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Can anyone suggest some good links or just explain this to me?

For example, I have read lots of natural-remedy-type suggestions for decreasing GBS colonization, but I have read elsewhere that a negative retest would not necessarily predict GBS level during labor. (If that's true, why would a negative test at 36 weeks predict the level during labor?) Is this like yeast, always remaining present in a "colonized" person in some quantity? And if so, how if at all does the quantity relate to the risk of infection for a baby? How do the IV antibiotics actually work, and why are they believed to work better than other ways of delivering antibiotics? And so forth. I'm always a little mystified by the workings of bugs, so nothing is too basic. :)
 

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Quote:

Originally Posted by eminer
Can anyone suggest some good links or just explain this to me?

For example, I have read lots of natural-remedy-type suggestions for decreasing GBS colonization, but I have read elsewhere that a negative retest would not necessarily predict GBS level during labor. (If that's true, why would a negative test at 36 weeks predict the level during labor?)
Ah, that's the tricky part of GBS. It comes and goes as far as colonization is concerned. You could be treated with antibiotics prenatally and unless you go into labor during that course of treatment, there's no guarantee that the colonization would not rise.

Quote:

Originally Posted by eminer
Is this like yeast, always remaining present in a "colonized" person in some quantity? And if so, how if at all does the quantity relate to the risk of infection for a baby? How do the IV antibiotics actually work, and why are they believed to work better than other ways of delivering antibiotics? And so forth. I'm always a little mystified by the workings of bugs, so nothing is too basic. :)
Yes, for the most part, a colonized person will retain some degree of the bacteria in their body. It's the level of colonization that is looked at in terms of risk to the baby. The greater the colonization, the greater the risk to baby, or so it's thought. It's one reason why many providers are now testing pregnant women's urine (without their knowledge, most of the time) - a high colonization in the urine often means a greater risk of preterm birth and infection in the baby.

IV antiobiotics not only enter the bloodstream, but also will cross the placenta. So, by treating the mother in labor, there is an assumption that you're "killing two birds with one stone" by also getting some to the baby.

In other parts of the world, GBS infection isn't viewed as such a huge deal. In fact, in those women with high levels of GBS, many other places are only giving the baby an injection of penicillin after the birth, rather than treating the mother.

In-labor antibiotics are not proving to be as effective as we once thought, but then again, I'm of the belief that we'd have a lower infection rate if we didn't induce women based on due dates (the biggest risk of GBS infection is to preterm babies, and quite often due dates are based on erroneous ultrasounds, rather than true LMPs), didn't do a crazy number of vaginal exams prenatally and during labor, and didn't routinely break water. I tend to think it's more about the BABY when babies get really sick/die from it, rather than from the bacteria itself. Surely there are a host of women out there who are GBS positive that birth without knowing it and their babies do fine.

There's also a strong belief system that the baby receives GBS antibodies via the placenta before birth.

Here is some good information on GBS infection and birth:

Treating Group B Strep: Are Antibiotics Necessary? http://www.mothering.com/11-0-0/html...0/strepb.shtml

Preventing GBS Disease - from the CDC
http://www.cdc.gov/groupbstrep/gbs/hospitals_start.htm

For Parents Recently Diagnosed with GBS
http://gentlebirth.org/archives/parentsFAQ.html

They're finding that late-onset (after a couple weeks from birth) GBS infection is actually CAUSED by cross-contamination in the hospitals from care providers.
 

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Hi, I'll give you my take on B -strep, as a pregnant homebirth/birth center licensed midwife. I woite this for another list a few days ago, and it was so long and exhaustive to write I am glad to share it somewhere else and get more mileage out of it!

First, some links:

the CDC guideline summary the complete ones are on-line here:http://www.cdc.gov/groupbstrep/gbs/h...guidelines.htm

general info for the public on GBS from CDC is here:
http://www.cdc.gov/groupbstrep/

and below I'll put the link to the parent group that made the strep thing an issue.....
http://www.groupbstrep.org/

First, how it is detected. Center for Disease Control (CDC) recommends all pregnant women be tested for it at 36 weeks by using a vaginal and rectal swab that is getting bacteria from the vagina and anus, to see the bacteria live in the reproductive or digestive tract. Generally, no one does this test at any time in pregnancy except at 36 weeks. The reason for doing it then is normal birth window starts at 37 weeks, and you will be able to get results on most women before labor starts if you test at this time. The colonization changes but it doesn't just change overnight, tests at 35-37 weeks are 87% accurate for predicting postive status at time of delivery, and 96% accurate for negative status at time of delivery....
http://www.greenjournal.org/cgi/cont...tract/88/5/811

The other way you can be tested for it is if you get a urine culture, and it is positive for a UTI, they will ID what bacteria is causing it, and sometimes it will be e-coli or something, sometimes B-strep. If you have B-strep in your urine, it is prolific and pervasive enough that even though it is early, CDC recommends that you be treated in labor, because it means your colonization is very high and you are at more of a risk for having problems if it is in the urine than just the vagina and rectum. Only because it means it is more well established in your system.

Generally, B-strep causes us no harm. But it is a leading killer (maybe the #1?) bacteria that causes fatal newborn infections. If it is in your vagina or digestive tract when you birth, your relatively sterile baby will get colonized with your vaginal bacteria on it's way out. If B-strep is there in large numbers your baby may get colonized with it disproportionately and get ill after birth- ill meaning anything from minor sicknesses to spinal meningitis to death. The very severe infections that usually show up with in 48 hours, but can appear as late as a few weeks later, called late onset GBS disease. Because it usually shows up with in 48 hours, hospitals like to keep all babies of Strep positive moms 48 hours for observation to see if they develop symptoms. 48 hour observation is part of the CDC guidelines. Some peds are real strict about the guideline, and want all babies in the hospital 48 hours. This is a good question when picking a pediatrician. Some peds will allow parents to observe babies at home by taking their temps and filling out a home record, or just being more aware that they would want to take in a baby that was lethargic or showing signs of being ill. Some peds want to draw blood and see if the bacteria grows out in a culture, indicating a blood infection of strep in the baby. If babes have it in the culture or get sick, the treatment is generally 7-10 days IV antibiotics, which means hospitalization and separation from mom.

A bit about the B -Strep bacteria in general- it is very common, 10-40% of people have it as part of their normal flora. It comes and goes- you may have it in one pregnancy and not in another- our body flora is dynamic, ever-changing. So you may have it in early pregnancy, but not later. (But like I said, if it's in your urine, its considered pervasive enough, that even getting a negative test later does not change the CDC's stance that you should be treated anyway in labor.If you have it in your urine, CDC says skip testing at 36 weeks and treat with IV antibiotics anyway).

Incidence of B-strep is 10-40% of us have it, and if not treated with antibiotics 1 in 200 babies will get sick from it. If you get two doses of IV antibiotics, which are given 4 hours apart, then the risk of baby getting sick goes down to 1:2000. Of the 1:200 or 1:2000 babies that get sick, 1:20 of those is severely ill, like deadly ill, the other 19 are somewhere on the spectrum.

A few things to realize- the USA overuses antibiotics-in farming is one big place(why it's good to buy organic meats-to discourage this trend), and of course in medicine we know about the prescription writing reflex many docs have. So realize the above statistics are for the USA. Bacteria strains vary from country to country. Other countries don't treat B-Strep as aggressively as us, but they don't necessarily compare to us either, because they may have low rates of colonization in the population, or may have weaker less antibiotic resistant strains of it, or not have the technology to understand what made the baby sick and so may under report the incidence (like countries where they don't do an autopsy or bacteria cultures after death).
Here are colonization around the world- It's a bigger deal in the US........US (26%), and lowest (12%) in India and Pakistan (19% in Asia, 19% in sub-Saharan Africa, 22% in the Middle East and North Africa, 14% in Central and South America).6 In the UK, there is a lack of contemporary data, but in the early 1980s studies reported prevalence rates between 15% and 28%.
http://ije.oupjournals.org/cgi/content/full/33/1/2

Also realize that none of these studies took homebirth into consideration. It is entirely possible that babies get sick with strep from being in hospital, as much as from their mom's vagina. But really, we don't know. All we have is stats gathered in hospitals on B positive moms.

And as far as how this thing became a big deal at all- B strep was always a leading killer of babies, and in the late 80's early 90's some parents who lost babies to b-strep were asking the "why me? how it have been different?" questions most ask after losing their babies, and found that the B-strep bacteria could be tested for and antibiotics in labor could have prevented their babies deaths. They lobbied CDC/American public health strategists to encourage doctors to offer testing and treatment to parents. So understand that parents who lost babies to Strep drove this trend. Eventually, it came to recommending testing everyone at 36 weeks, and treating everyone who is positive. I think it is a big pain, and wish it never became an issue. When I started doing births 8 years ago, no one had hardly heard of it. Now, it is a huge and common issue that homebirth midwives and families are forced to deal with. There are now set government standards from the CDC that practioners are expected to comply with to meet the "standard of care".

A few years ago the CDC offered two options in their recommendations- practioners could either screen everyone and treat positive people (universal screening), or treat based on risk factors- which were previous baby with GBS disease, birth before 37 weeks, water broken longer than 18 hours, or fever in labor. They changed that recommendation in 2002 or 2003, to recommend the universal screening, and eliminated the choice to just treat based on risk factors. There used to be a risk screen only protocol, and based on the old CDC recommendation, that allowed leeway for risk-factor treatment only. Now, treating just on risk factors is not considered an adequate prevention strategy. Risk factor still increase chances of problems, but the absence of them is not considered security.

So, I digress a moment to tell you how I think and feel about this personally, first by telling you how I personally/professionally think of health care decisions in general so you know where I am coming form cause this all sounds very medical. I personally think antibiotics are "big guns" medications that are way overused, that I don't take myself unless I feel I have exhausted preventative and natural remedies first, or the situation is painfully acute. But I am not opposed to antibiotics totally or think they are inherently evil. For instance, I get frequent earaches from teaching a water prenatal class, and if it's a sudden horrible earache, and I am on-call for births, I have no trouble using antibiotic ear drops- they are not systemic, won't screw up my whole body's flora, and I LOVE that they can take a pain so severe that it makes me want to scream in pain and tear my head off away in one night. I follow a decision making process called the six steps of healing, which means for any given problem I follow this rubric for decision making- which basically is a guide for staying low tech unless otherwise indicated.....in which case you move to the next step if your low tech approach didn't do the job. I do believe that each of these steps have their place, and can also be abused and used way inapproprialy. For instance C-sections save lives, but elective c-section cost lives. So being too aggressive is unsafe. Likewise, being too low tech can be equally a misuse of technology. If your baby is distress and dying and you refuse resuscitation because you want to still rely on prayer, that is to me utilizing the steps inappropriately. Or someone may fix a headache with steps 1-3 by using hydration, rest, and lavender oil, but another person may have a brain tumor and need drugs and surgery to deal with their headache. (This is a big difference, and where holistic people, especially us birthing folks, can get arrogant- like telling someone they wouldn't have needed brain surgery/c-section if they had just tried the lavender oil/ or whatever worked for the one being judgmental about the other's health care choice. it's important to remember how different we each are and how ultimately, the best care to me is using these steps to see what's best based on the individual situation)

SO here are The Six Steps of Healing
(Parentheses suggest a few of the modalities of each Step.)

Step 0: Do nothing (sleep, meditate, unplug the clock or the telephone). A vital, invisible step.

Step 1: Collect information (low-tech diagnosis, reference books, support groups, divination).

Step 2: Engage the energy (prayer, homeopathic remedies, crying, visualizations, ritual, aromatherapy, color, laughter).

Step 3: Nourish and tonify (herbal infusions/vinegars, love, some herbal tinctures, life-style changes, physical activities, moxibustion).

Step 4: Stimulate/Sedate (hot/cold water, many herbal tinctures, acupuncture, most massage, alcohol). Risk of developing dependence on step 4 remedies is influenced by frequency
(how often), dosage (how much), and duration (how long).

Step 5a: Use supplements (synthesized/concentrated vitamins or minerals, special foods like royal jelly or spirulina). Supple-ments are not step 3. There's always the risk with synthesized/concentrated substances that they'll do more harm than good, e.g., the men who took fish liver oil in capsules and had a greater mortality from heart disease (the oil was rancid).

Step 5b: Use drugs (synthesized alkaloids, oral and injectable hormones, high dilution homeopathics). Overdose may cause grave injury or death.

Step 6: Break and enter (fear-inspiring language, surgery, colonics, Rolfing, psychoactive drugs, invasive "diagnostic" tests such as mammograms and biopsies). Side effects are in-evitable and may include permanent injury or death.

With that in mind, I'll tell more about strep and my expereince with it my community...I use that above rubric, and weigh things by considering the risks against the benefits, so I try to tell parents that whole speil above. I also want them to consinder community standards, and how care will change for someone who needs to leave my care and a homebirth setting and go into the hospital. So, I hate using antibiotics on 10-40% of people, especially introducing something so medical as an IV to a homebirth. But I look at the risks/benefits....this is how it works in my town- I am a legal midwife and can give IV antibiotics at home. (Some places midwves are illegal and can't carry drugs or oxygen- how legal you are influences your choices considerably. For some midwves, IV antibiotics at home are just not an option. They can get put in jail for carrying oxygen or drug to stop bleeding, never mind IV and antibiotics!)). So anyway, the drugs are in a very small bag of IV fluid, take about 20 minutes to go in, and the mom does not stay hooked up to the bag any longer than that. She gets a "port" into her arm I can plug the IV into 4 hours late rfor the next dose so she only get stuck by the needle once. She can be in any postion for the antiobiotics, even in the tub. I just have her pick one postion and stay in it for the dose. If we try three times with IV and can't get a vein, I do it IM, which means two shots for first dose- one in each but cheek, and then one shot every four hours. This can sting. And they are not recogized as effective by the medical establishment- all research on preventing strep is on IV antibiotics, not IM. My doctor and hospital will recoginze it as adquaete though if we transfer, and if we can't get to a vein it's the best we can do. The risk of an allergic reaction to the drugs exists, so midwives should be ready for that if they use these drugs at home. See the six steps of healing- big guns always have risks as well as benefits.

ANyway, in my town, if we know a mom's strep status and a mom is negative and her baby or her transfer to the hospital for any reason, they know she is negative and will not treat her with antibiotics or try to keep the baby 48 hours on observation, do blood cultures, or treat with just in case antibiotics. They will also be nice to her and me, thinking she is not just a crazy hippy homebirther, but that she was receiving care at home that comlied with community standards. If we don't know a mom's status and transfer, she gets treated as though she is postive- and gets antibiotics and baby observed. a mom gets antibiotics in labor. She is also seen as irresponible for not testing for something as "deadly" as strep, and the nurses and doctors are more likely to be punative with her and give her less leeway in other decsions that are important to her like how long the cord can pulse, or how long they will wait to do the exam on the baby before whicking it away to be weighed, etc. This is not right of course, but it is reality....

So when I started my practice I tested everyone, but let them decline treatment unless risk factors appeared, or just let them decline with informed consent. But guess what, all three of the people who were positive and declined treatment had babies that had strep related problems after birth and needed IV antibiotics in hospital for 7-10 days. So, my expereince was really crappy with "informed consent" to decline the treatment. How can you get a mom to realize she may have to be seperated from her baby 10 days due to problem that occurs 1:200 times? I felt like the hassle of an IV in labor was less of a hassle and better for the baby than being seperated 10 days. So I hate doing it, but I screen everyone, and treat with IV antbiotics in labor, and aim to get in two doses before baby is born. I think it is easier for mom to bite the bullet and get two doses of antiobiotics and disrupt the homebirth vibe a bit than to risk her newborn getting sick and having to get IV antibiotics for 10 days.

Also, let me cop to the fact that I also make decisions on the larger picture of what is good for the majority of women in my practice, as well as individualized care plans. If I let a single woman "informed consent" her way through something way out of community standard, I quickly become a frowned on midwife and my clients get hassled. I have great back up, with tons of leeway. But by complying to community standards on things like B-strep, I am serving the majority of my women in the best way. My back ups (nurse midwives and a kind OB) are gods as far as how well they treat my women on transfers. I can take someone in that most OBs would section in a minute, and they will carefully take all the time in the world to treat my clients with respect and help them acheive the lowest tech possible, vaginal birth even if it is very inconvient for the doc. My doc does what is good for women, not what is easy for him. Having this relationship is worth it's weight in gold- it protects women from unnecessary c-section, and allows people with mild complications to stay in my care casue I can co-manage them with the doc (like thyroid, or other minor variations). It also means we don't have to be afraid to transfer- if we need to go we know we will be treated with respect, the cord won't get cut too soon, baby won't be whisked away against their wishes, the family won't have to go into defensive childbearing mode, and their birth can still be powerful and sacred. We have peopel we can trust to do a birth as we like it in the hospital. And part of how we get that is by doing things that are generally conisdered good practice- like treating strep, and not letting things go too far at home if stuff starts looking bad.

So, back to B-strep- holistic approaches are good for strep, but won't necesarrily address all the problems. And problem is it is all hit or miss- there is no research on any of it. If you transfer to the hospital, they won't recognize anything you've done except IV antiobiotcs as a treatment and will treat you anyway, and maybe cop an attitude with you. And, the approach you take must be tailored to your situation. If it's in your urinary tract, or rectum, vaginal suppositories of tea tree won't do diddly- you are barking up the wrong tree so to speak. Also, there is data that hibiclens kills B-strep and it is being researched as a treamtment for us ein thrid world countires. OSme homebirthers like to use a dilute form as a douche or wask to prevent strep infection, but again, not recognized as stnadard of care. It is something midwives in states where they can't do antibiotics use sometimes, I know.

So how I handle it is I let people know when they are interviewing me how I feel about this- it is a non-negotiable to me to treat if we know you are positive. Then, if in my care I give people the Glorida Lemay info in a hand out at 28 weeks and tell them how to reduce chances of being positve by cultivating a healthy vagina flora and generally being in good health. If someone had it before, I encourage them to use some of the ideas on the sheet- garlic (though my ayurvedic herbalist friend thinks pregnant women should avoid pitta/heating food like garlic and thinks that is scandalous to have pregnant women on garlic, and even I think hot pepper is to pitta producing, so I never recommned that even though some midwives do), yogurt, acidophilous, good health, sleep, vitamin C, grapefruit extract, tea tree oil (must be very good quality only and be careful it could effect the central nervous system of baby it is concentrated big guns stuff). It is also imporant to have vaginal walls in good shape- if you have had yeast or other infections then the skin integrity is bad, it gets little fissures, and that provides more places for bad bacteria to grow. Aviva Romm's Natural Pregnancy book has some recipes wash/suppositories you can make to heal inner tissues. They have calendula, comfrey, and mild antibacterial herbs in them. Then, I test at 36 weeks, and treat if postive. Generally, moms know the deal ahead of time andwe work together so I end up trying to get there at least five hours before the birth, so they get their two doses. I get the ones I treat on acidophillous to counter the effects of the antibiotics. If I get to birth and there is no time to do an IV, like she is close to pushing, we may do an injection but won''t mess with trying to get an IV in a woman in transition. If we don't get in both doses, I have her fill out a paper of her baby's temp every four hours and give her warning signs to watch for. I have everyone see a ped in 24-72 hours, so the peds will sometimes want a blood culture if mom missed her medication in labor due to a quicky. Other peds have actually wanted to hospitalize babies for observation- we just stopping using those folks!

Anyway, that's my spiel. I am 36 weeks, and got tested this week for it. I really don't want IV in labor either, but didn't so a special regimen ahead of time. I just hope it's not an issue.....I've never had an IV and don't want one, but guess I will get it if I am postive.

Heidi midwfe and mom to be in Florida
Due Jan 28th with my first

HERE IS THE GLORIA LEMAY INFO I GIVE- but I cross off the colloidal silver since I think metals in pregnancy are a bad unproven idea.... and I warn in case by case basis about hot peppers and garlic-Other things that are good are manuka oil, specific against strep, and clove tea, what they drive in india last two weeks of pregnancy- it's very anibacterial and anti viral....

B Strep Holistic Approach
-by Gloria Lemay and by Karen Ehrlich, CPM, LM

The concern about Strep B involves two groups at high risk of infection:

l. Premature infants under 37 weeks gestation

2. Any infant in utero with membranes ruptured longer than l8 hours

Contractions are a possible indicator of infection but this is a concern in weeks 0-36. After 36 weeks, Braxton Hicks are normal and a good sign of a healthy, toned uterus getting ready to push a baby out. Strep B in the vagina is not necessarily illness-related. Just as we commonly have Strep A in our throats on a swab and have no sore throat symptoms, so from one day to the next can we all culture positive for Strep B without any symptoms or danger to our unborn babies. This is why many practitioners refuse to test for it and simply wait to test until such time as the above two "at risk infant scenarios" show up. One day you might test positive and the next be negative. To treat with antibiotics before labour would NOT be recommended. Your body could build up a resistance to the antibiotics and so could your babe's body. Then, if either of you got a more serious infection after the birth, the antibiotics might be ineffective. It can also lead to thrush, vaginal yeast, and severe colic in the months after birth.

I would advise you to do as many things as possible to minimize your risk of ANY infections and maximize your immune system. Some safe suggestions:

· Boost Vit. C in your diet. For instance, eat 2 grapefruit per day. Other good sources of Vit C : are red peppers, oranges, kiwi fruit. Consider supplementing with Vit C- 500 mg with 200 mg bioflavonoids

· I THINK THIS IS A BAD IDEA_ Capsicum (cayenne pepper) is higher in Vit. C than any other known substance, *and* chases bacteria and viruses from the body.

· I THINK THIS IS A BAD IDEA IF YOU HAVE PITTA IMBALANCE OR ARE HOT BY CHINESSE MEDICINE STANDPOINT........Garlic! lots of garlic! antibiotic, antifungal, antiviral- and lowers blood pressure and cholesterol to boot. Twice a day take two 580 mg capsules.

· Twice daily use grapefruit seed extract - 15 drops.

· Supplement with the helpful bacteria acidophilus , twice daily take 4 billion cells per dose

· Drink a cup of Echinacea tea or take 2 (350 mg ) capsules of echinacea every day capsules - two capsules. Take echinacea for only two weeks at a stretch, with a break of two weeks. This stimulates your body's own immune system w/out it becoming 'dependent' on the herb to keep it in high gear. Don't take echinacea (or St. John's Wort, or ginkgo) if trying to conceive; they interfere
with the penetrability of the egg (sperm can't get in)- also men shouldn't take under same circumstances as their sperm is made less viable.

· Get extra sleep before midnight. Slow down your schedule.

· NO, BAD IDEA.....I DON"T LIKE USING UNPROVEN METALS IN PREGNANCY-Colliodal silver is very dilute, but still, PEOPLE USED TO USE MERCURY MEDICINALLY, REMEMBER......Take 3 tsps of Colloidal Silver per day. Take it between meals. Hold the liquid in your mouth a few minutes before swallowing. Coll Silver can be purchased in most health food stores.It is silver suspended in water. It is antibiotic in nature and safe in pregnancy. Store colloidal silver in cool dark place, away from anything metallic/mechanical (fridges, microwaves/radios etc).

· Plan ahead for extra warmth after the birth for both you and baby. Hot water bottles, heating pads, hot packs, big towels dried in a hot dryer during the pushing phase--will all help you and baby keep extra toasty after birth and reduce stress. Have a friend or family member assigned to be in charge of the "Mother/baby warmth team". The colostrum from your breasts is the best antibiotic treatment your baby could ever get.

· Other good prevention tips: Keep vaginal exams to a minimum--0 is best. Do not permit artificial rupture of the membranes. Do not allow children of other families to visit the new baby for the first 3 weeks. Keep your older kids healthy so they are not sneezing and coughing on new baby.
 

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Heidi, thank you so much for compiling all of that data. It was very informative- and I've printed out the hospitalization recommendations for our ped- who had my girls both stay 72 hours. Thanks again!!!!
 

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Thank you Heidi and Pam!

Heidi, I am curious as to whether midwives in my state can do the "quickie" (20-minutes, I think you mentioned) IV. If so, that may be my best bet. I am counting on being + for GBS b/c I was w/my first, and I'm just planning on the worst while hoping for the best. I will try to find out if they can do that here.

Pam, You mentioned in your post that some places will give the baby an injection of penn. just after being born- what are your thoughts on this? Do you think it is a good/effective idea?

Thanks ladies!
 

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I posted this on another gbs thread, but I'll do it here too:
Hey, I ordered Henci Goer's book Medical Myth vs. Research Reality and nothing in there on GBS testing/treatment or anything is jumping out at me-- do any of you have this book and know if it is covered at all. I don't think it's in there, but I'd be happy to be wrong if someone could let me know where I'm missing it.........
 
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