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PostPosted: Sun Jul 17, 2011 10:05 am 
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Hello everyone! I have been reading all the pregnancy threads on here since yesterday and while I haven't gotten through them all yet, I am so glad I found this site!

I just wanted to introduce myself. I'm 28 weeks pregnant today. I've been on Subs for about a year and a half. I was switched to Subutex early in my pregnancy. Before getting on Subs I had a 10 yr addiction to Vicodin that started after being put on them for collapsed vertebrae in my lower back. The addiction got worse and worse and included alot of other opiates and benzos at the end. I believe Subs saved my life. But, now I have come to hate them.

I am currently seeing a Sub doctor who has an OB specialty. I started seeing him when I got pregnant--switched from my regular Sub doctor in the same practice. He doesn't have the best bedside manner, though and getting answers from him about anything is like pulling teeth! After everything I have read on here, he has a lot of talking to do at my appt on Friday!

I am currently prescribed 8mgs 2x a day, but usually only take 8mg 1x a day. I want to taper down as low as I can before delivery. The thought of WD's makes me cringe! I am so scared. After delivery I want to taper off completely and that scares me even more.

Hope everyone else has a healthy and happy pregnancy :)


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PostPosted: Sun Jul 17, 2011 11:19 am 
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Hi Cinnagirl and welcome to the forum. First congrats on the pregnancy. You are correct in that most women do try to get to a lower dose when they are pregnant. One of the reasons is in case you need pain control then you won't be fighting to get relief from competing with the sub. But when it comes to tapering while you're pregnant, I'd suggest doing it so slowly that you barely feel it, if at all. You said you're taking 8 mg? Actually that's not really very high. I would drop down as slowly as going to 7 mg first and stay there for a week or two then go to 6 mg. That's what I mean by doing it very slowly.

I suggest this because everything you feel the fetus will feel as well. And opiate withdrawals raise the risk of miscarriage. Oh and when you make it to 4 mg (if you decide to go there), you might feel the dosage drops even more, so you might have to slow it down even more.

Remember, this is just my non-medical, non-professional opinion. Good luck to you and ask any questions you may still have.

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PostPosted: Sun Jul 17, 2011 11:40 am 
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Thanks for your input :) I actually just started taking 4 mgs yesterday and today. I'm not sure how I'm going to do on this dose yet, though. I know the long half-life will make me feel confident about it until maybe tomorrow, so I will find out.

I had no idea I should taper down at all. My Sub doc hasn't mentioned it, but I think it would be best, so I'm doing it and will talk to him about it this week. He's not very forthcoming with information, unfortunately. I've only really asked him about the pain management side of things so far and he kinda brushed me off with a glib answer about how he has helped probably 90% of the pregnant women in my area and not to worry about it. Well, I'm an information whore so that's not good enough for me. I put off researching online until recently and now I have lots of questions for him tha I WILL get answers to! LOL

My OB is pretty supportive, but admits she doesn't know much about Subs and will take whatever info my Sub doctor tells her and follow it. There has been a bit of run around in that dept from him also, but he finally wrote her a letter recently.

I'm just worried reading everything about CPS! I had no idea it could be a problem. My doctor did tell me that the hospital I chose is the best choice vs. the other big hospital in my area. He said the other one might give me problems, so crossing my fingers all goes well. I also had no idea my baby will be watched in NICU for 72 hrs.....So much to worry about :(


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PostPosted: Sun Jul 17, 2011 11:51 am 
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CPS is only brought in if the mom tests positive for illicit drugs. You are prescribed suboxone so there would not be a reason for them to be notified. So put that out of your mind and there's one less thing to worry about. I'm sure some women who have given birth while on sub will come along and I know that some have had babies with no NAS at all. Some do, some don't. I know it's easy to say, but try not to worry, especially about things you can't control. Just remember to make your taper as slow and painless as possible. You want the baby to feel no withdrawals - at least that would be my goal. Good luck and try to relax and enjoy this time.

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PostPosted: Sun Jul 17, 2011 12:50 pm 
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Hi, and welcome to the forum.

I had a baby on Subutex and she was completely healthy. I tapered down to 3 mg for the majority of my pregnancy. I'd suggest you do a slow and steady taper, specifically by doing small drops. So, you need the smaller tabs. Go down by only 1 mg or so at a time and then by .5 so you don't stress your body out. Even if your baby is born with some bit of NAS, your baby will be okay in the end, because they can absolutely treat it once the baby is born. A baby going through Sub w/d while in utero is a terrifying thought to me and I'd never take that risk, personally, because it is truly risking the baby's life. I know some women don't want their babies to have to suffer w/d after they are born, but isn't that better than when inside their mom? If a mom tapers too fast of jumps, the baby has no meds to comfort them and they suffer. Outside the womb, they can make your baby comfortable, so the worst case scenario still ends up with your baby being okay. Many non-Sub babies have to receive opiates after birth for a slew of reasons. My second baby (non-Sub) did when she was born prematurely. She got tons of morphine while on a ventilator. She's better than fine and I'm glad she got those meds to make her ordeal easier.

As far as CPS goes, I never had one single but of trouble with them. They never came to speak to me once. I don't see the basis for CPS getting involved in these cases. I mean, think about it. You are taking a med that your OB knows you are taking and your OB has agreed to you taking. As Hat said, Subutex is not illicit; it's a prescribed med and it's the safest route to take. You are following medical advice!! You cannot just stop taking Sub, because you could cause yourself to have a miscarriage. How can you be faulted for being responsible? I'd love to ask one of these social workers what the proper course of action should be for a woman, when stopping Sub risks your baby's life and the remaining on risks your baby being born with NAS AND (supposedly) CPS getting involved. Wouldn't they agree that chancing NAS is the better option? NAS is a temporary condition and it goes away and you are left with a HEALTHY baby. I believe 100% that if you taper to a lower dose responsibly and continue to receive your prenatal care and make decisions with your doctor, you will go home in the end with your baby and CPS will have no part in your life.

They may monitor your baby more closely, although I noticed no difference in how attentively they monitored mine compared to my other kids' births. If they do, do whatever you can to be a part of it. Ask tons of questions and make sure you understand why they reach the conclusions they reach. I read something Dr. Junig wrote about hospital's pointing to behaviors as evidence of NAS when those behaviors are fairly typical of all newborns. There's a lot of validity to that argument. I'd maybe print some of that stuff out and bring it to show them, so they don't end up medicating your baby when it's unnecessary. I mean, how can a NICU doc say whether a baby's fussy because of NAS or just because many babies are fussy?!

I toured the NICU before delivering and met the NICU docs. I let them know my worries and I don't know if perhaps that worked to my advantage in the end, as they likely saw that I was a responsible and concerned parent. I also don't know who even calls the social worker, but if one does come, it's not the end of the world. They just want to talk to you and you need to hold your head up and explain how you handled this the best way you could. They have nothing on you and they can do nothing to you!! Don't let anyone make you feel like a bad person. This is a ton of weight to carry on one's shoulders and all we can do is make the best decision. If a social worker had come see me, I would have been completely shocked beyond belief, after I ran around trying to do the best thing for my baby for all those months and following everything I was told to do!! They have zero, sip, zilch reason to find any fault with you, so remember that!!

I think you are doing everything right and should try to enjoy the rest of your pregnancy, because I worried myself sick for absolutely no reason. My baby's 3.5 now and she's totally fine. In fact, my Sub pregnancy was my healthiest pregnancy of the three when seeing it in hindsight. The worry can be terrible.

Here's an example of how things can be distorted. I always have had small babies. Small babies run in my family. My first two were small, but nobody really worried. I had serious problems with my first two pregnancies, but I was taking no meds, so no meds were blamed. With my Sub pregnancy, my baby was showing to be small all over. She was tiny, beneath the 15%, just like my first two babies.

Well, Sub during pregnancy was new ground, especially to my very protective OB, so he ended up putting me on bed rest and then in the hospital and making me eat gigantic amounts of food to try to make her grow. The main concern was 'head size', even though it was consistent with the rest of her tiny self. I was there over a week, and finally, my roommate suggested I measure my own head, since she said it looked smaller than average. I got a tape and did this, and guess what? I've got a small head. I imparted this information to my doc and was released the next day. It's genetic for her to have smallish head, but the Sub made everyone be incredibly overly cautious and they didn't even consider the other causes first. My daughter is STILL tiny and probably always will be, just like my other kids. It's not the Subutex!!

K, sorry I wrote you a book. I guess my heart just goes out to every mom in this situation. It will be okay. Please keep checking in and updating.

laddertipper

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PostPosted: Sun Jul 17, 2011 1:13 pm 
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Laddertripper-- Thanks so much for your input. I don't mind reading a book ;) I'm so glad I found this site. Thanks to you and everyone for taking the time to share your experiences. I have been active on a birth board, but I don't feel comfortable sharing this part of my pregnancy there for fear I will be judged/labeled.

I am going to try this 50% taper to 4 mgs, but don't worry I will go back up if I feel I need to and do it slower. I wish I would have researched all this sooner in my pregnancy because my Sub doctor hasn't mentioned tapering at all, but after all my reading I definitely think it is the best option. It just makes sense to take the smallest dose possible. I feel so stupid for not realizing that there is a possibility of WD for my baby. I mean, I'm not a dumb person, but it never crossed my mind and since neither doctor has mentioned it either--I just didn't think of it. And now I'm gonna worry about it. I just hope and pray that the hospital doesn't score the baby higher just because they know I'm on Subutex. My husband will be so pissed off at me if anything out of the ordinary happens. He knows all about my past addiction and that I'm on Subs, but he is very judgmental about it.

I also had no idea my baby will be monitored in the NICU and I definitely want to do all I can to be informed ahead of time. Touring the facility beforehand is a great idea. I'm going to be discussing all this with my OB and Sub doctor this week. I just don't understand why neither of them has brought any of this to my attention? They have just acted like this is no different from any other pregnancy. Maybe that is a good thing, though!

Sorry this is so long...I'm just so happy to find a supportive place to be with women who have been there/done that. I could just cry. Damn these hormones!


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PostPosted: Sun Jul 17, 2011 9:26 pm 
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I think it's a very good sign that your doctor doesn't seem worried. To be honest, after I had my baby, neither the baby docs nor the nurses seemed the slightest bit worried about her. As soon as she was out and checked, she was with me for nearly the whole time. They didn't seem to be monitoring her 'extra' at all. I kept asking "Is she okay!?" And they kept saying, "Of course she is. She's fine!" In fact, my pediatrician told me I could nurse, but I didn't because I was just too worried. Now I wish I had....I think my OB worried because Sub was new territory to him and there wasn't much info available in '07; plus I had a complicated medical history, like epilepsy, and I'd had complicated previous pregnancies, so even with no Sub, I'd have been high risk. The NICU docs certainly didn't seem concerned. They were more worried I'd end up with a baby in the NICU because I'd had a preemie previously.

You and your baby are going to be fine. You're doing a great job.

((HUGS)) Mommy

laddertipper

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PostPosted: Wed Jul 20, 2011 2:57 pm 
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Congrats Cinnagirl!

Good luck with the rest of your pregnancy. How exciting.

I have a lot of experience with subutex in pregnancy, and I thought I'd add my 2 cents for all that's worth.

Here is my understanding from talking with a number of docs who specialize in both Ob and Addiction. (most Ob's have no understanding of sub, and most sub docs have limited understanding of sub in pregnancy).
1. The safest time to wean off any opiate, including sub, is during the 2nd trimester before 24w. Your babe is in a relative safe zone from miscarriage, and it's too early to worry about stillbirth or preterm delivery.
2. Weaning down or off is okay during the first trimester is you accept the risk of miscarriage. I don't think anyone knows the exact odds, but it's definitely been shown to cause it.
3. During the third trimester... it's just not worth the risk of having a stillbirth or premie. All sub docs I know who really understand it from an Ob standpoint don't endorse weaning down at this point. Especially when you are already on a relatively reasonable low dose of subutex to begin with. Which leads into 4...
4. While risk of NAS can never be predicted based on the dose, babies born on low-ish doses of sub won't be hospitalized as long or receive as much morphine as other babies. Go visit a NICU -- babies on NAS treatment are actually pretty unexciting. Other than the 1 day when withdrawal is recognized and morphine (tiny tiny doses of liquid under the tongue) gets started... the babies are like any other normal baby.
5. Women are at the highest risk of relapse on opiates when they are postpartum. Hormonal changes, not sleeping, changes in family structure, etc. it obviously helps that you've been on sub for awhile, but it still can be destabilizing to not be at the dose where you also feel best.

Dang... I totally don't mean to be on a soapbox... I just wanted to share what I know about preg, sub and NAS.

I knew someone who had a stillbirth at 38w while they were weaning off sub. Maybe was completely not related... but she has a hard time living with that decision.

I was desperate to wean off sub while I was on it. And with a lil' one involved, I totally understand your dilemna. I just wanted to play devil's advocate so you had both sides. Good luck though. It sounds like you have some great support!


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PostPosted: Wed Jul 20, 2011 5:08 pm 
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Dopeless-- Thanks for your input :) I've decided to just wait until Friday after I talk to my Sub doctor before doing anything. If he says not to taper down, then I won't. I just wish I would have been better informed about all this sooner. But, it is what it is.

I was planning on tapering off completely after the baby is born, but I think I should wait awhile until my body is completely back to normal. I'm really concerned that if I stop too soon after the birth I will have crushing depression. I'm more worried about depression than any other WD symptoms! But, the other problem is that I lost my job as soon as I found out I was pregnant. I had no choice except to get on Medicaid while pregnant and my Sub doctor doesn't accept it, so I pay out of pocket for everything. Therefore, I really don't have the luxury of time and need to get off of it ASAP.

Suboxone saved my life, but I really hate it sometimes! I hate that I'm dependent on a substance to feel normal.


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PostPosted: Wed Jul 20, 2011 11:07 pm 
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Doh... I'm so sorry to hear about the insurance changes. It's so much better when you can make decisions about your dose irregardless of money issues. I live in a big city where there is an Ob Outreach clinic that ends up doing all the sub prescribing during pregnancy. I think medicaid reimburses regular sub docs so poorly they end not making any money. My heart goes out to you.

Can you find a doc who will at least not charge you for the visits? Paying for subutex out of pocket is crazy expensive, but when I think about what I used to spend on the streets, it helps keep it in perspective.

It sounds like a good idea to have the blessing from your sub doc before you do anything. My addict brain is always trying to flex it's muscles, and it comes out in sneaky ways like when I decide to play my own doctor. I've been sober for almost 3 years now, and I make sure I have my docs approval before messing with my sleep or anxiety meds.

I've been off suboxone for a couple years now. It did save my life, and while I truly believe some people need to stay on it for a long time, I wouldn't be where I was today if I was still on it. But then... I'm one of the lucky ones because I made it through the months and months and months of PAWS. So now I'm at a new 'normal' that feels quite different than I felt on subutex or while going through PAWS. And by different... I mean awesome.

We each have our own journey. Whatever you need to do, just keep living your life out load. I know I get in trouble when I isolate and don't share with folks what's really going on inside me.


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PostPosted: Thu Jul 21, 2011 3:38 am 
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I should clarify: I only pay for the office visits OOP. The insurance does pay for my RX, luckily. For how long after pregnancy I'm not sure, though. I do know that they will not pay for Subutex after 6wks post-partum and I will have to switch back to Suboxone, but that's ok. My Sub doc told me I should just stay with their practice because another one would probably not be willing to accept me due to being pregnant. I need to get on that and start calling around for after baby.

Really, I'm supposed to stay on Sub long-term for pain management due to collapsed vertebrae in my back. Which is why I was prescribed Vics in the first place and got addicted. And, I actually graduated to being a pain management case and not an addiction case about 6 months before I got pregnant and was on Subutex already. But, that's a whole other issue. UGH!

Thanks for listening to me ramble.....it really does help to get things out sometimes :)


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PostPosted: Fri Jul 22, 2011 11:41 pm 
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Well, after talking to my doctor, I have decided to stay on 8mg for the duration of my pregnancy. It's what he wants me to do and I'm terrified of the WD anyway. I want to get off completely sometime after the baby is here, but I will cross that bridge when the time comes. I wish it wasn't so hard!
On a brighter note, the doctor said in his experience at the hospital I am delivering at, the majority of moms go home with their babies. Hopefully I will be in that majority! Thanks for everyone's kind words and input. I will post after my delivery to let everyone know how it went. And to add to all the other stories for future mommies with worries to read one day :)


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PostPosted: Sat Jul 23, 2011 3:03 am 
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Cinnagirl,

Hi! Congrats on your upcoming arrival! When is your baby due? Is this your first? I apologize if you mentioned those things before.....I just don't remember. I think you/your doctor are being wise to decide for you to remain on the Sub.

I don't know if you read any of my posts from when I was pregnant (I gave birth to my son April 1st), but I was very nervous/scared just like you! Doing TONS of research, coming up w/a DETAILED birth plan with my O.B, and touring the hospital.....were just a few of the things I did, in which ALL really helped to ease mine/my husbands minds.

Also, if I were you......I'd bring as much information on Sub, Sub/pregnancy, Sub/surgery, as you can find. This is what I did, and boy did it come in handy. For instance, right before my (unplanned) c-section......I had a brief consultation w/my Anest. She had HEARD of Suboxone/Subutex.....BUT, HAD NO IDEA WHAT THEY WERE, OR WHICH MEDICATIONS INTERACT W/THEM NEGATIVELY.

So......I pulled out my trusty pack of papers, and had her read through them. Doing this not only benefited me as far as the surgery itself, but being an advocate for myself showed her/all the nurses and doctors how responsible I am, and just how serious I am about my recovery.

They ended up just stapeling that stack of paperwork on top of my chart......and then anytime doctors/nurses or hospital staff had a question where my Sub was involved.......they could simply refer to this information I brought. Cool, huh? BTW, my husband (whom really dosen't even favor me being on Sub) was elated by how RESPONSIBLE I was in regards to educating others about Sub, and by me being an advocate for myself. And trust me, you'll wanna do this....BE AN ADVOCATE FOR YOURSELF, because MANY healthcare professionals have very limited or no understanding of Sub.

My son was given to me about 15min after they finished closing me up. I began nursing IMMEDIATELY after they gave him to me......and NO-ONE gave me problems about this. And, my baby stayed in my room the entire hospital stay. They would take him to the nursery periodically to do the normal baby-checking stuff, and then bring him right back. Make sure you tell them this is what you want (if in fact you do).

My son showed no signs of NAS......until the day we were to go home. And honestly, Im NOT EVEN SURE that it was withdrawl. EVERY Pediatrician said he was fine. It wasn't until ONE SINGLE NURSE, a new nurse, who'd JUST come on shift......and didn't know us, she hadn't been around us all wknd like the other nurses. AND, my milk hadn't come in yet.....so my son was becoming agitated from being hungry and from my colostrum NOT satisfying him. Anyways, because of ONE nurse's opinion......the on-call Ped. recommended that we stay until that evening, so that NAS testing could be done.

Listen, IF this happens to you/your baby.......tell them YOU WANT TO BE PRESENT WHEN THEY DO THE SCORING. I believe the scale is 1-10, with 10 being the worst. At the hospital I delivered at, they start the babies on medication once they reach a SEVEN. My son was scored like 4 different times throughout that day/evening. The highest score he got was a 3......until this crabby nurse gave my son a mark for "snorting"! Even with that, he never scored any higher than a four.

Now, on the way home from the hospital, and ALL that night......my baby was in a TERRIBLE mood, inconsolible, HE CRIED ALOT THAT NIGHT! Though I DO believe he had VERY MILD NAS.....he was also (as I stated above) very hungry. THANK GOD, my milk came in......in the middle of the night, that night. When we brought our baby to the Ped's office the next morning, he had gained like 6-7oz overnight!! And she said he looked fine, and she didn't see any sign of withdrawl.

Ever since that first night, my baby has been super duper healthy and happy! In fact, he's not even four months old, and he already weighs like 17lbs, wears 9-12month clothing, and has already CUT A TOOTH!!!

Im just sharing this with you to ease your mind a bit. I was on 16mg of Subutex almost my entire pregnancy. I took my last dose of Sub about 10hrs before my c-section, and then picked it right back up the morning after my delivery. My surgery went FINE, BTW. (And if you want details, you can PM me, or find my birth thread, so you know what meds I had)

Trust me......I UNDERSTAND I AM ONE OF THE VERY FORTUNATE MOTHERS, WHO'S BABY DID NOT SUFFER, OR HAVE TO BE PUT ON MEDICATION, AND IM SO VERY GREATFULL. Because it seems as though whether/not your baby has NAS....IS NOT always dependent upon how much Sub you took during pregnancy. There have been moms who were on waaay less Sub than I took, and they're babies DID have NAS. And then, there have been mothers who's daily dose was even higher than mine, and they're babes DIDN'T have NAS.......SO, YOU JUST NEVER KNOW.

Ok, sorry I ended up writing a book here. I hope you enjoy the rest of your pregnancy. And I pray that you have a BEAUTIFUL BIRTHING EXPERIENCE!! Good Luck Cinnagirl!!!!!


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PostPosted: Mon Jul 25, 2011 2:30 pm 
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Marie-- Thanks for sharing your experience. I really appreciate it and it does make me feel better about things :)

This is my 2nd child. My daughter is almost 16 though, so it really feels like a new experience! I am due on October 9th (the day before my birthday!).

I definitely will be packing a folder of printed Sub information in my hospital bag! It really is amazing how little most medical professionals know about this medicine. Like you, I also want the baby with me as much as possible and will ask them to score him in my presence. Thanks for that tip.

I'm just going to stay on my 8mg and try to relax these last couple of months. There's no sense worrying about something I have no control over right now. All I can do is be prepared as much as possible and pray for the best possible outcome. I got a bit freaked out reading the posts about CPS and the moms who couldn't take their babies home for awhile, but after talking to my doctor and other people on here like you, I feel less stressed about it now.

I'm just so excited to meet my little guy :)


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