Removing screws and rods?

[sidrid]

I had my first scoliosis surgery in May 2002 at age 52. I am now contemplating having the screws removed, or rods and screws removed, depending on what is inside and how it looks.

The screws are so painful, I'm about to go crazy. Right at the top of the rods, and right where the back bra strap crosses my back are the painful areas. My doctor says it's because I am "so thin". I could lose a good 20 pounds before I'd be "just right" - not to heavy, not too thin.

My question is: has anyone else ever had just the screws removed? What about rod removal? Does the spine try to curve again? I've spoken to my doctor, but I'd like to hear from experienced patients. I'm told it's supposed to be fused completely, but I'm still concerned.

I guess I'm just afraid my spine will add more curves. I still have three curves and will never be fully straight because of the degrees of my original curves before surgery and my age. I'm afraid the osteoporosis at the top will turn the upper spine to mush without the rods. And I do dread the thought of more cutting, especially since I caught a staph infection the first time around.:mad:

Any thoughts?

[shicks72]

Hi Myrtle -
I am new to this site and I saw that you haven't had any replies yet. I may not have any great information for you but at least can let you know about rod removal.

I am currently 32 years old and I am still battling back pain issues. I was diagnosed with ideopathic scoliosis at age 7. At age 21, I had a spinal fusion (T5 through L2) with TSRH instrumentation in 1994. In 2001, I was suffering from repeated back spasms. The doc found that my rod was broken. I was in the same position as you as to whether I would have the rod removed. The doctor could not guarantee I would have no ill effects from the removal of the instrumentation. I decided to go ahead with the removal as I feared the broken rod would do further damage.

I went in for surgery on a Friday morning and left the hospital on Monday. They would have discharged me on Saturday yet my B/P was too low and my drain was still filling up with fluid. I took four weeks off from work as I thought I needed the time to recouperate (although looking back I probably only needed a week off). The recovery process from this surgery was much less difficult for me than the initial fusion and rod placement.

If you decide to have the surgery, the prognosis will probably depend on numerous factors. Given it has only been 2 1/2 years since your initial surgery I am not sure how well the fusion has healed.
Did you have donor bone or did you use your own bone? I had my own bone fused and they say that is more sucessful.

Do you smoke? Supposedly, fusions do not heal as well if you smoke.

What kind of instumentation did they use? The TSRH instrumention that I had was diffucult to remove as the rod and hooks are all attached as one unit - they couldn't take just the rod out.

I would make sure I found the BEST orthopeadic surgeon who specializes in this area before I went through another procedure.

Footnote: I am now battling with 3 protruding discs below my fusion which they tell me is something I will have to deal with for the rest of my life (I wish I had known this before the elective fusion and rod placement at age 21) :(

Sorry for the long message, but I hope it gave you a little insight.
Sincerely, Steph H

[Pikey]

hi all , i know of a lady from another site who had her rod removed after it broke .Some years on now her back has got worse and she has also has badly degenerating discs .She has just been told by her Surgeon at Great Portland Str in London that they are going to operate again .They will smash up the existing fusion , straighten the spine and refuse and put rods in.She will be in hospital for about 6 weeks and have 3 operations .The surgeon said they might look into replacing the discs that are real bad but they wont know about that til after the Op .

[shicks72]

Pikey -
that makes me really sad :(
I hope that happens in a small population of patients that are going through what we are.
I will be thinking of her and hoping for the best for her....

[Pikey]

dont be sad , i took her to the hospital because a few months before she chickened out. She is so happy that it is finally going to happen .Plus they reckon they can straighten her as well ,maybe i will be able to get her on to tell her story but if not i will let you know how it's going .Harrington rod patients are suffering but at least i know through "Smiler" that there is still hope ."Smiler " is the name of the lady aka "Jaquie".

[kathleensrose]

Myrtle:
Like you, I had a staph infection the first go-around.
So....I am afraid with the second operation looming close.
In Michael neuwirths book, he says that most patients are
not aware of the fact that the fusion which was done is the
most important part of the operation. The rods are only to
hold the back in place until the fusion takes hold; after that,
they are simply left in. The fusion is the procedure which
holds your spine in place. A consultation with your surgeon about the possibility of your back curving in areas not yet fused
is in order.
It feels strange telling you to hang on everything will be
okay when I am petrified of my own upcoming operation and
the memories of infection .But thats all we have. I wish
you good luck and talk to your doc about culturing your back
in the area where you had the infection. My doc will culture just before before he enters the back in the same area as the previous infection. There is only a small chace there will be spores left, but its a favor to the patient. Kathleen

[kathleensrose]

Myrtle:
Like you, I had a staph infection the first go-around.
So....I am afraid with the second operation looming close.
In Michael neuwirths book, he says that most patients are
not aware of the fact that the fusion which was done is the
most important part of the operation. The rods are only to
hold the back in place until the fusion takes hold; after that,
they are simply left in. The fusion is the procedure which
holds your spine in place. A consultation with your surgeon about the possibility of your back curving in areas not yet fused
is in order.
It feels strange telling you to hang on everything will be
okay when I am petrified of my own upcoming operation and
the memories of infection .But thats all we have. I wish
you good luck and talk to your doc about culturing your back
in the area where you had the infection. My doc will culture just before before he enters the back in the same area as the previous infection. There is only a small chace there will be spores left, but its a favor to the patient. Kathleen

[kathleensrose]

Myrtle:
Like you, I had a staph infection the first go-around.
So....I am afraid with the second operation looming close.
In Michael neuwirths book, he says that most patients are
not aware of the fact that the fusion which was done is the
most important part of the operation. The rods are only to
hold the back in place until the fusion takes hold; after that,
they are simply left in. The fusion is the procedure which
holds your spine in place. A consultation with your surgeon about the possibility of your back curving in areas not yet fused
is in order.
It feels strange telling you to hang on everything will be
okay when I am petrified of my own upcoming operation and
the memories of infection .But thats all we have. I wish
you good luck and talk to your doc about culturing your back
in the area where you had the infection. My doc will culture just before before he enters the back in the same area as the previous infection. There is only a small chace there will be spores left, but its a favor to the patient. Kathleen

[bunnie]

Myrtle,

Hi I am Bunnie and I read your post that was suggested by another on this site. I see you have had a staff infection. My daughter had a staff infection and all they did was try to lance it and use antibiotics locally. We were told that the infection would not go away unless the hardware was removed. What happened to you and your infection. What did they do for you to get rid of it? My daughter had her second surgery to remove the rods and now after almost 2 years now has curved again after the doctor said she was fused and would not curve anymore. We are very upset that she will have a third surgery to put hardware back in. She has been pretty strong about all this even though I have not been. She actually keeps he up because she is. We even asked when we saw an x-ray several months after at a checkup that it looked like she had curved and was told she did not. We are not blind. Since the insurance changed and we had to get another doctor it took forever to get her records to even start with a new doctor. Since you are 52 I would think you would not curve again since your growth is over but I did see something on another site but just can't seem to find it now that said you can still curve around 1 degree each year after growth is over. If I find it I will send it to you. My daughter was told mis-information about her curving again and look where we are today. I hope all goes well with you and if you can give me that information on the staff infection I would appreciate it. Thanks.

[sidrid]

Thanks for your replies.

Yes, I know that the rods are just "there" after the spine has fused. My fusion looks pretty cool on an X-ray, like a board. I am worried because I also have osteoporosis in the upper spine. The doctor didn't know it was there until she cut into me. The bone density tests don't tell the truth because they don't scan high enough.

Bunnie, I received your email and responded today. For the others who are curious, my MRSA staph infection hasn't shown it's ugly head in nearly 2 and 1/2 years. My blood work comes back negative so I no longer have to take the oral antibiotics they told me I'd have to be on FOREVER because the rods were there to stay.

I was treated with oral antibiotics for about 18 months, and IV antibiotics for 8 weeks. It was no picnic. I must say that it did have one positive effect. It killed all the body hair off me for quite awhile and I didn't have to shave my legs for one year and now only do so sporadically. Hair under my arms never did grow back. The hair on my head was okay although it was a bit icky for awhile. I like my hair soft and flyaway, but for a time it was stiff and in sad need of conditioner. It took ages for me to get it back to normal, now it's back to its soft flyaway self. My hair has always been thick, so I guess that's why I didn't notice any hair loss.

All these stories about people having problems with discs and broken rods is quite scary.

I'm sure no other surgery would be as traumatic on the body as the initial rod insertions, so I'm not in fear of removal itself. I'm just hoping nothing else goes wrong with it. Thanks for telling me about the infection site culture before any additional surgery. That's a very good idea.

I have an appointment with my doctor next week, so I'll discuss it all with her then. It's not definite I'll have surgery anytime soon. She does have to check my cervical spine (neck). I have degenerative disease there are she keeps track of it because I may need surgery there someday, too.

Thanks for your concern and I hope Bunnie's daughter and everyone else has quick healing.

I will not be jumping into surgery before additional tests are run and everything looks okay.

Just for the record, no, I've never smoked. I had bone grafting from a 'donor' because my bones are too small and in bad shape to use.

Thanks for all the responses.

[rita]

Myrtle,
Hi, I did not get your email. The email address has zeros in it and not the letter o's. Please send it again. Thanks.
Bunnie

[Karen Ocker]

I had an uninstrumented fusion in 1956 at age 14. Over my lifetime that "solid" fusion re-curved until by age 59 I had an 80 deg thoracic curve needing revision. I do not have osteoporosis, never smoked and am very active. I never had an infection.

Recently, at my check-up, I told Dr. Boachie I was afraid of losing the correction we got 2 years ago (because of what happened to my original correction). He told me it's rare unless something happens to the hardware. I also asked another doctor at HSS the same question; he gave the same answer.

In doing some research of the literature it mentions that many hardware failures are from poor bone quality where it becomes loose. Before hardware was used a person did not walk for a year while the fusion healed and wore a series of 3 casts. That was what I did. I had to learn to walk again. Instrumentation allows early ambulation and serves to support the spine during healing and reinforces the fusion permanently.

I personally would not have mine removed unless they were going to replace it with something else.

[Tiny]

what a long way they've come with correction surgery. I didn't know that's how surgery used to be done. Were you flat on your back for a whole year in a cast? It makes me feel fortunate for what I will be facing for my first surgery.
Tiny

[sins]

I agree with karen.Like her I had an uninstrumented fusion in 1983.My curve was 110 degrees and was not corrected.It seems to have progressed at a rate of up to a degree a year and I am debating revision surgery.My last consultant told me that larger fused curves without instrumentation i.e. those over 60 degrees tended to progress slowly,even after fusion . I also know the lady Pikey was referring to and in that situation it was a long c curve and the apex of the curve acted as a lever and allowed the curve to progress after the rod had been removed.As predicted the fusion was not solid, which may have explained why the rod broke.
Sins

[sidrid]

Thanks for all the responses.

Yes, one year in a cast was standard in the 1940s, '50s and '60s. That's why I opted not to have surgery in my teens, in the mid-1960s. There's an old book (1970s) by Rosalie Greisse, "The Crooked Made Straight" telling of her first surgery in the 1940s (they put her in a special hospital for a year!) through her seventh surgery in the 1970s. Makes you grateful for the medical improvements of today.

I had to reschedule my doctor's appointment for next week because my dad is having some medical problems that call for more immediate attention. So my new appointment is in mid-February.

[calico75]

Hello there. I've noticed several postings about Staph infection. I had Harrington Rod surgery when I was 12 and developed staph infection 12 years later. I have been battling the infection for over 3 years. In Nov 2001 and Feb 2002 they lanced the site of the infection, suctioned it out, and treated me with oral antibiotics. The last surgey in 2002 they gave me Vacomycin thru an IV and I had a severe reaction called Red Man's Syndrome (anaphylatic shock). Needless to say I'm not looking forward to having another surgery. I've been treated with oral IV level antibiotics every since. The infection comes and goes, and I've recently been told that I need to consider surgery to remove the rods. I have been been told that the infection will never go away as long as i have the rods. I have also heard horror stories about this surgery and my family isn't too happy with the idea of me having the rods removed. I am now 29 years old and never had any problems until the infection 3 yrs ago. Now I have lower back pain frequently that sometimes goes into my tailbone and legs, plus i have to fight the infection. My immune system is weak and I catch everything that goes around. I saw Bunnie's post about her daughter and though it sounded so familar. I've been doing alot of research and still confused on a decison. I've agreed to talk to a surgeon and get some opinions but the whole thing is overwhelming, especially with family and friends telling me not to do it. I realise that I may not have a choice, I cant live on antibiotics the rest of my life.

[Tiny]

In reading so much about theses staph infections, I was wondering where they come from and how can they be avoided? How common is this problem?
Tiny

[LindaRacine]

Tiny and Calico...

Here are links for abstracts of a few studies that might be of interest:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15553799
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15549484

Tiny, staph is everywhere in the environment, including your skin.

I have a friend who had a deep wound infection that was discovered about 5 years after her surgery. It was treated with multiple courses of IV and oral antibiotics. Finally, she had her implants removed about 6 months ago, and it looks like she's finally got the problem licked.

Calico, if you're on the wall about the implant removal surgery, I'd like to give you one piece of information that it seems doctors rarely tell their patients. I don't want to frighten you, but I think it's important to know that infectious bacteria eat away at your bones. So, if an infection is allowed to go on for a long time, it can cause the spine to lose some of its mass. From what I've heard from those who have gone through it, implant removal surgery is usually a relatively easy surgery.

Good luck!

Regards,
Linda

[luvteddybears]

I had a fusion with Harrington rods implanted in 1989 when I was 19 and never had any problems until about 5 years ago. I started feeling pain in my lumbar area and for 4 years no xray or any other test could find anything wrong then miraculously after 4 years of severe pain they found a piece of the rod was bent and pressing on the spinal cord so last March I had that piece removed and not replaced. As a result of the surgery though I now have nerve damage in my hip and leg and excruciating pain in those areas. My discs at L1 and S1 are also deteriorated because of the rod pressing there for so long before they caught the problem. I have just been approved for SS disability. I just wanted to let you know, make sure you get a second opinion before you do anything. Yea the doctors told me because I was so thin too that was what was causing the pain(122 pounds) but I knew that wasn't the case. Take care.

[sidrid]

Thanks for all the information. I didn't realize that infection could crop up years later, even though infection wasn't there during the original surgery. Live and learn.

I agree, "too thin" seems to be a cop-out. The pains I feel don't seem to have anything to do with lack of fat. Those screws poke into my skin and it hurts, especially when I lean back on them or lie down on them. "Too thin" my eye! I could afford to lose a few pounds. I'm about 20 to 25 pounds heavier than I should be -- and I don't want to be SKINNY.

Something I forgot to mention about my MRSA (staph infection) treatments: I went through a series of 20 hyperbaric oxygen treatments for my staph infection.

I was put in a single-person chamber and it feels something like being in an airplane on descent. The pressure on the ears is very strong. I had to be treated with Sudafed about an hour before HBO treatment and used earplugs during the treatment to make me more comfortable.

Do a Google search on "Hyperbaric Oxygen" and it will bring up lots of links and lots of information, including photos.

My doctors credit the HBO treatments for my recovery of the infection.

[Blondy232]

Hi! I Had AP fusion T4-S1 and I am having stabbing pain at T3. I am looking for some relief as well.

[LindaRacine]

Blondy...

When was your surgery?

--Linda

[Blondy232]

Linda, Dr. Boachie did my surgery in April, 1999. The rod at T3 never fused properly and I have pain from it rubbing the adjacent muscle causing inflamation across my upper shouders neck head etc. I need some direction in how I should proceed in fixing the problem. Boachie just wants to cut off the end if the rod. I am not so sure that will be the cure-all. I am 59 years old and basically in good health. Thanks.:)

[LindaRacine]

Hi Blondy...

I'm curious as to why Dr. Boachie wouldn't want to refuse the T2-T3 or T3-T4 disc. However, the surgery to cut off the rod would almost certainly be an easy surgery. If it were me, I'd probably give it a try if I felt the doctor had a good reason to suggest it.

Interestingly, I recently started having a lot of pain at the top of my fusion, and now the rod is prominent on the left side. I'm thinking that I may have had a screw pull out. If my doctor recommends that I have some of my instrumentation removed, I'll definitely go for it.

Regards,
Linda

[mamakay]

Linda,
I am sorry to hear you are having trouble with your rods.
You have been a great help to me.
My dtr said on our recent visit to her surgeon he told her she had titanium rods.
I was zoned out looking at the xrays and didn't realize what type rods were put in her.
Does anyone know the pros and cons of the rods they use now?
Linda do you have harrington rods? Are those still used?
Keep us posted so we can support you as you have us..
mamakay

[LindaRacine]

Hi Mamakay...

Harrington rods are rarely used any longer, at least in the U.S. Mostly, what is used for posterior surgery, are what is called a universal system. They're stainless steel or titanium rods, attached to the spine by hooks, screws, or more uncommonly, wires.

My implants are C-D, which was the first universal system.

Titanium implants weigh less, and don't interfere with MRIs. However, they're more brittle than stainless steel, so can break faster in certain circumstances. And, titanium is considerably more expensive than SS. I don't know if insurance companies push doctors to use SS, but it seems to me that they might.

Regards,
Linda

[sidrid]

Thanks for all your responses, especially yours, Linda, with the information on the types of rods.

I have titanium rods. Before surgery my doctor said there are no allergic reactions to titanium like there are to stainless steel. Just my luck, I have an allergy to my rods. They make me itch all the time and I must stay on lots of allergy medications to keep the itching down to a minimum. I'm always getting someone to scratch my back.

I'm reluctant to have more surgery to have the rods removed because of the MRSA I caught last time. It was no fun. Also, I'm not ready for additional surgery at this time. I'm just now able to feel more like my old self, my self in my 30s when the pain wasn't as awful as it was just before surgery when I was desperate for any relief.

I do have an appointment with my doctor on Monday so we'll go from there. I also have degenerative cervical spinal disease (neck) that also might require surgery. Ugh!

Someone asked me what MRSA stands for: methicillin-resistant Staphylococcus aureus. It is resistant to all but one antibiotic, I think, and it can be deadly. I was very lucky I made it through. It also causes other frightening and deadly conditions. Not good at all. So now you know my reluctance for additional surgery.

[Blondy232]

Hi!
I have had itching in my back since my surgery T3-S1. I never attributed it to allergy. I scratch myself raw. My husband is always rubbing cream on my back. Regards Blondy232

[Karen Ocker]

I had itching which I attributed to my nerves healing. It occurred in various places and it went away. I still get it rarery in a new area that is "waking up". It is not relieved by scratching.

I am positive it is not from my hardware(stainless steel).

Karen

[LindaRacine]

Hi Blondy...

When was your surgery? Do you actually get a rash or hives? I think it's something to report to your surgeon.

I've felt the same thing that Karen mentioned. It will about drive you nuts. It's an itch that cannot be scratched.

Regards,
Linda

[sidrid]

My surgery was almost three years ago and I still itch all the time. The itching was there immediately after surgery. I also have an allergy to adhesive tape, so I was a real mess. I had everyone who came into my hospital room scratching my back. They'd rub on top of the tape and around the tape's edges. When I say everyone, I mean the doctors, interns, nurses, nurse's aids, visitors, family, social worker....anyone who had at least one hand. I'd roll onto my side and say "scratch". When I was on my back when someone came in, they could really do a good job.

At first I had a rash but not now. I'm interested in Blondy's experience, too. Blondy, have you mentioned this to your doctor?

The itching is still there all the time. Even though I take allergy meds, I can still feel it. I'm always getting the family to scratch me. No, it doesn't relieve it, it just feels really good while they are doing it.

Whenever I get into something else I am allergic to, my back itches worse than ever, madly, wildly. It is quite an experience.:eek:

[Karen Ocker]

Myrtle:
I suggest seeing an allergist if not already. There are blood tests to help determine allergies. Narcotic pain killers are notorious for causing itching; that is not a true allergy but caused by the drug's release of histamine. You also could be allergic to something else in your environment that you were not allergic to before. For example: fabric softeners, detergents, soaps, creams. A dermatologist told me NEVER to use Benadryl cream, contrary to ads. It greatly sensitizes the skin. I am allergic to shea butter, musk and PABA. So I have a long history of skin problems since childhood.

Karen

[Blondy232]

Linda,
Dr. Boachie did my surgery in 1999. There has never been a rash or hives associated with my itching on my back. At first I thought it was the nerves waking up. As I said in a prior post, it itches to the bone. My stomach area that was also cut during surgery does not itch at all. It is actually still sort of numb. No part of my body that was involved in the surgery feels normal as of this date. Regards, Blondy

[LindaRacine]

Blondy...

You have me stumped. If it were an allergic reaction, I would think that there would be an associated rash/hives. I would definitely mention it to your primary care physician or Dr. Boachie the next time you see either one. For years, I've had a small spot on my left thigh that itches a lot. There's never been any indication on my skin that there's a reason for it. Luckily for me, it's only one small spot. I've been putting baby oil on that spot after every shower, and it seems to be working.

Regards,
Linda

[sidrid]

Like I said before, I have no rash either. In the beginning the rash I had was probably related to the adhesive tape they put on me after surgery.

I saw my doctor on Monday. Asked about the itching. She agrees it is definitely the titanium rods and says a few people are allergic to them and I am one. Also, because I normally only itch along the spine and where the rods are, she is certain the rods are the cause.

I have an allergist because I have numerous allergies, too. My other allergies never reacted the way my allergy to the rods reacts, only in the one area. Before surgery, my allergic reactions were system wide. Now when I get into something I shouldn't it also makes the area where the rods are itch like mad.

Linda, you should mark this down for future reference. I'm sure someday, someone will want to know this, especially if the titanium rods cause longterm effects.

Karen, my allergies aren't from pain medications, because the itching would be all over. Also, I can't take strong narcotics, I have very bad reactions: hallucinations, horrid nightmares, an awful spinning sensation........really bad stuff. I just have to suffer with the pain, although some days are very good, while others can really put me in bed, moaning and groaning. I have encountered antibiotics I'm allergic to, and it wasn't pretty. Yikes!

I'm still dealing with numbness in my legs, hips, and some areas of my back. My surgery was in 2002.

I'm scheduled for additional tests on my cervical spine where I have 3 diseased discs, because I'm constantly dropping things and am in intense pain. Like Gilda Radner used to say, "It's always something.":)

[mattie]

I am looking at having another surgery. My scoliosis surgery was sept.13.2004. One of my screws has moved and caused one of my rods to shift. The end of the rod is sticking out and causing me lots of pain. The doctor seems to think my back is fused enough that he can take the rods out. I am not so sure. I just know I can not go on with this rod sticking out.
When I had the surgery he said that if something happen and I had a problem he would have to wait at least two years to remove the rods. Now he says he thinks he can remove them now. I went today for a bone scan to see how strong my bones are. I don't know what to do.

[ErinB]

I had my first surgery when I was 12 for a Thorasic Curve of 76 Degrees in my spine - idiopathic at Toronto Sicks Kids Hospital.
I began having complications within a year and ended up having to remove my hardware at age 16 (same hospital). Apparently, I was in the 1% of patients having complications...niiice. :(

I had approx. 3/4 of rod removed on one side and 1/4 removed on other. I should've just asked them to reput the entire thing in (harrington rods) to replace the existing hardware. Now, at age 28, I am having constant back pain, and am trying to get into see a doctor to find out what's wrong.

[KML]

I am new on the forum though I have been reading the postings for a while.
I have a fairly long story: I had a harrington rod put in at 16, at 18 it broke. The doctor said if I was heavier I may have never felt it. I went in again for surgery to remove and they were hoping that I had fused but I had not so they put two smaller rods in distally & proximally. I had those in for about 5-6 years but continually had pain so when I was 24 I had a third surgery to replace with "newer" technology. My old doc was gone so I had to start up with a new one. (I am in Vegas and now being older and wiser, 34, I have found that even having surgery like this in Vegas was probably a mistake to begin with). Anyway, they took out the rods and replaced with clamps of some sort and within 3 days I felt pretty good but then all of a sudden I had severe pains that would go from the back through my ribs and it was so bad I could not move and would be crying hysterical when it came on. They wheeled me down to surgery again and took out the clamps and replaced with rods again!! I was in the hospital for 21 days that time. Then in 95, I spoke with the doc about removing them in hopes maybe it would alleviate some pain....so he did. Now I wonder if he should have. :confused:

Now I have a 105 degree kyphotic curve (humpback) and have pain all the time :( & try to manage with too many pain pills (3-4 day). Went to Dr. Deverin at UCSF on Mon and discussed revision surgery w/ multiple osteotomies. Anyone ever have that done? He said it is very complicated surgery with complete recovery time of 6 mo - 1 year. I have 2 small kids, work etc...
It is a tough decision to make. Any info would be wonderful! Sorry for the looooong story.

KML in Las Vegas