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[surfacehippy] Back from Belgium
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On Mon, 22 Jun 2009 08:03:25 -0000, "vicky4vi" <...@comcast.net
Hi Fellow Surface Hippies,
Too soon to resurface? The topic of joint space narrowing was a topic that came up in conversations in the evenings at the conference, during casual conversations. It was not brought up during the conference itself. I am hoping there will be a conference soon that Dr. Vijay Bose will be on the faculty again, I hear through the grapevine that there will be. He has SO much to add and can teach so many surgeons about his finding regarding AVN, joint space narrowing, angles, etc. What he and other Asian surgeons have learned about AVN, causes of it post resurfacing and how to resurface AVN cases successfully. AVN is an epidemic in the Asian culture for unknown reasons. Dr. Bose is working with a Korean doc and I believe a Japanese doc and they spend much of their time traveling and lecturing and teaching on the subject. Between the 3 of them they have done well over 1000 AVN cases, Dr. Bose leading the way in being the world expert in AVN for hip resurfacing patients. I advise and strongly suggest to anyone that has AVN to consult with him as well, prior to having resurfacing surgery with any doc. Not that you have to go to him, but some docs have said they would resurface the patient and Dr. Bose has adviced them to wait, others have said they are not candidates (with AVN) and Dr. Bose has said they were ideal.
That is why you will not see Dr. Bose numbers climbing like some other docs, due to all of his work, advancing the "fix" for AVN patients as well as his belief in the resurfacing cause. He is in the process of publishing a very important paper right now. But that in no way is indicative of his expertise in doing the procedure, just because his numbers are not climbing so quickly like some of the other docs. As I have told many, WHEN I need my right hip done, he is the only surgeon that will touch it. I have saved emails from him that he wrote to me back in 2005 stating his beliefs in papers that are just now being published by others, in other words, things Dr. Bose already knew back then. Many docs have adopted Dr. Bose methods, some will not admit they have, but it is clear in looking at live surgery videos that this is the case.
Those of you attending the hippy gathering on July 11, in the SF Bay area, will get a lot of info that I will not post, one of the advantages of attending these gatherings, getting some inside info. :-) It is still not too late to book your flights, Chris Saunders is flying out from Canada, last time Paul flew in from Chicago, I have patients fly in from all over. These are the largest hippy gatherings ever (Usually at least 50 patients and soon to be patients) that take place with patients that have had all different devices from many different surgeons and even some failed resurfacings attend to share their stories, like the last time. One patient attended that was revised to a THR, one that just had the cup revised but the resurfacing was saved, another that went in and ended up with a THR.
This case, Connie, is a very good close personal friend of mine and my family. Those that attended my hippy gathering met her. She is very happy with her MoM THR today installed by Dr. Bose. It is the perfect story of when a resurfacing is just not possible.
http://www.surfacehippyinfo.com/Stories/20081207228/Complications/43-year-old-f emale-patient-with-Advanced-AVN-Receives-a-large-Metal-on-Metal-Total-Hip-Replac ement/menu-id-30.html
You will see copied versions of this that I consider blatantly plagarized, because this personal friend of mine asked that her surgery photos be removed from another site and that person, (the owner of that site), chose to ignore that request, instead just removed my friends name or the fact that I had provided the information for that site. Connie has been a close friend for well over 20 years of my family.
I just got home from the airport a little over 4 hours ago, took a shower, started to unpack, uploaded my photos so I would not lose them and now need to go rest. The plane ride from Chicago (Brussels to Chicago, then Chicago to San Jose, CA) was the longest ever as far as how tired I felt. Well 2nd longest. It was close to the same flight I took post op coming back from India. The India one was the worst as far as being tired, but this felt really close. I barely had ANY sleep at all during the conference!
I had dinner with Dr. Su and Dr. Rogerson last night. Wow, what a pleasure, two top notch surgeons indeed. It was some great conversations. As you are all aware, I can talk hips 24/7 and be perfectly happy. :-)
Bringing so many case files with me, (anonymous patient files with background, x-rays, some pre-surgery some post op with problems) all that asked me to take their files with me to get opinions.
I had the opportunity to present them at times to a group of docs, like 5 or 6 of them at a time. It was clear to me, the docs that had the confidence in diagnosing the cases and the ones that were not really sure or second guessed themselves after hearing what some of the other docs said. After all, they are all only human and it is wonderful to g
I feel so fortunate to be able to call most of these docs my friends now. The video interviews with Mr. Andrew Shimmin and Mr. Mark Bloomfield also went really well, what a kick they both are.
The Gala dinner was incredible. I sat next to Dr. Mont and got a chance to get to know him as a person, that was a real pleasure. I will be attending his conference early September and have several video interviews already tentatively scheduled then. Also sitting at my table were Dr. Kim from Ottawa and his lovely wife, Dr. Gross and his beautiful wife, (they brought their 4 kids to Beglium) of course the kids were not at the conference. :-) Dr. Rogerson, Dr. Rubinstein, Mr. Mark Bloomfield. OK, it is getting way too late. More later....
Vicky
LBHR Dr. Bose Dec 01 05
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On Mon, 22 Jun 2009 19:05:49 -0000, "vicky4vi" <...@comcast.net
Somehow this sentence was cut off
I had the opportunity to present them at times to a group of docs, like 5 or 6 of them at a time. It was clear to me, the docs that had the confidence in diagnosing the cases and the ones that were not really sure or second guessed themselves after hearing what some of the other docs said. After all, they are all only human and it is wonderful to get them all to share ideas and thoughts on diagnosis. There will always be differing opinions and for the top docs to be able to share each others views only teaches each one more. As many of the surgeons that have done over 1000 resurfacings always say...there is always more to learn.
Vicky
LBHR Dr. Bose Dec 01 05
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On Tue, 23 Jun 2009 11:35:21 -0700 (PDT), Kelly Maer <...@yahoo.com
Hi Vicky,
Can you explain the major differences between the MoM THR that you describe your friend having and hip resurfacing in terms of the type of activity level one can return to with each. Also, does the MoM THR completely remove the bone?
Thanks,
Kelly
________________________________
From: vicky4vi <...@comcast.netTo: surf...@yahoogroups.com
Sent: Monday, June 22, 2009 12:05:49 PM
Subject: [surfacehippy] Re: Back from Belgium
Somehow this sentence was cut off
I had the opportunity to present them at times to a group of docs, like 5 or 6 of them at a time. It was clear to me, the docs that had the confidence in diagnosing the cases and the ones that were not really sure or second guessed themselves after hearing what some of the other docs said. After all, they are all only human and it is wonderful to get them all to share ideas and thoughts on diagnosis. There will always be differing opinions and for the top docs to be able to share each others views only teaches each one more. As many of the surgeons that have done over 1000 resurfacings always say...there is always more to learn.
Vicky
LBHR Dr. Bose Dec 01 05
--- In surfacehippy@ yahoogroups. com, "vicky4vi" <...@... resurfacing patients. I advise and strongly suggest to anyone that has AVN to consult with him as well, prior to having resurfacing surgery with any doc. Not that you have to go to him, but some docs have said they would resurface the patient and Dr. Bose has adviced them to wait, others have said they are not candidates (with AVN) and Dr. Bose has said they were ideal.
[Non-text portions of this message have been removed]
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On Tue, 23 Jun 2009 19:37:58 -0000, "Ron van Mierlo" <...@tele2.se
Not Vicky but just the same:
The claims given to both types of prostheses differ, but the extreme range that some say that only hip resurfacing can offer is not exactly correct, neither that only hip resurfacing can offer a return to a normal activity level.
There are may variables involved that can positively or negatively influence either type and the result that the patient experiences. The patient's present flexibility and condition, the surgeon's experience, the type of prosthesis used (there are 15 hip resurfacing types and even more shaft/head combinations for the MOM THR versions).
A great advantage of any MOM joint is that dislocation is just as low as with the natural joint, if the operation was performed by an experienced hip surgeon and once the muscles and other tissues have healed completely and normal strength is regained.
But the THR's shaft, whichever it's length and shape will always be a disadvantage over the hip resurfacing for a number of reasons. Only in extreme sports or an in an extreme line of work the differences of the two prostheses may show, but there are defnite differences, that's why you see younger people, firemen and sportsmen go for resurfacing mainly.
You could reverse the whole thing and ask yourself: Why wouldn't the surgeons otherwise give all their patients a MOM THR if the resurfacing wasn't having advantages? After all, the hip resurfacing is seen by many as more difficult to perform correctly, so if it is still applied it must have definite advantages.
Just to name a couple:
1- The natural head/neck/leg section has flexibility and keeps this even when the femoral cap of the resurfacing is fitted there on the head. This natural flexibility is required to keep the femur healthy, by stimulating bone renewal and strengthening. The THR's shaft and neck on the other hand are rigid and the lack of stimulation that this causes when it is sunk into the cut-off leg is bad news for the femur. The so-called "stress hielding" will occur and the degree of shielding differing with the sizes and forms of the THR shafts.
2- Some blood vessels that account for the nourishment of the top part of the femur are left untouched and in place with hip resurfacing. However with any THR, the whole femoral head/neck section is sawn off and the vessels around the femoral neck are tossed out together with the sawn off femoral head/neck.
3- The resurfacing's femoral cap doesn't touch nor remove any marrow in the leg. The THR's shaft causes-depending on the size shaft used that marrow is partially or the femoral canal completely emtied from it's marrow. Now we didn't have marrow in our bones just for fun....!
4- With hip resurfacing performed, that only touches the outmost surfaces of the hip joint, you still have part of the femoral head and all of the femoral neck. Further in life you can then still have a MON THR fitted if anything would have happened to the femur side of the resurfacing. You have bough yourself time in that way or if it goes as we expect you won't need any further surgery at all. With a THR in place it is possible that the femur gives in at some future stage, for a part depending in the amount of stress shielding present.
The THR shafts have in the past also caused cracks in the femur or loosened for other reasons.
I can name another 6 points but will leave it here...
Why should anyone choose a to the body more invasive solution if less invasive exists?
Ron van Mierlo
--- In surf...@yahoogroups.com, Kelly Maer <...@...
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On Tue, 23 Jun 2009 14:42:30 -0700 (PDT), Kelly Maer <...@yahoo.com
Thank you, Ron. I may need to read this a few times for it to sink in, but I appreciate the information.
________________________________
From: Ron van Mierlo <...@tele2.seTo: surf...@yahoogroups.com
Sent: Tuesday, June 23, 2009 12:37:58 PM
Subject: [surfacehippy] Re: Back from Belgium
Not Vicky but just the same:
The claims given to both types of prostheses differ, but the extreme range that some say that only hip resurfacing can offer is not exactly correct, neither that only hip resurfacing can offer a return to a normal activity level.
There are may variables involved that can positively or negatively influence either type and the result that the patient experiences. The patient's present flexibility and condition, the surgeon's experience, the type of prosthesis used (there are 15 hip resurfacing types and even more shaft/head combinations for the MOM THR versions).
A great advantage of any MOM joint is that dislocation is just as low as with the natural joint, if the operation was performed by an experienced hip surgeon and once the muscles and other tissues have healed completely and normal strength is regained.
But the THR's shaft, whichever it's length and shape will always be a disadvantage over the hip resurfacing for a number of reasons. Only in extreme sports or an in an extreme line of work the differences of the two prostheses may show, but there are defnite differences, that's why you see younger people, firemen and sportsmen go for resurfacing mainly.
You could reverse the whole thing and ask yourself: Why wouldn't the surgeons otherwise give all their patients a MOM THR if the resurfacing wasn't having advantages? After all, the hip resurfacing is seen by many as more difficult to perform correctly, so if it is still applied it must have definite advantages.
Just to name a couple:
1- The natural head/neck/leg section has flexibility and keeps this even when the femoral cap of the resurfacing is fitted there on the head. This natural flexibility is required to keep the femur healthy, by stimulating bone renewal and strengthening. The THR's shaft and neck on the other hand are rigid and the lack of stimulation that this causes when it is sunk into the cut-off leg is bad news for the femur. The so-called "stress hielding" will occur and the degree of shielding differing with the sizes and forms of the THR shafts.
2- Some blood vessels that account for the nourishment of the top part of the femur are left untouched and in place with hip resurfacing. However with any THR, the whole femoral head/neck section is sawn off and the vessels around the femoral neck are tossed out together with the sawn off femoral head/neck.
3- The resurfacing' s femoral cap doesn't touch nor remove any marrow in the leg. The THR's shaft causes-depending on the size shaft used that marrow is partially or the femoral canal completely emtied from it's marrow. Now we didn't have marrow in our bones just for fun....!
4- With hip resurfacing performed, that only touches the outmost surfaces of the hip joint, you still have part of the femoral head and all of the femoral neck. Further in life you can then still have a MON THR fitted if anything would have happened to the femur side of the resurfacing. You have bough yourself time in that way or if it goes as we expect you won't need any further surgery at all. With a THR in place it is possible that the femur gives in at some future stage, for a part depending in the amount of stress shielding present.
The THR shafts have in the past also caused cracks in the femur or loosened for other reasons.
I can name another 6 points but will leave it here...
Why should anyone choose a to the body more invasive solution if less invasive exists?
Ron van Mierlo
--- In surfacehippy@ yahoogroups. com, Kelly Maer <mtnbkr38@.. .
[Non-text portions of this message have been removed]
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On Tue, 23 Jun 2009 21:05:53 -0000, "vicky4vi" <...@comcast.net
Yes the MoM THR does still completely remove the bone and the huge metal rod is still inserted into the thigh which will cause stress shielding. The recent study done only was for one year that said there was no difference in activity level, but with the improper loading of the bone, that stem will end up loosening in the long run with any heave impact. Where with a resurfacing, it loads like a normal hip and some people have found that their bone density has even gotten better with resurfacing.
Take a look at these animation videos
http://www.surfacehippyinfo.com/Hip-Multimedia/Hip-Multimedia/menu-id-101.html
And read this article
http://www.surfacehippyinfo.com/Why-Resurfacing-/Why-Hip-Resurfacing-/menu-id-2 7.html
Excerpt:
Here is an explanation of Wolf's Law, remember, no matter what material is used with a THR device, it still has the long stem.
"... Wolfe's Law of Bone, which is that bone is formed and retained along the lines of stress in that bone. Another way of putting it is: "Form follows function." Look at the trabecular pattern in a calcaneus or a proximal femurit's easy to see where the lines of stress are here, because that's where the trabeculae are. Another way to express this rule is: "Use it or lose it." ..." and " ...What does this have to do with patients with prosthetic joints? Well, in an ideal world, a prosthetic joint component would carry stress and distribute it to the underlying bone in a manner identical to the original bone. Alas, this does not happen in real life. Prosthetic components react to stresses a lot differently than the original bone that they replaced, and tend to distribute it to the remaining bone much differently. For example, in a hip prosthesis, much of the load applied to the femoral component tends to be transmitted to the bone near its distal tip. The bone near the proximal part of the component tends to have less force transmitted through to it. What happens to the native bone that is now no longer receiving its usual loading? Bone loss occurs here. This phenomenon is called "stress shielding". Since one can get quite a bit of stress shielding around a prosthesis, it's no mystery why one sees progressive bone loss around prosthetic components over the years on follow-up radiographs.... "
The prosthesis referred to is the total hip replacement, not a resurfacing that loads the weight onto the femoral head, as the original issue joint does.
From http://medical-dictionary.thefreedictionary.com/
stress shielding
n. Osteopenia occurring in bone as the result of removal of normal stress from the bone by an implant.
osteopenia /osteopenia/ (os?te-o-pe´ne-ah)
reduced bone mass due to a decrease in the rate of osteoid synthesis to a level insufficient to compensate for normal bone lysis.
any decrease in bone mass below the normal."
With resurfacing the load on the hip is more like your natural hip. Again, it is similar to crowning a tooth instead of pulling it and doing a root canal."
Also read Mark Bloomfields explanations between THR's and resurfacing, they are excellent. I can't wait until his video interview is edited so I can post it, he is amazing. When I asked him if he can't do a resurfacing, which THR device does he prefer to use and why, his response to me was, "I HATE doing THR's I ALWAYS want to preserve the bone!" It took everything I had to not respond in an emotional way during this video interview since I try to keep them very neutral. I really wanted to say, "I WISH all doctors felt that way!!!" :-) Read his articles, they are amazing.
http://www.surfacehippyinfo.com/Resurfacing-vs.-THR/20090421430/THR-vs.-Resurfa cing/Hip-Resurfacing-vs-Total-Hip-Replacement-by-Mark-Bloomfield-Orthopaedic-Sur geon-UK/menu-id-89.html
http://www.surfacehippyinfo.com/THR-vs.-Resurfacing/20081130169/THR-vs.-Resurfa cing/Resurfacing-vs.-THR-By-Mark-Bloomfield/menu-id-89.html
If the links don't come up they are under Why Resurfacing, Resurfacing vs. THR the first and third articles
http://www.surfacehippyinfo.com/THR-vs.-Resurfacing/THR-vs.-Resurfacing/menu-id -89.html
Remember, no matter what size the head is, there is STILL the large metal spike and they still amputate that huge chunk of bone with a MoM THR. Yes, it is a good option if you have NO other choice, but a resurfacing should always be the first option if it is at all possible. Then the second choice IMO should be the BMHR, here is a photo of the three options.
http://www.surfacehippyinfo.com/Options/Options/menu-id-51.html
Vicky
LBHR Dr. Bose Dec 01 05
--- In surf...@yahoogroups.com, Kelly Maer <...@...
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On Tue, 23 Jun 2009 14:16:51 -0700 (PDT), Kelly Maer <...@yahoo.com
If it turns out I have dysplasia (there seems to be some discrepancy on this issue as to whether I have it or not), would resurfacing still be the way to go then?
________________________________
From: vicky4vi <...@comcast.netTo: surf...@yahoogroups.com
Sent: Tuesday, June 23, 2009 2:05:53 PM
Subject: [surfacehippy] Re: Back from Belgium
Yes the MoM THR does still completely remove the bone and the huge metal rod is still inserted into the thigh which will cause stress shielding. The recent study done only was for one year that said there was no difference in activity level, but with the improper loading of the bone, that stem will end up loosening in the long run with any heave impact. Where with a resurfacing, it loads like a normal hip and some people have found that their bone density has even gotten better with resurfacing.
Take a look at these animation videos
http://www.surfaceh ippyinfo. com/Hip-Multimed ia/Hip-Multimedi a/menu-id- 101.html
And read this article
http://www.surfaceh ippyinfo. com/Why-Resurfac ing-/Why- Hip-Resurfacing- /menu-id- 27.html
Excerpt:
Here is an explanation of Wolf's Law, remember, no matter what material is used with a THR device, it still has the long stem.
"... Wolfe's Law of Bone, which is that bone is formed and retained along the lines of stress in that bone. Another way of putting it is: "Form follows function." Look at the trabecular pattern in a calcaneus or a proximal femur—it's easy to see where the lines of stress are here, because that's where the trabeculae are. Another way to express this rule is: "Use it or lose it." ..." and " ...What does this have to do with patients with prosthetic joints? Well, in an ideal world, a prosthetic joint component would carry stress and distribute it to the underlying bone in a manner identical to the original bone. Alas, this does not happen in real life. Prosthetic components react to stresses a lot differently than the original bone that they replaced, and tend to distribute it to the remaining bone much differently. For example, in a hip prosthesis, much of the load applied to the femoral component tends to be transmitted to the bone near its distal tip.
The bone near the proximal part of the component tends to have less force transmitted through to it. What happens to the native bone that is now no longer receiving its usual loading? Bone loss occurs here. This phenomenon is called "stress shielding". Since one can get quite a bit of stress shielding around a prosthesis, it's no mystery why one sees progressive bone loss around prosthetic components over the years on follow-up radiographs. ... "
The prosthesis referred to is the total hip replacement, not a resurfacing that loads the weight onto the femoral head, as the original issue joint does.
From http://medical- dictionary. thefreedictionar y.com/
stress shielding
n. Osteopenia occurring in bone as the result of removal of normal stress from the bone by an implant.
osteopenia /os•teo•pe•nia/ (os?te-o-pe´ne- ah)
reduced bone mass due to a decrease in the rate of osteoid synthesis to a level insufficient to compensate for normal bone lysis.
any decrease in bone mass below the normal."
With resurfacing the load on the hip is more like your natural hip. Again, it is similar to crowning a tooth instead of pulling it and doing a root canal."
Also read Mark Bloomfields explanations between THR's and resurfacing, they are excellent. I can't wait until his video interview is edited so I can post it, he is amazing. When I asked him if he can't do a resurfacing, which THR device does he prefer to use and why, his response to me was, "I HATE doing THR's I ALWAYS want to preserve the bone!" It took everything I had to not respond in an emotional way during this video interview since I try to keep them very neutral. I really wanted to say, "I WISH all doctors felt that way!!!" :-) Read his articles, they are amazing.
http://www.surfaceh ippyinfo. com/Resurfacing- vs.-THR/20090421 430/THR-vs. -Resurfacing/ Hip-Resurfacing- vs-Total- Hip-Replacement- by-Mark-Bloomfie ld-Orthopaedic- Surgeon-UK/ menu-id-89. html
http://www.surfaceh ippyinfo. com/THR-vs. -Resurfacing/ 20081130169/ THR-vs.-Resurfac ing/Resurfacing- vs.-THR-By- Mark-Bloomfield/ menu-id-89. html
If the links don't come up they are under Why Resurfacing, Resurfacing vs. THR the first and third articles
http://www.surfaceh ippyinfo. com/THR-vs.. -Resurfacing/ THR-vs.-Resurfac ing/menu- id-89.html
Remember, no matter what size the head is, there is STILL the large metal spike and they still amputate that huge chunk of bone with a MoM THR. Yes, it is a good option if you have NO other choice, but a resurfacing should always be the first option if it is at all possible. Then the second choice IMO should be the BMHR, here is a photo of the three options.
http://www.surfaceh ippyinfo. com/Options/ Options/menu- id-51.html
Vicky
LBHR Dr. Bose Dec 01 05
--- In surfacehippy@ yahoogroups. com, Kelly Maer <mtnbkr38@.. ..
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On Wed, 24 Jun 2009 03:50:46 -0000, "leszekml" <...@gmail.com
Dear Kelly,
My hip problems were caused by severe dysplasia.
Right before the surgery (2007) I could hardly walk 100 feet (with a lot of pain).
Two weeks ago I did 16 miles day hike in a rugged Utah terrain, last year I trekked in Columbian jungle and I am taking Kung Fu classes 3 times a week.
So, there are some reasons not to perform BHR - but dysplasia is not one of them.
Good luck!
Leszek, LBHR 10/2007, dr. Ratterman
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On Tue, 23 Jun 2009 21:15:21 -0700 (PDT), Kelly Maer <...@yahoo.com
Thanks, Leszek, for your feedback-- what great adventures you having with your new hip!
________________________________
From: leszekml <...@gmail.comTo: surf...@yahoogroups.com
Sent: Tuesday, June 23, 2009 8:50:46 PM
Subject: [surfacehippy] Re: Back from Belgium
Dear Kelly,
My hip problems were caused by severe dysplasia.
Right before the surgery (2007) I could hardly walk 100 feet (with a lot of pain).
Two weeks ago I did 16 miles day hike in a rugged Utah terrain, last year I trekked in Columbian jungle and I am taking Kung Fu classes 3 times a week.
So, there are some reasons not to perform BHR - but dysplasia is not one of them.
Good luck!
Leszek, LBHR 10/2007, dr. Ratterman
--- In surfacehippy@ yahoogroups. com, Kelly Maer <mtnbkr38@.. . tip.
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On Mon, 22 Jun 2009 09:12:23 -0000, "vicky4vi" <...@comcast.net
Oh and PLEASE those of you that have my number, keep in mind I said to call me after the 23rd, NOT tomorrow, if it is urgent and you do need to call me tomorrow, do NOT call me early tomorrow morning. I am taking tomorrow off from work and really need to catch up on some well needed sleep. So if you call me early, I will NOT be happy! REMEMBER I am in California. I have had docs call me at 5:30 am my time because they are East coast. I just went through some of the photos I took, they are great. Too tired to post them tonight, will tomorrow when I get up.
Thanks,
Vicky
LBHR Dr. Bose Dec 01 05
--- In surf...@yahoogroups.com, "vicky4vi" <...@...
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