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Revisit Cataract Lens Choices Please?

Posted by chisue (My Page) on
Thu, Mar 22, 12 at 18:18

Today my eyes were measured for cataract surgery that is scheduled for April 11 (left eye) and April 18 (right eye).

I'm having trouble deciding whether to get 'standard' lenses or 'multifocal' lenses. Cost is not an issue. I realize that whichever lenses I get I will see more *clearly* because the cataract will be removed. I also need *corrective* lenses because I have been nearsighted since age 13.

This MD would correct my mild astigmatism separately, so I've been told I don't need 'toric' lenses. These are the only two types of lens I am looking at: Standard or Multifocal.

If you needed your vision *corrected* -- not just made less cloudy by cataract removal -- could you please tell me:

1) Which type lens do you have?

2) What is your resulting range of vision without glasses? Distance/Computer Screen/Reading Stanard Typeface? When do you use glasses?

3) How long did it take you to adjust?

4) Do you have a problem with 'halo's' around lights? When?Only at night (car headlights)? Indoors too?

Thank you SO MUCH! I'm going nuts over this!


Follow-Up Postings:

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RE: Revisit Cataract Lens Choices Please?

Sue, do you know the name of the multifocal the doctor uses? Maybe you can then do a search to see if you can find accounts of others' experiences.

I've heard negative things about Crystalens, but that's the only one I'm familiar with. My doctor told me he refuses to use them. I tried to Google multifocal lens implants risks but didn't have the patience to wade through page after page of links to eye care centers.

Have you gotten a thorough explanation of the expected outcome from each of your options? That would be important information to have.


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RE: Revisit Cataract Lens Choices Please?

Without doubt the multi focal lens, in fact my doctor and I have already talked about it, I would love to be able to have it done now but I don't have cataracts at this time. For me since I have such terrible vision having the multi focal implants would be the first time in my life that I would be able to wake up and see. I have never had that experience. I have been legally blind since the third grade, I can be corrected with contacts and glasses to some degree, but I have never had the pleasure of just seeing.

My sister also has similar vision, she did have cataract surgery, she chose to go with the two different prescriptions, near and far, monovision. I tried to talk her into the multi focal but for her money was an issue. She regrets her decision. She still has problems adjusting and she was wearing the same type of contacts before hand. She did agree it was amazing to wake up and be able to see.
I spoke to a lady at my doctor's office who had him do the multi focals for her and she absolutely could not say enough good things about it, she would definitely make the same choice and urged me to do it to.
I already know my decision.


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RE: Revisit Cataract Lens Choices Please?

I considered both and went with the monofocals. They've been around longer, and one ophthalmologist I talked with said the multifocals don't let in quite as much light, which can be an issue as you get older. The plan was to put in a prescription that left me a tad nearsighted, but I ended up a tad farsighted. I went from being very nearsighted to being able to see about 20/25 from about 3' away and beyond. For closer stuff, I need reading glasses, or my bifocals. I'm happy with my choice.

Despite all the computers and measurements, just remember that they can't get absolutely perfect correction most of the time, so, if you want to wear no glasses after the surgery (except for close work), expect to get a Lasik touch-up in order to be 20/20.

As far as the idea of having one close and one far prescription, I have known several people who have done it and not all of them are happy with it.


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RE: Revisit Cataract Lens Choices Please?

chiuse, I'm the one who had the surgery last week, just in one eye. I was only a candidate for the monofocal, and had it made with a prescription that gave me book/computer reading vision in the eye. My other eye is great for distance, so I essentially have one eye for each function. This is what I had pre-cataract, so it works fine for me. I don't wear distance glasses, but I do wear reading glasses for the eye that needs them.


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RE: Revisit Cataract Lens Choices Please?

I'd go for the multifocal - without my glasses, I can't read or see the computer, etc. I used to wear monovision contacts and they're hard to adjust to and some people never do.


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RE: Revisit Cataract Lens Choices Please?

Would someone be willing to educate me here? You need a lens when you have cataract surgery? You mean it's not just a procedure, but something is placed in your eye? I've never known about this. I have the beginning of a cataract but not time for surgery yet.


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RE: Revisit Cataract Lens Choices Please?

Socks, "cataracts" sounds like barnacles or something (that's the way I used to think of the term), but a cataract is a cloudy lens. Two eyes + two cloudy lenses = cataracts. Cataract surgery involves removing the cloudy lens and replacing it with a clear lens.

Medicare (and probably other insurance plans) will cover a non-prescription replacement lens that won't correct your vision, but the patient usually has to cover the cost of other options. I went with "mini-mono" lenses that left me slightly farsighted, like Kudzu. I have fabulous distance vision (for the first time in my life) and rarely need reading glasses. Love this!


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RE: Revisit Cataract Lens Choices Please?

Yes, the lens is implanted in the eye. Sounds gruesome but they stick it in and it "unfolds" in place! In fact, they gave me an "I have an implant" card that I'm supposed to carry in my wallet in case of an emergency!


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RE: Revisit Cataract Lens Choices Please?

Socks -- Yes, the surgeon removes the 'orginal equipment' that has started to become cloudy. (Can become completely opague, resulting in blindnes.) The surgeon makes a small cut, 'vaporizes' your cloudy lens and sucks out the debris, then pushes a folded-up new lens through the tiny cut and spreads it out in the same 'sac' that housed your own lens. All in a few minutes.

Of course you should then see much better. Your 'dirty window' lens has been replaced with a 'clean glass'. The new lens can also be made to a prescription, sort of like contact lenses, to correct vision deficits -- like my nearsightedness.

I am leaning towards the 'standard' lenses that will only correct my distance vision. People seem to adjust to them more easily. I don't think I'd mind having to wear glasses to read. If I am going nuts just deciding, I don't think I'm a good candidate for a frustrating, lengthy learning curve while I adjust to the multifocal. (What if I *never* adjust? Everything is brighter, but I can't *focus*? I'd have "Visual ADD"? LOL)

I am a little concerned about the 'middle distance' vision with a standard lens. I suppose I could get a larger computer monitor or zoom up the type size. It would be a little disappointing to still need to wear tri-focals! (I guess they would be the reverse of what I now wear. They'd have no correction at the top, middle-distance correction in the middle, reading correction at the bottom.)

Still, I'd prefer trifocals to being unable to adjust well or having halo's they can't correct with YAG laser. I've read about those outcomes for some people after multifocal implants. We can fool around adjusting prescriptions in glasses without *surgery*.

alisande -- The proposed multifocal is ReSTOR. Also, Medicare does now cover a 'standard' lens made to a single correction, but not a 'multifocal'. That's $1800 per lens, out-of-pocket. The lens costs more, and the MD plans on spending more time with you as you try to adjust. In my case $1000 would go to the hospital and lens purchase and $800 to the MD.

Something I find odd is that I would have to pay the $1800 at least a week BEFORE the surgery. Maybe that's the way of the world these days?


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RE: Revisit Cataract Lens Choices Please?

speaking of the card you have to carry, one of my friends had just had her surgery a month or so prior and she was on a trip and ended up on a roadway that the police were doing checks on so each car had to stop and show drivers license and insurance etc, she had hers ready and the officer said why aren't you wearing your glasses and she said she had corrective surgery he told her you are supposed to always present the card with your drivers license, she said oh wait I have the card! It had been so recent she had forgot. But yes you do have to carry that card with your right with your drivers license and present it also in those cases.

My sister had been able to adjust to the contact lenses that were different for each eye so she thought it would be easy for her to adjust with these lenses and her doctor agreed but it has taken her a really long time and even now she still wishes she had not done it. I tried to talk her out of it, her hope was to avoid reading glasses but she still has to use them occasionally.

I would prefer to never have to wear any glasses again but if it is only on occasion I can deal with that, I have permanent indentions in my nose and behind my ears anyway LOL But at least it would not be the coke bottle lenses I have to wear now.

My mother had her cataract surgery done back before implants so she has no replacement lens and has to wear glasses that are very thick. She wore contacts for as long as she could handle them.

In cataract surgery they use a device that basically liquefies the lens in your eye, at the same time the device is suctioning out the bits of the lens, there is also a drip tube that is putting in fluid into your eye to keep it in balance or inflated. Back in the day I used to be the assist on the scope as we did cataract surgery it is very interesting to watch through the scope. It is a very precise well oiled process and it goes pretty quickly, then the tiny lens which is folded in half is inserted and it pops open and is worked into place and the one little slit in the side of the eye is closed, some people need one stitch some don't. but the cut is in the white area not in the visual area.

The multifocal lens that originally came out had many problems like most things in their early stages the ones today are amazing. I definitely recommend using a doctor that is very familiar with using them however. A doctor that urges you not to use them may do so because he has not had the experience in placing them as another doctor that does them regularly. They do place a bit differently.
So if looking online for info be sure to check dates to make sure you are reading about the latest and greatest!


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RE: Revisit Cataract Lens Choices Please?

At least a week before, Sue? Do they want to make sure your check clears? I paid for mine (with a credit card) the day of each surgery. My doctor must use ReSTOR, as I've seen brochures for it in the office. But he didn't offer it to me as an option--possibly because of my severe astigmatism.

I am a little concerned about the 'middle distance' vision with a standard lens. I suppose I could get a larger computer monitor or zoom up the type size. It would be a little disappointing to still need to wear tri-focals!

That's why I got the mini-monovision. Would you consider doing that? As the doctor explained it to me, I'd be able to see the computer, piano music, and the dials on the stove, etc.--plus be able to take pictures. That's the way it has worked out.

It took me awhile to adjust to my close vision, but I'm fine with it now. I thought I'd have to wear reading glasses a lot more than I do. If the light is bright and the text isn't very tiny, I'm okay. Dimly-lit restaurants can be a problem, but I bought a little lighted magnifying glass at Jo-Ann's for $7, and that does the trick. I keep a few pairs of dollar-store reading glasses around the house, but use them only occasionally.


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RE: Revisit Cataract Lens Choices Please?

Hmmm...Maybe I need to put this off for a while. DH can drive me at night; I'm OK around town where I don't need to read signage.

I'm trying to think that this MD just had a bad day before he saw me yesterday. I got the distinct impression he thinks I am some 'mouthy babe' because I said I was trying to decide between 'standard' (single correction) and 'multifocal'.

He pointed to a note he'd made on my chart from my initial eye exam a week ago and said, "You SAID you wanted the standard lenses!" He'd made multifocal sound so difficult to adjust to that I HAD said that. He really got impatient when I said I'd looked for information on the internet and that I'd asked friends with implants how they had fared. He talked over my questioning. He said he didn't KNOW my friends or their vision problems -- their experiences were not relevant. When I asked what his patients' experiences had been -- what they'd chosen -- he was back to, "Not relevant," but he also said most people 'couldn't afford' the multifocals. (I had just said I was not concerned about cost; makes me not only 'mouthy' but a 'rich b****'?)

Later, he was all smiles at the desk when I was leaving. Maybe he'd remembered a brochure from his insurance company about keeping patient relations smooth.

Over my lifetime many people have guessed that I am/was a school teacher -- although I'm not. I never thought they meant I was too assertive.


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RE: Revisit Cataract Lens Choices Please?

I had my cataracts done last Nov. My doctor will only do the multifocal implant if a patient wears multifocal contacts for a few months to see if they can tolerate the multi focal. I knew I would not be able to adjust to it. I love having good distance vision now but it is a hassle to wear readers. Medicare paid for everything I think. I also have a good second insurance. I just got bifocals and the only thing I paid was $100 for the Transition lenses and $30 for non scratch coating. I like the frames. After 4 months of only wearing readers, I am having trouble adjusting to the bifocals and only wear them in church.


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RE: Revisit Cataract Lens Choices Please?

chisue are you just honor bound to use this doctor? if not I think I might talk to some of your friends that had this done and see who their doctor was. This is an area you really do not want to go into with a doctor you are not confident with. Only go with a very well known respected ophthalmologist who is well versed in all types of lenses and has done implants of the various types.
One of my good friends from high school had hers done recently and got very poor results and it was her doctors fault she had to have repeat surgery on the eye to fix it. I had cautioned her about that doctor from the things she had told me about him.

Just be sure and feel secure and confident in who is handling your precious eyes!!

I too have extreme astigmatism and it may be what keeps me from getting what I am really wanting but hopefully with all the amazing advances they are making by the time I need it done it will happen for me.
I wore contacts (hard lens) for most of my life could not wear soft lens due to the astigmatism factor, then when I started having dry eyes due to my Sjogrens Syndrome I had to change over to bifocals glasses again. I really miss my contacts.


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RE: Revisit Cataract Lens Choices Please?

Sue, maybe this is a good time for a second opinion? When we commit our vision to someone's care we shouldn't have reservations about him. At least not very many. :-)


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RE: Revisit Cataract Lens Choices Please?

I had my cataract surgery last December, both eyes. I was offered the ReStor multifocal lenses for another $4000. I was willing to pay that much if they were as good as they are advertised to be. After MUCH online research, I decided against them. Yes, the majority of people who get them do like them, but a significant percentage cannot adjust.

Later I met a woman who had gotten the ReStor lenses and is just miserable with them. She is going to try to have them explanted and replaced with standard lenses.

I got the monovision lenses and I am not entirely happy with the result. The difference in the two eyes is disorienting. I have to wear glasses, although I can get along with out them if I want to.

My night vision has improved and I have no halos or glare. It was so bad before I was avoiding driving at night.

If I had it to do over I would go with standard lenses for the best possible distance vision. Everyone I know who has them is very satisfied with the result. Popping on some reading glasses at times isn;t that big a deal. I recommend going with the tried and true standard lenses.

It is very difficult to find unbiased info about multifocal lenses. All the docs are pushing them because they make a lot of money on them. I would think long and hard before getting them.

I think a second opinion is a great idea. Do you have a good optometrist? Since they see eyes all the time and have nothing to gain or lose through the multifocals, they might give you an honest opinion.

Does your doctor have a web site? Do they promote the multifocals there? If so, s/he is a salesperson as well as a doctor, which compromises their advice.


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RE: Re visit Cataract Lens Choices Please?

Dedtired, it could be that you need a longer period of time to adjust. December wasn't that long ago. I forget how long it was before I adjusted to my "mini-mono" vision, but it took awhile. Our situations might be different, though, because I didn't wear glasses. I simply gave up reading. LOL

Now I read, etc., with or without glasses depending on the situation, and it's fine.


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RE: Revisit Cataract Lens Choices Please?

Alisande, I keep hoping that my brain will "get it" sooner or later -- preferably sooner. Do you remember how long it took you?

I also have to go back for the YAG laser procedure in May. On top of that I have a vitreous floater which is a huge nuisance. It's not the little threads you see floating around but like a glob of vaseline floating by. The floater is not the result of the cataract but a separate issue.

What I thought was going to be a simple procedure (actually the procedure WAS simple)has become an ongoing PITA.


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RE: Revisit Cataract Lens Choices Ple ase?

I wish I remembered, Dedtired, but I know it was a lot longer than I had anticipated. I was sure the vision in my left eye wasn't the way it was supposed to be, despite the assurances of my doctor.

I had the YAG procedure not too long ago. I wish they'd told me that sometimes people need to have this done. I didn't know, and thought I'd have to live with wretched night vision. I learned about YAG only when I called to see if it was normal to see night lights as starbursts. The YAG procedure was a snap, and made a world of difference in my night vision. I think it brightened up my day vision as well. Good luck with all this, DT!


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RE: Revisit Cataract Lens Choices Please?

socks-
The natural lens has a very high power itself, so when they remove that, you would be left extremely farsighted if they didn't put in a corrective lens. Thus, they insert an artificial lens to offset what you have "lost." They make these artificial lenses in a range of prescriptions, so that people who are farsighted or nearsighted can get that corrected as a side benefit of the cataract surgery. Basically, it's like wearing a contact...only better, because it's just behind the cornea and can't be dislodged, and you don't have to worry about it. I have friends who are hoping to get cataracts so they can get their vision corrected this way!

Years ago, before these artificial lenses came on the scene, after the cataract surgery was done, people had to wear glasses with a really high power far-sighted correction to get back to "normal." These prescriptions were so strong that it made your eyes look really big.


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RE: Revisit Cataract Lens Choices Please?

First thing, I think you need to find another doctor and get get another opinion.

I have multifocal lens, on my cards it says Allergan, AMO and that's all I know about them, but they have done me well. I got them 14 years ago, luckily I was still working and my insurance paid for about half and I paid the other half in installments set up by the clinic.

I have a great eye Dr. and only need to see him every couple of years now.

I wore glasses since I was 17 and really needed them before that but no one was really aware of that fact. I was told I was getting cataracts about 10 years before I had the surgery. When it got so bad I couldn't read street signs when I was driving I had the surgery

I remember seeing 'halos' at first around lights but don't even notice them anymore.

I was working for the health dept. at the time, I'm an RN, and the first thing I did upon returning to work was get one of the side effects papers regarding immunizations. When we would get a new type in I would take out the paper to read all the info on it and there was LOTS but unable to read the tiny print I would put it on the copy machine and enlarge the print so I could read it. I took that paper with my 'new' eye and could read every bit of it without a problem and talk about excited, my co-workers thought I was crazy bragging about my vision. Wait until they get old!!!

Having worn glases for over 45 years I was in heaven being able to see so well. First thing on in the morning and last thing off at night was my glasses.

I can read still without them, but a pair of the very lowest $ store reading glasses does help sometimes.

I can't say that I ever had any trouble adjusting to the multifocal lens, and am so glad my eye Dr. recommended them to me. I imagine they are very much improved now as I think they were just coming on the market when I got mine.


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RE: Revisit Cataract Lens Choices Please?

Thank you, everyone! I had no idea that the doctors put something in your eye for cataract surgery. I think I would go with the lens which would leave my eye essentially the same as it was before (except the cloudiness, of course). I've worn glasses since elementary school. You all know so much about this.

Chisue, are you near a university which might have an eye clinic? Your doctor's attitude is so irksome. I go to the clinic afiliated with our area medical school.


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RE: Revisit Cataract Lens Choices Please?

Thank you all! It's a big help to hear your experiences and your reactions to my weird appointment yesterday.

I have a 'pre-surgery check-up' appointment with my internist April 2. I will ask for more names. I already called to ask about this ophthalmologist. Now I'm wondering if he was sending me a message when he had his nurse call back to tell me he thought "Grumpy) is an excellent doctor."

He is Board Certified. Maybe he IS an excellent doctor -- but he sure displayed 'an attitude' yesterday! Maybe he'd had a bad day. I know they were running behind and that they were having to reschedule surgeries that had been booked for April 26. Maybe he is of an upbringing where women only say, "Yes, sir." He's not 'old'.

Maybe I wasn't impressed enough that he'd gone to India to practive early in his career. (One of DH's fraternity brothers did the same. It was a good place to 'practice' -- nobody sues.)

I have to say that he definitely was NOT pushing the more expensive lenses -- quite the opposite. I did wonder when he said he had done cataract surgery on many patients with Alzheimer's. What's THAT about?


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RE: Revisit Cataract Lens Choices Please?

I had the same gender thought, Chisue. My dear girlfriend is confident, well-educated, assertive, and has bumped heads with more than one doctor.

Or maybe he truly believes the standard lenses are best for you because others have trouble with the multifocal. And being rushed definitely does not bring out the best in anyone.


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RE: Revisit Cataract Lens ....

After my surgery my opthalmologist told me to go to the DMV and take the eye test to get the glasses restriction off my license. He told me that on each visit. I still haven't done it. He told me I did not have to carry the card with me but to keep it in a safe place.
My opthalmologist is one of two very popular in town for the cataract surgery.


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RE: Revisit Cataract Lens Choices Please?

I had my surgery done one eye in July of 2009. I drove myself for my eye appt the next day after each of them. I have the monovision, since medicare only will pay for that. I chose distance rather than close up. I dislike having to use reading glasses now, because, I didnt have to before, but, having the freedom to go out shopping or visiting a friend, or just going for a drive at night is wonderful. It gives me the freedom, to come and go as I please. No more halo's on lights, no more night blindness, when meeting another car. Its wonderful. I had a wonderful doctor. He had done hubbys one eye a couple of years before (hubby is blind in the other eye) and we really liked him then. I go for a checkup once a year now. No problem with the middle distance. I have never worn glasses in my life, so having to wear readers, took a bit of getting used to. Now, I just keep a pair in various places in the house, so I dont have to run around looking for them. Everytime, I sit out on the patio at night, and look at the lights around the houses across the field, I am so very glad, I had it done. The lights used to look like big starbursts to me, and now, they look just like they are supposed to look. The cataracts came so slowly, that I didnt even realise that things used to look differently, until after I had the first eye done.


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RE: Revisit Cataract Lens Choices Please?

Although I am not entirely happy with monovision (one eye for near the other for distance), I must say that my night vision has vastly improved. Before surgery, I would slow down when another car came at me,especially on narrow roads because the other headlights created such a glare I couldn't tell where the road started or ended. I always wondered why old people step on the brakes so much. The glare is almost entirely gone now and I no longer drive like an old lady at night. I do have much more tolerance for those who do!

I also like to walk around my street at night. I enjoy the cool and dark. I stopped doing that before the surgery because it was literally like walking into a dark tunnel. Now I can go out and enjoy the stars again.

I am typing this on my laptop in my lap without my glasses. I also can see the tv about five feet away. It is really the farther distance that I find is a strain on my eyes due to the monovision. I am remaining hopeful that I will adjust to it. I must wear my glasses when driving, which the doctor had said would be the case with monovision or with multifocal lenses. Your distance vision simply is not as sharp as with the standard distance lenses.

My friend's husband is a neurosurgeon. He had his lenses set to see well at mid-distance for his work and has glasses for distance, although he says he really doesn't need them.

In the 1950s my great aunt had cataracts removed. The lens could not be replaced and she had to wear coke bottle glasses or contact lenses all her life. Thankfully she adjusted to the contact lenses, which were not so great at the time. Imagine what life was like before this operation could be done. So many of us would become basically blind. That is still the case in many third world countries. Sad.


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RE: Revisit Cataract Lens Choices Please?

Monovision is the practice of correcting one eye for distance and one eye for near vision. Some people can adjust to this and thus avoid reading glasses. I tried this with contacts and it drove me nuts. I now have multi focal contacts where both contacts somehow allow you to see both close up and distance. I could adjust to this much better than monovision. I'd seriously consider this for cataracts but not monovision. My correction with multi focal contacts is not quite as good as it is with my progressive lense glasses - close up vision not quite as good. I chose to have perfect distance vision vs better closeup correction. I like that I can drive to the store, go shopping and read labels - all without glasses. If I were going to do serious reading for an extended period of time I might wear some light readers. However I wear contacts mostly in the summer for sailing and other water activity so much of the time just wear my glasses.


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RE: Revisit Cataract Lens Choices Please?

I should explain that the "mini-monovision," which I have, isn't as extreme as monovision; it's a modified version. Following the surgery I have perfect distance vision, but am slightly farsighted (after being severely nearsighted all my life). Glasses are sometimes required for very close work (like my rug hooking) or very small and/or dimly lit print. I suspect the mini-mono is easier to adjust to than the classic monovision.


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RE: Revisit Cataract Lens Choices Please?

I had this surgery this last spring; right eye in April, 2012, and left eye in May, 2012. I LOVE them and would do it again in a heartbeat....however... they are not perfect and they will not be as good as your old 20/20 vision, even if they test at 20/20.

I can read easily with sufficient light, but sufficient light for these lenses means a lot more than with or without glasses. I have several new desk lamps about the house to get that extra light when natural light is not around. I also have to be closer to the laptop screen than I used to; hard to get used to at first, but after a few weeks, being closer to its screen is automatic. If you have larger pupils as I do, you will find that you now need more light than others, perhaps.

I do see concentric circles in oncoming headlights, or sometimes when I look directly at some lights, but again, you get used to it, and it has not affected my night-driving.

One of the strange effects that I was not told about is the issue with looking at shiny, metallic surfaces. When I look at my own credit card with its silver numbers, I have to turn it around at different angles in order to read the numbers. I also noticed that when I trim my fingernails, I have to hold my hands considerably farther from my eyes than I used to; however, I have some old, weak reading glasses and I can use them for that job.

I do notice a small semi-circle that I can see on the edge of my left eye, but I've gotten used to it (it's due to my larger pupils). The ReStor lenses have UV protection, but I still wear sun glasses as I always have.

There are some small annoyances with these lens, but compared with wearing glasses? No contest; they are spectacular. Vision in my right eye was restored to 20/20, and my left eye to 20/25.


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RE: Revisit Cataract Lens Choices Please?

how does one go about having a cataract removed if they do not have 4,000 or insurance to help pay for this. I cannot see street signs so have to know how to get somewhere day or evening. I am not old enough for medicare yet and am getting alittle scared of the empacted it will have on me.. anyone have this issue that can send me in some sort of direction...Deb


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