressing need to have bm so I thought the cortifoam did the trick; but when I had my a.m. BM it started off fine but just when I thought I was finished I had more to go, but still semi formed; then an hour later I had to go again...by mid afternoon by rectum was on fire and I had some considerable spasms (it's amazing that none of the current docs i've been seeing ever offered to give me an anti spasm med???) my rectum still burns but not as bad and the spasms have subsided for the most part due to finding some left over Levsen (I took only a half)....I was in quite a bit of pain prior to the Levesen and if I could of, I'd elected for surgery on the spot the pain was that bad. 

 

I placed a call into Dr Abreu and was told she was treating an emergency IBD case and would call me back. When I was there i saw a girl in her mid 30's with Crohn’s who was just told she needed surgery right away...i was so badly saddened for her I could have cried. 

 

Pre Conclusion:  It appears that the mild forms of meds/mesalamines may not be doing enough to keep me in remission and for very long, so I may have to go the 6 mp route. It's amazing the docs keep telling me my UC is "mild" ??? I await Dr Abreu's call. I don't know if I gave the cortifoam enough of a chance but I feel if anything, I shouldn't have worsened either...the foam also burned a bit perhaps due to my fragile rectal area. The other interesting thing is I have had no blood for the last 4 days.

 

Something else I'd like to discuss; how the heck are we supposed to know if we catch a stomach bug especially when in the midst of a flair as we may be fooled into thinking we are getting much worse? The reason I ask is quite a few of our friends have been getting stomach bugs in the last few weeks. It's wierd but even more sad to actually wish I have a stomach flu... sad

 

Thanks for listening and as always I welcome your thoughts  :-)  . 

 

 


Moderate Pancolitis
Dx'd 05/2007
4 Lialda per day
Trying Canasa 2 per day a.m./p.m.
Probiotics, Bowel Soother, Fish Oil, Calcium, Multi Vitamin and Melatonin
Trying to reduce sugar in my diet but cannot tolerate artificial sweetners
I excersice daily
Did I happen to mention I HATE this disease!!!

Post Edited (bbc) : 9/14/2008 1:59:18 PM (GMT-6)


Christine1946
Veteran Member


Date Joined Aug 2008
Total Posts : 5975
   Posted 9/14/2008 3:11 PM (GMT -6)   
Hi bbc,
     Join the club.  I was hospitalized (2nd time in ten years I have had UC) for ten days in May.  I've been told by my GI doctor and a colorectal surgeon that I have "mild to moderate" ulcerative proctitis.  It's confined to my rectum.  However, because of the location, my GI doctor said it makes me feel miserable.  I feel a LOT better now, but still have urgency..feeling like I gotta "go". Still bleeding too after all these months.  Taking tons of meds....you can read my past scripts...too many to mention right now.  Wondering if and when anything is going to help.  I try to eat right too...no spicey foods, no caffeine, no fatty foods.  Oh well, guess I we just have to bite the bullet...could be worse.

bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 9/14/2008 3:54 PM (GMT -6)   
Christine,

Have you tried the 6mps yet?
Moderate Pancolitis
Dx'd 05/2007
4 Lialda per day
Trying Canasa 2 per day a.m./p.m.
Probiotics, Bowel Soother, Fish Oil, Calcium, Multi Vitamin and Melatonin
Trying to reduce sugar in my diet but cannot tolerate artificial sweetners
I excersice daily
Did I happen to mention I HATE this disease!!!


LondonRed
Veteran Member


Date Joined Oct 2007
Total Posts : 1198
   Posted 9/14/2008 4:51 PM (GMT -6)   
I bleed with every BM 3 times a day yet I too am told my colitis is mild.

Diagnosis Oct 07 and then Aug 08: Inditerminate Patches of Mild Colitis (including Rectum) - Currently Minor Bleeding
Medication: 1000mg Mesalazine Suppository at night.


quincy
Elite Member


Date Joined May 2003
Total Posts : 30995
   Posted 9/14/2008 7:15 PM (GMT -6)   
Hi....happy to hear you like the new GI. Did the doctor have you add the cortifoam to your current rectal meds...or have you use it alone?

Looking forward to what she suggests when she calls....remember to ask for dicyclomine antispasmodic.

Regarding the gastro bugs...I would think that if symptoms increased while on meds it would have to be determined through stool samples if there's anything else going on. Did this new doc suggest stool samples?

You could consider to use zinc oxide on your poor anus to help with some of the discomfort...or also ask the doc for a lidocaine cream.

quincy
*Heather* Status..Asacol 6 (3 twice daily); enemas every 4th night
~diagnosed January 1989 UC (proctosigmoiditis)
~Bentylol (dicyclomine) 20mg as needed
~vitamins/minerals/supplements 
~Probiotic 4(Natural Factors Protec) bedtime + Primadophilus Reuteri Pearls occasionally
~multi-digestive enzymes as needed
~Ranitidine,Pariet (reflux);  Effexor XR 75mg(depression);  Pulmicort/Airomir (asthma)
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!
 


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 9/14/2008 9:37 PM (GMT -6)   
Q,

Cortifoam replaces the rowasa and or canasas...

I did hear back from Dr Abreu and she says to give the cortifoam about 4-5 days and to look for any (God willing) improvement. I told her that I want to use an anti spasm when in such pain after a BM which she agreed to. She seemed very confident in the cortifoam. Tonight I'm finally feeling less pain and burning and I hope and pray to almighty God that I don't go through the same pain tomorrow.

Thanks
Moderate Pancolitis
Dx'd 05/2007
4 Lialda per day
Trying Canasa 2 per day a.m./p.m.
Probiotics, Bowel Soother, Fish Oil, Calcium, Multi Vitamin and Melatonin
Trying to reduce sugar in my diet but cannot tolerate artificial sweetners
I excersice daily
Did I happen to mention I HATE this disease!!!


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 9/14/2008 9:38 PM (GMT -6)   
LondonRed said...
I bleed with every BM 3 times a day yet I too am told my colitis is mild.

I know its very wierd.
 
Are you only on a rectal med?
Moderate Pancolitis
Dx'd 05/2007
4 Lialda per day
Trying Canasa 2 per day a.m./p.m.
Probiotics, Bowel Soother, Fish Oil, Calcium, Multi Vitamin and Melatonin
Trying to reduce sugar in my diet but cannot tolerate artificial sweetners
I excersice daily
Did I happen to mention I HATE this disease!!!


jenjim
Regular Member


Date Joined Apr 2008
Total Posts : 55
   Posted 9/14/2008 10:30 PM (GMT -6)   
All I can really add is that Dr Abreau was my GI Dr in Southern CA from 2000-2004 and I thought she did a great job. I thought she listened and she got me through my pregnancy. She left and went to NY, and I've been told, from there to Miami. My current Dr (not in southern CA), as well as the specialist he referred me to when I didn't like his answers, all speak really highly of her. I think she is really knowledgeable and well respected in the GI community. I hope she can help you out and get you into remission!

LondonRed
Veteran Member


Date Joined Oct 2007
Total Posts : 1198
   Posted 9/15/2008 3:48 AM (GMT -6)   
bbc - I am ononly on rectal Asacol 1000mg a night. It isn't working at all - my symptoms remain.

Diagnosis Oct 07 and then Aug 08: Inditerminate Patches of Mild Colitis (including Rectum) - Currently Minor Bleeding
Medication: 1000mg Mesalazine Suppository at night.


ErinD
Regular Member


Date Joined Jul 2008
Total Posts : 94
   Posted 9/15/2008 11:11 AM (GMT -6)   
I like you was told my colitis was 'mild' but i still don't respond well to Asacol type drugs. I had to go the prednisone route to get my flare under control and then it became steroid dependant. I am now on 6-MP to try and get off of the prednisone and keep my UC under control. Everyone is different and i don't think your severity of UC should matter, just what meds will actually work for you.

As for the stomach bug question...my GI doc said to give any 'stomach issues' 24 hours before deciding as bugs usually only last that long...if you are still not well after that it may be a flare.
Diagnosed with UC 3/2008
10mg Prednisone
75mg 6-MP
Entocort 9mg daily
800mg Asacol 3X daily


Christine1946
Veteran Member


Date Joined Aug 2008
Total Posts : 5975
   Posted 9/15/2008 4:21 PM (GMT -6)   
Yes, I am on 6MP.  Been on it since 04.  When I was hospitalized in May my Amylase and Lipase tests were off the wall and my GI took me off the 6MP for fear it affected my pancreas. However, lo and behold for some odd reason, five days later the Amylase and Lipase returned to normal levels.  When I was discharged from the hospital my GI put me back on the 6MP but I have blood tests done every two months or so.  Last testing showed normal Amylase and Lipase levels.  What exactly is the 6MP supposed to do?  It certainly hasn't kept me in remission, that is for sure.  I sometimes think we are just guinea pigs.

perach
Regular Member


Date Joined Apr 2007
Total Posts : 116
   Posted 9/15/2008 4:25 PM (GMT -6)   
Dr. Abreu was my doctor in NYC before she moved to Miami. You are in great hands! I wish she was still practicing here.
-Lialda (4 pills/day), Rowasa, canasa, Align probiotic, kefir, multivitamin, calcium with vitamin d, iron


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 9/15/2008 10:52 PM (GMT -6)   
jenjim said...
All I can really add is that Dr Abreau was my GI Dr in Southern CA from 2000-2004 and I thought she did a great job. I thought she listened and she got me through my pregnancy. She left and went to NY, and I've been told, from there to Miami. My current Dr (not in southern CA), as well as the specialist he referred me to when I didn't like his answers, all speak really highly of her. I think she is really knowledgeable and well respected in the GI community. I hope she can help you out and get you into remission!
We really like her alot so far and she has a great sense of humor. Today I felt much much better thankfully and I hope the cortifoam and Pentasa combo keep working (God willing). Thanks for the info.

Moderate Pancolitis
Dx'd 05/2007
4 Lialda per day
Trying Canasa 2 per day a.m./p.m.
Probiotics, Bowel Soother, Fish Oil, Calcium, Multi Vitamin and Melatonin
Trying to reduce sugar in my diet but cannot tolerate artificial sweetners
I excersice daily
Did I happen to mention I HATE this disease!!!


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 9/15/2008 10:53 PM (GMT -6)   
LondonRed said...
bbc - I am ononly on rectal Asacol 1000mg a night. It isn't working at all - my symptoms remain.

I'm surprised you're not on any Asacol, Lialda Pentasa etc etc?
Moderate Pancolitis
Dx'd 05/2007
4 Lialda per day
Trying Canasa 2 per day a.m./p.m.
Probiotics, Bowel Soother, Fish Oil, Calcium, Multi Vitamin and Melatonin
Trying to reduce sugar in my diet but cannot tolerate artificial sweetners
I excersice daily
Did I happen to mention I HATE this disease!!!


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 9/15/2008 10:53 PM (GMT -6)   
ErinD said...
I like you was told my colitis was 'mild' but i still don't respond well to Asacol type drugs. I had to go the prednisone route to get my flare under control and then it became steroid dependant. I am now on 6-MP to try and get off of the prednisone and keep my UC under control. Everyone is different and i don't think your severity of UC should matter, just what meds will actually work for you.

As for the stomach bug question...my GI doc said to give any 'stomach issues' 24 hours before deciding as bugs usually only last that long...if you are still not well after that it may be a flare.

Great info and thanks.
Moderate Pancolitis
Dx'd 05/2007
4 Lialda per day
Trying Canasa 2 per day a.m./p.m.
Probiotics, Bowel Soother, Fish Oil, Calcium, Multi Vitamin and Melatonin
Trying to reduce sugar in my diet but cannot tolerate artificial sweetners
I excersice daily
Did I happen to mention I HATE this disease!!!


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 9/15/2008 10:55 PM (GMT -6)   
Christine1946 said...
Yes, I am on 6MP.  Been on it since 04.  When I was hospitalized in May my Amylase and Lipase tests were off the wall and my GI took me off the 6MP for fear it affected my pancreas. However, lo and behold for some odd reason, five days later the Amylase and Lipase returned to normal levels.  When I was discharged from the hospital my GI put me back on the 6MP but I have blood tests done every two months or so.  Last testing showed normal Amylase and Lipase levels.  What exactly is the 6MP supposed to do?  It certainly hasn't kept me in remission, that is for sure.  I sometimes think we are just guinea pigs.

Have you thought about Remiciade?
Moderate Pancolitis
Dx'd 05/2007
4 Lialda per day
Trying Canasa 2 per day a.m./p.m.
Probiotics, Bowel Soother, Fish Oil, Calcium, Multi Vitamin and Melatonin
Trying to reduce sugar in my diet but cannot tolerate artificial sweetners
I excersice daily
Did I happen to mention I HATE this disease!!!


Christine1946
Veteran Member


Date Joined Aug 2008
Total Posts : 5975
   Posted 9/16/2008 4:57 PM (GMT -6)   
My GI doctor has been pushing Remicade for over a year.  However, when I worked in a lab years ago I was exposed to the TB virus and have a positive patch test.  I had a chest xray which turned out to be normal, no signs of active TB.  My GI's associate was my main doctor in the hospital and he strongly advised me against Remicade.  Can you beat that now?  One guy says YES YES and the other NO NO!  The reasoning the associate is against it is  he watched a patient (who also was exposed to TB years ago) die from a Remicade infusion.  So, not for ME.

bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 9/18/2008 10:09 AM (GMT -6)   

UPDATE:

 

Good and Bad...

 

It's been 3 nights since I started the Corti Foam/also switched to Pentasa 8 per day from 4 Lialda; the pain, spasms and overall ill feeling has stopped (thank God) however I started bleeding again, first one spec on Monday then a bit more and now a mucous patch the size of a quarter clinging to the stool mixed with red blood. My stool is large and firm and only 1 BM in the a.m. I don't know if the applicator from the cortifoam is irratating my old fissure but the bleeding seems to be tied directly to when I insert any kind of applicator in my rectum within a day or so I start bleeding...when I used the Canasas I had no blood but it would not control the spasms etc like the cortifoam is doing...I also started bleeding when using the rowasa. Its so wierd I either have pain w/spasms and feeling poorly with no blood or some blood and I feel fine???

What do you guy's think?

 

THanks



Moderate Pancolitis
Dx'd 05/2007
8 Pentasa per day (4X2)
Corti Foam p.m.
Probiotics, Bowel Soother, Fish Oil, Calcium, Multi Vitamin and Melatonin
Trying to reduce sugar in my diet but cannot tolerate artificial sweetners
I excersice daily
Did I happen to mention I HATE this disease!!!

Post Edited (bbc) : 9/18/2008 10:37:50 AM (GMT-6)


quincy
Elite Member


Date Joined May 2003
Total Posts : 30995
   Posted 9/18/2008 10:14 AM (GMT -6)   
Hi...do you use any type of lubrication before inserting the med?

You could possibly use the Canasa during the day while on the Cortifoam.

When you insert the foam, you could withdraw it a bit to the edge of the anus, but still inside and make sure some foam gets right to the edge. That should heal the fissure...as well, maybe use some anusol on the outside or zinc ointment to keep it in check.

Still sounds like progress to me.
quincy
*Heather* Status..Asacol 6 (3 twice daily); enemas every 4th night
~diagnosed January 1989 UC (proctosigmoiditis)
~Bentylol (dicyclomine) 20mg as needed
~vitamins/minerals/supplements 
~Probiotic 4(Natural Factors Protec) bedtime + Primadophilus Reuteri Pearls occasionally
~multi-digestive enzymes as needed
~Ranitidine,Pariet (reflux);  Effexor XR 75mg(depression);  Pulmicort/Airomir (asthma)
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!
 


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 9/18/2008 11:58 AM (GMT -6)   
Hi Q,

Yes I do lube the applicator etc and pull it out toward the end while still dispensing the med but it seems that whenever I insert something other than a suppository I have been getting blood...but I also wonder if the bleeding may be coming from a bit higher upstream out of reach of the rectal meds (I have pan colitis). I suppose I could use canasa in the a.m. and corti foam at night ...I have a call into dr Abreu and I await her response.

Not quite sure what is going on with me as since using the foam I'm almost perfect except for the minor blood spots...I feel I'm close, just not quite there yet.

I'm considering a new colonoscopy (last one 5/07) as I've heard with pan colitis one should be scoped every year...is that true? Last week my doc felt I did not need another one however her opinion may change since I'm bleeding.

It's also great to see you are managing so well with only 6 asacol and rowasa every 4 th night...you're truly blessed not to have pancolitis which appears to take much more to get under control.


Thanks : )


Moderate Pancolitis
Dx'd 05/2007
8 Pentasa per day (4X2)
Corti Foam p.m.
Probiotics, Bowel Soother, Fish Oil, Calcium, Multi Vitamin and Melatonin
Trying to reduce sugar in my diet but cannot tolerate artificial sweetners
I excersice daily
Did I happen to mention I HATE this disease!!!

Post Edited (bbc) : 9/18/2008 11:08:48 AM (GMT-6)


LondonRed
Veteran Member


Date Joined Oct 2007
Total Posts : 1198
   Posted 9/18/2008 12:37 PM (GMT -6)   
Hang in the BBC. It sounds like you are doing well. Mucous is normal in IBD and IBS, it doesn't mean you are flairing. If you are going once a day I'd suggest you are fine and the blood is the fissure.

We often need to take a longer view as things can flactuate. At the moment I get Mucous and slight specs of blood on the tissue if at all but before I get my hopes up I need to see over a few weeks first.

May God help all of us and you mate.

Diagnosis Oct 07 and then Aug 08: Inditerminate Patches of Mild Colitis (including Rectum) - Currently Minor Bleeding
Medication: 1000mg Mesalazine Suppository at night.


LondonRed
Veteran Member


Date Joined Oct 2007
Total Posts : 1198
   Posted 9/18/2008 1:47 PM (GMT -6)   
I spoke too soon. The mucous obviously meant that the inflammation is back and now I have lots of wind and blood. Some the blood is mixed with mucous. Looks like the Bee Propolis has stopped working. I am going to stick with it and God willing the bleeding will go away.

Diagnosis Oct 07 and then Aug 08: Inditerminate Patches of Mild Colitis (including Rectum) - Currently Minor Bleeding
Medication: 1000mg Mesalazine Suppository at night.


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 9/18/2008 7:34 PM (GMT -6)   
LondonRed said...
Hang in the BBC. It sounds like you are doing well. Mucous is normal in IBD and IBS, it doesn't mean you are flairing. If you are going once a day I'd suggest you are fine and the blood is the fissure.

We often need to take a longer view as things can flactuate. At the moment I get Mucous and slight specs of blood on the tissue if at all but before I get my hopes up I need to see over a few weeks first.

May God help all of us and you mate.

Right on and thanks
 
I'd bet if you went on some oral meds and cortifoam you'd be much improved...just a thought from my own experience.
Moderate Pancolitis
Dx'd 05/2007
8 Pentasa per day (4X2)
Corti Foam p.m.
Probiotics, Bowel Soother, Fish Oil, Calcium, Multi Vitamin and Melatonin
Trying to reduce sugar in my diet but cannot tolerate artificial sweetners
I excersice daily
Did I happen to mention I HATE this disease!!!


quincy
Elite Member


Date Joined May 2003
Total Posts : 30995
   Posted 9/18/2008 11:17 PM (GMT -6)   
bbc...I agree with trying the supp in the morning and the enema at night.
The oral meds should take care of above the rectum....considering you're on the max of Pentasa. If you believe you're improving...then you are.

Since you were diagnosed in '07, you should have another scope this year to see how you have improved and to take lots of biopsies for a good base-line regarding wonky cells.

After that..if all the biopsies come back unremarkable regarding precancer..etc, you shouldn't need one until another 2 - 5 years.
I had two the first year (diagnosis then a year later), then one every 3 years.

I've used meds since diagnosis, and the worst flares were in the first year. The second year, the enema tapering varied and eventually by the third year I totally got the hang of using the enemas earlier and earlier.

Since I have PSC as well...I MUST keep my colon in as nice a neutral state as possible for as long as possible. I still have small flares about once to twice a year...depending on what all is going on in my life.

Christmas isn't good or early spring. Stressful times for me.

Let me know about what the doc says regarding using the supps.

quincy
*Heather* Status..Asacol 6 (3 twice daily); enemas every 4th night
~diagnosed January 1989 UC (proctosigmoiditis)
~Bentylol (dicyclomine) 20mg as needed
~vitamins/minerals/supplements 
~Probiotic 4(Natural Factors Protec) bedtime + Primadophilus Reuteri Pearls occasionally
~multi-digestive enzymes as needed
~Ranitidine,Pariet (reflux);  Effexor XR 75mg(depression);  Pulmicort/Airomir (asthma)
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!
 


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 9/19/2008 10:28 AM (GMT -6)   
Q,

The doc said she may add the canasa in the a.m. but wants to see how it goes with just the corti foam and Pentasa

I am taking 4 Pentasa twice a day which is 4000mg of mesalamine , so I'm about 800mg shy of the max does.

Today I had no blood but some mild cramping spasms after my a.m. BM...I did eat quite a big mea last night so that may have something to do with it.

The new GI doc who is head of GI at University of Miami Miller Schoool of Medicine said I did not need another scope as did the previous GI doc I saw for another opinion...???

Thanks
Moderate Pancolitis
Dx'd 05/2007
8 Pentasa per day (4X2)
Corti Foam p.m.
Probiotics, Bowel Soother, Fish Oil, Calcium, Multi Vitamin and Melatonin
Trying to reduce sugar in my diet but cannot tolerate artificial sweetners
I excersice daily
Did I happen to mention I HATE this disease!!!

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