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RSD/antiinflammatory diet
the RSD pain in my left foot is so fickle and weird that this may be a coincidence, but i thought i'd post about it anyway:
On the recommendation of somebody on the message board (I forget who, sorry!), i tried the RSD diet that cuts out certain antiinflammatory foods--no gluten, no added sugar (i still ate tons of fresh fruit), no processed foods (I eat almost nothing processed anyway), and no caffeine or alcohol. i tried it for three weeks in advance of a vacation where i knew i'd be doing more walking than usual. well, i stuck to the diet, my pain was noticeably reduced, and the vacation went so, so well. i walked everywhere, and my pain, mostly mild, was mainly limited to the evening, after a long day of being far more active than i'm used to, and only on the second to last day (of five days) did i feel enough "foot fatigue" to make me cut down on the walking. at one point i remember wondering if i was actually getting better--an insane thought for someone who has had RSD for seven years. But i went back to eating gluten, sugar, caffeine, and alcohol), hoping the reduction in pain was in answer to vitamins and the desensitization exercises i've been doing. well, after about two weeks of my regular diet, my pain has gone right back up. it had gotten to where it only hurt when i was walking--my pain when not weight-bearing was miraculously low--but now i'm back to having pain when sitting. Bottom line: i'm not prescribing this diet to other sufferers, and it may or may not have to do with my reduction in pain, but i'm going back on it. I thought it might be food for thought for other RSDers. (Not an intentional pun, I swear.) |
I'm really happy to hear it has made a difference for you too. I think diet is so important and especially as it relates to the inflamation process.
Thanks so much for sharing this with us Mimi. MsL |
Holy crap!
I think I'd starve to death. That being said, I think I'll try the no alcohol and no gluten thing. I'll die without coffee though. :) Thanks for the advice, glad to hear your pain is lowered by the diet change, anything that cuts it is a good thing.
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Me too!!
It would be truly life alertering for me to switch my diet. I ate several candy bars yesterday afternoon for lunch so I threw my sandwich out (after all, I didn't want to look like a pig!). And for breakfast, my dog and I usually share Pop-Tarts, we prefer brown sugar cinnamon (he eats the crust). If my kids eat the last package of them I've been known to throw a temper tantrum to rival any toddler's. I am addicted to caffeine and drink about 20-30 ounces before noontime. When I get to work I often buy a homemade muffin from an awesome bakery down the street from my office.
I don't drink much alcohol, though, and my husband usually makes us a healthy dinner. I take a lot of vitimins also. I try keep my weight in line by walking a lot. And I blame any weight gain on my meds.... |
Diet can help with pain and inflammation.
Too much sugar releases insulin (also very large meals) and when insulin is high, then inflammatory cytokines are made more by the body. Dr. Barry Sears has several books about this. If you Google him you'll find them. Also other authors are coming out with similar tomes. |
here's an interesting article on gluten and inflammation:
http://www.gluten-free-guide.com/glu...lammation.html i should say that i'm not entirely giving up pizza and baked goods, just eating them very sparingly. even if it doesn't help the pain, i'll end up staying in better shape--RSD keeps me from every cardio activity but swimming, so i can't just run off a slab of cake. |
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Thank you very much for the information. It appears that I've been inadvertently adding to my pain levels by not being vigilant about my diet. I've never been that good about watching what I eat, except when I was pregnant with my kids. When I am unhappy or stressed or the office re-stashes the candy supply I tend to overindulge. And my coffee habit is a really old one - I've been drinking too much caffeine since my college days. (Probably why I am tense and hyper at times...do you know any CPA's that aren't??) By the way, what is "gluten?" Thanks again for your help. Every bit helps!! and I really apppreciate it. Sandy |
gluten is a protein found in wheat (also in rye, barley, bulgur, even oats unless the packaging specifies that they're gluten free).
my boyfriend and i are having fun experimenting with other carb sources--polenta, corn tortillas, quinoa, buckwheat (not actually wheat), all different kinds of rice (red, black, brown). it's super cheap from health-food store bulk bins. |
I saw through all my reg doctors and specialist a holsitic doc who focused on diet and supplements. I have seen many nutritionists as well. I do think that diet plays a role in ones body functioning. I know when I was severly malnurished my brain did not work right so I am thinking other things could be the same in the body. The problem for me is I like instant results and I would think with change in diet or supplements a lot is slow changes which of course is better then not at all. Also a good reminder is it may help to prevent other problems in health.
Mrs D or someone else I have heard about the wheat and even like whole wheat breads not being good for pain. I don't get why if you are not gluten intolerant. Can you explain this as I thought 100 percent whole grain bread would be ok and a similar nutrient as like brown rice but now I am thinking not in terms of how the body reacts. Thanks for sharing this and keep up the good work |
Food for thought... literally!
Didn't know anything about an RSD diet. I know that smoking and caffiene are triggers which I am working on reducing both of these bad habits. But certain food... didn't really make the connection. Thanks for this information!:)
I will spend the day researching this new tidbit!!! AJ __________________________________________________ ___________ Newly diagnosed with RSD... fully involved left leg due to knee injury and subsequent surgeries. Learning how to deal with this Monster. |
The article posted by Mimi offers further information about foods that can help to keep the inflammation at bay as well as others that stoke the fire so to speak.
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It really does make a difference in my pain levels and my overall health is much better not to mention my weight. I eat what I want and lost 15 pounds and my husband lots his belly bulge (40 lbs for him) I was not trying to lose weight he was. I stopped coffee long ago and rarely have any alcohol, just for a special occasion as I know both of those are triggers for my pain and inflammation. Seriously folks we can help ourselves to some extent. Here is a study out of Würzburg Germany showing the pro-inflammatory cytokine profile in patients with CRPS. Quote:
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Differential expression patterns of cytokines in complex regional pain syndrome
My dear Ms. L -
A full text copy of "Differential expression patterns of cytokines in complex regional pain syndrome" can be found listed alphbetically by author under the heading "Research" on the RSDSA Medical Archeives webpage at http://www.rsds.org/2/library/articl...ive/index.html However, a subsequent, and by all appearances real interesting study (which I don't yet have access to in full text) came out a little more more ambiguously. Here's the abstact: Systemic inflammatory mediators in post-traumatic complex regional pain syndrome (CRPS I) - longitudinal investigations and differences to control groups, Schinkel C, Scherens A, Köller M, Roellecke G, Muhr G, Maier C., Eur J Med Res. 2009 Mar 17; 14(3):130-5.PMID: 19380284 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/sites/entrez That said, I found something that would have made Vic - an old friend of the board - very happy: even if it didn't mention ischemic reperfusion injuries. :winky: And it's on point, no less: Grape-seed procyanidins prevent low-grade inflammation by modulating cytokine expression in rats fed a high-fat diet, Terra X, Montagut G, Bustos M, Llopiz N, Ardèvol A, Bladé C, Fernández-Larrea J, Pujadas G, Salvadó J, Arola L, Blay M., J Nutr Biochem. 2009 Mar;20(3):210-8. Epub 2008 Jul 7.PMID: 18602813 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/sites/entrez be well, Mike |
Thanks for the list. My big problems is sugar and artificial sweetners. So hard for me. After this post I too was looking more up on the net. I know everyone is different in response but still it is interesting to see connections.
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Dear Mike,
Can you please explain your message in laymen's terms for those of us that are scientifically challenged? thanks. Sandy |
Through my doctors like regular ones my gramps pushed me to see his holsitic doctor. Anyhow he focused more on natural things like diet/supplement/self coping. He was an MD GP. Anyhow my gramps finds him super helpful and sees huge benefits and to be honest in him I do see a change for the better and he is 86 so that is usually not true in general. I think some things he said were interesting but he was unreal expensive and I have learned a lot of the same from Mrs D here and others. I also think one has to implement it of course and for me that is hard but am trying. There is a website called www.whfoods.com. I hope I can put this here anyhow it rate tops foods for different conditions and also explains what nutrients each foods have with some recipes and food plans.
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Mike |
I'm glad to hear that diet changes helped you, MsL. Thanks for posting about it.
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Thanks again mimi, Food just doesn't mean the same with all this pain. Take care, loretta:D |
I was reading more on the foods to have and not and I think dairy depends on the person and how you tolerate it. See I read that if you are allergic or sensitive to a food that can delay recovery. This may or may not be true. I have osteoporsis and I think dairy is important but that is just me. I know Mrs D was talking about how having flaxseed I think with cottage cheese helps with inflamation but I could be wrong
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that's great, loretta! i hope diet changes will make a difference for you.
i've been back off gluten/sugar for less than a week, but i remain optimistic. |
This is in response to Sandy's request the other day that I clarify my post under the heading of "Differential expression patterns of cytokines in complex regional pain syndrome."
To begin with, a "pro-inflammatory cytokine" is any number of protein messengers that trigger an inflammatory response. (And for a more precise definition of cytokine, see the online mondofacto medical dictionary at http://www.mondofacto.com/facts/dict...ion=look+it+up) One, such pro-inflammatory cytokine that has been identified as, among other things, an independent risk of death from cardiac artery disease (CAD), in some but not all studies, is something called Interleukin-6 or IL-6. Now, in 2005, a paper came out finding relatively high levels of IL-6 in the cerebral spinal fluids of CRPS patients. Changes in Cerebrospinal Fluid Levels of Pro-inflammatory Cytokines in CRPS, Alexander GM, van Rijn MA, van Hilten JJ, Perreault MJ, Schwartzmann RJ, Pain, 2005; 116: 213-219, free full text at http://www.rsds.org/2/library/articl.../alexander.pdf As you might imagine, this got a lot of people excited. On a referral from a rheumatologist I saw a year later that the Mayo Clinic, I went packing to Johns Hopkins in the thirds week of October, 2006 to try to get into a large trial of an anti-IL-6 drug, only to have cold water thrown in my face: first the trial was at that time only open to people with defined rheumatological conditions, and CRPS wasn't one of them, and, more importantly, while it was believed the link between IL-6 and, for instance, CAD was quite high, it's role in CRPS was described to me as "iffy," notwithstanding the 2005 article of Alexander, et al. And, sure enough, a month later out came the epub of a second study by essentially the same group of authors reporting somewhat less robust results: Changes in immune and glial markers in the CSF of patients with Complex Regional Pain Syndrome, Alexander GM, Perreault MJ, Reichenberger ER, Schwartzman RJ, Brain Behav Immun., 2007 Jul; 21(5): 668-76. Epub 2006 Nov 28.(I'm guessing that someone at Johns Hopkins was familiar with follow up study by Alexander et al, before it was posted online.) It was against this background, and other related studies, that Differential expression patterns of cytokines in complex regional pain syndrome, Uceyler N, Eberle T, Rolke R, Birklein F, Sommer C, Pain, 2007;132:195–205, free full text at http://www.rsds.org/2/library/articl...erle_Rolke.pdf came out, finding in part that: We found elevated levels of pro-inflammatory cytokines and reduced levels of anti-inflammatory cytokines in patients with CRPS. Specifically, mRNA levels of the pro-inflammatory cytokines TNF and IL-2 and serum IL-2 protein levels were elevated, and mRNA levels of the anti-inflammatory cytokines IL-4 and IL-10 were reduced. TGFb1 protein levels were also lower in patients with CRPS. Taken together, these findings show a pro-inflammatory cytokine profile in our patients with CRPS. [Emphasis added.]The point I was trying to make when I compared the Uceyler et al study of 2007 with Systemic inflammatory mediators in post-traumatic complex regional pain syndrome (CRPS I) - longitudinal investigations and differences to control groups, Schinkel C, Scherens A, Köller M, Roellecke G, Muhr G, Maier C., Eur J Med Res. 2009 Mar 17; 14(3):130-5, was that the latter, and far more ambitious study - which had hoped to find a distinct pattern of change in cytokine expressions, as the disease went from the acute to chronic stage - instead only found a handful of changes in CRPS patient from controls (notably finding no significant change in the levels of either IL-2 or IL-6, in which the Uceyler and Alexander groups, respectively, found significant changes) and concluding instead: Although clinically appearing as inflammation in acute stages, local rather than systemic inflammatory responses seem to be relevant in CRPS. Variable results from different studies might be explained by unpredictable intermittent release of mediators from local inflammatory processes into the blood combined with high interindividual variabilities. A clinically relevant difference to various control groups was not notable in this pilot study. Determination of systemic inflammatory parameters is not yet helpful in diagnostic and follow-up of CRPS I.Now, at first blush, it looks like the authors as saying "pattern, what pattern?" But having given it some consideration, I'm starting to think that their findings tell a new story altogether. Now this is not to say that there is no evidence of an inflammatory response in acute cases of CRPS, where the 2009 study by Schinkel et al apparently found statistically significant differences in between acute cases, on the one hand and chronic cases on the other hand, in the levels of IL-12, Substance P (a protein found in the brain and spinal cord that is associated with some inflammatory processes in the joints), and Tumor Necrosis Factor-Alpha, a cytokine involved in systemic inflammation and is a member of a group of cytokines that stimulate the acute phase reaction, and is among other things the key mediator of septic shock in response to infection. But the sole statistically significant difference that was found between patients with chronic CRPS and healthy volunteers that Schinkel et al found was with respect to something called calcitonin gene-related peptide (CGRP). Now, it turns out that CGRP is far from uninteresting. As I posted last night on the "Botox" thread, when I ran a Wikipedia search on CGRP, it noted, among other things, that: It is the most potent peptide vasodilator and can function in the transmission of pain [fn. 2: Brain SD, Williams TJ, Tippins JR, Morris HR, MacIntyre I (1985), "Calcitonin gene-related peptide is a potent vasodilator," Nature 313 (5997): 54–6] [fn. 3: McCulloch, J., et al. (1986), "Calcitonin gene-related peptide: Functional role in cerebrovascular regulation," Proc Natl Acad Sci USA 83: 5731–5735, abstract at http://www.pnas.org/content/83/15/5731] . . . . CGRP receptors are found throughout the body suggesting that the protein may modulate a variety of physiological functions in all major systems (eg, respiratory, endocrine, gastrointestinal, immune, and cardiovascular). Increased levels of CGRP have been reported in migraine and Temporomandibular joint disorder patients as well as a variety of other diseases such as cardiac failure, hypertension, and sepsis.http://en.wikipedia.org/wiki/Calcito...elated_peptide Bottom line: there may well be a single and quite specific inflammatory aspect to chronic CRPS, but there's no reason that I can see in the literature to believe that those agents which tend to reduce most acute inflammation will necessarily have any effect on it. I hope this clarification is helpful. Mike |
I attended a pain conference recently, and this subject came up:
Opiates actually stimulating pain, thru the reaction of glial cells in the nervous system sending out inflammatory cytokines that induce further pain response. This is one paper that discusses it: http://www.nature.com/npp/journal/v2.../1300315a.html If you Google "morphine glial cells" you can find others. This is pretty new, and some doctors are unaware of this research at this time. But this finding is explaining why people with chronic head pain, develop MORE pain when using opiates for it. Other links of interest: http://www.colorado.edu/honors/Honor...teraction.html and this is interesting too: http://www.neurologyreviews.com/09mar/C1.html This is a pretty complex subject. |
Mrs D my pain doctor just told me that too and why he feels long term other then just severe flare ups opiates are not the way to go. I am still confused I guess as what is one supposed do and you do hear of people on here that are benefiting from them on a more regular basis. Thanks for those links.
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I don't know Daniella....the research is looking for a way to
block the glial cells responses. The last link I gave explains that. This information is definitely going to be influencing the FDA and other government actions in the near future. There will be quite a uproar...wait and see. |
Mrs. D -
But the papers on morphine glial cells do not explain the vasodilation/edema of CRPS, whereas high levels of CGRP might, don't you think? From my perspective, any theory of CRPS, not simply one's garden-variety back pain, that can't address vasodialation, can only explain how too high an opioid comsumption can only make our pain worse. And beyond that, may not worth the paper it's printed on, at least as to CRPS per se. Unless it can. Please discuss. Mike |
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What I see, is that the glia which holds the spinal cord and brain together, is an active promoter of inflammatory cytokines. The RSD response is complex. Certainly the vaso effects are obvious. But then there is the PAIN part...some of that IS mediated in the brain centrally. I have been reading here some members who have had tolerance to opiates and also new pain/burning--the Opana posts by Dew. These responses are in addition to the regional damage, IMO. So I put this up because....because use of opiates for all chronic pain is on the table now, and may be very altered in the future. Based on the attitude of the specialist neurologists I heard discuss many chronic pain states, opiates are not going to be popular in the near future. That is unless Big Pharma finds a way to block this glial response, soon. It just might be that the anti-inflammatory diet, helps with these issues as well as those in the periphery. I know myself that certain foods trigger my PN pain and burning significantly. It stands to reason that others with chronic pain are also in a similar situation. (I don't use opiates, BTW) |
Rsd Diet Revisited
I've been away for a while.Just dropping in to see whats up with everyone.
I thought I'd repost the RSD Diet for those that may have missed it and still might be interested. My best to you all. Di 01-14-2009, 03:39 PM #2 DianaA Member Join Date: Jun 2007 Posts: 260 My Mood: RSD Diet -------------------------------------------------------------------------------- Quote: Originally Posted by screwballpookie Hey you all, I see everybody talks about the rsd diet and I don't know what it is. Can anyone help me? I would like to know what it is to see if it will help me as well. I am willing to try anything at least once to see if it helps. If it doesn't then I know what not to do. So please help me. I also have another question. Can anyone explain in short form what HBOT is? If maybe it is something I can try to see if it helps with my pain. Thanks and you all take care. Sincerely, Tracy(screwballpookie) Tracy, I hope this helps. Here's the copy I have. I picked this up on the interent, All the best! Diana RSD Diet Guidelines Dr. Hooshmand states this diet isn't for losing or gaining weight. The purpose of this particular diet of his, is to exclude foods that are harmful to one's health and that aggravates chronic pain such as with RSD. The Five C's you need to avoid are: cookies, cakes, chocolates, cocktails and Candy. Other foods that should be avoided are internal organ meats like: liver, sauage and hot dogs. There are certain foods that help the inhibitory nerve cells that suppress the pain input, and they are the Four F's: Fresh Fruit, Fresh Veggies, Fish and Fowl. Four F's- Fresh Fruit (not canned) Fresh Vegetables(Olive Oil is best to cook with) Fish-DOn't use margarine. Baked or broiled Fowl-Skinned. not fried.(baked, roasted or grilled is fine) Foods that are allowed rarely or sparingly Tea, Lamb, Pulp of potato Foods To Avoid Coffee, soft drink with sugar crystalline sugar ,Pies, Bologna, Salami, Hot Dogs, Sherbert ,Ice Cream, Enriched Flour(bleached) ,Syrups, Mayonnaise, All fried foods, Canned fruits packed in syrup, Candies, Bacon, or pork, Donuts, Margarine, Nondairy cream substitutes ,Alcohol, Cake Mixes ,Potato Chips, Dips ,Crisco & other shortenings(replace with olive oil), Lard, Sweetrolls and Cakes. FOODS YOU CAN HAVE Diet drinks(low to no sodium, no sugar or caffine) ,Nuts-salted & raw, Honey(natural) ,Skim Cheese, Apples, All Fresh Fruits, Unsweetened orange juice, Natural fresh squeezed orange or grapefruit juice ,Apple juice(natural), All Fresh Vegetables, Veal ,Chicken & Fowl(skinned) ,Lobster(no butter), Lean Roast Beef(moderation), Raisins ,Skim Milk, Tuna(packed in water). Drink 6-8 glasses water daily. Fruits(dried), Shrimp ,All Fish Cereals(low sugar , whole grain) Sardines Sweet Potatoe & skin Lowfat plain yogurt(add yoour own fruit), Lowfat cottage cheese, Oatmeal(plan and unflavored) ,Crab here is the link to Dr Hoosmands Diet http://www.rsdrx.com/four_f's_diet.htm |
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I think that we are in full agreement that the CRPS patient is at equal risk with any other patient of developing Opioid Induced Hyperalgesia. I particularly enjoyed your posting of "Glial Cells—A New Target for Chronic Pain Treatment," with it's interview with Linda Watkins, Ph.D. For another treatment of the subject, check out, "Opioid Guidelines in the Management of Chronic Non-cancer Pain," Trescot AM, Boswell MV, Atluri SL, et al, Pain Physician, 2006; 9: 1 - 40 at 17, free full text at http://www.rsds.org/2/library/articl...ician2006.pdf: Hyperalgesia or abnormal pain sensitivity manifests as increased pain from noxious stimuli and as pain from previously non-noxious stimuli. Long-term use of opioids may be associated with the development of hyperalgesia. Experimental and clinical studies describe that cellular mechanisms of neuropathic pain may be similar to opioid-induced hyperalgesia. In an experimental setting, NMDA-receptor-mediated changes that cause abnormal pain sensitivity have been shown to occur in animals in the spinal cord dorsal horn cells of animals after repeated exposure to opioids. Similarly, these changes have been observed in the spinal cord in animal models of neuropathic pain. Consequently, interactions between neural mechanisms of opioid tolerance and neuropathic pain involving spinal and supraspinal neural circuits may have important clinical implications.That said, I see no reason, following the results of the 2009 article by Schinkel et al, referred to in my prior post, to assume that chronic CRPS has the same "inflammatory signature" as does - say - PN or back pain, where only a single pro-inflammatory cytokine - calcitonin gene related peptide (CGRP) - was observed to stand out to any level of statistical significance in chronic CRPS patients. If that's the case, I would suggest that we have to consider at least the possibility that a diet with wonderful anti-inflammatory properties in general, might have little or no effect on chronic CRPS unless it happens to effect the regulation of the CGRP gene, which: . . . is in part controlled by the expression of the mitogen-activated protein kinases (MAPK) signaling pathway, cytokines such as TNFα and iNOS. 5HT1 agonists such as sumatriptan increase intracellular calcium which cause decreases in CGRP promoter activity. Botulinum toxin type A is able to prevent stimulated release of CGRP through the cleavage of SNAP-25 protein. Receptor antagonists such as telcagepant, which is in phase III from Merck Pharmaceuticals, also has promise in limiting the effects of CGRP. [Citations omitted.]http://en.wikipedia.org/wiki/Calcito...elated_peptide You have stated that you believe "It stands to reason that others with chronic pain are also in a similar situation." But you have to acknowledge that is only an assumption, which may or may not be correct. All that I am suggesting is that we be prepared to think of this analagously to the manner in which CRPS has been shown to produce patterns of gray brain matter atrophy and white matter structures on structural MRIs that are wholly unlike those observed in patients with either chronic back pain or fibromyalgia. See, "The Brain in Chronic CRPS Pain: Abnormal Gray-White Matter Interactions in Emotional and Autonomic Regions," Paul Y. Geha, Marwan N. Baliki, R. Norman Harden, William R. Bauer, Todd B. Parrish, and A. Vania Apkarian, Neuron 60, 570–581 at 574 - 575 (November 26, 2008), free full text at http://www.apkarianlab.northwestern....S_Neuron08.pdf As such, I simply submit that if Schinkel et al are correct, the most amazing anti-inflamatory diet in the world may or may not have an effect on chronic CRPS, depending on its effect on the regulation of the CGRP gene. And one of the things that makes me feel that they are are on the right track is if you do a PubMed search under "CRPS calcitonin gene related peptide" you get only 5 articles, but written by some of the best minds in the field, e.g., two by Frank Birklein and one co-authored by Anne Louise Oaklander. Still, nothing would make me happier to know that if I stuck to Diet X for six weeks, there would be a 50% reduction in my pain and all of my edema would resolve. Mike PS It's unfortunate that Merck had to put telcagepant on hold in April of this year, perhaps permanently, due to issues of elevated liver enzymes when migraine patients started taking it on a daily basis - as any CRPS patient would have to - as opposed to the episodic use for which it was planned, but word has it that Merck and perhaps others may be trying to tweak the molecule even in the present moment, so there may be more news yet on that front. http://www.thedailyheadache.com/2009...rmanently.html |
I guess when we find out what is unique to RSD patients compared to those who do not develop this, we will have our answers.
This seems similar to Fibromyalgia, which is becoming obvious, as an inherited problem. Once triggered by an injury, trauma, Fibro does not go away either. The central pain sensitization is similar in Fibro patients and PN patients, as well as RSD patients. PN patients also have demyelination that is now being tested for. The new skin biopsies, are proving this condition. It might be that PN has several subsets, of peripheral degeneration + central pain perceptions. Right now MS is being looked at as a multiple process. Beginning with an inflammatory phase and followed by a disruption in astrocytes -- http://ms.about.com/b/2009/06/09/cou...sease.htm?nl=1 So we are all in the same boat, waiting for research to point the way, more clearly. |
hey aj,,
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good choice
really helps to know,,,how are you doing with rsd..im having a hard time at the monent ,,but trust that jesus will deliver...........bobber
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Take care, loretta |
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