J-pouch Redo, Part II

by on Monday, February 17, 2014 9:12
This entry is filed under: Coping/Support


Hey, friends. If you’ve followed my story you know it’s been a frustrating 8 years since the inception of my J-pouch.  A post-colectemy, end-ileostomied 22 year old Liz wondered, “Should I do this J-Pouch thing? Do I really need a J-pouch? I don’t mind the ostomy…It works great, I feel better. But, if there’s an internal option, I’ll probably do that.” Because, you know, although I was 22 and dating someone, I knew he wasn’t THE one.  And although I could deal with an ostomy, it seemed like a lot to introduce to most college-aged guys.  Anything internal seemed more convenient vs. an external bag.  So, that’s what I did. I got a J-pouch.

At the time, I had a wonderful surgeon who had a high success rate.  A three-step J-pouch procedure was performed in 2005 in May, October, and December, respectively.  I felt great after the colectemy.  After the J-pouch creation I felt not-so-great. I had a fever and horrible pain in the hospital.  It was a pretty brutal surgery.  The takedown was a breeze and although I spent the next year dealing with a recurrent stricture and chronic pouchitis, things were so much better than they’d been before the colectemy, I thought I was home free.  I wasn’t crapping exclusively blood 30 times a day, writhing around in my bathroom floor praying for relief or death anymore-anything was an improvement!

Then came more mechanical problems including prolapse (the pouch came out of my bottom so much that I had to push it back inside) and a twice-twisted pouch (ouch!), more surgeries, and a Crohn’s diagnosis.  Then I started a biologic that scared the hell out of me, but all other drugs had failed, so I succumbed.  I took it in combination with 6mp, a chemo drug that I’d taken many times before surgery. I took hand fulls of antibiotics for chronic pouchitis on a daily basis and rotated them when necessary.

Despite worsening problems like photo-sensitivity to any sunlight (turn lobster red from 20 min in the sun and start vomiting), severely swollen joints (I could barely walk and couldn’t bend my knuckles) all my doctors blamed Crohn’s and upped my meds. I got sicker and sicker, then after insisting on a slew of blood work to check for some of those scary-ass biologic side effects, I was diagnosed with drug-induced lupus and stopped the biologic.  I considered going to Northwestern to have my body blasted with chemo and rebuilt with stem-cells, but through divine providence a better option presented itself.  I got my arse to Cleveland Clinic, the hub of pouches, and in TWO DAYS got a proper diagnosis of IGG4 autoimmune pouchitis and an improperly constructed pouch.  After an improved 3 years of trying pouch guru Dr. Bo Shen’s tricks, my pouch finally gave out on me in early 2013.  He told me from the inception of our treatment I may have to eventually have a reconstruction of the J-pouch or have a permanent ostomy, though he was not excited about either of those options.  But at least I was prepared for it.

By the beginning of 2013, I was miserable.  I had constant, more intense pelvic pain, my stomach was so swollen I looked 5 months pregnant. I also had symptoms of a fistula and one showed up on an MRI, so I went back to Cleveland in March 2013 for a fistula surgery with Dr. Remzi, the surgeon recommended to me by Dr. Shen.  During that surgery, Remzi examined my pouch and said essentially that my pouch was a hot mess and had to be redone or cut out. He thought it was responsible for 90% of my problems.  So, after a few months of deliberation, worsening symptoms, I knew he was right.  I scheduled the first surgery to revamp my pouch: a temporary loop ileostomy in June 2013.  The ostomy was necessary to give my infected pouch time to rest.  After the surgery, with the J-pouch in rest (or limbo) I immediately lost 10 pounds that I never regained after that surgery. (Full of shit anyone?)  I felt pretty good through the recovery, and I hoped I could just enjoy my new ostomy and let the J-pouch hang dormant, but no such luck. I developed diversion pouchitis which meant I was passing blood through my pouch, had low-grade fever, arthritis flares, and generally felt awful.  Combined with a high-output ileostomy which denied my body of nutrients and hydration, I lost about 16 pounds in two weeks. My body was sick again. After following a strict high-protein diet, coupled with gallons of Pedalyte, handfulls of immodium, and daily enemas for the diversion pouchitis, I saw vast improvement.  Still, I had pain and occasional bleeding.  Also, I passed a lot through the old pouch (thank you, loop ileo) and it was just too much damn maintenance.  The special enemas were expensive, and I just wanted ONE butthole-not too much to ask for, right? So, after months of deliberation, I decided I’d try for the J-pouch redo with Dr. Remzi at Cleveland Clinic.

A former surgeon in Oregon who was on the right diagnostic track back in 2010, told me my rectal cuff was way too long and needed to be shortened, but said the surgery had a high failure rate (success less than 10%) and that no surgeon would attempt it, that I’d have to have my pouch amputated and have a permanent ostomy.  I was fine with the ostomy option, but less thrilled with the prospect of losing that much of my small intestine. So, when I found out Remzi’s success rate for a J-pouch reconstruction, shortened rectal cuff and all was 85%, and that there was a chance he could salvage the old pouch, I figured I have to try; mostly to save what’s left of my guts. (By the way, thanks to all you guys for the support on that decision! I love my Jpouch.net family!)

I had the reconstruction just over a month ago. Every single doctor from Shen to Remzi to the nurses, told me how horrible this surgery would be.  Dr. Shen could barely talk to me about it because he knew what I was about to go through. He would just shake his head, look down and say, “Okay to do.” I believed them all and I dreaded it right up to the moment they put the oxygen mask on me in the operating room. I kept thinking, “It’s not too late…I can jerk the IV out of my arm and bolt out of here. The crazy expensive enemas aren’t so bad. Shitting blood’s not so bad.” But, then I realized, it really was. The pouch hurt so much. It always had, even when it wasn’t officially working. It had to be redone or come out and for the sake of preserving what’s left of my insides, I decided to try the option that might let me keep what’s left.  So, I sucked it up, sucked in the oxygen and passed out on the table and let Remzi work his magic.

This was approximately my 15th surgery. (I’ve lost count of some of the “lesser” surgeries like stricture dilations, etc.)  and, it was rough. I had my first epidural before the surgery. I always incorrectly assumed an epidural was a single shot that provided hours of blissful numbness from the waist down. Nowadays, they insert something akin to a catheter or an IV into an area by your spine and you get a button (much like a pain pump) to shoot numbing meds and Fentanyl into your back.  It worked the first day-so well that one of my legs went numb and I couldn’t move it. So, they backed off the dose. After that, the sucker came out. I knew this because there was blood all over my pillowcase, bedding, gown, etc. and my back felt wet. Despite this, and my multiple complaints, it took 3 days to have it removed.  There was a fresh new crop of interns and residents, and as a result, I had to deal with some frustrating situations.  I’ve never dealt with pain management before. My doctors have just always given me a pain pump. The end. This was a frustrating game of changing meds around and relying on an epidural that wasn’t working, so the second day I had no pain control in my pelvis-the area that had been cut open for the upteenth time, incision extended into half my “mons pubus” (aka, hello lady parts) and re-worked in the biggest surgery I’d ever had.  You couldn’t touch the area where the incision was extended without the area spasming and me jumping and yelping in pain. (I’m not a yelper!)  I was miserable. I finally got help from a wonderful ostomy nurse and a shift of new nurses who knew the epidural was not working and hadn’t been for days.  Terri and Elana were my angels. They got things done and they listened to patients and worked with them. I’d never before had an experience of not being heard or believed by a doctor.  Dr. Remzi and his fellows were fantastic, but some of the new blood on the pain management team were not.

Once I had a pain pump (which has always worked in the past), and developed my usual itchy reaction to the pain meds, a new pain management resident wanted to eliminate it because I was itching. Despite politely telling her that this was normal for me (read my chart) and that I could deal with itching, but not the level of pain I was in before (because the epidural wasn’t working), she ignored me and removed it. Unsurprisingly, the pain was back with a vengeance, and Remzi’s residents were pissed.  It finally got fixed, but I’ve never had that level of pain after surgery in my life, and never had it go untreated for so long.  I was not happy and spoke with each department head about my concerns. I was angrier from a patient advocate perspective than I was for myself, but I was mostly just shocked because my previous experience had been stellar.  I suspect new training, new interns and residents were a big part of the issue.

After this, my incision had to be reopened because of infection, I blew 8-10 IV’s (bent one with my scar tissue ridden veins) and failed 2 midline IV attempts (very rare).

 

IMAG0834

The IV graveyard.

Eventually things improved and I was discharged on day 8. My incision opened up more and I experienced tunneling for the first time.  After a follow-up appointment, a wonderful WOCN showed me how to pack it with sterile, antimicrobial ribbon gauze and saline.

Warning! Graphic incision photo:
IMAG1120

The good news is, the surgery went well and Dr. Remzi was very happy.  He mentioned what a difficult surgery it was on multiple occasions, but he was able to do the following: Shorten my too long rectal cuff, remove the recurrent stricture at the anastamosis site, clean out 8 years worth of inflammation in the pouch, and make it symmetrical and mechanically correct.  He had to give me a new ostomy (farewell, Stella!) in order for the pouch to reach my rectal cuff without stretching it and putting stress on the pouch, so the new ostomy (hello, Stella 2.0!) is about a foot higher which means it’s even higher output. So, until takedown, I have to be extra super-duper careful about nutrition and hydration.

The JP drain. Felt like the Lochness Monster coming out!
 IMAG0845

So, a lot of people asked me, “Why didn’t you just go for a permanent ostomy?” The reason is, I cannot afford to lose any more intestine, especially because I have historically high-output ostomies.  There was at least a chance with the J-pouch redo that he could salvage the old pouch (ie, no loss of intestine) and he was able to do that because Dr. Remzi is the bomb.com It also gave me more options.  There’s a 15% chance this won’t work, and if that happens, I can go to a permanent ostomy then, but IF, just if, this works, maybe I will be able to preserve the precious few guts I have left.

I should note that since the surgery I’ve had obnoxious incontinence.  I used to experience that occasionally, mostly at night, but I always knew it was happening because there was an obvious sensation “down there.” Now, there’s nothing. The mucus just runs out at its own desire and I’m alerted by the disturbing warm feeling.  I have hopes this will improve. He just did a LOT of intense work down there, so it makes sense that things are all a twitter.

Hindsight being 20/20, and this being my 15th surgery in 15 years with this damn disease, I have to say, I kind of wish I’d stopped with the end ostomy after my colectemy.  But, I didn’t. I tried and I failed.  A lot.  I really hope this time works for me because in addition to getting older, I’m getting really, really tired.  I’m ready for something to work.  I would love to have just a few years of semi-decent health.  For anyone considering a J-pouch, I urge you to think long and hard about your options. I also want to emphasize, that for MOST people, the J-pouch surgery is successful.  I am by no means a good example of the norm, but there are plenty of people out there like me.  It may shock you to know that the J-pouch surgery is not, yet, a board-certified procedure.   Dr. Remzi spends about 2/3 of his practice fixing other people’s work-either reconstructing a poorly made pouch or amputating it and giving someone a permanent ostomy. Because of that, he’s trying to make it a board-certified procedure.  I say this not to scare you, but to inform you.

Surgeries are risky business, especially surgeries that create a neo-organ.  Knowing how I felt as a 22 year old single girl and knowing the perspectives of the hundreds of women and girls I’ve counseled about these surgeries and diseases, as a patient advocate and through my work with Girls with Guts, I know the only reason people want a J-pouch is because they don’t want an ostomy.  They don’t want an ostomy because of the stigma.  So, instead of stopping at one surgery, we put ourselves through one or two more…or 14 more, in my case.  Frankly, that pisses me off.  I’m proud to do the work we do at Girls with Guts and on this blog to help raise awareness and erase the stigma of IBD, ostomies, and pouches, but through this work, I have seen how significantly the stigma affects patient’s care and health and that infuriates me.  I think of the time I could have had-the 8 years of good health I likely would have had if I had chosen the “gold standard” and stayed with the ostomy and part of me longs for that, but let me be clear: I don’t regret my choices because they’ve lead me down beautiful paths.  I love my life. I am passionate about what I do and what I do keeps me going. How many people can say that?

An example of my great friendships: An inspirational scroll and pillow from Casey & an original painting of me as a Samurai Warrior by my dear friend, Josh.
IMAG0873
IMAG0883IMAG0836

The bad experiences have put me through hell, but as a result of surviving that, I’ve been able to meet all sorts of incredible, strong patients, and just maybe help them because of those hellish learning experiences.  I’ve made friendships with people who are now family, but I do regret the suffering I’ve endured because of vanity.

The reconstruction was brutal. It was absolutely brutal.  As much pain as I’ve endured in my life, and as high as my pain tolerance is, my body felt like it had been destroyed after this surgery.  I’m starting to feel better, the giant incision is starting to heal, and the pain is beginning to abate.  I pray this works for me, but more so, I pray that patients considering this, or any surgery, will do their due diligence and seek the best care possible. I pray they will make decisions based on their health and what option will give them the best quality of life vs. which option will make you look better in a bikini. (Check out the Girls with Guts Facebook page to see how hot our ostomy girls look in their bikinis!)

Lastly, I am so grateful to the amazing staff at Cleveland Clinic’s Digestive Disease Institute who have devoted their lives and work to patients like us.  For pouch issues, there is no better place in the world to go, and I feel truly blessed to be able to seek their counsel.

 

 

 

 

 

 

 

These posts might also help out:

You can leave a response, or trackback from your own site.

66 Responses to “J-pouch Redo, Part II”

  1. avatar

    Sylvia K Hagy says:

    February 18th, 2014 at 6:35 am

    Hi,  Elizabeth,  I am so glad to have read this blog of yours.  I better understand the enormity of what you have gone through, and what you deal with every day.  I am  most blown away by your statements concerning your life with this.  You have found the aces in tHe hand you have been dealt.  The good you are doing by offering people hope, especially those going through these surgeries for the first time.  You are an example of grace under fire.  Love and Hugs to you, your amazing mom, and that sweet Rob.  Sylvia

    [Reply]

  2. avatar

    Elizabeth Newell says:

    February 18th, 2014 at 8:30 am

    My dear sweet niece! What a story, what a journey. You are the most courageous person I know! I rail against you having this, then have to turn it over to God. Those who love you are “standing in the Gap” for you.

    [Reply]

  3. avatar

    検討 says:

    May 14th, 2014 at 12:12 am

    検討

    Jpouch Life: Stories of Colitis, Crohn’s, IBD, Ostomy, Ileostomy & J-Pouch Surgery from around the world

  4. avatar

    http://support.tetrisbattle.com/entries/38333044-Japanese-Kei-Tora says:

    June 2nd, 2014 at 11:17 pm

    regalo international bedding

    [Reply]

  5. avatar

    new.livestream.com says:

    June 2nd, 2014 at 11:18 pm

    how many cups is 100 grams of chicken

    [Reply]

  6. avatar

    http://www.lookuppage.com/users/duaneshekarchi1 says:

    June 2nd, 2014 at 11:30 pm

    how many carbs on induction phase

    [Reply]

  7. avatar

    img4lol.com says:

    June 3rd, 2014 at 5:04 pm

    I’d been suggested this site with my own relative. I am no longer beneficial if it submit is usually authored by technique for him or her seeing that nobody know like special roughly my personal difficulties. You are incredible! Appreciate it!

    [Reply]

  8. avatar

    www.goodreads.com says:

    June 12th, 2014 at 9:02 pm

    What i don’t realize is in reality how you are no
    longer really much more smartly-preferred than you
    may be now. You are so intelligent. You recognize therefore significantly when it comes to this matter, produced me in my view consider it from so many various angles.
    Its like women and men are not fascinated unless it’s
    something to do with Girl gaga! Your own stuffs great.

    All the time deal with it up!

    [Reply]

  9. avatar

    http://www.lookuppage.com/users/russelrozzi says:

    June 15th, 2014 at 1:47 pm

    gluten free diet

    [Reply]

  10. avatar

    my site says:

    June 26th, 2014 at 1:23 am

    Which is really attention-grabbing, You are a completely skilled blog writer. I’ve truly signed up with ones supply and search in advance in order to in search of even more of your own excellent submit. In addition, I have got embraced your website at my web sites

    [Reply]

  11. avatar

    Tracy says:

    July 14th, 2014 at 7:45 pm

    Hi Liz, 
    I’ve enjoyed reading your story this evening and was wondering how you are doing?  I too had a J-pouch done at Cleveland Clinic back in July 1994.  I just passed my 20th anniverserary with it.  It has definitely not been a picnic but not as problematic as yours.  My original surgeon in Cleveland was Dr. Ian Lavery and he was amazing. I give him full credit for giving me a chance at a healthy life.  My story is long (diagnosed at 15 with UC), so I won’t go into it here but I do hope you are doing well and I would love to hear an update?   

    [Reply]

    avatar

    Chris Reply:

    A strange relief washed over me knowing you went to CC – where I just had my colectomy and where I’d get the jpouch done (I was on steroids so I’d have a 3 step procedure).

    Tracy – Dr. Lavery did mine just two weeks ago. AMAZING and so glad to know you’ve had some success. He’d do my jpouch too. I feel pretty confident in that choice now.

    [Reply]

    avatar

    Tracy Reply:

    [Reply]

  12. avatar

    Tracy says:

    July 17th, 2014 at 7:52 pm

    WOW Chris! So glad to hear from you.  You won’t be sorry! I haven’t regretted my surgery for one minute.  I’m in the Nashville area now and have not found any where near the quality of care that I received in Cleveland.  I have had problems with a fistula that developed after a successful pregnancy in 1997 and the doctors here didn’t want to compromise my pouch so they sent me back to DR Lavery for the repair.  I’m sorry to say I still have problems with it so the Doctors here think I may have Crohn’s.  I’m not buying it since I made a second trip to Cleveland another time to take part in a post pregnancy study (they like to know how the pouch holds up) and I ask to see one of the doctors for a second opinion. He didn’t think it was Crohn’s (no granulomas).  Anyway,  you really can’t go wrong with Cleveland.  They are the best.  Mine was a 2 step surgery, I had the illeostomy for about 3 months before my takedown.   Good luck and let me know if you have any questions or need some encouragement.  Tough surgery no matter where you have it done but so worth it!  
    Tracy

    [Reply]

    avatar

    Tracy Reply:

    P.S.  Chris,
    I had thought about sending Dr Lavery a Thank you note on my 20th anniversary but I wasn’t sure if he was still in Cleveland or retired.  I’m glad to know and will write that note for sure now.  :) 

    [Reply]

  13. avatar

    Simplestart.Zendesk.Com says:

    July 22nd, 2014 at 7:31 am

    Simplestart.Zendesk.Com

    Jpouch Life: Stories of Colitis, Crohn’s, IBD, Ostomy, Ileostomy & J-Pouch Surgery from around the world

  14. avatar

    differently says:

    July 24th, 2014 at 3:15 am

    differently

    Jpouch Life: Stories of Colitis, Crohn’s, IBD, Ostomy, Ileostomy & J-Pouch Surgery from around the world

  15. avatar

    ways says:

    July 31st, 2014 at 11:07 pm

    ways

    Jpouch Life: Stories of Colitis, Crohn’s, IBD, Ostomy, Ileostomy & J-Pouch Surgery from around the world

  16. avatar

    medical hcg drops says:

    August 3rd, 2014 at 3:49 pm

    medical hcg drops

    Jpouch Life: Stories of Colitis, Crohn’s, IBD, Ostomy, Ileostomy & J-Pouch Surgery from around the world

  17. avatar

    Nancy says:

    August 10th, 2014 at 9:00 am

    Hi Liz, wow I’m blown away at your story because it mirrors mine almost to the tee. I also have Dr. Shen and Dr. Remzi. When I had the 1st of the 3 surgeries to reconstruct the J-pouch. The Dr.s came in my room the  next day and gave me the bad news that I wouldn’t be able to have anymore surgeries.(there words we don’t think you’ll make it through another surgery) so that left me with the loop iliostomy with a surgical opening at the bottom of it so mucus could expel from it, the J-pouch with diversion pouchitis that is prolapse pressing in my spine and bladder, vistulas in vagina and living the rest of my life with those fatty acid enemas daily, cortifoam  and Rowasa enemas. It’s been 3 years of living this way and it’s not easy. I pray to God that your reconstruction works and you will be able to live life to the fullest. Those of us who are like me waiting for a new procedure or new technics to be discovered  some kind of hope are rooting for you that you will be the one that the brilliant Dr.s we do have and all there hard work and research pay off in you. Keep fighting, stay positive some how our attitude we take through these battles help us and others. Thank you for sharing your story. God Bless You!

    [Reply]

  18. avatar

    Becky says:

    August 26th, 2014 at 6:14 am

    Hi Liz – We haven’t heard from you in awhile and, some of us who have followed your stories were concerned. You are an amazing young woman and we hope you are doing well.

    [Reply]

    avatar

    Jane Reply:

    Hi Becky 
    I, too, follow and read every word, up, down, sideways, funny, scared, hopeful, angry, honest and true from Lizz. I hope much of a muchness Lizz has recovered enough since her truly gnarly surgery in February. May she be out there living life as fully as she wishes. 

    Lizz – if you are reading this – you are terrific, unique and gifted, so please –  we are listening for your next honest comments about how you are doing. 

    [Reply]

    avatar

    Lizz Reply:

    Hi, all! Thanks so much for the sweet comments :) I really appreciate them all. The recovery has been rough and I’ve had several ongoing complications, so I’ve been focusing all my energy on healing and getting better. When I’m able, I’ll give everyone a full update. Thanks again for the truly humbling words and for your friendship and concern. Best wishes to you all! Liz

    [Reply]

    avatar

    Jane Reply:

    Hi Liz,
    Oh, thank you so very kindly for taking the time to give us an update. It is so very good to “hear” from you. We are with you in spirit (whatever in spirit means via the internet, I mean it most sincerely) and definitely want you to focus wholly – heart, soul and toenails – on achieving a more comfortable and stable level of recovery. Darn it all anyway on the complications. Beyond gnarly. I am so sorry to learn it is still such rough sledding, you have been at it for a long time. In the meantime, we know you are saving what strength you have to deal with what’s in front of you right now and we know you will tell us all about it when you have a shred of energy to spare. One day you will look back on this long haul healing chapter and it will all be behind you, but for now, thank goodness you are a strong lass with a sharp mind, and a mighty will. You’ve climbed the Mount Everest and Mount Kilamanjaro and Mount Everything of jpouch complications, and it sounds like the oxygen is mighty thin up there. I would send sherpas to come rescue you if I could, but I can’t, so take good care, best wishes to you, we look forward to your return. 
    Jane
    Jane

  19. avatar

    fast weight loss says:

    September 3rd, 2014 at 10:27 am

    fast weight loss

    Jpouch Life: Stories of Colitis, Crohn’s, IBD, Ostomy, Ileostomy & J-Pouch Surgery from around the world

  20. avatar

    painters brisbane northside says:

    September 10th, 2014 at 6:59 pm

    Pretty section of content. I just stumbled upon your
    weblog and in accession capital to assert that I acquire in fact loved
    account your blog posts. Any way I will be subscribing to your augment and even I success
    you get right of entry to constantly rapidly.

    [Reply]

  21. avatar

    anal says:

    September 15th, 2014 at 6:36 am

    It is really a wonderful as well as practical piece of information and facts. I am content you discussed this beneficial details here anal. Be sure to continue being you advised like this. Many thanks revealing.

    [Reply]

  22. avatar

    Jackqueline Z. Reap says:

    September 20th, 2014 at 2:10 am

    Everything is very open with a very clear explanation of the issues.
    It was truly informative. Your site is useful. Thanks for sharing!

    [Reply]

  23. avatar

    ships coffee says:

    September 24th, 2014 at 8:25 am

    It’s an amazing paragraph in support of all the online visitors; they will get advantage from
    it I am sure.

    [Reply]

  24. avatar

    webpage says:

    September 30th, 2014 at 6:03 pm

    Awesome issues here. I’m very happy to look your article.
    Thank you a lot and I am looking forward to contact you.
    Will you please drop me a e-mail?

    [Reply]

  25. avatar

    m88 says:

    October 20th, 2014 at 7:16 pm

    I blog frequently annd I really appreciate your information. Your
    areticle has truly peakerd my interest. I’m going too book mark your blog and
    keep checking foor new details abbout once per week.
    I subscribed to your Feed too.

    [Reply]

  26. avatar

    ?? ??????? says:

    October 24th, 2014 at 2:58 am

        Considering that man invented watches,ニューバランス 正規販売, they have been the most commonly given away in addition ,ナイキ スニーカー, useful gifts in the area. Except in a number of countries where presenting a watch is regarded as bad fortune, any other countries in entire world gift watches for their beloved ones. People who get luxury watches remember

    [Reply]

  27. avatar

    link homepage says:

    October 28th, 2014 at 6:45 pm

    It’s going to be end of mine day, however before finish I am reading this fantastic post to improve my knowledge.

    [Reply]

  28. avatar

    ears ringing says:

    November 23rd, 2014 at 2:34 pm

    each time i used to read smaller content which also clear their motive, and that is also happening with this post which I am reading now.

    [Reply]

  29. avatar

    maxi skirt pattern simplicity says:

    December 11th, 2014 at 9:51 pm

    Must order paper sample from Sewaholic Patterns online or considered one of their distributors and it’s the most costly pattern ($15.98) of the three skirts.

    [Reply]

  30. avatar

    discount grocery stores says:

    December 12th, 2014 at 4:30 pm

    Hi, i believe that i noticed you visited my web site thus i came to return the
    choose?.I’m attempting to find things to enhance my web site!I guess
    its ok to use some of your ideas!!

    [Reply]

  31. avatar

    calvin klein jeans size 10 says:

    December 19th, 2014 at 3:45 pm

    Hey there, I think your website might be having browser compatibility
    issues. When I look at your blog in Safari, it looks
    fine but when opening in Internet Explorer, it has some overlapping.
    I just wanted to give you a quick heads up! Other then that, excellent blog!

    [Reply]

  32. avatar

    tditx.info says:

    December 24th, 2014 at 8:30 pm

    I think the admin of this web page is genuinely working
    hard in support of his site, because here every data is quality based material.

    [Reply]

  33. avatar

    Spooky Pop Cheats says:

    December 26th, 2014 at 10:48 pm

    The latter is probably going to be the biggest
    unknown as a vast number of commercial and open source software applications are built on the Java platform.
    The game has plenty to offer, providing hours of fun, family friendly themes,
    and fascinating game play for sure. If you buy IOS source code for game development from Nipps – App.

    [Reply]

  34. avatar

    Dragon city astuce accouplement says:

    December 29th, 2014 at 12:23 am

    What’s up tto every body, it’s my firs pay a quick visit of this website;
    this website contains amazing and really fine
    data inn support of readers.

    [Reply]

  35. avatar

    Bailey says:

    January 1st, 2015 at 11:43 am

    Thanks for the auspicious writeup. It in truth was once a amusement account it.
    Glance advanced to far delivered agreeable from you! By
    the way, how could we communicate?

    [Reply]

  36. avatar

    Vida says:

    January 29th, 2015 at 2:27 am

    I knew I needed a bottom for your molding of the deer.

    [Reply]

  37. avatar

    Augustus says:

    January 29th, 2015 at 4:37 am

    Our laboratory imported it from New Zealand and has procured.

    [Reply]

  38. avatar

    atunbi wedding photos says:

    February 2nd, 2015 at 4:20 am

    Great blog right here! Also your website a lot up fast!
    What host are you the usage of? Can I am getting your associate link for your host?
    I wish my site loaded up as quickly as yours lol

    [Reply]

  39. avatar

    vuzix m100 smart glasses says:

    February 3rd, 2015 at 11:57 pm

    The Calendar software is a Native M100 Application designed to sync
    with the calendar on the companion device.

    [Reply]

  40. avatar

    Spiele Deutsch says:

    February 5th, 2015 at 7:57 pm

    The game itself involves matching three items in a line to clear them
    and gain points, all with a time limit. Your computer, or
    smart phone can be used to access the game in a flash. However, it is
    fantastic for little hands that just cannot seem to keep a
    hold of things.

    [Reply]

  41. avatar

    CASINO says:

    February 10th, 2015 at 1:26 pm

    Hello to all, it’s actually a pleasant for me to pay a visit this
    web page, it includes useful Information.

    [Reply]

  42. avatar

    weight loss meal plans on a budget says:

    February 10th, 2015 at 9:09 pm

    Music can be ann extraordinarily outstanding aidd when youre exercising and several
    people have attested to this; it will keep
    you motivated and will suely provide a steady rhythm for you.

    The Truth About Six Pack Abs is the fasttest way to Get a Flat Stomach.

    Pictures of the workout plan improve you to understand how to carry outt the work outs.

    [Reply]

  43. avatar

    CASINO says:

    February 12th, 2015 at 2:57 am

    Aw, this was a very good post. Taking a few minutes and actual effort to
    produce a top notch article… but what can I say… I hesitate a lot
    and don’t manage to get anything done.

    [Reply]

  44. avatar

    peeling do ciala – niezbedny zabieg dla Kazdej kobiety znalazlem tutaj says:

    February 12th, 2015 at 10:35 am

    After looking over a number of the blog articles on your blog, I
    really appreciate your technique of writing a blog.
    I book-marked it to my bookmark webpage list and will be checking back soon.
    Please check out my web site too and let me know what you think.

    [Reply]

  45. avatar

    younique fibre lashes says:

    February 15th, 2015 at 10:01 pm

    What’s up, the whole thing is going nicely here and ofcourse every one is sharing information,
    that’s actually excellent, keep up writing.

    [Reply]

  46. avatar

    nintendo ds games says:

    February 18th, 2015 at 1:04 am

    Good post! We will be linking to this particularly
    great article on our website. Keep up the great writing.

    [Reply]

  47. avatar

    Avineet Brar says:

    February 21st, 2015 at 7:48 am

    ive had colitus and crones diagnosed in 2008 ive had 3 surgeries through 2011 and 2012 i have a j pouch right now with pouchitis my doctor reccomended permenent ostomy but i said its not that serious since i go 9-13 times a day and he prescribed me to a enema called budesonide and since then that start of it was great but using it a month later i started to have accidents in my bed every night making it impossible to sleep for more than 4 hours i found myself taking two or three showers every day and my stools were all water and my pee is dark but i drink a lot of water also i cant sit on my butt for the most part because little bits of liquid stool comes out its getting very annoying but i can live with it but im not growing due to the lack of nutrition can someone suggest something to help because everytime i go to the doctor he gives me more medication and i know thats not what i need

    [Reply]

  48. avatar

    www.arablionz.co says:

    February 25th, 2015 at 4:56 pm

    Quality articles is the crucial to attract the people to visit the website, that’s what this web site
    is providing.

    [Reply]

  49. avatar

    Diety Oczyszczajace says:

    February 28th, 2015 at 6:15 am

    I’m really loving the theme/design of your weblog. Do
    you ever run into any browser compatibility problems?
    A handful of my blog audience have complained about my website not operating correctly in Explorer but looks great in Opera.
    Do you have any tips to help fix this issue?

    [Reply]

  50. avatar

    cydia wont open says:

    February 28th, 2015 at 3:12 pm

    You might also add memory and date status in your status bar.
    It is free of charge, risk-free in addition to undoable by using the
    iTunes to recover the device. Actually, you can purchase an application for right around $25 dollars.

    [Reply]

  51. avatar

    seaside3.com says:

    March 1st, 2015 at 6:56 pm

    No one needs to hide when there is a number of ways on how to get rid
    of a pimple overnight. You may want to consult with your dermatologist before starting treatment
    to see what they recommend based on your particular situation. There are actually alternative methods to remove
    acne scars without having to resort to the high technology used by other skin care manufacturers (coupled with
    the same high price).

    [Reply]

  52. avatar

    test obciążeniowy organizmu kielce says:

    March 2nd, 2015 at 8:43 am

    Nadzwyczaj szałowy post, ciekawe wpisy zalecam wszystkim
    lekturę test obciążenia glukozą w ciąży,
    test obciążenia glukozą w ciąży 50g, test obciążenia glukozą w ciąży normy

    [Reply]

  53. avatar

    Derma Essence Serum says:

    April 25th, 2015 at 6:16 pm

    Wonderful post! We are linking to this great content on our website.
    Keep up the great writing.

    [Reply]

  54. avatar

    Derma C says:

    April 28th, 2015 at 9:27 am

    Hello my friend! I wish to say that this post is awesome, nice written and include almost all important infos.

    I’d like to see more posts like this .

    [Reply]

  55. avatar

    Hydresence says:

    June 11th, 2015 at 7:53 am

    Hello to every , as I am really eager of reading this weblog’s post to be updated daily.

    It consists of nice stuff.

    [Reply]

  56. avatar

    Gabriella says:

    June 23rd, 2015 at 1:06 pm

    Whilst blogs are a personal representation of you and your company,
    here are some tips on content which may increase the popularity and readership.
    Customer loyalty: This develops the customer’s loyalty towards
    the brand. Consumers today are making decisions more carefully, and that favors small businesses that they can trust – especially local
    businesses they can personally get to know.

    [Reply]

  57. avatar

    family fun in sydney says:

    June 25th, 2015 at 6:55 pm

    I pay a quick visit each day some blogs and information sites to
    read posts, but this blog gives quality based content.

    [Reply]

  58. avatar

    luminique says:

    June 29th, 2015 at 10:19 am

    It’s impressive that you are getting ideas from this article as well as from our
    argument made at this place.

    [Reply]

  59. avatar

    Floyd says:

    July 10th, 2015 at 7:13 am

    This is what you should ask yourself before undergoing any surgery because
    it is your life and you should take a decision to have a 100 percent satisfaction. Dozens of shopping apps permeate the App Store, bringing shopping right
    to the palm of your hand. We suggest you to avoid heavy workouts
    for a month.

    [Reply]

  60. avatar

    Alphonso says:

    August 21st, 2015 at 7:34 am

    Though, to profit from the best deals you need do inclusive do research of online market.
    To that effect, only those whose age is above 18 years could be
    eligible to receive a person to person used auto loan. And online
    processes could be extremely fast as a result of
    which you could derive valuable information regarding your alternatives in the shortest possible time.

    [Reply]

Leave a Reply