SuperPath Total Hip Replacemt

Posted in the Hip Replacement Forum

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Jim

Lake Worth, FL

#1 Dec 9, 2012
On Monday afternoon, December 3rd I had Total Right Hip Replacement. My surgeon was Elvis Grandic of Boynton Beach, FL (10 miles south of Palm Beach) He used the newest technique out there for THR called SuperPath. There are 7 doctors that I know doing this procedure in the USA. In addition to my Dr. Grandic, there are the following: Harbinder Chadha, MD, Chula Vista, CA, Jimmy Chow, MD, Phoenix, AZ, Michael Anderson, MD, Germantown, WI, William Kurtz, MD, Nashville, TN, and Patrick Meere, MD, NYC. Most of these physicians were trained in this new procedure in a year long Joint Replacement Fellowship in association with Harvard Medical School and Boston hospitals.

I was studying the DAA Hana Table procedure for sometime as my symptoms worsened. I was sold on the idea and it was my choice, then I discovered SuperPath. I spent several months this year studying this procedure. I spoke to three of the doctors on the list above. I saw two of them in their offices, but I continued email and telephone dialogue with all three until all my questions about the procedure, hip parts and bearing surfaces were answered. I chose SuperPath over DAA Hana because NO muscles or tendons were cut. Further, because of this "northern approach" through a 3" incision the surgeon can prepare the femur stem WITHOUT dislocating the hip ball or cutting it off. Thus the hip is stable when doing the femur and stem work. The approach provides the ability to make leg length geometry a more simple challenge as the femural component is already in place as mentioned. The surgery is well away from femural arteries and nerves and the sciatic nerve, thus eliminating some of the risks with DAA and posterior. The hip is NOT dislocated, thus less tissue/ nerve trauma. Lastly, I was attracted to the "no restrctions" orders given by my physician to the hospital and outpatient physical therapists. I do not have the typical 90 degree restrictions. I do not, for example, need a raised toilet seat.

I was operated at 3:00 pm Monday and released 5:00 pm Wednesday. Prior to discharge I had 4 physical therapy sessions. We walked using a walker beginning on Tuesday. I walked to and from my room to their workout room and I climbed and descended all of the stair sets they had at least 3 times. I used the walker on discharge on Wednesday. On Thursday the outpatient therapist let me use my cane (my request). I felt so good after the therapy that I went with my wife to a Target to pick up an item. For me 3 days out of surgery, this was too much. I went back to the walker and will try the cane again at the 8 day mark.

One last comment on bearing surfaces. With 3rd generation alumina ceramic, there are no better bearing surfaces out there today, IMHO. My doctor told me if he needed a hip it would be ceramic on ceramic because of its wear characteristics, no metal ion risk, no risk of poly particles from wear to a poly liner that can lead to osteolysis. It is my opinion alone that most doctors prefer and use highly crosslinked, high density poly because it is the most "forgiving." If they miss the geometry a bit, the poly will forgive it by using a wear pattern to accommodate. A doctor needs to be precise in the placement of a ceramic ball on a ceramic liner. I have read all the studies I can from here and overseas. Some are clinical, some are not, but I come away with the feeling ceramic is best. New generation ceramic is many times harder than the original used in THR's mainly because of smaller grain size and better manufacturing controls. I don't care how many times the manufacturers radiate polyethylene, ceramic will continue to wear 100+ TIMES less than poly.

I will keep everyone posted. I know this is long winded but this is what I wish everyone would do. I will also start another Topix on SUPERPATH if I can figure out how. Six days out as of this moment.
Jim

Lake Worth, FL

#2 Dec 9, 2012
Please share your Super Path experiences and questions. Thanks to all.
Jim
Gerald

Kansas City, MO

#3 Dec 30, 2012
Superpath looks promising. It’s a minimally invasive procedure so recovery period is faster maybe compared to that of traditional hip replacement surgery. Not to mention the adverse effects that patients may suffer from metal-on-metal hip implant devices used in a typical hip replacement operation. Read more at http://stryker-hip-replacement-recall.com
Anonymous

Jacksonville, FL

#4 Jan 26, 2013
Jim-Nassau County wrote:
Bryan, Silver Spring Maryland =
I just had Superpath 6 weeks ago. I was wondering if I sent you my email with my phone number, might we have a brief conversation. I watched you comments with interest prior to Superpath. I'd like to hear your experience first hand to compare notes
Jim

Hi Jim/Bryan
Would be very interested as well in your experience. Maybe you are experiencing unexpected results, Jim? This is, as you know, a difficult decision for all of us. Depits glowing reports we all wonder jow it really feels to have the surgery, and what we can expect-"negative" as well as positive.
Thanks for sharing your path. Your "Superpath" :)

Marcy
Anonymous

Jacksonville, FL

#5 Jan 26, 2013
Bryan
Rockville, MD
Reply »

Luckily I checked in today, as I was about to stop accessing because all talk is about anterior and my usefulness was nil. I do wonder about the relative effectiveness of the two procedures, as I have a hip to replace sometime, though it is fine right now. Superpath may not have a numbness issue, for example. I don't, anyway.
Feel free to e-mail me: Bryan@Byrd.net. Since your post we have had others express an interest, so we can distill our conversations and post for the benefit of others. Hope I can be of benefit.
Anonymous

Jacksonville, FL

#6 Jan 26, 2013
Jim-Nassau County
Jacksonville, FL

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Reply to Marci »

Marci -
Dr. Stephen Murphy did work with Brad Penenberg to marry two procedures into SuperPath. It is in a 1 year Fellowship with Murphy at Boston General/Harvard that my doctor, Elvis Grandic, learned and adopted SuperPath as his favored THR procedure. Dr. Murphy actually recently had his own hip replaced and used the same parts I decided on for my hip prior to Murphy's surgery.

I had been studying the DAA Hana Table procedure for a few years as my symptoms worsened. I watched it gain acceptance by more and more surgeons. I met with a doctor in Ocala, FL and one in Savannah, GA. I was sold on the idea and it was my choice. Then, I discovered SuperPath. I spent all of 2012 studying this procedure. I spoke to three of the seven doctors on the list above. I saw two of them in their offices, but I continued email and telephone dialogue with all three until all my questions about the procedure were answered. I also had a preference for hip parts and bearing surfaces that I wanted to get the Docs' agreement on. I finally chose SuperPath over DAA Hana because NO muscles or tendons were cut. They do get pushed around a good bit, though! My doc didn't even release my piriformis. Further, because of this "northern approach" through a 3" incision the surgeon was able broach and insert the femural stem WITHOUT dislocating the hip ball or cutting it off first. Thus the hip is stable when doing the femur and stem work. The approach provides the ability to make leg length geometry a more simple challenge as the femural component is already in place as mentioned. The surgery is well away from femural arteries and nerves, thus eliminating some of the risks with DAA from twisting and dislocating your hip unnaturally. The hip is NOT dislocated, thus less tissue/ nerve trauma.

Sorry for being long-winded, Marci, and these are just my obsevations and opinions. Lastly, the 2 docs of the 7 who do SuperPath in the USA and are closest to you are Harbinder Chadha, MD, Chula Vista, CA and Jimmy Chow, MD, Phoenix, AZ. Google Jimmy Chow, MD for a fair amount of good info.

Jim
Anonymous

Jacksonville, FL

#7 Jan 26, 2013

Mitch in Virginia Beach
Virginia Beach, VA
Reply »
["the surgeon was able broach and insert the femural stem WITHOUT dislocating the hip ball or cutting it off first."]

I am confused. If he did not dislocate the hip ball then you did not have a hip replacement unless he manufactured a new socket and placed a ball in there and the two hip joints work side by side.
Jim-Nassau County
Jacksonville, FL

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Comment to Marci »
Marci -

You will notice from the info on Jimmy Chow's site that there are examples of folks who have had SuperPath. Some are at the driving range (golf) in 2 weeks, etc. This "marketing" made me even more excited about SuperPath, adding to its physiological advantages. I am 7 weeks from surgery and I am not at the driving range yet. This may be a function of my body, my age or the fact that I've take no pain medication since 3 weeks after surgery. My doctor is Elvis Grandic, MD of Boynton Beach, FL. He is a wonderful surgeon with an amazing human touch. He is a young doctor(38). I was out of the hospital in 2 days. I remained in the Palm Beach area ( 5 hours from my home ) until my first post-op appt (10 days). I drove home. I had 4 weeks total of in-home physical therapy and now 3 weeks of out-patient therapy. Elvis said I was very tight and muscular thus he had to work hard to retract everything out of the way. I am improving everyday. I drive, am up and down ladders (it seems every ceiling light has burned out since my surgery!!). I guess I expected to be golfing in 3 weeks. My wife says I had the wrong expectations after such a major surgery. She says it's like the weight loss commercials. They always say in small print - "results not typical." Smart lady, right. So, I would still choose SuperPath for all the reasons I stated before. I just set my expectations for full, unassisted by cane, no muscle weakness recovery a bit high for myself. I think I'll be ther by the end of February based on my progress.(That will be 3 months from surgery)

Jim

Jim
Jim-Nassau County
Jacksonville, FL

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Reply TO MITCH»
Mitch -

I've watched your many comments in the thread over a long time. I'm sorry I was not clear. This "northern approach" enables the surgeon to see the top of the femur and the femural ball, after entering the hip capsule with an "L" shaped incision. He then removes a small portion to the ball and neck exposing enough of the top of the femur to broach (prepare) it for the femural stem and insert it. The natural ball is still attached to the femur and positioned as normal in the acetabulum, thus the hip remains stable throughout and is never dislocated until the final neck cut when the ball is pulled out basically with a long screw. Thus the surgeon has an advantage at getting the geometry right as he can select neck size and angle that matches what you had before cutting the neck and ball or any dislocation. My leg length and toe point is perfect. Hope this helps.

Jim
Anonymous

Jacksonville, FL

#8 Jan 26, 2013
I have copied all recent SuperPath posts from the "Direct ANTERIOR" discussion to this Topix discussion entitled "SuperPath Total Hip Replacemt"(note misspelled "replacement". It is in the hip replacement Forum. I suspect more and more will be discused about SuperPath as I understand Wright Medical (parts and tool maker) and some of the USA SuperPath doctors will beginning teaching this technique this year to other doctors who scrub in to SuperPath surgeries. Thus, it will grow much as Direct Anterior did, from Dr. Matta to surgeon to surgeon.

Jim
Ann

Somerville, TN

#9 Jan 26, 2013
Glad to see a superpath discussion. I had both hips replaced by Elvis Grandic of Boynton Beach FL. Reason was bilateral labral tears with grade 3-4 arthritis. Has tried to repair one labral tear with hip scope. Since no tests showed the severe underlying arthritis-the scope was a failure as it actually increased the arthritis.
I am a 54 year old healthy female who found the arthritis progressed to severe pain and decreased quality of life.
Left hip done in Feb 2012 and right one 6 weeks later.
Left hip: hospital 2 days & then home PT-everything went great and to this day it is flexible and pain free. I was off the walker/cane in a few weeks
Right hip: 3-4 days in hospital-this was just a more rough surgery. i went to a snf for rehab one day and got out of this nasty place and went home with home pt. Had it for 3-4 weeks and then went outpatient aqua therapy. I had to be chair assisted to the pool as I could not walk in it although I was walking with a walker. Water therapy was a lifesaver. I could not get off the walker for weeks and weeks and had a difficult time progressing to cane. I did not give up my cane until the very end of June 2013 or 1st week of July.
I still have some discomfort on the left. Since my next appt will be a year out I am going to ask for an MRI. Perhaps I have some tendonitis or something.
The strength in that leg is weaker also-I favor it. I hate the fact I have implants-it really bothers me. However,I would choose superpath and this physician again. I would NOT have them 6 weeks apart. I would wait maybe a year. Sorry this is so long. I know people want to hear the stories. Oh-my xrays look great every time and I have had 4-5 since the surgeries. Placement and position of everything is fine. I walk, bike and do gentle yoga. I need to get to hiking so once I find out why the right bothers me I will take care of it.
Ann

Somerville, TN

#10 Jan 26, 2013
Correction, I mean I still have discomfort on the right. Don't want to freak people out. The left is perfect. I would describe walking with two hip replacements as follows:
In the beginning: it felt like my legs weighed 50 pounds each
! month later: they weigh 30 pound
2 months later: they feel like 15 pounds each
so on and so on.
Now they feel like they should.
Anonymous

Jacksonville, FL

#11 Jan 26, 2013
Ann -

You said, "I did not give up my cane until the very end of June 2013 or 1st week of July."

Did you mean June 2012? So, three or four months for the cane? From then, are you walking normally without any limp or hitch?

Jim
Ann

Somerville, TN

#12 Jan 26, 2013
Gee I cannot get my dates right. Yes, I meant June 2012. i actually spent about equal time on the walker and the cane after having the second hip done. The first hip I used the walker for a week after I came home from the hospital and the cane for 2 weeks, I recall my family saying to me-it sure seems like you have been on that walker much longer the second time and they were correct. I do have a slight lip on the right side. Somedays it is worse than others. IT seems to sloooowly be getting better. It has been almost 11 months for that side. Sometimes after sitting for a while it seems worse once get up and better if I walk it out. I cannot start up the steps with the right side-it hurts a bit so I always start with the left. But I can walk and walk in the right shoes.
Bryan

Rockville, MD

#13 Jan 27, 2013
I'll add this from the anterior hip forum:

Re: Superpath, Jim has done a great job on the details. He and I spoke, and agreed the biggest problem with the procedure may have been the marketing that set expectations too high. Jim appears to be progressing faster than I did; expecting great results in just weeks caused us both some initial concern. I eventually came to the realization it is major surgery, not a teeth cleaning. Expect to do PT for a full recovery.

I chose Dr. Kurtz as my surgeon as he was close to Atlanta, my “care center” of several weeks. He also had an engineering degree, which seemed apt, and has developed a device that ensures the new leg is the right length. Dr Kurtz cuts the piriformis (only), unlike Grandic, so my recovery may have been extended partially due to that. Both Jim and I had/have muscle pain in the groin, which is lessening. Never had any nerve damage, but the surgery leg does get pain down as far as the ankle for a few weeks. You will have some restless nights, in any case.

Nine months out, I still have some muscle imbalances, hip flexor in particular. Amazing how a muscle forgets what it was like just a few days ago, but you start all over, and it takes time. Eventually my doc said:“If you don’t see any improvement over a month, then we need to get together.” He was right; eventually (with work) range of motion recovered and is better than in the last ten or twenty years. Golf stroke is stronger and painless, actually helps restore body balance overall. The leg will not pop out; I tried it in his office. Many docs (and my older sister!) say it takes a year for the body to recover completely from any major surgery. I’m still perfecting stride and balance. It does seem Superpath gets you up and about sooner than some other techniques, especially posterior. Not sure about anterior, rated highly here.

Kudos to Jim for his analytical research. Kurtz and staff were fantastic, and Baptist Hospital could not have been nicer. They also accepted what Medicare provided as full payment. I also met with Grandic, and were he not farther from Atlanta, could have easily asked him to do the surgery. Both docs are quite willing to communicate with you.

I have been told: Don't rush to get off the cane. Get your gait back, correctly. And, if you hurt getting up from sitting, use a chair where your hip angle is not less than 90 degrees for awhile. Some recliners have a deep well creating too sharp an angle with the hip. FWIW
Anonymous

Jacksonville, FL

#14 Jan 29, 2013
Thanks for your comments, Bryan, and for the phone conversation yesterday. I had my 8 week anniversary of surgery yesterday. Each week has been better, but as we agreed, my expectaions were that I'd be climbing Mt. Everest 2 weeks ago! These expectations were driven by the SuperPath videos on Jimmy Chow's website:

http://www.chowhipandknee.com/superpath-thr.h...

My expectations were also driven to some extent by many of the postings from Direct Anterior thread that I read over the last few years which added to my decision data. I have been re-reading some of those posts. Perhaps I read more into the posts than I should have. Not many were clear on use of a cane or how much pain medication allowed for such brief recoveries. While I have no doubt that some recovered quite rapidly, especially those who have had this surgery at a fairly young age, I think Bryan is right about major surgery not being like a teeth cleaning (of course you don't know my dental hygenist, Bryan!). I also agree that releasing (cutting and repairing) the piriformis, which is a core body muscle, could create a longer recovery than not releasing it. It seems that my SuperPath doc changed this part of his surgical protocol sometime in mid-2012.

I remain a supporter of SuperPath as it seems to be the least tramatic. The preparation and insertion of the femural stem with the natural hip ball still in place seems to have resulted in the appropriate neck, ball and liner geometry and, as near as the therapists can tell, leg length and tracking that is right on. Oh, and probably overlooked as we focus on recovery, the debilitating pain that slowed activity, made sitting and walking painful and sapped sleep is gone!

My conclusion is that at 8 weeks from surgery, off narcotic pain meds since week 5, still using a cane because of some muscle weakness and some discomfort which improves each week, that I should be pretty positive about my recovery thus far. Well, I'm looking forward to week 9. As the old saying goes, " Time will tell." :-)

Since: Feb 13

Orlando, FL

#15 Feb 10, 2013
January 31 had Superpath THR on my right hip with Dr Kurtz in Nashville. Chose Will Kurtz after interviewing a number of other surgeons, including Dr Chow. Resident in Central Florida, so had to travel anyway. Dr. Kurtz was the easiest to communicate with and most forthcoming.

Released from Baptist on Saturday Feb 2 and stayed at Hutton Hotel, close to Baptist until flying home yesterday, Saturday Feb 9. Left walker in Nashville and walked through airport using cane. Orlando is much bigger airport so discretion had me use a wheelchair service there.

It is now Sunday about noon. Woke up this morning with very little stiffness and have been moving ok around the house without aid. Last took hydrocodone yesterday morning and feel ok.

I did have a burst blister beneath my dressing which is causing some small anxiety as I do not need an infection from it.

I agree with my fellow posters that Dr Chows marketing would have you believe that I would be running a marathon next week. I will not!

I feel good, however, and if I can continue from here without further narcotics I will be very happy. I think a 2 or 3 month rehab program is probably more realistic that the golf in 2 weeks offered by Chow.
Anonymous

Jacksonville, FL

#16 Mar 17, 2013
To Dralloc:

Just curious why Will Kurtz when Elvis Grandic (Boynton Beach, FL) was much closer. I met with Kurtz as well. How are you doing after 2 months? Where is your most significant pain when walking or shifting weight from operated to good leg? Using cane?
Marcy

Rochester, NY

#17 Mar 17, 2013
Ann wrote:
Gee I cannot get my dates right. Yes, I meant June 2012. i actually spent about equal time on the walker and the cane after having the second hip done. The first hip I used the walker for a week after I came home from the hospital and the cane for 2 weeks, I recall my family saying to me-it sure seems like you have been on that walker much longer the second time and they were correct. I do have a slight lip on the right side. Somedays it is worse than others. IT seems to sloooowly be getting better. It has been almost 11 months for that side. Sometimes after sitting for a while it seems worse once get up and better if I walk it out. I cannot start up the steps with the right side-it hurts a bit so I always start with the left. But I can walk and walk in the right shoes.
Ann, thanks for sharing your experience. It is frightening to see that after a year you can still not do anything too "vigorous", like hiking. I use quotes because hiking seems like one of the least vigorous things one could do on a hip while still getting lots of exercise: low impact but high cardio if you are on steep hills. I am a runner and devastated by the need for hip replacements, even more so when I read of all the trouble folks have getting back any semblance of vigor in their physical abilities.
I am also discouraged by your IT trouble. I thought that IT issues might just be due to a surgery where the knee is manipulated(like posterior). Another reason why I am interested in Superpath. I have IT trouble. Do you know what might cause an IT to react to surgery?
Thanks
Carol G

New York, NY

#18 Mar 19, 2013
Jim-Nassau County wrote:
Jim-Nassau County
Jacksonville, FL
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Reply to Marci »
Marci -
Dr. Stephen Murphy did work with Brad Penenberg to marry two procedures into SuperPath. It is in a 1 year Fellowship with Murphy at Boston General/Harvard that my doctor, Elvis Grandic, learned and adopted SuperPath as his favored THR procedure. Dr. Murphy actually recently had his own hip replaced and used the same parts I decided on for my hip prior to Murphy's surgery.
I had been studying the DAA Hana Table procedure for a few years as my symptoms worsened. I watched it gain acceptance by more and more surgeons. I met with a doctor in Ocala, FL and one in Savannah, GA. I was sold on the idea and it was my choice. Then, I discovered SuperPath. I spent all of 2012 studying this procedure. I spoke to three of the seven doctors on the list above. I saw two of them in their offices, but I continued email and telephone dialogue with all three until all my questions about the procedure were answered. I also had a preference for hip parts and bearing surfaces that I wanted to get the Docs' agreement on. I finally chose SuperPath over DAA Hana because NO muscles or tendons were cut. They do get pushed around a good bit, though! My doc didn't even release my piriformis. Further, because of this "northern approach" through a 3" incision the surgeon was able broach and insert the femural stem WITHOUT dislocating the hip ball or cutting it off first. Thus the hip is stable when doing the femur and stem work. The approach provides the ability to make leg length geometry a more simple challenge as the femural component is already in place as mentioned. The surgery is well away from femural arteries and nerves, thus eliminating some of the risks with DAA from twisting and dislocating your hip unnaturally. The hip is NOT dislocated, thus less tissue/ nerve trauma.
Sorry for being long-winded, Marci, and these are just my obsevations and opinions. Lastly, the 2 docs of the 7 who do SuperPath in the USA and are closest to you are Harbinder Chadha, MD, Chula Vista, CA and Jimmy Chow, MD, Phoenix, AZ. Google Jimmy Chow, MD for a fair amount of good info.
Jim
Hi Jim - I've been following your posts with great interest. I am due for both hips to be replaced. Can the Superpath approach do bilateral as well? It seems so much superior to the anterior approach which Iknow can accomodate bilateral. Also I am in NYC and Dr. Meere seems to be the one doing Superpath. Have you ever spoken to him or heard anything about him? Is he one of the ones who had the special one year training you spoke about?
Thanks
I am 65; in good shape and good health and would like to get back to dancing which has become more and more difficult for me to do.
Anonymous

Jacksonville, FL

#19 Apr 2, 2013
Hello, Carol -

I'm not sure who trained Dr. Meere in SuperPath. I got his name from Will Kurtz's website some time ago. The last line of the Dr. Meere's web page immediately below indicates he is doing a clinical study with Dr. Murphy in Boston who is one of the creators of SuperPath with Penenberg from California:

http://www.drpatrickmeere.com/total-hip-repla...

Dr. Grandic told me that Dr. Murphy had his own hip replaced in the last 3 months using SuperPath and ceramic on ceramic.

Drs. Grandic, Kurtz and Chow all take Medicare. I'm not sure of the others.

Now, as to the results of my surgery, I am not satisfied thus far. I expected to be back golfing in 6 to 8 weeks. Actually, I just stopped using my cane last week - week 15 - but with a limp after lots of walking.. I will admit that I put off this replacement for several years (first symptom June 2004) until I had stopped about everything. In hindsight I wish I had done this in 2008 or so when I had to stop golfing and I was years younger. I'm told with the deterioration and muscle tightness that I should not have expected to be normal as quickly as the marketing for SuperPath indicates. By the way, no doctor I visited who performs SuperPath told me this, however.. They all told me 4 to 6 weeks to golf.

I still have groin pain at certain times and I am sore after walking a few blocks. Riding my bike ( I used to ride 50-70 miles per week before my surgery) is not painful. I will be meeting with my surgeon later this week to discuss and work out reasons and actions to remedy. I had x-rays last week. My doc say thay look good. I also compared them carefully to post-op and everything seems to be in the same place.:-)

I may have some sort of impingement or tendonitis/ bursitus causing my slow recovery. Of course without a video I don't know if there was something unexpected in my surgery. My surgeon said he never saw anyone as tight. I was really never flexible in my memory. He really had to work and I guess all that pushing muscles out of the way may have been more tramatic as the result. You are a dancer so perhaps you are limber and well-streched. Also, hopefully, you did not wait nearly 9 years since your first symptom!

I read Ann's comments on Topix. She had bilateral 6 weeks apart. Her story is interesting. I would try to speak to her if I were you. I might be reluctant to do both hips at once. I would want to be fairly well recovered with the first one. That's just me. I still believe SuperPath is the best choice for hip replacement. I feel positive about Direct Anterior (only on a Hana Table) too. I just don't like hearing about DAA nerve problems, but I guess that stuff happens a certain percentage of the time.

I'm interested in hearing what Dr. Meere tells you. Please let me know and good luck with you decision.
Anonymous

Jacksonville, FL

#20 Apr 2, 2013
Ann from Boca Raton.

Would you mind sharing your email address with me?

Tell me when this thread is updated:

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