Discussions By Condition: Medical Stories

My 8 Year Old's Private ***l. How On Earth Can I Get Someone To Take US SERIOUSLY!!!

Posted In: Medical Stories 6 Replies
  • Posted By: k8alicious
  • June 28, 2009
  • 09:17 AM

:confused:My 8 year old son, Lance, has had type 1 diabetes for the past 7 years. For the first six years, his blood sugar control was abyssmal. He was catergorised by his endocringolist as being a "brittle diabetic." When it got to the stage that he was on 8 injections a day, I bought an insulin pump for him. It took a lot of work out of our day, and provided us both with confidence and a better quality of life. His blood sugar readings are now almost perfect, and he occasionally will have a hypo that requires drastic attention. It was the best money I ever spent. However....

Nine months ago, I found Lance holding his feet up to his fan before bed. When I asked him what he was doing, he said that his feet felt like they were on fire. I thought he must have had a fever, however when I felt his feet and the rest of him, his skin was cool. I asked him if this was the first time he had experienced this sensation, and he said that it had been annoying him at bedtime for a few weeks.

I immediately let our doctor know. He wrote a referral to a podiatrist to investigate. She performed a filament test on Lance. He was unable to feel many of the jabs she gave him in his feet and legs. When she got to his knees, he responded with "OW!" She tested for deeper under the skin to see if he could feel a series of vibrations. He felt every one of them. She performed the filament test again, just to double check, and this time, she blindfolded Lance. She got the same result. She sent a report back to our doctor with her diagnosis-Symmetrical Polyneuropathy.

Our doctor refused to believe that an 8 year old could have this condition. He sent Lance to a Neurologist for a Nerve Conduction Test, which came back inconclusive.

Before Xmas last year, Lance's condition deteriorated very quickly. Every evening, he would begin to have pins-and-needles sensations in his feet and up his legs, as well as a throbbing pain, and a sharp, shooting pain. He also describes a sensation as "having a sharp stick scratching up and down" his feet. Paracetamol and ibuprofen proved to be unsuccessful in treating the pain. His appetite was poor, and his energy levels were terrible, partly because he was only having approx 5 hours sleep a night.

In January this year, i had to rush him to the E.R. His pain was through the roof, and he was actually moaning and grimacing. (After thousands of needles and fingerpricks, he's one tough cookie,so it was very odd to hear him responding audibly to pain.) His blood sugar level was 22mmol/L, despite the fact that he had gone to bed with a bsl of 7.2mmol/L. The registrar at the hospital was very concerned by the symptoms that were presented, and she wanted to start him on a morphine drip. However, she soon reconsidered and gave him a 50mg tramadol capsule. She also wrote a perscription for a anti-convulsant, (Tegretol) to help deaden the nerve endings.) He is on this medication to this day.

It wasn't long before I noticed a distinct pattern-whenever the pain begins in the evenings, his blood sugar levels soars to dangerous levels. (This is his body's natural response to pain/stress, caused by the release of adrenalin and cortisol.) His last A1C blood test was the highest it has ever been during his diabetic life.

We have been to so many different doctors and specialists. Many of them have little experience with insulin dependent diabetes, and therefore, do not understand what is going on. One paediatrican diagnosed "Pain Syndrome", and just 3 days ago, we travelled 150km to be told that Lance had "Growing Pains" by a paediatrician who has had some successes with diagnosing mysterious conditions.(I had Growing Pains as a girl, and remember the very difficult-to-explain dull ache in my legs.) The doctor suggested that he take paracetemol at 5pm in the afternoon, and this would block the pain that occurs in the night. (At this point, I sat in silence, and switched my brain off.)

Once Lance had taken Tegretol for about 4 weeks, there was a marked improvement in his condition. It gave us a 3 week grace period before the pain and discomfort reappeared. Our GP looked into increasing his dose, but a blood test showed that he couldn't take anymore, as it posed a high risk of liver damage/failure.

Lance's paediatric endocrinologist told us to not mention these symptoms to him for another nine months, as he was certain that they would go away. He too, refuses to believe that a child could show symptoms of neuropathy, or nerve pain related to diabetes.

Another doctor has suggested that Lance is feigning these symptoms for attention, and that he is stealing food at night to make his blood sugar levels soar. For one, my son doesn't know a life without diabetes. He has no desire to "cheat." I also spend every second of every day with him, and I am in control of his meals, snacks and hypo treatments. He insinuated that Lance had read about complications and was "acting out" the symptoms. Bring on an Academy Award for spending the time equivilent to a human pregnancy "searching for attention." We have not had the "complications" talk, and I am very particular about what he reads concerning type 1 diabetes. After all, he IS only 8 years old.( Despite having to endure some difficult trials in his short life, he is a bright, happy and loving little boy who is extremely charismatic and genuinely polite and respectful.) Lance has had to commence home-schooling, as he was missing huge amounts of school, and was falling asleep in class. Fortunately, he was able to skip Grade 3 and move straight onto Grade 4 at the beginning of this year. Before Lance was diagnosed with diabetes, I was a full-time teacher.We have organised Australian curriculum to be sent to our home, and I teach him.

We have the most absurd routines due to this condition. We are currently going to sleep at 3am,after hours of medicating, warm packs, TENS machine, meditation and making sure the bedclothes dont touch Lance's feet by using many pillows etc. (The sensation of blankets/sheets on his feet is very painful for him.) I wake up at 8am, and have to perform finger *****s on Lance every hour to ensure that his blood sugar isn't slipping while he sleeps. Lance will then wake at around 11am, eat "breakfast" and begins his schoolwork. Some days he is just so exhausted, and he is also beginning to experience pain during the day. We are both suffering from severe sleep deprivation, however this doesn't seem to be an issue to any of these doctors. It is impossible to plan activites in advance because we never know how each day is going to pan out.

I have spoken to a lady who has had type 1 diabetes for 23 years, and has the exact symptoms as Lance. She was diagnosed with diabetic neuropathy.I have also spoken to some diabetes specialists who have found that after 5 years since diagnosis, children are beginning to develop nerve damage in their feet, but the majority of them do not have any symptoms.

Don't get me wrong, I DON'T WANT him to have neuropathy!! That's the last thing that I would wish upon my son! However, we need help, and the team of doctors and specialists are not providing us with ANY support. I have suggested to our doctor that some blood tests ruling our Lyme Disease etc should be done. He laughed at me- mind you, his diagnosis was Restless Leg Syndrome. :eek:

I am desperate for any words of wisdom or advice. If you have heard of ANYTHING that sounds remotely familiar to what I have described, I would be so grateful for your input.

Out of sheer desperation, I have videotaped Lance in his tent of pillows, groaning and kicking all of the bedclothes off. I was also able to get footage of a fingerprick, his blood sugar level was 24.8mmol/L in the middle of a nightly episode. He also ripped his pyjama pants off out of frustration, because he said that they felt like they had been next to a heater. This, along with the nightly peaks in blood sugar are my only way to PROVE that this pain is real. :(

I look forward to your input. Sincerely, Kate.

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6 Replies:

  • :confused:My 8 year old son, Lance, has had type 1 diabetes for the past 7 years. For the first six years, his blood sugar control was abyssmal. He was catergorised by his endocringolist as being a "brittle diabetic." When it got to the stage that he was on 8 injections a day, I bought an insulin pump for him. It took a lot of work out of our day, and provided us both with confidence and a better quality of life. His blood sugar readings are now almost perfect, and he occasionally will have a hypo that requires drastic attention. It was the best money I ever spent. However.... Nine months ago, I found Lance holding his feet up to his fan before bed. When I asked him what he was doing, he said that his feet felt like they were on fire. I thought he must have had a fever, however when I felt his feet and the rest of him, his skin was cool. I asked him if this was the first time he had experienced this sensation, and he said that it had been annoying him at bedtime for a few weeks. I immediately let our doctor know. He wrote a referral to a podiatrist to investigate. She performed a filament test on Lance. He was unable to feel many of the jabs she gave him in his feet and legs. When she got to his knees, he responded with "OW!" She tested for deeper under the skin to see if he could feel a series of vibrations. He felt every one of them. She performed the filament test again, just to double check, and this time, she blindfolded Lance. She got the same result. She sent a report back to our doctor with her diagnosis-Symmetrical Polyneuropathy. Our doctor refused to believe that an 8 year old could have this condition. He sent Lance to a Neurologist for a Nerve Conduction Test, which came back inconclusive. Before Xmas last year, Lance's condition deteriorated very quickly. Every evening, he would begin to have pins-and-needles sensations in his feet and up his legs, as well as a throbbing pain, and a sharp, shooting pain. He also describes a sensation as "having a sharp stick scratching up and down" his feet. Paracetamol and ibuprofen proved to be unsuccessful in treating the pain. His appetite was poor, and his energy levels were terrible, partly because he was only having approx 5 hours sleep a night. In January this year, i had to rush him to the E.R. His pain was through the roof, and he was actually moaning and grimacing. (After thousands of needles and fingerpricks, he's one tough cookie,so it was very odd to hear him responding audibly to pain.) His blood sugar level was 22mmol/L, despite the fact that he had gone to bed with a bsl of 7.2mmol/L. The registrar at the hospital was very concerned by the symptoms that were presented, and she wanted to start him on a morphine drip. However, she soon reconsidered and gave him a 50mg tramadol capsule. She also wrote a perscription for a anti-convulsant, (Tegretol) to help deaden the nerve endings.) He is on this medication to this day. It wasn't long before I noticed a distinct pattern-whenever the pain begins in the evenings, his blood sugar levels soars to dangerous levels. (This is his body's natural response to pain/stress, caused by the release of adrenalin and cortisol.) His last A1C blood test was the highest it has ever been during his diabetic life. We have been to so many different doctors and specialists. Many of them have little experience with insulin dependent diabetes, and therefore, do not understand what is going on. One paediatrican diagnosed "Pain Syndrome", and just 3 days ago, we travelled 150km to be told that Lance had "Growing Pains" by a paediatrician who has had some successes with diagnosing mysterious conditions.(I had Growing Pains as a girl, and remember the very difficult-to-explain dull ache in my legs.) The doctor suggested that he take paracetemol at 5pm in the afternoon, and this would block the pain that occurs in the night. (At this point, I sat in silence, and switched my brain off.) Once Lance had taken Tegretol for about 4 weeks, there was a marked improvement in his condition. It gave us a 3 week grace period before the pain and discomfort reappeared. Our GP looked into increasing his dose, but a blood test showed that he couldn't take anymore, as it posed a high risk of liver damage/failure. Lance's paediatric endocrinologist told us to not mention these symptoms to him for another nine months, as he was certain that they would go away. He too, refuses to believe that a child could show symptoms of neuropathy, or nerve pain related to diabetes. Another doctor has suggested that Lance is feigning these symptoms for attention, and that he is stealing food at night to make his blood sugar levels soar. For one, my son doesn't know a life without diabetes. He has no desire to "cheat." I also spend every second of every day with him, and I am in control of his meals, snacks and hypo treatments. He insinuated that Lance had read about complications and was "acting out" the symptoms. Bring on an Academy Award for spending the time equivilent to a human pregnancy "searching for attention." We have not had the "complications" talk, and I am very particular about what he reads concerning type 1 diabetes. After all, he IS only 8 years old.( Despite having to endure some difficult trials in his short life, he is a bright, happy and loving little boy who is extremely charismatic and genuinely polite and respectful.) Lance has had to commence home-schooling, as he was missing huge amounts of school, and was falling asleep in class. Fortunately, he was able to skip Grade 3 and move straight onto Grade 4 at the beginning of this year. Before Lance was diagnosed with diabetes, I was a full-time teacher.We have organised Australian curriculum to be sent to our home, and I teach him. We have the most absurd routines due to this condition. We are currently going to sleep at 3am,after hours of medicating, warm packs, TENS machine, meditation and making sure the bedclothes dont touch Lance's feet by using many pillows etc. (The sensation of blankets/sheets on his feet is very painful for him.) I wake up at 8am, and have to perform finger *****s on Lance every hour to ensure that his blood sugar isn't slipping while he sleeps. Lance will then wake at around 11am, eat "breakfast" and begins his schoolwork. Some days he is just so exhausted, and he is also beginning to experience pain during the day. We are both suffering from severe sleep deprivation, however this doesn't seem to be an issue to any of these doctors. It is impossible to plan activites in advance because we never know how each day is going to pan out. I have spoken to a lady who has had type 1 diabetes for 23 years, and has the exact symptoms as Lance. She was diagnosed with diabetic neuropathy.I have also spoken to some diabetes specialists who have found that after 5 years since diagnosis, children are beginning to develop nerve damage in their feet, but the majority of them do not have any symptoms. Don't get me wrong, I DON'T WANT him to have neuropathy!! That's the last thing that I would wish upon my son! However, we need help, and the team of doctors and specialists are not providing us with ANY support. I have suggested to our doctor that some blood tests ruling our Lyme Disease etc should be done. He laughed at me- mind you, his diagnosis was Restless Leg Syndrome. :eek: I am desperate for any words of wisdom or advice. If you have heard of ANYTHING that sounds remotely familiar to what I have described, I would be so grateful for your input. Out of sheer desperation, I have videotaped Lance in his tent of pillows, groaning and kicking all of the bedclothes off. I was also able to get footage of a fingerprick, his blood sugar level was 24.8mmol/L in the middle of a nightly episode. He also ripped his pyjama pants off out of frustration, because he said that they felt like they had been next to a heater. This, along with the nightly peaks in blood sugar are my only way to PROVE that this pain is real. :( I look forward to your input. Sincerely, Kate. Hi kate, There is a pretty significant chance that your son is funtionally deficient in the real genuine active b12s. That all by itself can cause poly neuropathy, as I developed, though at a more advanced age than your son. The synthetic inactive b12s such as cyanob12 and hydroxyb12 don't have the profound effect on the nerves that methylb12 does. Methylb12 has been shown to help heal nerves regardless of the cause of damage. "Growing pains" in children may also be on early symptom of b12 deficiency. There are all sorts of reasons why a child may be deficient, some of them genetic, almost all unrecognized and not treated until they are adults at a terrible price in ill health and pain. At 61 I am now for the first time in my life healthy. I grew up chronically ill because of deficient b12. http://forums.wrongdiagnosis.com/showthread.php?p=187772#post187772 is where we can help you with the b12 deificiency. We have lists of symptoms and multiple participants with chidren who are deficient. Come on over and at least let's talk about it.The good tghing with the b12 hypothesis is that it can be testyed quickly so that you will either know that b12 works or not. It's not a theory that leaves you dangling with a "so what can we do about it". It's easy to put into practice and have effective results if you do it correctly or to know that you need to look elsewhere.
    Freddd 3576 Replies Flag this Response
  • Hi, I was just browsing the sections and thought Id read yours. I cant really offer any help, other than to say, dont give up. Im sure you've been told that a thousand times, just believe it. My son, who is 10, has shingles....I have a thing on here asking for info from anyone, maybe read it, so you can get an idea of my problem, I'll spare you the details...LOL. Ive just learned that with ALL three of my kids, and myself, that I am my best Dr. Just because someone has MD, or whatever initials at the end of their name, doesnt mean they know what they are always saying. If a Dr. refuses to do something, I ask for a second opinion, and if I still cant get the problem addressed, I change Dr.s till I find one who'll listen. I have SEVERAL things wrong with me, and finally had to start playing Dr myself. If a Dr., refuses to do something at first, I tell them to just do it to shut me up, otherwise, I'll continue to gripe about it or find someone who actually cares. Cause I want a Doctor, not one who just PRACTICES medicine. LOL My son had also been having constant peeing problems too, and I had several doctors tell me one thing or another. I just kept telling them they were wrong and to keep digging. Especially when it came to him being diagnosed with shingles. Luckily I have a great ped. dr for my kids now, but I still dont hesitate to tell her what I think she should do. Im the only one who will look out for my child completely, and if that means making a dr. mad, then so be it!! Ive always gone with my feelings of, "if it doesnt seem right, feel right, sound right, or make me happy, then it isnt the answer". I have no problem changing Drs. I figure I'll change enough and find the RIGHT ONE!!! When I found out I had a kidney problem, my primary dr. kept telling me that my tests came back fine. I spent two years looking into why I was losing potassium. I kept telling him that something wasnt right, and saw several dr.s till one finally took interest and figured out what was wrong. And when the dr that figured out what was wrong asked if I wanted the report sent to my primary dr, I said yes, and tell him Im not a hypocondr. !!! Then I went home and changed drs! LOL Im sorry that you have to and that your son has to go through what you are going through. I know first hand that it KILLS to see a child in pain, especially when its your own and theres nothing you can do to ease it, and it seems like no one is listening. I just want to die everytime my son has a shingles outbreak!! Just dont ever give up, (which I know you wont) ;c} And the next time some ***k dr says that its all a game that your son is playing or the other outrageous things theyve said, just look at them and tell them they are rude, hateful and uncaring. Because if they can dare to say that to you, then you dont worry about putting THEM on the spot either. AND, that after 7yrs of dealing with what you have dealt with, you KNOW what you are talking about and you have a lot more insight into whats happening than they do, because you LIVE IT, EVERYDAY, they only live it when you come in for maybe 30 mins, and even still, they dont even see a fraction of what his life and your life if like, and that they need to start doing their job, because so far they arent doing a very good job of doing their job!! I wish you ALL THE LUCK in getting answers and lots of relief in the years ahead, and your son a healthy life! Maybe he should grow up to be a Dr. himself...hahaha!! And put to shame all those other ones!! hahaha!!! Sincerely, Anna
    Sweetypie 12 Replies Flag this Response
  • Hi, I was just browsing the sections and thought Id read yours. I cant really offer any help, other than to say, dont give up. Im sure you've been told that a thousand times, just believe it. My son, who is 10, has shingles....I have a thing on here asking for info from anyone, maybe read it, so you can get an idea of my problem, I'll spare you the details...LOL. Ive just learned that with ALL three of my kids, and myself, that I am my best Dr. Just because someone has MD, or whatever initials at the end of their name, doesnt mean they know what they are always saying. If a Dr. refuses to do something, I ask for a second opinion, and if I still cant get the problem addressed, I change Dr.s till I find one who'll listen. I have SEVERAL things wrong with me, and finally had to start playing Dr myself. If a Dr., refuses to do something at first, I tell them to just do it to shut me up, otherwise, I'll continue to gripe about it or find someone who actually cares. Cause I want a Doctor, not one who just PRACTICES medicine. LOL My son had also been having constant peeing problems too, and I had several doctors tell me one thing or another. I just kept telling them they were wrong and to keep digging. Especially when it came to him being diagnosed with shingles. Luckily I have a great ped. dr for my kids now, but I still dont hesitate to tell her what I think she should do. Im the only one who will look out for my child completely, and if that means making a dr. mad, then so be it!! Ive always gone with my feelings of, "if it doesnt seem right, feel right, sound right, or make me happy, then it isnt the answer". I have no problem changing Drs. I figure I'll change enough and find the RIGHT ONE!!! When I found out I had a kidney problem, my primary dr. kept telling me that my tests came back fine. I spent two years looking into why I was losing potassium. I kept telling him that something wasnt right, and saw several dr.s till one finally took interest and figured out what was wrong. And when the dr that figured out what was wrong asked if I wanted the report sent to my primary dr, I said yes, and tell him Im not a hypocondr. !!! Then I went home and changed drs! LOL Im sorry that you have to and that your son has to go through what you are going through. I know first hand that it KILLS to see a child in pain, especially when its your own and theres nothing you can do to ease it, and it seems like no one is listening. I just want to die everytime my son has a shingles outbreak!! Just dont ever give up, (which I know you wont) ;c} And the next time some ***k dr says that its all a game that your son is playing or the other outrageous things theyve said, just look at them and tell them they are rude, hateful and uncaring. Because if they can dare to say that to you, then you dont worry about putting THEM on the spot either. AND, that after 7yrs of dealing with what you have dealt with, you KNOW what you are talking about and you have a lot more insight into whats happening than they do, because you LIVE IT, EVERYDAY, they only live it when you come in for maybe 30 mins, and even still, they dont even see a fraction of what his life and your life if like, and that they need to start doing their job, because so far they arent doing a very good job of doing their job!! I wish you ALL THE LUCK in getting answers and lots of relief in the years ahead, and your son a healthy life! Maybe he should grow up to be a Dr. himself...hahaha!! And put to shame all those other ones!! hahaha!!! Sincerely, Anna
    Sweetypie 12 Replies Flag this Response
  • Hi my name is Chuck i am new here i read your post, and a bit of news for you i have seen this in diabetics alot Pain is hard to understand but with diabetics alot of time they have it in there legs. And to the supprise of many doctors the drug amitriptyline which is really a antidepressant just by accicdent years ago they stumbled on this that it stoped the pain in the legs they don't know why for sure but it would be worth a try the pain is very real. I have several friend that have this and some of my customers i work as a pharmacy technician. and fill amitriptyline for alot of diabetics.. hope this well help some.. ASK YOUR DOCTOR ASAP NO CHILD SHOULD HAVE TO GO THROUGH THIS chuck w. portland,or:)
    wise49cew 3 Replies Flag this Response
  • Hi, I was just browsing the sections and thought Id read yours. I cant really offer any help, other than to say, dont give up. Im sure you've been told that a thousand times, just believe it. My son, who is 10, has shingles....I have a thing on here asking for info from anyone, maybe read it, so you can get an idea of my problem, I'll spare you the details...LOL. Ive just learned that with ALL three of my kids, and myself, that I am my best Dr. Just because someone has MD, or whatever initials at the end of their name, doesnt mean they know what they are always saying. If a Dr. refuses to do something, I ask for a second opinion, and if I still cant get the problem addressed, I change Dr.s till I find one who'll listen. I have SEVERAL things wrong with me, and finally had to start playing Dr myself. If a Dr., refuses to do something at first, I tell them to just do it to shut me up, otherwise, I'll continue to gripe about it or find someone who actually cares. Cause I want a Doctor, not one who just PRACTICES medicine. LOL My son had also been having constant peeing problems too, and I had several doctors tell me one thing or another. I just kept telling them they were wrong and to keep digging. Especially when it came to him being diagnosed with shingles. Luckily I have a great ped. dr for my kids now, but I still dont hesitate to tell her what I think she should do. Im the only one who will look out for my child completely, and if that means making a dr. mad, then so be it!! Ive always gone with my feelings of, "if it doesnt seem right, feel right, sound right, or make me happy, then it isnt the answer". I have no problem changing Drs. I figure I'll change enough and find the RIGHT ONE!!! When I found out I had a kidney problem, my primary dr. kept telling me that my tests came back fine. I spent two years looking into why I was losing potassium. I kept telling him that something wasnt right, and saw several dr.s till one finally took interest and figured out what was wrong. And when the dr that figured out what was wrong asked if I wanted the report sent to my primary dr, I said yes, and tell him Im not a hypocondr. !!! Then I went home and changed drs! LOL Im sorry that you have to and that your son has to go through what you are going through. I know first hand that it KILLS to see a child in pain, especially when its your own and theres nothing you can do to ease it, and it seems like no one is listening. I just want to die everytime my son has a shingles outbreak!! Just dont ever give up, (which I know you wont) ;c} And the next time some ***k dr says that its all a game that your son is playing or the other outrageous things theyve said, just look at them and tell them they are rude, hateful and uncaring. Because if they can dare to say that to you, then you dont worry about putting THEM on the spot either. AND, that after 7yrs of dealing with what you have dealt with, you KNOW what you are talking about and you have a lot more insight into whats happening than they do, because you LIVE IT, EVERYDAY, they only live it when you come in for maybe 30 mins, and even still, they dont even see a fraction of what his life and your life if like, and that they need to start doing their job, because so far they arent doing a very good job of doing their job!! I wish you ALL THE LUCK in getting answers and lots of relief in the years ahead, and your son a healthy life! Maybe he should grow up to be a Dr. himself...hahaha!! And put to shame all those other ones!! hahaha!!! Sincerely, AnnaHats off to your reply. I learnt in my life also that "You are the best doctor for yourself first" and many people are afraid to say so. 90perc. of the time doctors dont know what you are saying and they put you down that they are only qualified to say whatever they want to say. Here is my story......I am 61 year old and 12 years ago when I had a walking gait problem, I had gone through lots of doctors, hospitals, tests but of no vain. Luckily I met an elderly healer here in Scottsdale, AZ who taught me Bioneuroenergenology healing arts and made me a healing doctor. Now I heal many people FREE of cost. I lost my job 8 years ago and retired. In the last 8 years I never visited an MD, Dentist, or taken any pill and I am very healthy except for my gait problem not 100 perc. back.Anyone can contact PArjuna85210@yahoo.comGarla Arjuna.
    PArjuna 43 Replies Flag this Response
  • :confused: Yes i have learned that you must stand up for your self against some doctors. They are not always open to what you have to say but there is always another dont give up. :) there is a answer but first getting the right doctor to address it serious.. chuck.w.
    wise49cew 3 Replies Flag this Response
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