Skip to content
in this discussion +12 following Follow this discussion

Treatment for Post Herpetic Neuralgia

Any new or novel treatments for post Herpetic Neuralgia? Nothing has worked so far.

Report this
1

67 Replies

  • paulbklyn mervyn3507

    Hi Mervyn

    I came across while googling new medicines for PHN, a therapy called the scrambler came up  never heard of it, go good reviews.

    I myself have the Nevro spinal cord stimulator, my pain is down but they 

    havent made any adustments yet, hopefully this Wed.

    Good Luck, let us know how your doing, best of luck

    Paul

    0 Report this reply to paulbklyn

  • anon987654 mervyn3507

    Hi Mervyn, Yes there's a drug in development at the moment that looks promising: http://www3.imperial.ac.uk/newsandeventspggrp/imperialcollege/newssummary/news_5-2-2014-12-24-59

    0 Report this reply to anon987654

  • ruth57682 mervyn3507

    Haven't really found anything new.  Went to a pain management doc and about all he wanted to do was inject cortisone into 2 spots in the spine and hope to temporarily block nerve pain.  Other alternative was to implant something and have wires into the spine to control pain. Anyone tried this stuff.  I am reluctant to do these invasive things as I had a cervical spine fusion just before I got shingles.  ( Propably the reason I got this was the trauma to the spine which I believe lowered my immune system). So, mervyn, the only minimal temporary relief I have found is a 4%

    0 Report this reply to ruth57682

    • paulbklyn ruth57682

      Hi Ruth

      I had the Spinal Cord Stimulator implanted 3 monhs  it has cut down on my pain. It has three programs  so far when I increased program 1 i got more pain, program 2 I got increased pain  few days will try program 3.

      Next week I have an appt. with my dr and the tech.

      I need a mri on my foot, no local imaging place will do it,

      seems only the hospital is equiped to do.

      Hope this helped

      Feel Better

      Paul

      0 Report this reply to paulbklyn

    • ruth57682 paulbklyn

      Thank you for the info.  I hate the thought of something invasive but it may come to that.  Are you comfortable enough to wear decent clothing without awful pain with the stimulator?

      0 Report this reply to ruth57682

    • paulbklyn ruth57682

      IHi Ruth

      I never wore fittered shirts but decent clothes yes I do.

      It's not bulging out of my back, just a slight bump , at least

      I know where to place the charging pad.

      God Bless

      Paul

      0 Report this reply to paulbklyn

  • ruth57682 mervyn3507

    Melvyn, really nothing new even  after seeing the pain management Doctor who really only could only suggest invasive measures  The only thing that has helped me is a 4% lidocaine cream that is available over the counter other than that I  sometimes can get relief by rubbing a cold washrag over the most painful areas. Actually plain old acetaminophen helps minimally.  I have been trying to get a hold of a topical cannabis cream or ointment but don't know to get that as I would need a medical prescription and the docs I have seen aren't licensed to write that since  marijuana is illegal. The pain is not bad at nite as I don't move around much and do take a sleeping pain.  It has literally ruined my social life as I can barely tolerate clothing, a bra especially is definitely a torture devise.  I live alone so can go topless here!  Wish I had more ideas to offer you.  This surface pain and semsivetivity is awful,

    1 Report this reply to ruth57682

    • ruth57682 mervyn3507

      I have been suffering from PHN now for about 6 months.  The severe shooting pains have gone but the skin sensitivity is still there some days worse than others.  Has anyone also had awful, almost unbearable itching to the point one doesn't know if the pain or itching is worse??  Also since the itching is relatively new, does that eventually go away along with the pain?  I was hoping someone would know if that means the nerves are somehow healing.  Another question, has anyone known if this PHN can just go away after having it 6months?  Strange thing about the itching, seems to also spread from where the original rash was   Please let me know if anyone can answer any of these questions.

      0 Report this reply to ruth57682

    • mervyn3507 ruth57682

      I have not (thankfully) had any itching during the shingles rash or afterward. The painfully sensitive skin - feels like it's burned, is enough. Unfortunately, I know that PHN can last for years, or the rest of our lives. For me, it's been 3 & 3/4 years. Sadly, we are part of a huge number of people suffering from this ailment for which there is no single or complete cure. All the more reason for us to support each other as we seek to find some relief. All the best!

      1 Report this reply to mervyn3507

    • MissUSA ruth57682

      My pain is from a stroke two years ago. I suffered terribly with Neuropathic itch of the scalp for about 18 months after the stroke, but am happy to say that it has stopped for some reason. Shampooing seemed to give some relief during the terrible itch time, but over time it just "wore off". 

      0 Report this reply to MissUSA

    • carol94752 ruth57682

      I am new to "patient" and this forum.  I've read many of the posts left by sufferers of PHN, and what surprises me is that I haven't seen any (Maybe I've missed a few) mention of sufferers (like myself) taking opoids to relieve the pain.  I have had PPHN for two years now (skin, some areas more sensitive than others), and after the doctors (and I) tried everything, I was finally put on an opoid....and glad I was.  I am 79 years old, and Ii think enjoying each day, remaining active, is no small thing.  

      0 Report this reply to carol94752

    • MissUSA carol94752

      Glad you can get relief from narcotics. I cannot tolerate the side effects, even at low doses. I suspect that others on this forum may have intolerance to them as well. I take nothing for the pain right now, as I would prefer to be able to think clearly and not feel drugged.  

      0 Report this reply to MissUSA

    • carol94752 MissUSA

      Yes, I am fortunate (if one liviing with PHN can be considered "fortunate'wink to tolerate opoids.  It has made my life pain-free (except between "feedings," when I am reminded (!) that I have PHN.

      0 Report this reply to carol94752

  • ramesh1936 mervyn3507

    Hi Last four years I tried many creams and nothing have worked.

    If you have any idea please write to me.

    Ramesh

    0 Report this reply to ramesh1936

    • mervyn3507 ramesh1936

      Hello Ramesh:

      Sorry I have no answers yet. Have tried many creams without success. Some people get relief from Palmitoylethanolamide (PEA) available from Holland and the U.S. Am trying with no success yet. Medical marijuana is a possibility and is available in Canada. Maybe not where you are.

      Merv

      0 Report this reply to mervyn3507

    • carol94752 ramesh1936

      Like you, Ramesh, I tried all kinds of topicals... and shots by the pain doctor... but nothing killed the pain ... until finally I was given Percoset.  I am not a drug pusher, but I do not see the value of suffering when I have a choice (until the government takes it away biggrin 

      0 Report this reply to carol94752

  • MissUSA mervyn3507

    EMA401 is being developed by Novartis and their website says it is due for "filing" in 2020. 

    My pain is affected by the weather (post stroke regional pain syndrome).  Anyone else notice that?

    0 Report this reply to MissUSA

  • raymond24308 mervyn3507

    Mervyn

    I have suffered from Post Herpetic Neuralgia now for 21 months, and I have found a topical mixture that gives great relief from the intense pain.

    I have posted this recipe several times, but repeat it for new sufferers.

    My topical mixture works very well to relieve pain and reduce the need for analgesics.

    The mixture is 250grams of Invite Vitamin E Cream, two five gram tubes of Aciclovir Cold Sore Cream, and 65 grams of Dencorub Heat Gel.

    Mix thoroughly and apply sparingly to the scar area and any new troublesome areas, as required for pain relief.

    This mixture gives immediate relief from pain, and it dramatically reduces the need for pain relief drugs. Apply as often as required for pain relief. 

    Also, one Evening Primrose Oil 1000mg capsule taken daily desensitises the nervous system and reduces the pain.

    I have found this topical treatment to be very effective in reducing PHN pain,   and the need for analgesics. It is quite inexpensive, as this quantity should last two to four months, depending on application frequency.

    Best of luck in your search for relief from this debilitating complaint.

    Regards, Ray

     

    0 Report this reply to raymond24308

    • raymond24308 paulbklyn

      I have stored this mixture for many months without adverse affects, but you could mix half the quantity at one time if you think you may not need that much.

      The Aciclovir pack recommends storing below 25 degrees centigrade, and do not refrigerate, so these are the only limitations I have encountered.

      I am sure you will get great benefit from this treatment.

      Regards, Ray.

      0 Report this reply to raymond24308

    • mervyn3507 paulbklyn

      The Primrose Oil is readily available in Canada, but the Dencorub appears to be an Australian product with a low price but very high shipping costs. Invite Vit. E cream is also an Australian brand, but there are many other brands available. The aciclovir cream is by Dr.'s  prescription.I'll try to put these all together.

      0 Report this reply to mervyn3507

    • raymond24308 mervyn3507

      Mervyn

      Yes I am in Australia. No doubt similar products are available in Canada.

      Invite Vitamin E Cream contains 50mg of glycerol, per 100grams, so it does not form a skin with continual use, as other creams do.

      Dencorub Heat Gel is the strongest and cheapest pain killing Gel available in Australia. The formula is 26 percent Methyl Salicylate and 7 percent Menthol. No doubt you have a similar product in Canada.

      Aciclovir is available in Australia from discount chemists, at $7 per 5gram tube, with no prescription.

      I am sure you can find a suitable product in Canada. It is well worth the effort.

      Regards, Ray.

      0 Report this reply to raymond24308

    • raymond24308 mervyn3507

      Mervyn

      I misquoted the formula for Invite Vitamin E Cream. 

      It has 50mg of Glycerol per gram, so it is completely different to the water based Vitamin E Creams. It also has 100mg per gram of Vitamin E.

      Kind regards, Ray.

      0 Report this reply to raymond24308

    • ruth57682 carol94752

      Carol, my pain also is the skin and the only thing that helps minimally is the 4% lidocaine over the counter pain and itch cream that you can get without a prescription here in the US.  Also I often will take a cool shower and then the cream.. Percoset didn't even touch it!

      0 Report this reply to ruth57682

    • carol94752 ruth57682

      Hi Ruth:  I am in the U.S.  Problem for me and my skin is that it covered my body!  That's why I am on Percoset, which does the trick and with minimal side effects.  Occasionally I "experiment" to see if the PHN has gone away, (in which case I would happily detox) but it's still with me!  Patches?  II need to be a walking patch.

      0 Report this reply to carol94752

  • carol94752 mervyn3507

    i am new to "Patient."  therefore, did I already answer Mervyn?  Getting confused.  Sorry.

    2 Report this reply to carol94752

    • raymond24308 carol94752

      Carol

      Yes, the topical mixture works just as well on the skin itch and the small

      irritating pimples that appear from nowhere. The Aciclovir Cold Sore Cream destroys the eruptions and itches in about two weeks. 

      My shingles keeps trying to return so the Aciclovir is an essential ingredient in the mixture. It is an ongoing problem, but the mixture can

      cope with it.

      Best of luck in your treatment.

      Regards, Ray.

      0 Report this reply to raymond24308

    • ruth57682 carol94752

      Wow,  I have it in the areas where I had the shingles rash which is pretty much my whole right torso front and back.  I can not imagine having this all over.  Glad you can get relief from the percoset.  I didn't t know you could get that all over your bod!

      0 Report this reply to ruth57682

    • carol94752 ruth57682

      Yes, the 'tender" areas of skin in particular.  Even the wind blowing on my skiin was painful.  Will it ever go away?  One can only hope.  I'm glad I found this website.  Few people I know really understand siince PHN is rather exotic.  

      1 Report this reply to carol94752

    • ruth57682 carol94752

      I tried puting on the ceiling fan once and couldn't stand that.  This kind of pain can't be understood by someone that has never had it.  I too am glad I found people I can relate to.

      1 Report this reply to ruth57682

    • paulbklyn carol94752

      Hi Carol

      I have PHN for almost 3  yrs, like you my skin is very sensitive,

      wind, clothes, touch.

      Tomorrow going to purchase some topical cream, using one now

      its, helps little.

      January going to my 4th pain dr for a consultation as I feel my present

      dr is not compassionate, rushes thru exam, never gave me a full exam.

      Money hungry.

      Hope you feel better

      Paul

      0 Report this reply to paulbklyn

    • carol94752 paulbklyn

      Hi Paul:  I feel for you. Trust me.  What I've found is that 99% of the doctors mean well but know nothing about PHN.  they don't know how to help.  My pain doc here tried many things, but none worked. In the end, he put me on percoset and Gabapentin (for nerve pain).  It's 2 years later, and I'm able to hold the amount I take.  I did try once to get off of the Percoset, but it became clear that the virus was still alive and "well" so there was no point to detoxing.  If I ever see an indication that the virus has "gone away," I will get off of the percoset.  In the meantime, I live a relatively pain-free life, and I think that's important.  As for side effects, I do forget a few short time things... but all in all, I'm doing very well.  Good luck to you.  Carol

      0 Report this reply to carol94752

    • paulbklyn carol94752

      Hi Carol

      Thank you for your kind words.

      My dr told me he would increase the dosage of Lyrica

      Then he told me I was at the top dosage.

      After doing about 15 mins of research  I found that

      he can increase the doage one more time.

      Now I printed out 2 websites giving the proper doesage

      of Lyrica for PHN

      They are not up on the dosages.  He is very arrogant.

      Wishing you the best

      Paul

      0 Report this reply to paulbklyn

  • charlie58834 mervyn3507

    Hi mervyn.  Sorry to hear of your difficulties, and others' problems with chronic pain also.  I have had PHN for 26 years, in the opthalmic branch of the trigeminal nerve.  this involves the right eye, forehead, and scalp.  I'm also a retired psychologist and have specialized in chronic pain for 35 years.  For the first 10 years or more I had a great deal of difficulty, but now am far more successful at managing the disorder.  I don't think the pain has decreased, but I manage it much better.  Several things helped a lot:  A modern antidepressant [not amitriptylene], such as the Wellbutrin I'm currently on.  Oddly, Aspercreme has been very helpful.  I use it at night mostly.  And, severe bouts of itching [I used to tear my scalp open with scratching during the night] have disappeared since I have been careful about staying hydrated.  Odd that water has been the main thing that helps with the pain, not drugs, for me. 

     

    0 Report this reply to charlie58834

    • mervyn3507 charlie58834

      Hi Charlie:

      Thanks for your comments. I can't imagine having PHN for 26 years! I know it can last a lifetime and, sadly, those of us with it are legion. I'll try Aspercreme as well as other creams that have been suggested. So far I've tried Capsaicin (various strengths), LivRelief, 15% Lidocaine,, and several mixtures from the pain clinic, with no relief from any of them. They don't seem to penetrate deeply enough. After a year of drug treatment from one pain clinic  and a Nerveblock injection - none of which helped, I was told to go home and "change my brain". My brain isn't co-operating!

      I've read books on how the brain changes and heals itself, but have been unsuccessful in attempts to harness the findings.

      I'm currently taking Naltrexone and Palmitoyletholanamide (PEA) as recommended by my current pain clinic, but have no positive results so far. Will keep trying. Thank you to all of you who are participating in this forum for your comments and support.

      Merv

      0 Report this reply to mervyn3507

  • charlie58834 mervyn3507

    A HUGE key to success in dealing with PHN is changing the way you think about the whole thing.  Really, this does make a difference.  First, give up the idea of a "cure," or complete eradication of pain.  It's not realistic.  Instead, shoot for PAIN MANAGEMENT.  If you are looking for a cure or 90% decrease in pain, you'll reject helpful alternatives.  Instead, look for a 25-30% improvement with each method.  Then you'll find helpful things.  Aspercreme decreases my symptoms by about 30%...but that's enough to help me sleep better.  By the way, the knock-off brands of this from Target or Walgreens, etc., work just as well and cost less.  I've worked with PHN patients for years.  Almost all of them said that Aspercreme was the most helpful thing they had found.  In my experience and theirs, no doctor had ever recommended it.  This is not because they're idiots or because of some conspiracy to sell drugs.  It's because they're not trained to look for OTC alternatives.  I like the idea of not having side effects of an internal medication, and the fact that it's cheap.  Here's a fact, a different way of thinking about PHN, that might be very helpful to you:  PHN is not curable but it is manageable, and you can have a good life with PHN.  I've proven this to myself, and that's how I've lived well with it for 26 years.  Thoughts like "I can live with this...I WILL find ways to make this manageable...I WILL find a way to have a good life, even with PHN," have been extremely helpful to me, and have helped me to eradicate depression. 

     

    0 Report this reply to charlie58834

    • r.oka charlie58834

      I have come to the conclusion after 5 yrs. with PHN, that healing as you say, comes from overcoming this terrible affliction with ones mind. I have tried everything from bee venom therapy to steroid injections without success. No topical has worked either. Opioids through titration have been whittled to 20mgs per day from 80mgs. One has to believe the only way to a normal life is to live with the PHN and come to embrace the battle to overcome the mental health disruption that comes with it. I have yet to regain a lifestyle that resembles what I had before 2012. You sound as though you have fought your way to normalcy after 26yrs. How long did it take before you felt as though you were winning the struggle? You are to be commended on showing those of us who are struggling, the path to recovery. Keep on that path for all of us. Thanks my friend.

      0 Report this reply to r.oka

    • charlie58834 r.oka

      Hi R.oka,

      I felt that I began winning the struggle against PHN when I got my depression under control, and when I changed my thinking from thoughts like "I can't live with this...This is horrible and awful...My life is awful" to thoughts like "I WILL find a way to have a good life even with PHN...This is not horrible and awful, but it is a great challenge...My life will be good again as I learn better ways to manage the pain." 

      Two things helped the depression:

      1. Antidepressant medication [not tricyclics, SSRI's or other more modern ones].  The best for me has been Wellbutrin.

      2. Cognitive behavior therapy, which basically involves changing your thought patterns to be 100% true and helpful to you, not allowing more negative thoughts, and working toward solutions rather than focusing on pain. 

      I decided I would search for solutions other than oral meds, and did find some that worked well.  But I also accepted that I will not get rid of the pain, I will just tone it down a bit and then learn to live well with what pain is left. 

      0 Report this reply to charlie58834

    • r.oka charlie58834

      Thanks for your support. Mind over matter is not something I am trained for but I have a brother who served and retired from Army Special Forces. He has shown me how that is possible even when chronic pain is the issue. I hope you can provide techniques as well with your background in psychology. Your help is greatly appreciated by all who suffer. Thanks again.

      0 Report this reply to r.oka

    • charlie58834 r.oka

      R.oka,

      Techniques you asked about:  Cognitive Behavior Therapy [CBT] is, in my opinion, the most effective and fastest way to alter one's emotions, as well as one's experience of pain.  When I began changing my thinking, not only did my mood improve, but the pain did not seem as severe.  It did not seem to interfere as much in my life.  So, you can access CBT from two sources:  A therapist who specializes in CBT, or books on CBT.  Books:

      Change Your Brain, Change Your Life, by Amen

      Mind Over Mood, 2nd Edition, by Greenberk and Padesky

      Retrain Your Bran:  CBT in 7 weeks, by Gillihan

      Cognitive Behavioural Therapy for Dummies, by Branch and Wilson

      Feeling Good, the New Mood Therapy, by Burns [good but long, one of the first books on CBT, published in the 70's].

      CBT seems complex at first, but once you kind of get the hang of it, it is easy to use.  There is more research, showing this therapy is the most effective, than any therapy I've read about in the research on psych therapies. 

      0 Report this reply to charlie58834

    • MissUSA charlie58834

      Yes, our mood follows our thoughts. Seems so simple, but a lot of people don't "get it". and realy get themselves in emotional stews. The 7-day mental diet by Emmett Fox won't cost you a thing. You will find it in a Google search and can read it online or print it if you prefer.   if you are trying to change your mood and outlook, you need to go on the mental diet. It was wildly embraced a couple of generations ago.  I went on it years ago and it works. It is a technique so effective that it lasts a lifetime. I think the reason it would help one feel better is because the mind becomes so active and "unleashed" after dwelling on negative thoughts. Once those are abandoned then the mind entertains other things which are positive and optimistic. Charlie has expressed great advice. The 7-day mental diet printed is just a very small booklet. You won't have to study the whys and wherefors with the 7 day diet. It gets right to how to change your thoughts.  

      0 Report this reply to MissUSA

    • charlie58834 MissUSA

      A lot of people think CBT is too simple to work, that to make good change we should have to spend months or years in therapy.  They think of it as "positive thinking" and believe that somehow that would be lying to yourself.  CBT is a little more complex, but still pretty easy to learn.  It's effectiveness has been proven many times over. 

      My rules for healthy thoughts:

      1.  The thought must be 100% true.

      2. The thought must make you feel better, not worse.

      If a thought fails either rule, it must be changed to satisfy both rules.  Then, the thought must be practiced, so it becomes a habit. 

      Example:

      Original thought might be "This pain has ruined my life."

      1.  100% true?  Well, maybe partially true, but for a life to be ruined you must have no enjoyment at all, ever, not even for a few seconds or minutes.  Not really true...all of us have at least moments of enjoyment.

      2. Make me feel better?  No, makes me feel much worse, drags me down in mood.

      So, it fails not one, but both rules.  Has to be changed.

      Change:  "This pain is really difficult, but I still have some times I can enjoy."

      1. 100% true?  Yes.

      2. Make me feel better?  Yes, a little better.  The pain is still difficult, but it helps me feel a little better.

      Now I know it's a healthy thought.  Now I practice the new thought, and don't allow the old thought since it's an unhealthy one. 

      So, CBT is not simple "positive thinking," but that has something to do with it. 

      0 Report this reply to charlie58834

  • keith46188 mervyn3507

    Hello I've had PHN for 2years and 2months now and it gives me big time pain, I've been taking lyrica 150 mg twice a day for quiet a while now and before that I was on 300mg morning and night and I found I just couldn't remember things or would be talking about something and midway through sentence my mind would go blank an couldn't remember what I was talking about. I've had lidocaine infusion x3 and never worked or lowered my pain, I've got another appointment at pain management next week an hope I can get something from them to help. But I read your paragraph and your remidy with the vitamin E cream cold sore omointment and Dincorub gel , I went an got the ingredients an mixed them up and applied it to my chest across the nipple line an a bit lower around to my back and yes it did work for me by about 30% but only with out a shirt or singlet. It's the only help that has worked except the lidocaine patches and lidocaine cream.

    0 Report this reply to keith46188

  • ruth57682 mervyn3507

     have had the nerve pain in the same area for over a year now.  I get about a 50 % relief from gabapenten 300 mg x 3(total 900 mg) a day plus 4% lidocaine cream.  No side effects. I can now tolerate a bra for part of a day which is a vast improvement.  When not wearing clothing at home, I am almost pain free.

    .

    0 Report this reply to ruth57682

  • susan46308 mervyn3507

    I live in Texas and have been treated PHN for the past 18 months.  Lidocaine ointment, gabapentin, antidepressants p, nerve blocks, and codein inclusive drugs have done little to deter the severe pain.  It extends from mid-spine around my right side and under my right breast.  About one month ago I was referred to a physical therapist who has treated many pain patients.  She suggested that I might get some relief using a device similar to tens treatment, although she had never used it on a shingles patient. She has given me five treatments using a Dolphin neurostimulator. It uses an electric current to treat the painful nerve areas.  It has worked to stop the very bad pain on the main nerve going from my back to my front. I am no longer having to take the codeine for the extremely bad nerve pain.  I still have sensitivity on the surface of my skin, but I can deal with that much more easily than I can deal with the really severe main nerve pain.  The Dolphin neurostimulator treatment helps to relieve the bad pain for 3 to 4 days, at which time I take another treatment. She has trained my husband and I how to use the device and we are now treating me at home and conferring with her as needed.  It is so wonderful not to take the codeine as I certainly do not want to become addicted to it and need to drive without being under the influence.  We are curious as to what the long term effects will be using the Dolphin device, but so far it is great!!!

    0 Report this reply to susan46308

  • ramesh1936 mervyn3507

    Where do you buy this simulator?

    How long it takes to learn the simulator?

    Do you use daily?

    0 Report this reply to ramesh1936

    • susan46308 ramesh1936

      Look it up on the internet. It is a Dolphin neurostimulator (not simulator).  I would try to find a physical therapist who has one of the devices first before buying one.  They cost around $400 each and the treatment goes much faster if you have two and use both about 1" to 2" apart at the same time. I need to do a treatment every 3 to 4 days, but you can use it as needed.  They have training sessions for physical therapists in the U.S.  It took about two or three sessions with the therapist helping my husband and I learning how to correctly hold it, how much pressure to use, etc.  You can feel the small electric current in the nerve when it is being used correctly. It is generally not painful; however, in the area of the nerve which is most aggravated or sore, it can be slightly painful. Although you do not need a doctor to buy it for you, I would not attempt to use it without a therapist's assistance to make certain I am doing it correctly.

      0 Report this reply to susan46308

Back to top

Report as inappropriate

Thanks for your help!

Already approved

You can't report this, it's already been approved by a moderator.



We want the forums to be a useful resource for our users but it is important to remember that the forums are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the forums is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.