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Treating Troubling Fibroids Without Surgery
NY Times ^ | November 23, 2004 | LAWRENCE K. ALTMAN

Posted on 11/27/2004 12:56:17 PM PST by neverdem

Condoleezza Rice, the national security adviser, shares at least one thing with millions of other American women: she had fibroids, benign tumors in the uterus that required treatment.

Ms. Rice, the nominee for secretary of state, entered the hospital for an overnight stay last week to undergo a procedure - uterine artery embolization - that is rapidly becoming an alternative to major surgery for troublesome fibroids.

For most women, fibroids, consisting of muscle and fibrous tissue, are no bother. But for millions of others, fibroids can be so large (in some cases, the size of a melon) or so numerous that they cause discomfort, severe bleeding, anemia, urinary frequency and other symptoms.

What causes fibroids is unknown, although estrogen is known to promote their growth. More than one woman in five age 40 and older has the tumors, with higher rates among black women.

For decades, major surgery - a hysterectomy to remove the uterus or a myomectomy to remove selected fibroids while leaving the uterus in place - was the main therapy for women whose symptoms were not controlled by oral contraceptives or other hormonal therapies. About 30 percent of the 600,000 hysterectomies performed in the United States each year are for fibroids.

With the introduction of technologies like ultrasound, C.T. scans, magnetic resonance imaging and new drugs, however, doctors have in recent years developed a number of alternative therapies.

This year in the United States, about 13,000 women are expected, like Ms. Rice, to choose the embolization technique, which is less invasive than surgery. French doctors first reported the embolization procedure in 1995. Since then, the number of the procedures has grown, in part because of direct-to-consumer advertising by interventional radiologists, who perform them.

Embolization involves injecting pellets the size of grains of sand, made from plastic or gels, into uterine arteries to stop blood flow and shrink the tumors by starvation. The procedure is so named because the pellets are emboli, objects that lodge and stop blood flow. M.R.I. scans are often used to screen out fibroid patients who are not candidates for the embolization procedure.

In performing the procedure, interventional radiologists insert a thin tube into an artery in the groin and thread it up to the main uterine artery in the pelvis. A dye is injected that outlines the smaller arterial branches on an X-ray, producing a map that guides injection of pellets through the tube into the arteries that nourish the fibroids.

"Of the patients we see, at least a third have fibroids the size of an orange or larger," and the size does not influence the outcome of the procedure, said Dr. John H. Rundback, an interventional radiologist at Columbia University.

The procedure, which may be painful, usually lasts 60 to 90 minutes. Most patients also experience intense pain for several hours afterward and stay overnight in the hospital. For some patients, the pain persists for several days, or even two weeks. Surgery for fibroids requires a longer hospital stay.

Additional complications from the embolization procedure can include abscesses and other infections; heavy uterine bleeding; early menopause from the pellets damaging the ovaries; or destruction of the uterus, requiring emergency surgery.

Although the procedure is safe, "there are still significant uncertainties about the procedure, especially in terms of future fertility and long-term outcomes," said Dr. Evan R. Myers, chief of the division of clinical and epidemiologic research in Duke University's department of obstetrics and gynecology.

Judging the safety and effectiveness of embolization compared with to other therapies is hard because randomized controlled studies are lacking and because earlier studies did not report how different symptoms responded to different treatments, Dr. Myers said.

"It is amazing that for a condition as common as fibroids, that has such significant impact on reproductive-age women, there is not a lot of high-quality scientific evidence for many of the things that are done for fibroids," Dr. Myers said.

"There still is no gold standard randomized trial comparing embolization to the other interventions," he added. This is largely because patients and physicians have such strong preferences for one method or another that it is hard to recruit enough patients for clinical trials comparing the embolization procedure to hysterectomy, myomectomy, hormonal and other therapies.

Dr. Myers directs a registry that the Society of Interventional Radiology has created to monitor the outcome of 3,000 women who have undergone the embolization procedure. He said that the effectiveness and complication rates for embolization seem comparable to surgery. But there is insufficient information to draw conclusions about the procedure's safety for women who desire to become pregnant, according to Dr. Myers, the interventional society and the American College of Obstetricians and Gynecologists.

In very rare cases - less than 1 percent - fibroids are cancerous. The cancers usually develop among postmenopausal women and the embolization procedure is not recommended for that group. Biopsies are not routinely performed on fibroid patients before embolization, and even if they were done, biopsies would not be able to detect cancerous fibroids deep in the uterine muscle. So statistically, as more women undergo embolization procedures, the cancers are unlikely to be detected in the very few patients who have them.

"That small risk has to go into the counseling before the embolization procedure," said Dr. Howard T. Sharp, chief of the general division of obstetrics and gynecology at the University of Utah.

Dr. Sharp said he believed that there were probably more cases of cancer than the single report in the medical literature, because doctors often "don't report the bad outcomes."

While some researchers are trying to study the embolization procedure further, others, like Dr. Elizabeth Stewart of the Brigham and Women's Hospital in Boston, are testing another fibroid treatment, the ExAblate 2000 System, that won approval from the Food and Drug Administration last month.

The system, made by InSightec Ltd. of Israel, uses ultrasound to destroy the fibroids with heat and M.R.I. to map the uterine anatomy and monitor the degree of fibroid destruction from a repeated application of multiple ultrasound waves on the tumor. The device centers the ultrasound waves similarly to the way a magnifying glass focuses light.

The patient remains in an M.R.I. machine for about three hours and then can go home. Initial studies found that serious side effects occurred in 2 percent of cases, compared with 13 percent among women who underwent a hysterectomy, Dr. Stewart said. Additional studies are being conducted at a small number of hospitals. The procedure is intended for women who have completed childbearing or who do not intend to become pregnant.


TOPICS: Business/Economy; Culture/Society; Extended News; Government; News/Current Events; US: District of Columbia
KEYWORDS: cancer; fibroids; health; healthcare; surgeons; surgery

1 posted on 11/27/2004 12:56:17 PM PST by neverdem
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To: neverdem

First, take nine white raisins. They have to be white...


2 posted on 11/27/2004 1:00:45 PM PST by billorites (freepo ergo sum)
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To: neverdem

I was watching the baby channel last week. A woman with fibroids had a C-Section. When they cut her open the doctor pointed out a fibroid, it was as big as a BASEBALL. BUT he didn't remove it. I couldn't believe he left it in her!

I know they say fibroids are suppose to shrink on their own but it seems to me if you have the patient open and you can see these large tumours you should cut them out.


3 posted on 11/27/2004 1:21:35 PM PST by Recall
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To: Recall

maybe right after delivery is not a good time to excise a large area - the uterus is thinned out and has a huge number of blood vessels at the surface to nourish the baby - the linear cut of a c-section is one thing, but a whole area? you want to sew it up and get the muscles contracting as fast as you can, to stop the bleeding.

Mrs VS


4 posted on 11/27/2004 1:29:59 PM PST by VeritatisSplendor
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To: neverdem

"Most patients also experience intense pain for several hours afterward and stay overnight in the hospital. For some patients, the pain persists for several days, or even two weeks...Additional complications from the embolization procedure can include abscesses and other infections; heavy uterine bleeding; early menopause from the pellets damaging the ovaries; or destruction of the uterus, requiring emergency surgery...Although the procedure is safe, "there are still significant uncertainties about the procedure, especially in terms of future fertility and long-term outcomes,"

I'm glad they slipped in "although the procedure is safe..." because I was beginning to wonder.


5 posted on 11/27/2004 1:35:30 PM PST by Felis_irritable
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To: Recall
I think some doctors are not sure what to do about fibroids. There are only a few doctors nationwide who are experts....real experts. I have had friends who have had all kinds of experiences with fibroids and surgery, good and bad. It has been traditionally easier for doctors to just go in and do a quick hysterectomy rather than addressing and spending time on the problem at hand.

The main thing women should know is that a hysterectomy is NEVER necessary unless there is cancer and should never be performed for simple fibroids. If your doctor recommends a hysterectomy for benign fibroids you need to change doctors fast and search until you find one trained and educated properly enough to know this.
6 posted on 11/27/2004 1:43:50 PM PST by Swede Girl
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To: Recall

I'm not an OB/GYN, but maybe the nature of the cutting required for a complete excision of the fibroid would make any future pregnancy problematic with respect to uterine integrity, i.e. spontaneous rupture and emergency C-section.


7 posted on 11/27/2004 2:07:13 PM PST by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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To: Swede Girl
The main thing women should know is that a hysterectomy is NEVER necessary unless there is cancer and should never be performed for simple fibroids.

I wouldn't say never :)

8 posted on 11/27/2004 2:11:42 PM PST by mewzilla
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To: fourdeuce82d; El Gato; JudyB1938; Ernest_at_the_Beach; Robert A. Cook, PE; lepton; LadyDoc; jb6; ...

FReepmail me if you want on or off my health and science ping list.


9 posted on 11/27/2004 2:13:51 PM PST by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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To: neverdem

Thanks for this article.
I had surgery for fibroids (1 grapefruit size and 3 or 4 smaller ones) in 1997 and felt much better afterwards --- but now I have some back again -
one is 12cm x 10cm and some smaller ones.
No wonder I feel distended...!
I do not want surgery again and hubby and I are still trying for a baby after some miscarriages. I pray every day.


10 posted on 11/27/2004 2:49:10 PM PST by LibertyLight (I Am Grateful For FreeRepublic!)
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To: mewzilla

Me neither! Getting rid of that cotton-picker was a blessing and a half!


11 posted on 11/27/2004 2:53:40 PM PST by Ladysmith (November 2, 2004: Taking America BACK!!!)
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To: Ladysmith

Multiples run in our family. Big ones, too.


12 posted on 11/27/2004 2:55:57 PM PST by mewzilla
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To: neverdem

Thanks for posting this. I'm learning a lot.


13 posted on 11/27/2004 2:57:19 PM PST by Recall
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To: mewzilla

Ouch! Is that so? I'll keep that in mind for my relation.


14 posted on 11/27/2004 2:58:15 PM PST by Ladysmith (November 2, 2004: Taking America BACK!!!)
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To: Ladysmith

We've had myomectomies and hysterectomies, tried different meds. Don't know anyone who's had the procedure that Dr. Rice just had. Glad there's another option for women. I'm just curious about where those little pellets go, if there's any chance they can get back into the bloodstream.


15 posted on 11/27/2004 3:00:27 PM PST by mewzilla
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To: LibertyLight

Good luck to you! They spotted a small one in my uterus while I was pregnant last time. The next time they scanned me, post-baby, it was gone.


16 posted on 11/27/2004 3:03:07 PM PST by Yaelle
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To: neverdem

No they are not complex to remove. They mostly "shell out" of the wall of the uterus. But they can bleed and especially vigorously in a gravid uterus.


17 posted on 11/27/2004 3:09:35 PM PST by Texas Songwriter (Texas Songwriter)
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To: Swede Girl

NEVER? Not so. If the uterine fibroids have degenerated and cause intractible pain....if the fibroid tumors cause bleeding. In some patients with cancer you should not perform surgery. You may need to irradicate certain uterine carcinomas with intrauterine radiation implants. You have not given your freeper good information, except in that you infer second opinions.


18 posted on 11/27/2004 3:13:33 PM PST by Texas Songwriter (Texas Songwriter)
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To: Recall
I was watching the baby channel last week. A woman with fibroids had a C-Section. ...When they cut her open the doctor pointed out a fibroid, it was as big as a BASEBALL. BUT he didn't remove it. I couldn't believe he left it in her! I know they say fibroids are suppose to shrink on their own but it seems to me if you have the patient open and you can see these large tumours you should cut them out.

Unless the fibroid is pedunculated (on a stalk) the excision of a large fibroid will result in a gaping raw wound in the muscle of a uterus that is already more vascular because of the pregnancy. The medical literature therefore discourages a fibroidectomy at C-Section because of the increased risk of hemorrhage.

"First, do no harm."

19 posted on 11/27/2004 3:24:57 PM PST by Polybius
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To: Yaelle
They spotted a small one in my uterus while I was pregnant last time. The next time they scanned me, post-baby, it was gone.

Was it seen on repeated sonograms(ultrasounds), or was it just seen in one image, i.e. could it have been an artifact?

20 posted on 11/27/2004 3:26:54 PM PST by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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To: neverdem

This article is a sight for sore eyes. My mother had terrible fibroids and had a hysterectomy by the time she was 23. I have fibroids that cause me great pain, to the point where I can't sit down for long. I've been looking into options for a while but I could never figure out what was best, and I want the hysterectomy to be a last resort, just in case I want children someday.

But it has been hard to find information that made sense. Thanks for this article.


21 posted on 11/27/2004 3:37:08 PM PST by DameAutour ("The dumber people think you are, the more surprised they're going to be when you kill them.")
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To: mewzilla
I'm just curious about where those little pellets go, if there's any chance they can get back into the bloodstream.

Unless there's a fistula - an abnormal connection between arteries and veins - they should clog up the near end of the capillaries and arterioles. The blood starts from the heart to aorta with branches breaking off to form arteries serving organs, muscles, etc. to arterioles(little arteries) to capillaries where the blood goes through as cells in single file in the tissue it serves. The various blood cells types are suspended in plasma. Think of the root system and branches in a plant.

The blood goes back from the capillaries which join back to form venules(little veins) which join to form veins and then finally form both the inferior and superior vena cava which deliver the blood back to your heart's right atrium from below and above, respectively.

22 posted on 11/27/2004 3:57:53 PM PST by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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To: DameAutour

Look for a very experiened doctor who deals only with woman gyno surgeries and especially problems as well as fertilty issues. They can see where the fibroids are with the ultra sounds - Good Luck!

I had very big fibroids removed - - now I have them back. THis is definitely annoying the heck out of me and I find that I do not want to really face this again!

It helps to stay off of sugar and caffine. Those things love sugar and caffine!


23 posted on 11/27/2004 4:16:00 PM PST by LibertyLight (I Am Grateful For FreeRepublic!)
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To: neverdem

"Fibroids" 'The complete guide to taking care of you physical, emotional, and sexual well-being'
by: Johanna Skilling

have this book recommended by my chiropractor/keniesologist (sp?) -have not read it yet.


24 posted on 11/27/2004 4:19:17 PM PST by LibertyLight (I Am Grateful For FreeRepublic!)
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To: neverdem

My wife had many problems with fibroids, cysts, and bleeding, and recently had a hysterectomy. Life has been great since! I know hysterectomies get a bad rap, but if a woman has already had children, it is the way to go.


25 posted on 11/27/2004 4:23:26 PM PST by flair2000
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To: neverdem

Dang. Going up the femoral artery. That's gotta hurt!


26 posted on 11/27/2004 4:26:04 PM PST by kstewskis (Political correctness is intellectual terrorism.......M Gibson)
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To: VeritatisSplendor; Recall

Mrs. VS is totally correct. The patient could bleed to death.


27 posted on 11/27/2004 4:40:29 PM PST by GummyIII (The shortest distance between two people is a smile.)
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To: LibertyLight

Fibroids: The Complete Guide to Taking Charge of Your Physical, Emotional, and Sexual Well-Being. Johanna Skilling, Eileen Hoffman. Marlowe & Company; 1st edition (January 15, 2000); ISBN: 1569246203.

Review by Amazon.com, Joan Price - Author Johanna Skilling sees fibroids as "an interruption" of your uterus, blood flow, physical well-being, and lifestyle, as well as a disruption of your self-image and self-esteem, which may leave you feeling shamed, damaged, and helpless. Skilling is not a doctor; she is a woman with fibroids. When she was diagnosed, she read everything she could find, interviewed medical experts, and compiled stories from other women. She presents information about conventional medical treatments, alternative therapies, and diet, along with tips, anecdotes, and humor (for example, the "top 10 things you resemble while taking an MRI" includes "one of those pretzels with cheese filling" and "a lime wedge in the neck of a beer bottle"). Skilling's aim in writing this book is to provide both a source of information about fibroids and a "support group in a book" for women with fibroids to find comfort and sharing. She succeeds.


28 posted on 11/27/2004 4:42:31 PM PST by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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To: neverdem

My mom just had surgery to remove a fibroid the size of a melon. It was causing her more and more pain + bleeding along with anemia. They gave her a hysterectomy as well. She says she looks like she lost 10 pounds.


29 posted on 11/27/2004 4:46:51 PM PST by grimalkin ("A man can fail many times, but he isn't a failure until he begins to blame others." - Anon.)
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To: LibertyLight

I was plagued by fibroids in my 30s, with excessive bleeding and clots, and I took Vitex, which worked for me to make them disappear. Vitex will even out any female hormone imbalance. Health food store hasit in pills or liquid tincture.


30 posted on 11/27/2004 5:07:18 PM PST by tinamina
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To: Swede Girl
The main thing women should know is that a hysterectomy is NEVER necessary unless there is cancer...

Not so. For example, hysterectomy is, I believe, the only treatment for a patient presenting with life-threatening hemorrhaging caused by benign fibroids.

31 posted on 11/27/2004 5:28:17 PM PST by Mia T (Stop Clintons' Undermining Machinations (The acronym is the message.))
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To: neverdem; mewzilla

I'm with mewzilla.

Intentional introduction of emboli (especially in the form of probably non-resorbable plastic pellets) into the circulatory system, which is, by definition, continuous, does not seem to me to be the smartest strategy.

This treatment modality assumes the absence of fistulae (as you point out) as well as the existence of theoretically predicted relative size of ductwork vs. pellets and aggregated pellets.

Leave it to the French to push this thing.


32 posted on 11/27/2004 6:01:13 PM PST by Mia T (Stop Clintons' Undermining Machinations (The acronym is the message.))
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To: Texas Songwriter

Read "No More Hysterectomies" by Dr. Vicki Hufnagel. This is a quote from her. She has saved hundreds of women from hysterectomies and women have gone on to have children after other doctors wanted to give them a hysterectomy.

She is 50 years ahead of her time and has innovative ways of helping women with fibroids, etc. I have spoken with dozens of her patients and they all agree.


33 posted on 11/27/2004 6:01:44 PM PST by Swede Girl
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To: DameAutour

Read "No More Hysterectomies" by Vicki Hufnagel. Search, search, search on the internet for all you can find on this. You should never need a hysterectomy for fibroids at your young age. But, you will need the surgery that Dr. Hufnagel performs. She has saved many women from hysterectomies. There are a few other doctors out there who are experts at removing fibroids without resorting to a hysterectomy....but just a few. You have to search and do your homework. Good luck.


34 posted on 11/27/2004 6:11:12 PM PST by Swede Girl
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To: Felis_irritable

Seems like the cure is worse than the problem, doesn't it?!


35 posted on 11/27/2004 6:45:33 PM PST by Americanchild
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To: tinamina

Vitex...do you know what is in that?


36 posted on 11/27/2004 6:50:52 PM PST by Americanchild
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To: tinamina

Vitex? I not heard of 'vitex' - is it a herbal remedy?
I am taking chaste berries - I read about this as a help - but of course any 'natural' remedy really takes alot of time and consistancy and probably a variety of supplements working together.
I am going right now to check my Nutritional Healing book by the Balch couple - MDs


37 posted on 11/27/2004 7:16:42 PM PST by LibertyLight (I Am Grateful For FreeRepublic!)
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To: Swede Girl

I suspect if you followed Dr.Hufnagel around for a week or two and watched the surgical schedule you will find she does hysterectomies. You never say never in terms of prohibiting a proceedure. You will find a need to do it for certain surgical indications. I would agree that the current day indications have substantially shrunk from what it was 25 years ago.


38 posted on 11/27/2004 7:20:31 PM PST by Texas Songwriter (Texas Songwriter)
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To: LibertyLight

I believe Vitex and Chasteberries are one and the same.


39 posted on 11/27/2004 9:21:40 PM PST by tinamina
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To: Americanchild

It has been a while, but I believe Vitex is the Latin name for Chasteberries.


40 posted on 11/27/2004 9:32:22 PM PST by tinamina
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To: neverdem

PROGESTERON....get a doc to give you a script go to a good compounding pharmacy...these will desolve them so quickly it'll blow your and the docs mind.


41 posted on 11/27/2004 9:37:04 PM PST by shield (The Greatest Scientific Discoveries of the Century Reveal God!!!! by Dr. H. Ross, Astrophysicist)
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To: tinamina; Americanchild

Yes...
I just got my bottle of Chasteberry (Vitex) is there on the label also..
thanks...


42 posted on 11/27/2004 9:52:12 PM PST by LibertyLight (I Am Grateful For FreeRepublic!)
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To: shield
PROGESTERON....get a doc to give you a script go to a good compounding pharmacy...these will desolve them so quickly it'll blow your and the docs mind.

Hormones can cause adverse effects. After my sister became anemic, she took some hormone and started having migraine headaches. She's married to a pharmacist who was trained to compound. Both combination estrogen/progestin preparations and their analogs as well as only progestin containing preparations can have adverse effects.

43 posted on 11/27/2004 10:05:31 PM PST by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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To: neverdem
Progestin is about as bad as you can put in your body...it's not natural to a woman's body...the key is progesteron...that's natural to a woman's body.

She obviously does not have docs and a pharmacist that knows what their doing. Which does not surprise me in the least.

44 posted on 11/27/2004 10:12:21 PM PST by shield (The Greatest Scientific Discoveries of the Century Reveal God!!!! by Dr. H. Ross, Astrophysicist)
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To: neverdem

I don't know. The first time was on the Level II at 19 weeks, and they said it was small so not to worry, and the 2nd one was on a 3D machine a couple of months after delivery, and she was LOOKING for it. Fine with me that it's gone!


45 posted on 11/27/2004 11:07:04 PM PST by Yaelle
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To: neverdem

bttt


46 posted on 11/28/2004 2:44:11 AM PST by lainde
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