Guess I don't really need a perineum (long) - Mothering Forums

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#1 of 39 Old 05-31-2005, 02:22 AM - Thread Starter
 
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Or do I? What do they do anyway? Will I be fine going through life without one?

Here's my story (or skip to the part titled SO HERE'S MY CURRENT SITUATION:

My first child, Skanda, was born at home. I hired a midwife who had lots of experience. It was my first birth and I didn't feel confident in my body and the birthing experience so I trusted her to help me make decisions that would be best for me and the baby and in line with natural birth. She even loaned me Spiritual Midwifery. But when it came time to have the baby, she seemed to be pushing to hurry it up. She kept suggesting that she break my water even though I didn't really like the idea. She said I was almost complete but the water was bulging and I said I wanted to wait. But the anticipation was too much. Everyone around wanted me to just get it over with. So fine. I told her to break the water. Then I was complete. So what? I didn't feel any urge to push. Everyone around me wanted to meet the baby. They kept asking me when I was going to push the baby out. I said I was tired and laid on my back on my bed to rest. And my midwife held up my leg and asked me to try pushing. I tried. She said it was working. She encouraged me to tuck my chin down and hold my breath and push while she counted. The other midwife held my other leg. It HURT!! My labor had been virtually painless, but it HURT to push. I didn't like it. They said they could see the baby and I was almost there. So I gave a might push and his head was out. I was hurting and pushing seemed easy even though I never felt any urge. There was no cord or anything in the way and I thought the worst was over since his head was out. Then I gave one heaving push and the rest of him came barreling out including an elbow that tore right through my perineum. I have pics of the birth. The assisting midwife had her hands there and was attempting to support me, but I guess it didn't matter.
So the midwife tried to stitch me up after the placenta came out. There was a lot of blood from the tear. And then there was even more blood. She turned pale and said we were going to have to transport me to the hospital. She had punctured an artery while trying to suture me. I guess I have an artery pretty close tot he surface.
She notified the on-call surgeon before we even arrived at the hospital. But he didn't come, despite multiple pages, for about 2 hours. I had a hematoma the size of a walnut when I arrived at the hospital and it was bigger than a softball by the time he got around to draining it and sewing me up. It took me 10 weeks to brave sex and 6 months before I could sit right.

Next birth: I had a different midwife in Hawaii - the most awesome midwife in the world. I had the baby in water. I was so scared to push. She stroked my hair back and told me that I didn't have to push. And I didn't. Nadia came right out into the birth pool in about 10 minutes without much work on my part. I had a tiny tear on my old scar and Roxanne put one stitch in to help it heal but the stitch fell out a few days later. It healed up just fine.

Next birth: I wanted to have the baby in water but I couldn't get into a comfortable position and felt my pushing was not at all productive. Intellectually, I didn't want to push. I knew from my last birth that babies come out whether you push them out or not. But mentally, I was tired and I could feel the pressure of my baby and thought a few pushes and she would be out and we could rest. Then I decided to get out of the water and rest first. I woke up from a short nap in front of the fireplace and decided I was going to push her out. I was pushing. It hurt. She wasn't coming out. I thought I should squat to help her out but didn't want to tear. I tried sitting up with the midwives supporting my legs but it still wasn't working.
Finally, I was getting really frustrated so I asked my midwife to feel around. She was surprised to feel that the baby had moved up and the cervix was still soft, but over her head again. Before my nap, I had felt and her head was right there, practically out. While the midwife's fingers were in there, I had the strangest sensation. The baby started head butting my cervix and then she wiggled her head around some. I sat up on my knees and leaned over the couch and gave some mighty pushes and she was out. I was so exhausted that I couldn't even catch her or pick her up.
After I delivered the placenta and baby was all wrapped up and mommy and daddy were cuddling up with her, my midwife Ann examined my area. She saw no tears. My perineum was intact. She brought me a mirror. I was very happy. I didn't even feel that sore. There was a tiny bit of stinging by my anus when I urinated but I thought maybe it was a stretched area because I had felt strain there when I was pushing.
For a few days after the birth, I felt great. I even started thinking of having sex. And then it started getting sore by the end of the week. I called my midwife and let her know. I self examined but didn't have a mirror and felt my perineum was very separated. The length of the area was about half as long as it used to be. At my two week check up, she looked and was taken aback by what she saw. My perineum had separated along the scar on the outside and into my vagina. It didn't look raw. It was smooth and healed looking, only a tiny bit pink. She got me a mirror and we looked in amazement. She said that stitching it would do no good because it looked healed. She suggested I wait and see how it healed but that it could take months to see any change. My insurance was running out in 2 months so we decided it might be good to get an OB/GYN to look at it.

SO HERE'S MY CURRENT SITUATION:
The gynecologist examined me and noticed a rectocele. The mucosa between the vagina and rectum seemed to have a very small hole and wasn't healing properly. This was exactly where the hematoma was at my first child's birth. He suggested that he shave it and it would heal properly. At the same time, he could rough up the scar tissue that had separated and stitch it back together. That was 3 weeks ago.

One week post surgery - and it was a rough surgery with a difficult recovery and more pain than expected - I could feel things were healing.

One and a half weeks post surgery, I could feel spots where the dissolvable stitches had already dissolved. Then I felt again and there was a gap. It had separated!!

Two weeks post surgery, I have an appointment with my gynecologist and he sees that there is a gap in part of the area that was stitched up. He tells me to stop lifting things and try to take it easier. I do. I haven't even been taking the kids to the library or walking much. I'm doing the best I can to keep my legs together.

Today, three weeks post surgery. My perineum is gone. The scar has completely separated again!! It hurts too What do i do? Is a gynecologist the only one qualified to look at this issue? Is there another type of specialist I'm supposed to see? I"m taking vitamin E to try to help my skin be elastic. He noticed some redness and thought I might be developing an infection so prescribed antibiotics (that would be round 3). I didn't pick up this round of antibiotics and I'm feeling bad about it. I have been taking Grapefruit Seed Extract pills instead because I don't think it's bacterial, I think it's yeast. But last time I told him I had a yeast issue, he said it didn't look like it because there was no white discharge. *sigh*. So do I need to get this stitched up again?? I am feeling like there must be some sort of reason it keeps separating. Do I need to see a chiro? Could something have prolapsed and is putting pressure on that area making it separate? Or does my perineum just want to be split? Maybe I've started a new body modification trend.
I'm feeling so disconnected and vulnerable
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#2 of 39 Old 05-31-2005, 04:05 AM
 
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OMG Nipuna. This is horrible! I'm so sorry you've been through this and still don't have an answer. I wish I had some words of wisdom or an answer for what you should do, but I don't

It sounds like there must be something going on there- why would your tissue just come apart again? Did the stitches rip open? or just dissolve like you wrote? it seems that there must be some kind of specialist- maybe a pelvic floor person? sigh....

mama
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#3 of 39 Old 05-31-2005, 04:20 AM - Thread Starter
 
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Hi Karen
How's the family?
No, there was no tearing. I bought a mirror today and looked. It's totally smooth and healed looking as before. It's like my just won't knit together. Once the stitches come out, it just separates and looks totally healed.
Think I should ask (or could you ask) Roxanne for advice?
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#4 of 39 Old 05-31-2005, 04:38 AM
 
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We're doing great! Luka is growing and we're ALL enjoying having a baby around.

I thought about asking Roxanne for you- you can contact directly if you want. Her email is birthrite @ verizon.net and her # is 965-5355 (i think it's OK to post that here, don't you think?). I don't know if she could help, but she would listen! I do know she told another mama who's tear healed poorly that if that mama birthed with her again that she could rough up the scar after the next birth and re-put it back together- like what you had done. perhaps your tissue didn't really abraid well when the doc did it?
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#5 of 39 Old 05-31-2005, 07:21 AM
 
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Oh my goodness -- what an ordeal! I'm sorry you have to deal with this.

I would get another opinion, for sure. If there is a prolapse, you would probably feel it -- you could most likely feel the weight of your bladder or uterus on your pelvic floor. But it sounds like maybe you need a scar revision. I'm not a gynecologist, but that's the first thing that came to mind. But definitely see another GYN.



P.S. I love your signature!
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#6 of 39 Old 05-31-2005, 08:21 AM
 
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I tore pretty badly with my first and didn't want stitches. I have a fear of needles and such.

My mw told me that most women can heal naturally if they keep their legs together at all times... that the sides can naturally knit back together.

Mine started to knit back together but never totally finished. A few months later, when dh and I had sex after the birth for the first time, I'm pretty sure it opened back up some. After a few MORE times, I'm pretty sure the entire scar line separated.

It feels strange and was quite tender for a while. I have to admit, it's kind of weird having a disfigurement in such a "sacred" and private place. But it hasn't affected how "it" functions during sex and there is no pain... so I am assuming it's mostly superficial and won't cause problems later in life.

Try getting some boric acid powder and packing it into water soluable veggie capsules. Insert one finger-deep before bed for three nights in a row. That should take care of any yeast that may be making your tissue brittle. It sounds rough but it's not at all! I did this right after the birth of my first when my tear was fresh and raw and it didn't hurt or burn in the least. The name is much scarier than the product, trust me!
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#7 of 39 Old 05-31-2005, 09:10 AM - Thread Starter
 
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Luka is probably rolling all over the house these days
Thanks for Roxanne's contact info. I might email her since phone conversation is always difficult these days with all my little interruptions
Thanks for the info about prolapse, reader. I guess that's not my problem. I'm wondering if a chiropractor might help a little? Maybe my hips or back are really out of whack and pulling? I thought the gyn really DID do a scar revision. At least the part in the vagina held up just fine (or I hope it stays together - who knows). It's just the outer part of the perineum.
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#8 of 39 Old 05-31-2005, 09:14 AM - Thread Starter
 
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Thanks, candiland
My sister uses boric acid for yeast so it doesn't scare me. hehe. I've been taking the GSE and it seems to have taken care of the problem. I just hope the doc isn't mad that I didn't take the antibiotics without telling him I didn't want to. I have a good relationship with this doc but Amelie was crying and I didn't feel like debating the antibiotic issue at the time. The GSE should have covered both bases, right?
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#9 of 39 Old 05-31-2005, 10:05 AM
 
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Wow, I'd be tempted to contact a plastic surgeon, I think that for that to heal roughing up the scar is not going to be enough, I would think it needs to be resected and sewn back together properly, scar tissue by nature doesn't knit, so to rough up enough would be difficult. Sorry you're going through this.
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#10 of 39 Old 05-31-2005, 10:24 AM
 
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over the counter GSE is 1/4 strength but is suppose to kill bacteria and yeast-- thing is you need to recolonize with good flora because it does wipe out all flora... I wonder if you have something like mycoplasma or BV and would want to test to see
although I think that trapped blood was probably the cause of the dehiscence- and was probably in there since then and enlarged and probably became inflamed with this birth then caused the split

Some providers are better than others at repair and suturing-- you could talk to a plastic surgeon
try doing things to colonize with lactobacillus like taking caps eating yogurt, sour dough bread... also instil some into the vagina
consider sitz baths and if you have this repair- redone by someone else- either ob or plastic surgeon use comfrey leaf soaks with some added lavender flowers maybe some plantain leaves thrown as well for about 5 days after to help speed healing-

(use of comfrey is controversal and some strains of comfrey are high in PAs but lowest amount is in leaves and leaf teas have the lowest amount)
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#11 of 39 Old 05-31-2005, 11:39 AM
 
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Wow, what an ordeal!! I'm so sorry your perineum is so traumatized.
When I had my first son, about a week later I felt something was amiss, it felt like a teeny hole. I went to my OB and she looked, said it was just some residual tearing. She said that she takes ANY feelings like that very seriously. When she had her first they said she didn't tear. Happy was she until a couple weeks later when she felt something amiss, went to her GYN to find out there was a hole. It took one rather long surgery to fix it and another small procedure to re-fix the fix. So she takes holes seriously. She said that if she can't fix one, she sends people to a plastic surgeon "the sooner the better". I think after all you've been through, I'd heed my old OBs advice and the same about: get another opinion and go to a plastic surgeon. Best wishes for healing to you!
Namaste,Tara
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#12 of 39 Old 05-31-2005, 11:41 AM - Thread Starter
 
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Thanks Shannon If anyone knows about medical trials, you sure do. The weirdest part of this ordeal is the vicodin. I keep second guessing myself when I take one. "Do I really need it? Is the pain that bad? Can't I tough it out? Am I going to turn into a pain killer addict?" :LOL I've been taking one every other day but yesterday I took two.
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#13 of 39 Old 05-31-2005, 11:48 AM - Thread Starter
 
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Thanks, mwherbs. My gyn said not to take baths so I assumed that meant no sitz baths. He didn't want the stitches dissolving too soon. I have been putting an ointment on it that my midwife gave me from Susun Weed. My doctor agreed that it was a good thing to use. I think it has goldenseal and comfrey and maybe even plantain. (Did we talk about this in that thread I started when I first noticed this problem?). I'm taking 1500 mg grapefruit seed extract daily and I just so happen to be eating sourdough right now. I've been craving yogurt too. Putting like 1/2- 1 cup of plain yogurt on top of my meals.
Tara, do you think this is something that I need to get fixed right away? The rectocele (hole) seems to be healing just fine. It does cause a stabbing sort of pain here and there, but when I self examine, it's not painful to touch it anymore.
I still don't know if this is something that needs immediate attention or it will get worse or just something I can put on the backburner for a year or so. Or can I just live with a split perineum with any further issues?
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#14 of 39 Old 05-31-2005, 03:11 PM
 
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I don't think you should wait. I think it's important to find a doc who knows what's up and get his/her opinion. if they say it's ok to wait, then ok, but this is part of your sacred anatomy!
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#15 of 39 Old 05-31-2005, 03:20 PM
 
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I would also look for a plastic surgeon, mama.
Big hugs to you. That sounds stressful.
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#16 of 39 Old 05-31-2005, 03:23 PM
 
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Check out this site: Urogynecologists
It tells you about urogynecologists (who specialty includes helping women with postparum problems) and how to find one. Perhaps your primary care physician could refer you to one as well? Hope this helps
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#17 of 39 Old 05-31-2005, 03:27 PM - Thread Starter
 
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This doc seems to be pretty competent. I'm wondering if there's just too much scar tissue in the area for it to heal properly. I don't know what's going to happen next. I may go see him this afternoon.
I left a message for Roxanne so maybe I'll get to talk to her today
I talked to the midwife who assisted with Amelie's birth and she thinks it's a scar tissue problem. She also told me that the umbilical cord was coming out with Amelie's head. I had no idea. She never breathed a word about it. I guess I was really focused on pushing her out anyway so no need to scare me?
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#18 of 39 Old 05-31-2005, 03:41 PM - Thread Starter
 
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Quote:
Originally Posted by KiwiZ
Check out this site: Urogynecologists
It tells you about urogynecologists (who specialty includes helping women with postparum problems) and how to find one. Perhaps your primary care physician could refer you to one as well? Hope this helps
Thanks KiwiZ! I'm on the phone with my insurance right now.
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#19 of 39 Old 05-31-2005, 03:43 PM
 
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Hi!

I am soo sorry your going through all this but I wanted to ask you when you say Rectocele what exactley are you refering too? I understood that a Rectocele was inside the vaginal vault on the posterior wall of the vagina and was a thinning of the wall between the layers of the skin that seperates the rectum from the vagina, I also understood that its not an actual hole.. you can see bulging ect.. but there is no clear passage from one side of the wall to the other.

I understood fistulas to be actual holes..

Can you clarify for me? or can someone else as I am genuinely wondering about this.. I second the idea you should have another opinion just in case.
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#20 of 39 Old 05-31-2005, 03:51 PM
 
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Isn't there a great physical therapist that specializes in pelvic work in your area? (I'll try to remember who is recommending her and PM them) Perhaps the skin will not suport what the muscles "want" apart? It's possible that a surgical repair is not enough, but a combination repair would be. Like a torn rotator cuff requires not just surgery, but therapy afterwards.

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#21 of 39 Old 05-31-2005, 04:26 PM - Thread Starter
 
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Marsupialmuma: I don't really understand the terms. Doc called it a rectocele and he thought it was a hole but I told him it wasn't. He kept asking me if I was passing gas through my vagina. After he performed the surgery, he said it was as thin as could be without being a hole. That part is healing fine. It's the perineum that won't stay healed. The stitching looked like this ---o--- at my last appointment and now it looks like this -< When I checked this morning, it looked like even the stitched up part inside the vagina was coming apart as well.
Apricot: Who, where? I'll call anyone. I even called my chiro to see what he thought it would cost me. He said he'll examine me for no cost and we can set up a payment plan for the treatment I would need.
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#22 of 39 Old 05-31-2005, 05:04 PM
 
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I know that you don't want the sutures to dissolve too quickly but on the other hand once open you want to start healing the area--- even good doctors can be somewhat inept in repair-- I have watched some pretty poor sewing from some pretty good doctors--- the thing with a plastic surgeon is often he is very use to dealing with putting tissue back together and getting good results-- his job depends on doing good closures as well and often they use very tiny sutures

if you are still in pain do the sitz baths now and I agree with you that you can table this until later
take care
PS I have seen all different lengths of perineums does everything come together when you kegel?
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#23 of 39 Old 05-31-2005, 05:28 PM - Thread Starter
 
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I did some kegels over a mirror and everything comes together. But it looks like my kegels are pretty weak. I'll start sitz baths. I think my perineum is about 1/4 in long. It's barely there at all.
What do you think of applying vit E to the are now?

Oops. Forgot to mention that some of the pain is in my leg. I have a strange hip joint and I think the nerve and muscles were stressed during the surgery. When I start to get the piercing type of pains somewhere inside, my hip also hurts. I don't know what's causing the pain. It sometimes feel like there's a poker shoved into my butt.
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#24 of 39 Old 05-31-2005, 05:44 PM
 
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Quote:
Originally Posted by kavamamakava
I did some kegels over a mirror and everything comes together. But it looks like my kegels are pretty weak. I'll start sitz baths. I think my perineum is about 1/4 in long. It's barely there at all.
What do you think of applying vit E to the are now?

Oops. Forgot to mention that some of the pain is in my leg. I have a strange hip joint and I think the nerve and muscles were stressed during the surgery. When I start to get the piercing type of pains somewhere inside, my hip also hurts. I don't know what's causing the pain. It sometimes feel like there's a poker shoved into my butt.
Ok the poker in your butt feeling :LOL thats sacroiliac pain something that I suffer from very badly right now and cannot walk some days.. chiro technically should help that but right now does nothing for me.
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#25 of 39 Old 05-31-2005, 07:19 PM
 
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kava - I'm so sorry, but I misremembered. The physio that someone was raving about was in Minnesota! D'oh. However, in trying to find that, I found that there were other women that found pelvic physios from a recommendation from a CNM or GYN.

One more thought - how's your blood work? Hb, platelets, etc? The process of healing is so dependant on the components of blood working in concert. If something's off, the process can continue in a disordered way.
I wonder if maybe you should stop supporting your immune system so well - at this point, granulation and bad scarring would be better than this uber-healing that you have going.

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#26 of 39 Old 05-31-2005, 07:25 PM
 
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My gosh, kavamamakava, good luck to you in your pursuit for perineal happiness!

This thread reminds me that there are lots of surgical miracles that happen, , sex-changes, cosmetic, reconstructive, and the like...I applaud your efforts at finding the proper surgeon (if that's what you decide you want) to repair and fix what deserves to be fixed.

For the record, a rectocele is a bulging of the rectum into the vagina. (A cystocele is a bulging of the bladder into the vagina.)

A rectovainal fistula is a hole in the vaginal wall between the vagina and the rectum.
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#27 of 39 Old 06-01-2005, 01:26 AM
 
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so for the pain poker in the butt pain how about a chiropractor? and I would use St John'swort oil topically on the entire butt and lower back-- I really love the stuff calms the nerves down---
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#28 of 39 Old 06-02-2005, 01:04 AM - Thread Starter
 
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Apricot: I could be low on iron. Should I start taking Floradix again?
mwherbs: I've never used St. John's oil before. I'm not sure when I'll get some, could I use arnica gel?
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#29 of 39 Old 06-02-2005, 04:15 PM
 
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Does Floradix bring up your iron well before? I have to just throw stuff at something that's not a known problem. Did they draw blood before they did your last repair? You might see if he/she can fax you a copy of that bloodwork.

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#30 of 39 Old 06-02-2005, 06:03 PM - Thread Starter
 
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No. No blood draw but I tend to go low on iron often.
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