Constipation and Crohns?

Crohn's Disease Forum

Help Support Crohn's Disease Forum:

Joined
Sep 19, 2010
Messages
4,369
Hi I was just wondering about something and I was wondering if any of you know. Is severe constipation a sign of crohns? I am constantly worried that one of my other kids has crohns. My youngest child has to take miralax or she cannot go to the bathroom. If we forget to give it to her for a few days she will get impacted and we have to disempact her (not fun). When she was a baby she also had very strange stools. They were always green and smelled abnormal as well. Once she started solid foods the constipation issues started. It is just always in the back of my mind could these be signs of crohns or put her at risk for developing crohns? She did have an issue with bloody stools for a while but it turned out she had strep in her behind. (same as strep throat something little kids get) Once she had antibiotics the blood went away.
 
Consitpation can be a sign of Crohn's, particularly when disease is higher in the bowel. Ileal disease can produce constipation due the degree of narrowing that inflammation and scarring can produce. That would not necessarily be consistent with the type of impaction you are talking about though, perhaps she has a functional problem.

In view of Caitlyn's diagnosis I would most likely start to pursue answers.

Dusty. xxx
 
Yes, it's probably a good idea to have it checked considering Caitlyn's illness. However, when Stephen was much younger (maybe 6, 7 years, give or take a year??), he used to get constipated. (Yes, he does have Crohns now but I don't think this was related.) It used to cause him quite a bit of pain. The first time it happened, just the bouncing in the car to the doctor elicited groans!, the doctor suggested a glycerine suppository (just an OTC med) and said that Stephen should hold it in for 10-15 minutes and then go to the bathroom. It working amazingly! As soon as he'd go, the pain would instantly disappear. This happened to him maybe 5, 6 times over a couple of years and then stopped. I think it was caused because he would be playing and would 'hold' it so he could continue playing and, due to his eating habits, ate very little fibre.

Perhaps it was a very early sign of Crohns?? But, in this case, I really don't think it was...
 
I have mainly had problems with constipation so I'd say yes, it could be a sign of Crohn's.
 
Heck YES, it can be!
I have read more than a few stories on this very forum (and elsewhere) wherein the pt presented w/constipation, and whenever I said to any doc that V's sx didn't seem like IBD as she never had diarrhea, they would say, "what about constipation?". Her stools are always normal, though, which in just the few days I've been reading this forum, seems to be not that rare, nor is having no GI sx at all. I find that kind of fascinating.

At risk of seeming weirdly fixated on fecal lactoferrin, ask for it to be done on a stool specimen of the constipated child. Quick, easy, noninvasive and RELIABLE (according to V's doc) for inflammation in the gut and nowhere else. He loves this test, has ordered it done every two weeks hence to assess her response to Humira.
 
Rosalyn doesn't get can't-go-for-days constipation, but she has the strain and push for long periods of time red-face, eyes-watering type of constipation with bowel movements, most days.
She only gets diarrhea for a stretch of half a day or 2 days at most, every few weeks. The rest of the time, it's the constipation & straining.
 
Kim, nor had I prior to her getting sick. I knew about sed rate and CRP, but had never heard of this. Her pediatrician actually was the first to order it when she was seen at the beginning and the GI has always done it often.
It measures a byproduct of WBC's. If present in stool it indicates gut inflammation, unequivocally.

When hers was sky high as it always is but she felt great as she always did until Oct, I asked if there were any other possible reason for it to be elevated in feces other than gut inflammation, and was told no, it is specific for inflammation in the gut.
NOT specific as to the REASON for the inflammation, that is, a gut that is inflamed for reasons other than Crohn's would also have high lactoferrin, so it must be done in conjunction with other diagnostics in a pt not yet diagnosed. But when seeking an answer as to whether inflammation is present, as a precursor to doing further diagnostics, it can answer that part of the question easily.

Julie
 
Hi All,
So Sophia my little one had a few bad days of not wanting to eat and complaining and complaining that her tummy hurts. No fever, diarrhea. (she actually had normal bowel movements just a little more frequent. Today she was pretty much back to her normal self except for complaining this morning that her legs hurt. I spoke to the nurse at Caitlyn's GI and she said she will speak to him about seeing her. I am sooo worried and hoping I am just crazy and she is really fine. ABout that lactoferrin test the nurses said they never heard of it. I did read up on it and interestingly you cannot do it on a nursing child. Even though Sophia is 3 I am still nursing her because I read prolonged nursing may help prevent crohns disease. I had planned to stop but decided to continue because of her stomach issues.
 
Good luck Kim!!! I truly hope it turns out not to be Crohns! Can you do a calprotectin test? From what I've read here, the tests/results are similar.

Will keep you in my thoughts!! :ghug:
 
Thanks Tess, I looked up that test it sounds promising. I am sooo stressed out I just drank a half glass of wine to try to relax!
 
Gosh, just down the other half! :). But, I know... Once your mind starts racing, its almost impossible to stop it! I hope you can get her in quickly and, hopefully, all that will come out of it will be peace of mind! :ghug:
 
Yes, lactoferrin is secreted in breast milk (and tears) so on a breastfed child may have skewed levels.
So sorry to hear this, God I hope it's just IBS. That can cause similar symptoms to IBD. :kiss:
 
The nurse from Caitlyn's doctor called. She has an appointment next week. (which I did not know about I think it was put in by accident) ANyway she said she mentioned to the doctor about Caitlyns sister and that we can discuss it at the visit. I will keep you posted.
 
yup....thats how i got diagnosed. was in the hospital because i hadnt had a bowel movement in over a month! did a colonoscopy and found my crohns.
 
They may know it as fecal calprotectin. That's what Claire's doc orders along the labs.
 
Hi all,
It has been a while since I updated about my other daughter Sophia. She was doing really well until about two weeks ago she started complaining frequently about her stomach hurting. The weird thing is her bowel movements have been much better. Less constipation and she has not needed the miralax in a while. She does seem to go a little more frequently but mostly normal movements. No blood, occacional loose stools. Anyway this morning something weird happened with her. She had a very strange heart beat. Her heart was skipping a beat, then getting irregular for a few beats then back to normal for about eight to ten beats then did it again. I called the pediatrician and they got her in right away with a different doctor not our usual one. She said young kids ( she is four now) can have such things and it can be normal but to be safe we need her to see the cardiologist and she got her in for an appt next week. I also mentioned about the stomach aches and the history of crohns in her sister. She asked did I want to take her right to the GI as well. I suggested why don't we check a fecal calprotectin first and see what it comes back? She liked that idea, once I explained what the test was as she had never heard of it before. I got the lab slip and the cup. I am very pleased about this as I didn't want to be seen a mom who panics at every little thing but she was really sweet and asked me to ask the GI next week if it is a good idea to screen all the kids in the family with this test to kind of get a baseline because there is such a high familial association( I think it is a 30% chance of a sibling developing crohns). I really liked her and am going to try to see her from now on.
 
Doesn't it just make you feel better when they understand, my younger son was having lots of tummy issues, stomachaches, diarrehea, etc. and with a brother and father with Crohn's you can understand why I was extremely worried but the pediatrician just poo-pooed it as me being overly concerned. Needless to say he retired and the new doc who just happens to have UC, when I once again voiced my worries and saying what had been going on for the past year was just as concerned as I was and scheduled blood tests to check for markers for Crohn's, celiac, etc. and a referral to Jack's GI. All his tests came back normal (YEAH!) but he is lactose intolerant just like me. Good thing is he is on the doc's radar now and they are always asking how the intestinal issues are going.
 
It is so fab to hear that you happened upon a doc that listens to and validates your concerns! That is priceless! :)

I do hope all is well with Sophie Kim. I will be thinking of you both over the next little while and wishing and hoping that all is normal. :hug:

Dusty. xxx
 
We dropped off the sample for the fecal calprotectin yesterday morning. Does anyone know approx how many days it takes to get the results? :poo:
 
Ours took about a week to get results back the two times we did.
Beware kids under 9 are "normal" with a level less than 160 I believe.
Over 9 the level drops to 50 for non Ibd kids .

Also if the disease is in the small bowel the number may still be normal .
Since constipation and Ibd tends to be small bowel related .
If the colon is affected then you get diarrhea and high fecal caloprotectin numbers.

Hugs
 
Sorry, for some reason I am just catching up with this thread. Hope your little one is feeling ok at the moment, good luck with the GI and cardiologist. That's good that they will be seeing her quite quickly. As for the calprotectin - ours takes about 4 to 6 weeks to come back, but not sure whether that's just the med system over here or whether it takes that long to culture whatever it is they need. Waiting for Amy's but only handed it in a week ago so we have a long wait!
 
Finally got the results of the fecal calprotectin yesterday the doctor said it was normal. My daughter has been having more stomach aches though. Also after having a BM she has been having blood on the toilet paper and complaining her butt hurts her. I looked and don't see any fissures or anything I am wondering what is causing this? Does anyone know if it is possible to have an internal fissure that you can't see from the outside?
 
I'm so sorry to hear that your daughter is continuing to have issues Kim. :hug: I love normal results but they are of little comfort when problems persist. :(

Sometimes fissures can be very difficult to see with the naked eye but they are characteristic of the tear being largely external in nature rather than internal.

I hope you are able to find answers soon hun and your daughter can find relief from the symptoms she is having.

Dusty. xxx
 
That's a shame she is still having the stomach pain, especially since the test was fine. I'm sure it's possible to have a fissure internally - I would imagine it would be quite hard to heal so it's possible the blood is just coming from just inside. Never had to deal with a fissure, but maybe there is a cream or suppository she could put inside to help?
 
Hugs
Another one here with consistently normal results.
We still had issues until DS had the right meds
Has she been seen by a Gi ?
If not I would take her.
 
Would the FC test reflect any issues with her stomach (opposed to the small or large bowels)? Could it be possible she has some inflammation in her stomach only?

When Stephen's had some issues with fissures, he's found that sitz baths with epsom salts have helped as well as using penaten lotion.

:ghug:
 
FC typically is the most accurate for the large bowel.
It will not reflect inflammation in the upper Gi tract and is marginal in the small bowel.
 
MLP, I've wondered about this since you posted this in a previous thread. C's inflammation is located in his TI or that was where it was seen with MRI and colonoscopy at dx. His FC level a month ago was 1200, so now I'm wondering with the level that high is it that the inflammation has moved to large bowel or is TI low enough in small bowel that inflammation shows up on FC?
 
[A prospective multicenter study was conducted by Gisbert et al. (2009) to determine the role of fecal calprotectin and lactoferrin in the prediction of inflammatory bowel disease relapses. A total of 163 patients with ulcerative colitis (UC) (n=74) and Crohn's disease (CD) (n=89) who had been in clinical remission for 6 months were included in the study. At baseline, patients provided a single stool sample for calprotectin and lactoferrin determination. Follow-up was 12 months in patients showing no relapse and until activity flare in relapsing patients. Twenty-six patients (16%) relapsed during follow-up. Calprotectin concentrations in patients who suffered a relapse were higher than in nonrelapsing patients. Relapse risk was higher in patients having high calprotectin concentrations (30% versus 7.8%) or positive lactoferrin (25% versus 10%). Fecal calprotectin (>150 μg/g) sensitivity and specificity to predict relapse were 69% and 69%, respectively. Corresponding values for lactoferrin were 62% and 65%, respectively. Better results were obtained when only colonic CD disease or only relapses during the first 3 months were considered (100% sensitivity). The investigators concluded that fecal calprotectin and lactoferrin determination may be useful in predicting impending clinical relapse-especially during the following 3 months-in both CD and UC patients. This study did not confirm the utility of such findings in improving care and outcome of patients.
Garcia-Sanchez et al. (2010) performed a prospective study of 135 patients diagnosed with IBD in clinical remission for at least 3 months. All patients were followed-up for one year. Sixty-six patients had Crohn's disease (CD) and 69 had ulcerative colitis (UC). Thirty-nine (30%) suffered from relapse. The fecal calprotectin concentration was higher among the patients with relapse than in those that remained in remission. Patients with CD and calprotectin greater than 200 μg/g relapsed 4 times more often than those with lower marker concentrations. In UC, calprotectin greater than 120 μg/g was associated with a 6-fold increase in the probability of disease activity outbreak. The predictive value was similar in UC and CD with colon involvement and inflammatory pattern. In this group, calprotectin greater than 120 μg/g predicted relapse risk with a sensitivity of 80% and a specificity of 60%. Relapse predictive capacity was lower in patients with ileal disease. Larger studies are needed to demonstrate that fecal calprotectin testing has sufficient diagnostic accuracy to provide clinically relevant information when compared to other currently available diagnostic tests to allow for clinical decision-making

From:
https://www.oxhp.com/secure/policy/fecal_calprotectin_testing.pdf


a ccfa conference I went to stated unlike adults with Ibd - kids tends to spread during the 10 years from dx.
Mini med school on Ibd environment vs gentics by silva forest md ( Canada) was where I heard the small vs large bowel and fc .
 
MLP,
Thanks for the info. We are trying to get her an appt with Caitlyn's GI doctor. I am awaiting a call back from her. When I called to make an appt they did not have one for three months. I know if I speak to her she will get her in quicker. Meanwhile it seems like everything My little one is eating is causing her pain :( she doesn't have diarrhea just pain and hard BMs. She worriesmeso much. Hopefully tomorrow I will speak with the GI.
 
Good luck in the am
Hugs..
We were so there last year with DS - hard stool pain etc..
Not pleasant for anyone let alone watching your child go through it.
 
Thanks MLP I appreciate the links. Kimmidwife, I hope you are able to get the lo in to see Caitlyns GI soon!
 
Sorry to hear she is suffering again. Hope you manage to get the appointment sooner! I am also confused as to the role of the calprotectin. My daughter is really suffering but because her calprotectin came back normal all the paediatrician said was "well it's definately not Crohn's then"
 
Sascot,
From what I haven been hearing and reading you can have a normal calprotectin and still have active crohns. It is just one tool used and should not be the definitive answer, scopes are still the standard for diagnosis. I can't remember has your daughter had a scope?
 
Kim - I'm so sorry to hear Caitlyn's still having pains!!! :ymad: I'm hoping you can get an apptmt SOON!

Sascot - from what I've read, calprotectin results will probably indicate inflammation in only certain areas (large bowel), it might not reflect inflammation in the small bowel.
 
Tesscorm I was told that also! Sascot what did her calp. number come back as? Grace was 60 something. Again doc said if it's upper GI it might not "read it" as well.

Kim I'm so sorry to hear she's still so poor. I completely understand. I hope you get answers soon.
 
Tess,
Caitlyn is doing Ok it is her little sister who is having issues. Okay so we got her an appt for Dec 11th with Caitlyns doctor which is only a month off so I am a little happier with that compared to 3 months but now something weird is going on that I wan to ask you all about. THis week when I picked Sophia up from school on Thursday she complained that her bottom was hurting I looked and saw she had some poop in it and thought she had gone to the bathroom and not cleaned up well after. I cleaned her up and we went home. At home a few hours later we were sitting on the bed and she suddenly said I just went poo in my underwear. I looked and sure enough she had a small amount of mucousy watery poo in her underwear. Changed her and she was Okay until this afternoon it happened again and this time there appeared to be a little blood in it. I have not seen her have a regular poop in a few days but sometimes she will go and not tell me. I am not sure what to make of this. Has this happened to any of your kids?
 
Hope I am not jumping in where I shouldn't be but it sounds like the loose stool that can leak around constipation. Many people can not control it and it just sneaks out. Apparantely you can go everyday and still have constipation if the bowel is not evacuating properly.
 
Sorry Kim, don't have any real advice... Stephen had mucus when he was initially diagnosed with small specks of blood but he never had any 'accidents' that I know of... of course, quite a difference in their age... :ghug:
 
Hugs...
DS had that more than a few times last year .
His rectum was inflamed which led to the constipation and small stuff would leak around it .
Does the ped still have her on miralax?
We would have to increase the dose almost to the point of D clean it out and start over again. If we decreased the dose too much it would happen again .
Once the inflammation was under better control we could decrease the miralax.
Remicade was the only thing that permitted us to stop the miralax.
Glad you have an appt in Dec.
 
While it is true that Crohn's can be on the differential diagnosis list for constipation it is waaaaaay down the list. My son presented with constipation but he also had long standing growth failure (3 years), anemia, fissures and skin tags, LRQ mass and belly pain. It is my impression that it would not be typical for the only symptom to be constipation. Possible but not typical.

The leakage you're seeing is called encopresis. It is a typical progression of constipation and I'm not surprised that you haven't seen her poop in several days. Encopresis means she has a solid mass basically stuck in the colon and stool is leaking out around it.

I think it's good that you have a GI appointment. Hopefully they can help.

When my son's constipation was severe (10+ days without pooping) our doc had him do mineral oil. This worked every time. I have heard that most docs don't use this any more but our does when miralax doesn't work. So you might want to consider that. If you do, be forewarned, it comes out bright orange.

If you haven't tried an enema, you may want to do that now that she is having encopresis.
 
Thanks for the advice. it happened again this morning. the weird thing also is the past three days she has not complained of her stomach hurting.
 
Assuming it is constipation and not anything else, that is most likely because she has developed mega colon and lost the normal ability to sense when her rectal vault is full and she needs to go.

Have you done any reading on constipation? If not you might want to review the information here:

http://emedicine.medscape.com/article/928185-overview

It is very thorough and helpful information.

When she has pain, is it in the upper right quadrant or across the top of her tummy under her rib cage?
 
I know I've mentioned it on this site before but, can't remember if I've mentioned it to you, Kim.

When Stephen was around maybe 8 years (I've forgotten now...), he would periodically become constipated and it would cause him lots of pain in his abdomen area. His GP once suggested glycerin suppositories and they were a miracle for him!!! We would insert one, he'd 'hold' it and then have a BM 10-15 minutes later and ALL the pain would be gone. You may want to ask the doctor, or at least the pharmacist, first however, I wouldn't want to suggest you try something and then have it cause problems! :eek:

:ghug:
 
Yes Grace uses those now. Glycerin suppositories are the best! Our GP said he'd rather have Grace use those then Miralax. Like Tess said have her walk around a few minute. They need time to melt. We don't use the Glycerin enemas anymore as they caused a lot more pain to put in.
 
Hi Kim,

Just getting caught up on this thread. My oldest daughter was encopretic (no IBD) and yes the soft stuff leaks out around the hard. I would say though that the presence of blood would escalate the concern. My daughter also had rectal prolapse from trying to hard to push her backed up poop out and you definitelyt don''t want that. Best to get n top of this constipation with a doc onboard now.

I know we all think of the GI's as IBD related but even if a child doesn't have IBD, severe constipation is most certainly in their realm. Especially with the appearance of blood and mucous. I would call and see if you can't get that appointment moved up.

Good luck!
 
Hugs
Another one here with consistently normal results.
We still had issues until DS had the right meds
Has she been seen by a Gi ?
If not I would take her.

I agree- sorry to hear the pain is persisting and test results don't show anything. I was the same before diagnosed, and by then I had 70cm of stricturing, so persist with the gi! I'm taking my daughter at the end of this month, but already I'm worried about possibly having no results from stools and bloods alone. So if there's still pain, I wouldn't just leave it. Best wishes xoxo
 
Hi All,
Patricia when she is in pain she says it around her belly button area.
She finally had a bowel movement last night and it was totally normal and she did not have such a hard time with it either. No blood in it.
 
With kids it is apparently typical for belly pain from anywhere to feel like it's around their belly button. Just thought I'd ask.

The reason I asked about whether she had pain in that area is because she might experience pain there if she is backed up. The transverse colon comes across the belly and up around the stomach before making a sharp u-turn to become the descending colon. When there is FOS (full of stool) issues there may be a lot of pressure in that spot because of the anatomy.

Here's my best advice to you. Even if she turns out to have something more serious, these are things that will serve her/you in the long run:

if you haven't already done it, to set up a rigid toilet routine and stick to it no matter what.

If she won't go to the bathroom at school try to problem solve that issue with school staff. Maybe she'll go in the nurse's bathroom or something.

Do not give her too much attention for the pain. Give her practical tools to help like hot packs, warm drinks, sitting on toilet when she is feeling discomfort but focus on being matter of fact about it. If possible make them things she can do for herself with minimum involvement from you or other adults.

Try not to show her how distressed you are by her pain or by delays in getting appointments, etc.

Keep written records. Especially track when she goes, when she has pain, degree of pain and how long it lasts, when she ate, physical activity

Dietary interventions for constipation include apple juice, pears in any form, apricot nectar/fresh, cherries. Avoid bread, milk except yogurt, rice etc. Encourage vigorous exercise.

Hang in there. I hope she will feel better soon.
 
Thanks Patricia! She went again tonight but a small amount and like hard little rocks. Then again an hour later complaining of tummy pain. I am definitely noticing a correlation between her eating and then complaining of pain afterwards.
 
Sophia my little one is seeing the GI doctor finally tomorrow. Of course today she told me Mommy my tummy does not hurt anymore! LOL
 
:rof: apparently she met my older son- who went to the docs for a broken toe ( it doesn't hurt now)-
It was still broken by the way.

Good luck at the GI's:hug:
 
Hi! We have constipation here -- and normal labs. She did have ileal inflammation on her scope (as well as large colon), though. She's still undiagnosed. The doctors really do not take kids with constipation & normal labs very seriously. My father-in-law, dad, and brother all have IBD, though, so it is in our family, too. I hope your GI will listen -- ours won't. He won't even order a feacal cal!
 
Hi all,
The doctor was wonderful! I really like her. She really listened and right before we saw her Sophia went to the bathroom and it had blood in it. I was able to get a picture and show it to her. She said we are going to start with blood work and then make a decision on whether or not she needs scopes. I was very happy with that.
Also asked about Caitlyn's biopsy results. She said she couldn't remember 100% but she was 99% sure they came back normal with no inflammation seen. She is going to double check and email them to me. I will keep you posted as soon as I receive them.
 
Thanks for the update Kim. :)

It is so good to hear that you have been given a plan and direction! YAY! :hug:

And fab news about the biopsies! :)

Dusty. xxx
 
hi kimmi ive just read your post and it sounds just like lewis with the constipation and sometimes watry leakage . lew has never had runy poo . he takes laxatives morning and night he trys going sometimes but just water goes out . i do hope she dosnt have crohns as i no you suffer with ur other child. i to get concerned for my daughter who is 9 she.l say my tummy hurts then get a runny poo then she.ll start with a tummy bug . as mad as it sounds im kinda glad its a tummy bug . hope you get the answers you need .take care em
 
Since most people in general are low on Magnesium, and even more that have IBD, I would consider using Magnesium Oxide as a laxative.

Mg Oxide is not absorbed as well as other forms, but it does have a laxative effect. It is safe and cheap, and you can kill two birds with one stone.

For children you should consult you doctor for dosage and any other considerations.

Dan
 
Hope things are ok. That is good the she thought the biopsy was good. Hope the blood tests go alright for Sophia
 
Caitlyn is feeling better although last night she was really not feeling good. But Sophia has a bad cold and I think caitlyn may be getting it as well.
 
Today I am sick in bed but caitlyn and Sophia are feeling better so I am happy! Gonna stay in bed all day. Hopefully be feeling better by tomorrow and ready to start the week.
 
Good to hear the girls are better Kim :) but not so good for you though. :hug:

I hope you are able to stay in bed and get some decent rest and are feeling much better on the morrow. :heart:

Dusty. xxx
 
Taking Sophia for her blood work today. Not looking forward to it. But I plan to drop her at school afterwards and let them deal with her. Lol, last time she had bloodwork done she was six months old and after that refused to wear long sleeves for six months!
I am still sick can't seem to shake this bug. To much stress. I am looking forward to two weeks off from school starting on Monday.
 
Good Luck with blood work and hope your are feeling better to enjoy the weeks off. We start break on Friday, 1/2 day of school on Thursday. I can't wait!
 
Hi all,
Sophia was great with the blood work but I don't know if it will go so smoothly next time. She did not know what to expect this time. I bought her some presents from the dollar store after and she felt much better. Counting down the days till school holidays! ( hopefully the world won't end on the 21st like the Mayans supposedly predict!) I guess we will know on Friday! I have been watching all these shows attempting to explain that the Mayans really did not mean that the world will end plus they did not account for leap years so supposedly the date they predicted was seven years ago.
 
Glad it went smoothly this time!!! C recently had to have a flu shot and even though he gets blood draws often and an remicade infusion every 6 weeks he was stubbornly adamant that the flu shot was not happening. All the way to the dr. office he protested and then he's giving me the stink eye as the nurse readies his arm, turns out he didn't even realize when she did it! HA! So I'm hoping it goes easier next year!
 
That is funny Clash!
Dusty,
I am finally feeling better. I ended up starting myself on a zithromycin pack. My old doctor in St. Louis had given me an extra one because it seems like every time I get sick I end up with strep or a sinus infection and since I was not getting better and it felt like it was moving into my sinuses I knew I needed an antibiotic. Today is the last dose and it has finally kicked in.
 

Latest posts

Back
Top