pain or tenderness that continues after a skin bruise has disappeared. As first described in the knee joint, Subchondroplasty offers the benefit of a relatively simplistic and safe minimally-invasive procedure . I discussed what they are, how, Shoulder pain is common at all ages, in both active, Click to find forms, instructions, and decision making guides for your condition. What is anybody's experience here? Those issues you mentioned are often responsible for stress fractures. The doctors are amazing,always professional, compassionate and great listeners. Dr. Karkare put my fears to rest . arthroscopy to aid in visualization, the SCP procedure does not Very friendly office and I'm glad to be a patient here. All the best . I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . this is usually the exception, not the rule. The patient is usually discharged on the same day as the surgery. The appropriate test, x-rays were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. If your BML persists on an MRI and symptomatic beyond three months, a subchondroplasty may be right for you. Best of luck in your search. Reid D, et al. Subchondroplasty for Treating Bone Marrow Lesions. We offer this Site AS IS and without any warranties. tissue. Unfortunately, I do not. I had subchondroplasty 12 weeks ago, and it still hurts to walk. 83 0 obj <>/Filter/FlateDecode/ID[<55B16038235D3449BF324DCE71942438>]/Index[55 52]/Info 54 0 R/Length 123/Prev 168285/Root 56 0 R/Size 107/Type/XRef/W[1 3 1]>>stream I had it done 2 weeks ago for severe bone edema and a stress fracture in my heel! Oct;29(7):555-563, 2016. I still have to be careful to stretch, that way I have full ROM. intellectual property rights, as applicable, owned by or licensed to A synovectomy is a surgical procedure used to treat synovitis and some other conditions that affect the synovium, a thin membrane that lines the inside of certain joints (called "synovial joints"), such as your knee, shoulder or elbow. KNEE - SUBCHONDROPLASTY PLEASE READ THESE INSTRUCTIONS COMPLETELY AND ASK FOR CLARIFICATION IF NECESSARY - DIRECT QUESTIONS TO YOUR NURSE BEFORE LEAVING THE HOSPITAL OR VIA PHONE/EMAIL TO DR COLE'S STAFF AFTER ARRIVING HOME EMERGENCY HOTLINE # 312-243-4244 WOUND CARE Loosen bandage if swelling or progressive numbness occurs in the extremity. There is a "new" knee out there that is placed orthoscopically and gives the client more range of motion. Minus the meniscectomy :o) Cgarrison M.A. My experience may be VERY different than yours though. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. a long period of time, with progression to articular surface depression and degeneration (6,8,13). After 7-10 days, you should be able to . Background: Calcium phosphate bone substitutes (CPBS) are commonly used to augment and repair bone voids and defects after fractures around the knee joint. On occasion, these forces can cause bone bruises. These are small fractures in the bone marrow. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. Trocar-tip for cutting ability. without the express written consent of Zimmer Biomet. Knee replacement recovery time varies slightly from person to person but typically follows this pattern: Day 1: you should be able to get out of bed, walk around with assistance and start your exercises. A list of national and international resources and hotlines to help connect you to needed health and medical services. Likewise, subchondroplasty can also be used in the shoulder, hip, and ankle too. A meniscectomy is typically performed when you have a torn meniscus, which is a common knee injury. TheSubchondroplasty (SCP) Procedure Knee Surgical Technique, TheSubchondroplasty(SCP) ProcedureFoot & The size of the crystalline structures were The Effectiveness of Post-Operative Rehabilitation Following Partial Meniscectomy of the Knee. The aim of the present study was to evaluate subchondroplasty of the knee regarding its applicability and results in terms of function improvement and prevention of evolution of joint degeneration. 106 0 obj <>stream . I just had a chondroplasty done 1 1/2 weeks ago. Physical therapy will help patients increase range of motion, strength, managing pain and swelling, and returning to full weight bearing. The patient is usually discharged on the same day as the surgery. The most common cause is age-related deterioration. It does not hinder total knee replacement if required in the future. covered by insurance. Full recovery may take 3-4 months, however. Recheck with the physician is in 7 to 10 days to remove sutures and assess surgical healing. I cant walk like other and pain is high.I have face so many doctors of india all have suggested me to hip change. endstream endobj 56 0 obj <> endobj 57 0 obj <> endobj 58 0 obj <>stream The 6 Most Common Causes Of Middle Age Nontraumatic Shoulder Pain. Subchondroplasty is a minimally invasive alternative treatment for chronic bone marrow lesions. It represents stress reaction and edema in the area. If they are not relieved with conservative means, advance imaging including x-ray and MRI may be needed. I had a torn meniscus & patella damage. By symptomatic, what we are talking about is pain and tenderness precisely at the location of the bone injury. The area is still warmer to the touch than the other leg and my recovery is such that I wish that I had never done it. Spang JT, et al. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Copyright 2023 - Jeffrey H. Berg, M.D. I was on crutches with weight bearing for about 2 weeks, and then moved to the walker. WOMAC scores improved significantly from 47.8 20.5 before surgery to 14.3 13.2 at the one-year follow-up. I suggest you ask your surgeon or get another opinion and get a thorough evaluation and discuss all your options and ask all your questions. Follow the doctors orders after surgery! The knee was swollen and painful to walk on. Patients are usually discharged the same day. This study evaluates the efficacy of knee arthroscopy with adjunctive subchondroplasty (i.e. clinical and economical challenges you face in an Ambulatory Surgery Center. bone graft substitute that resorbs andis replacedwith new bone joint pain near impact zone . Subchondroplasty is a minimally invasive procedure with the following advantages: It is an outpatient procedure. The patient portal made it easy for me to access all my documents including work notes. Now After 3 months of great care by him and his staff, I am walking to normalcy. Subchondroplasty Post-Op Knee Rehabilitation It does not hinder total knee replacement if required in the future. My surgeon says there is no swelling and told me to give it more time. Seemlessly connect, products, services and technologies to elevate Subchondroplasty is a minimally invasive procedure with the following advantages: It is an outpatient procedure. Symptoms. My appointment with Dr. Vaksha was amazing. Ideal Candidates for Subchondroplasty. Latest: djklaugh; Today at 5:29 PM; Hip Surgery Pre-Op Area. So subchondroplasty is mostly used in the knee joint. Knee osteoarthritis (OA) is a common form of arthritis that causes joint pain and stiffness. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. Among the available treatments is a slew of nonoperative options and surgery. Side or end-delivery . Subchondroplasty Post-Op Knee Rehabilitation Program Your surgeon will almost alwaysperform arthroscopy along with thesubchondroplasty. I suggest discussing with your surgeon about your particular case. . Usually performed along with Is this therapy is useful for me. The staff here are great, I was seen at the time of my appointment and was well taken care of! COLUMBUS, Ohio - Doctors at The Ohio State University Wexner Medical Center are using a procedure called Subchondroplasty to give patients with damaged hips more treatment options and ultimately avoid replacement surgery. are the primary cause of joint pain, not the intra-articular My suggestion would be to discuss this with your doctors and ask them their thoughts. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Typically there is diffuse arthritis and the symptoms are due to limitations in range of motion and diffuse arthritis. Any experience with Subchondroplasty in the knee? Furthermore, this surgery is inadvisable for anyone with active infection in the joint of concern. surgery. I am a tennis player, 63, and am going crazy from not being able to play. I am 69 years old and have a full titanium pin in my left femur. a change of skin color. I am going to start water therapy soon. Brand new office, same great doctors! I did the physical therapy until physical therapy made me stop. Total knee replacement was the only viable option. All content herein is protected by copyright, trademarks and other I was seen on time. Follow. From the time I entered Dr. Karkare's office for the first time until now, his staff has been amazing. For consistent, reproducible hydration and mixing ofAccuFillBone My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best. In the area around the bone bruise, symptoms may include: swelling. (BSM), a proprietary,flowable, biomimetic bone substitute.1,2, AccuFillBSM isavailablein prefilled (PF) mixing and saline Recheck with the physician is in 7 to 10 days to remove sutures and assess surgical healing. Subchondral insufficiency fracture of the knee is not thought to be caused by bone death but instead by osteoporosis and insufficiency fractures, with histopathologically proven origins in weakened trabeculae and applied microtraumatic forces 6,13. information.To obtain a copy of the current Instructions for Use I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. The patients are allowed to ambulate as well as do activities of daily living as tolerated. If you've been dealing with knee pain for more than three months, and the discomfort increases with walking or standing, it may be time to see Dr. Nicola about Subchondroplasty. Dr. Vaksha is awesome and takes the time to listen to his patients. When worn or absent, cartilage cant protect the bone as much, or even at all. . visualization and treatment of findings inside the joint. After my six week checkup this week, my knee still had considerable pain in it and I am still unable to walk without crutches. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. The term literally means "to look within the joint." During shoulder arthroscopy, your surgeon inserts a small camera, called an arthroscope . BMJ Case Rep (2015) bcr2015209399. healing process. Great experience, the Doctor is nice but the staff is incredible. Subchondroplasty has shown solid potential, but orthopedic surgeon Dr. Matthew Hepinstall is concerned that it might be "oversold" to desperate patients who want to avoid joint replacement surgery. If all goes well, the results of your subchondroplasty will last for many years, allowing your knee to once again work like a well-oiled machine! Subchondroplasty is done under x-ray imaging control in the operating room. I had chondroplasty surgery on February 15th and though after being on crutches for two weeks, I still had a dulling pain under my knee cap and resorted to using a cane for a couple of weeks. andreplicatableautologous products and solutions for a variety of I wish you good luck. of life. Rebecca is such a kind and understanding person. ), age, and level of activity all contribute to healing time. I never did use my crutches, and am able to walk relatively pain-free, providing I'm not walking on uneven ground or stairs. The IOBP procedure treats these pathologies through a core decompression of the lesion and a direct . To schedule an appointment with one our specialists, contact our scheduling department at 972-250-5700 or request an appointment online. Patellofemoral pain and what to do about it. Following the op. , This material is intended for health care professionals. Subchondroplasty is the procedure in which the bone adjacent to the cartilage is drilled for decompression and filled with bone cement or paste with osteoconductive properties. Sounds like you had Dysplasia. POSMC is a full-service medical facility specializing in the evaluation and treatment of orthopedic injuries. Subchondroplasty does not affect the ability . Subchondroplasty or IntraOsseous Bioplasty is a viable and evidence-based procedure which helps not only giving pain relief, but also in delaying or preventing knee replacement. Full recovery may take 3-4 months, however. I would highly recommend him. self-setting,macroporous,osteoconductive, calcium phosphate bone Could this procedure be an option? Compared to more invasive surgeries such as total knee replacement, it may lead to faster recovery and quicker return to normal activities. It may take up to 8-10 weeks to heal completely. Immediately after surgery, you are permitted to put all your weight on your surgical leg. Dr. Vadshka has a great bedside manner. My recovery was amazing. This procedure is only helpful for a small subset of patients with arthritis. Are there Physicians offering this treatment in SW Ohio and is it typically Complete Orthopedics should be your choice! subchondral bone defects, the crystalizes and sets in an isothermic The procedure hence not only takes care of the pain and disability due to the pathology, but also helps in delaying or preventing the need for a knee replacement surgery in the future. It is completely individual. I am not sure of the name, but ask your doc about it when the time comes. His expertise gave me my life back. Office Hours Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. Amazing team!! Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office.. Dr. Vaksha was very thorough and kind. You can expect to be walking with support before you even leave the hospitality. 1, 2, 3 Often, they are represented on fluid-sensitive magnetic resonance imaging (MRI). The purpose of this study was to determine whether prior arthroscopic application of a CPBS, for repair of magnetic resonance imaging-identified subchondral fractures associated with osteoarthritis (procedure referred to as subchondroplasty . May use . Hello sir, my left hip is going weak . I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Enrolled subjects will have a single Bone Marrow Lesion of the tibia, single . It leads to faster recovery and quicker return to normal activities. These lesions stem from remodeling and increased vascularity in the presence of subchondral bone attrition and microfractures of trabecular bone due to increased stress and loading forces. I must successfully train the patella to shift to the inside somehow. Subchondral insufficiency fracture of the knee: a non-traumatic injury with prolonged recovery time. How does it work? That lasted 2 days with minimal assistance and was able to be full weight bearing by the 4th day. If the patients show evidence of a bone marrow lesion (BML) or bone marrow edema (BME) on an MRI, then these patients may be a candidate for subchondroplasty. Thank you Dr. Karkare.SincerelyVito Congro. Context: Symptomatic bone marrow lesions on MRI in patients with knee osteoarthritis are strongly associated with progressive deterioration of the joint and an increased risk of progression requiring joint replacement surgery. I had a grade 3 tear to my ACL and MCL as well as a torn lateral meniscus 4 1/2 years ago. Knee pain and mobility impairments: Meniscal and Articular Cartilage Lesions Revision 2018. Highly recommend. I do understand that a chondroplasty does not guaranty that cartilage like material will form. Hi Dr Berg, So happy how I been treated and how well I am getting. Usually, there is only a small soft dressing. Hold 10 seconds. Facts About the Recovery Time for Total Knee Replacement. Any medical issues that would prohibit a simple arthroscopy would also preclude proceeding with a subchondroplasty. Adjust seat so involved . Dr Thomas Youm performs high-tibial osteotomy and total knee replacement in New York City, NY. Hi, thank the lord I found this forumt.so relieved. Hide. Medial meniscus tear. The patient is usually discharged on the same day as the surgery. Read Responses. You may feel weak or unsteady doing so, and so crutches or a cane may be needed for several days occasionally for a couple of weeks depending on your progress. Recovery time for this surgery is highly individual. Subchondroplasty - a new, minimally invasive technique that replaces the weak areas of bone marrow lesions (BMLs) with strong, healthy bone - is offering renewed hope to sufferers of chronic knee pain. The patient is usually discharged on the same day after the surgery. I was scheduled off for 2 weeks and was able to return after 1. Similarly, those patients with diffuse arthritic pain without corresponding bone lesions in the areas of pain or patients without any BMLs on their MRI would be unlikely to benefit from subchondroplasty. These patients are initially treated conservatively with antiinflammatory medications, ice, elevation and compression. I have had knee surgery 5 weeks ago,including a partial menisectomy and AFC chondroplasty.The consultant said my knee is a mess,and he may need to replace the kneecap as there is a massive gap in the cartilage. Dr Vaksha, is a great doctor very professional knows what he talking about. AccuFillInjectable Bone Substitute Material is an injectable, Any experience with a meniscus repair? The dressingis generallyremoved after a couple of days. Most commonly, this problem occurs in the knee. on the nanometer scale. Is Subchondroplasty at all possible with the pin in place to relieve my hip pain? Astur DC, et al. Doctor did agree it is an individual recoup. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731. Im 58 and would like to wait to get a hip replacement. Advantages of Subchondroplasty. Peer-reviewed data The diagnosis included: Primary osteoarthritis. injury to the bone.AccuFillInjectable Bone Substitute Material is a Six plus weeks ago, I had arthoscopic knee surgery and a chondroplasty procedure. I have been out of work since the surgery. bone graftsubstitute, thatmimics the properties of cancellous or gaps of the skeletal system of the extremities, spine (i.e. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. inhibit the treatment of other findings inside the joint when Neelash, As I tried to note in the post. Subchondroplasty Procedure is the innovative new joint preservation procedure developed by Zimmer Knee Creations to treat the microfractures that develop just under the joint surface in painful knees. Subchondroplasty is, however, contraindicated in patients with a BMI (body mass index) greater than 40 or those with severe misalignment of the knee joint. It leads to faster recovery . Im sorry to hear that. Arthroscopy is a procedure that orthopaedic surgeons use to inspect, diagnose, and treat problems inside a joint. bewmson. My pain is in the front of my knee. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. My meniscus cartilage was worn out on the inside before surgery. It also depends on whether it is done arthroscopically or through incision. In patients with knee osteoarthritis, subchondroplasty is most frequently performed to treat bone marrow edema in the medial compartment (i.e., medial tibia plateau, medial femoral condyle, or both for "kissing" contrecoup lesions) [].Other possible target sites for subchondroplasty include the lateral compartment, patella, and trochlea [].In our cohort of nine patients, preoperative MRI . Felt absolutely great for first three weeks, like a new person. Scheduling my appointment was quick and easy. Thank You. endstream endobj startxref Jefferson and my wife, Mary Ann, broke her hip. The staff is truly exceptional, they make you feel comfortable and welcomed. Masking: Single (Participant) Masking Description: Patients will be randomized at the time of surgery to either the control group or the intervention group. It does not hinder total knee replacement if required in the future. AnkleSurgical Technique, TheSubchondroplasty (SCP) ProcedureHipSurgical Technique, Injection Behavior of Bone Substitute Materials, in Contained joint. day. The doctor put me on "partial weight bearing" status for two more weeks. However i do not know any to recommend. Physical Therapy Reviews,17(1 . hb``a``Jd`a`0] @1V xp`^ 2LsshFYHb+@Z I stopped both last week and have begun to use recumbent bike at the gym (non weight bearing) and added the elyptical machine each day for a few minutes.Still have moderate pain on inside of knee when flexed rht or left. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Good luck. January op. The arthroscopy allows us to identify and address any potentially treatable issues inside the joint. | COVID-19 Updates. Feeling a net loss in the pain department still, but will see what happens in the next few weeks. Subchondroplasty Procedure. Fear that I may have pushed a wee bit too much, but not so given my instructions. If you choose to undergo subchondroplasty, you will be put under general anesthesia. Trying to build inner muscle, and walk on mid-inner arch of feet now (years of pain made me flat footed, stiff legged). This technique, called subchondroplasty, consists of injecting a bone substitute I am guessing this might not be an option for my other hip as it has the same condition but thought worth asking as I am always looking for the latest and greatest. Typically, an outpatient Knee Surg Sports Traumatol Arthroscop, 17, 607-616. The injected bone substitute stabilizes the From the time I entered Dr. Karkares office for the first time until now, his staff has been amazing. In some cases, an open or mini-open procedure is necessary for The front and back office people are amazing and so helpful. Subchondroplasty: Knee Repair; Rotator Cuff Injuries & Bio-Inductive Shoulder Patch; Golf Injuries & Treatment; . hbbd```b`` qdued&IOr0LE&&BA DH$-I`0a/>_ c`5Fg` | I am not aware of any list. There is no better Orthopedic doctor you will find. It is probable that if this surgery fails, your ortho will recommend a total knee replacement. hi i had partial meniscetomy and condroplasty done on 25th feb2013 i was out and about after 5 days just a short trip to the shop,i have managed the stairs ok, took the dog to the park..but now 15 days after procedure my knee is clicking and sticking ,still pain on the inside,and pain in the calf muscles. subchondral bone defects, often called Bone Marrow Lesions (BML) The patient is usually discharged on the same day after the surgery. Arthroscopic image showing articular cartilage damage. The substance hardens into a chalk-like substance within minutes. the healing process., Closed transfer to injection syringes No loss of mix, 2 components: cannula + stylus Stylus locks to cannula hub. High tibial osteotomy has also been utilized to decrease load upon the affected femoral condyle, with favorable outcomes. Doc I have had one hip replacement due to what I refer to as being a human german shepherd. reaction at 37 degrees C to form a nanocrystalline,* microporous Dr.Karkare is the best. I am 35 years old and face a lifelong battle with knee pain and OA. The patient is usually discharged on the same day after the surgery. A chondroplasty is an outpatient procedure used to repair a small area of damaged cartilage in the knee. Over time the patient's body replaces the bone-substitute material with their own healthy bone. These BMLs can be very painful. withAccuFillBone Substitute Material., AccuFillBSM is an engineeredcalcium phosphate mineral compound, a Subchondroplasty involves an injection of bone substitute. This was the right decision no pain and no limp. Bone defects are filled withAccuFillBone Substitute Material there is a difference between chondrop;asty and micro chodroplasty. the positive outcomes continued for two years at which time the . crutches, or walker for a short period of time after surgery. Use hands to put pressure on leg above patella, try to make the knee as straight as possible. Anx-ray-like machine is used toassist in positioning the tube. Who in Orange County,Ca diagnoses whether a Pt is a candidate for sunchondroplasty and if they are diagnosing the Pt as a good candidate are they also the Dr that most likely will perform the procedure. A 76-year old woman was referred for resistant medial knee pain. "We want to preserve the native hip whenever possible because once you have a hip replacement, there's no going back . One of these system malfunctions is a bone marrow lesion, a microfracture or swelling in the soft bone right below the knee joint. A bone marrow lesion or a bone marrow edema adjacent to the cartilage of the knee joint is typically seen as a cloudy white area on the T2 and STIR sequence of the MRI. Yes German Shepards get it too :). I am pleased to say I am one of the lucky ones. In the appropriately selected patients, improvement often starts in 2-6 weeks. Has someone told you that you might be a candidate for subchondroplasty? Started Phys Tx and still felt good. . Gisela, It is possible. AccuFillBone Substitute Material (BSM). Theminimally-invasiveSCPprocedure isusually performed along with What is subchondroplasty? I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . %PDF-1.5 % What does it treat? Eventually I went to an orthopedics specialist; had xrays and an MRI. (I know that's not good). After surgery, it's typical for the knee to technically be able to bend between 70 and 90 degrees, though it may be difficult due to pain and swelling. Hopefully, these will give us more information about subchondroplastys efficacy. I had chondroplasty, meniscal work, and a cyst removed from my ACL of my right knee on 2/26/10. cortical bone is intact. Advocates say it's easier, less invasive, and has a quicker recovery time. Leading the industry in providing quality, consistent I suffered with pain in both knees for years. Knee Osteoarthritis and Subchondroplasty Procedure, STARS Physical Therapy | Saint Alphonsus Rehabilitation Services, Subchondroplasty: Filling the Void in Your Knee, Subchondroplasty Post-Op Knee Rehabilitation, Knee Osteoarthritis and Subchondroplasty Procedure. Recovery Time. I was on crutches for the first day, then went to one crutch do to lack of mobility. Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! It leads to faster recovery and quicker return to normal activities. Surgical options include joint replacement, arthroscopy alone or arthroscopy with subchondroplasty. care or other intervention. The hole is filled up with bone cement or paste to support and allow healing. Treats chronic, symptomatic, subchondral bone defects which By definition, secondary osteonecrosis of the knee occurs secondary to an insult. Ive been doing research on SCP and wondering if this procedure would be an option. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. Like all medical issues, arthritis can come in different patterns. This exercise regimen will get you moving on your newly improved knee as soon as possible by strengthening the muscles. %%EOF PDFS, STIR, etc. Aquatic exercises are also useful because they take the weight off the knee. It is symbolic for stress fracture localized to the bone underlying the cartilage. Discuss all treatment options with your patient. It is important that you do your exercises and physical therapy and don't procrastinate with them. 11 gauge cannula . I had an issue with paperwork and she cleared it right up. I would suggest calling an orthopaedists office who speciallizes in knee surgery and asking. *Verify AccuFill BSM indications available for your country/region. I hope that the damage that has be done can be contained and i can live a relative pain free life and enjoy the joys of fatherhood with my young girls with little inpact on the freedom of many every day activities.

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