During this recovery period, you will be extremely tired and need to rest. A ruptured spleen can cause pain in the left shoulder because bleeding from the spleen may irritate the phrenic nerve, a nerve that originates in the neck and extends through the diaphragm. Laparoscopy-induced pain is still not fully understood. Later, a pulmonary recruitment maneuver consisting of five manual pulmonary inflations was performed with a maximum pressure oof 60 cmH2O. Because it is the same nerve that send pain signals to both the shoulder and the diaphragm, the brain is confused and thinks that the signal of irritation or pain is coming from the shoulder - what . Symptoms typically improve when you are in a sitting or standing position. Surgical procedures affecting the phrenic nerve can cause pain. Consult privately with the doctor of your choice. One way to relieve phrenic nerve pain after surgery is to drink lots of water and use heat packs. Another simple way to reduce the pain is to find a position that is most comfortable. After laparoscopic surgery, it is common for patients to experience shoulder pain. I love to write and share science related Stuff Here on my Website. Randomized double-blind comparison of phrenic nerve infiltration and suprascapular nerve block for ipsilateral shoulder pain after thoracic surgery. [2] All the nerve branches are no closer than 1.5 cm me-dial to these land-marks for all positions of humeral rotation with the arm at the side. Results: You can wrap a word in square brackets to make it appear bold. Postoperative shoulder pain is a common complication of laparoscopic surgery. eCollection 2021. Pain occurs in the neck or scapula when the phrenic nerve is irritated 16,17,22. . Shoulder pain is a common side effect after laparoscopic surgery. BMI: 29.6. Conclusion: This practice has been proven in numerous studiesto provide patients with the following benefits: Less patient pain means less need for long-term narcotic medication; Less narcotic pain medication leads to less nausea or bowel symptoms; Less tissue damage leading to decreased inflammatory response; and. Tsai H, Chen Y, Ho C, et al. We have demonstrated that this pain can be reduced through the effective techniques we practice, including not only removal of the C02 before the end of the procedure but, importantly, heating and humidifying the gas, which prevents cellular death and quite simply, results in less shoulder pain.7We always utilize the latest technology and surgical practices to minimize pain and recovery time for all of our patients, including (but not limited to) use of Insuflow technology. lasts for more than 5 days. . Laparoscopic Surgeon 10 yrs exp Ghaziabad. This study aimed to determine the incidence and risk factors of shoulder pain after hepatectomy. Thus, the phrenic nerve receives innervation from parts of both the cervical plexus and the brachial plexus of nerves. Still; even in the best of hands with use of the most meticulous techniques, some shoulder pain may persist - though it should begin declining markedly around the 48 hour mark.8 Anecdotal tips for coping include applying a heating pad to the affected shoulder, alternating between lying flat or on your side and ambulating (walking around), judicious use of post-operative analgesia, use of over the counter medications like GasX and consumption of hot liquids such as tea. World J Surg. Applying heat packs to the lower abdomen is safe and can reduce pain. Shoulder pain after laparoscopic surgery has been thought to be due to the irritation of the phrenic nerve, which may be mainly caused by insufflated carbon dioxide. In the meantime, patients should apply heat to the affected area and take prescribed pain medication. Sixty patients were randomized into two groups, with one group receiving PNB with 4 ml (30 mg) of 0.75% ropivacaine (group P, n = 28) and a control group (group C, n = 32). We report the case of a 52-year-old female who presented with chronic left shoulder pain following a motor . About 35 percent to 70 percent of patients experience it after surgery. Rather, the sufferer would deteriorate if nothing is done. Neurologist: no it shouldn't. Plus the phrenic nerve is on the left side of the abdomen and her liver surgery would have been on the right side so I doubt that this is phrenic nerve damage. Background Post-laparoscopic shoulder pain (PLSP) frequently follows a laparoscopic cholecystectomy. Anyone who has undergone Laparoscopic surgery knows about that shoulder pain. This site needs JavaScript to work properly. injury to the shoulder or neck. Some of the gas used to inflate your abdomen can remain inside your abdomen after the procedure, which can cause: These symptoms are nothing to worry about and should pass after a day or so, once the patient body has absorbed the remaining CO2 gas. Read our, ClinicalTrials.gov Identifier: NCT01433874, Interventional
These nerves run to the shoulder, and if they are stimulated, it can cause shoulder pain. Talk with your doctor and family members or friends about deciding to join a study. Sodium Bicarbonate Sub-Diaphragmatic Irrigation Relieves Shoulder Pain After Total Laparoscopic Hysterectomy: A Randomized Controlled Trial. You can also do these things to help. If The surgeon may also give you a cleansing enema or oral laxative. It can also be affected by surgical procedures. If youre looking for information on how to relieve phrenic nerve pain following laparoscopic surgery, youve come to the right place. Unless the phrenic nerve is injured on both sides, making the patient unable to breathe on his or her own, this is often an elective treatment situation. Phrenic nerve irritation, following a laparoscopic surgery, can impact both motor and sensory functions. You should wear sanitary pads during this time, and take anti-inflammatory medication to alleviate any discomfort. Unexplained shoulder and arm pain can sometimes be a warning sign of a heart attack. It happens usually due to irritation of diaphragm while passage of bolus of food. Background Shoulder pain is commonly reported after hepatic surgery; however, the factors affecting post-hepatectomy shoulder pain remain unclear. The anesthesiologist held the fifth positive pressure inflation for approximately 5 seconds. How long does gas pain from laparoscopy last? internal bleeding, speak to your doctor immediately. This pain is caused by the CO2 gas used during the procedure. should go away within 3 - 5 days. doi: 10.5812/aapm.118278. If the pain perceived in the tips of the shoulders is related to inflammation of the peritoneal reflections supplied by the phrenic nerve, this may also be reduced by anti-inflammatory analgesics. ABDOPAIN.com. Unexplained shoulder and arm pain can sometimes be a warning sign of a heart attack. Have as much rest as possible. However, recovery time varies depending on the type of surgery. Due to the well-known advantages of minimal invasive surgery, the majority of procedures for benign gynaecological diseases are performed by laparoscopy. The phrenic nerve is a nerve that originates in the neck and goes down to the diaphragm. A pulmonary recruitment maneuver consisting five manual pulmonary inflations was performed with a maximum pressure of 60 cmH2O. Shoulder pain is a common side effect after laparoscopic surgery. 2021 Aug 29;11(4):e118278. Multiple research studies have hypothesized that PLSP is due to phrenic nerve irritation at the diaphragmatic level, creating referred pain Dr. Matthew Kaufman is reconstructive plastic surgeon, who is also board certified in Otolaryngology (head and neck surgery). Goldberg J, Falcone T. Gasless Gynecologic Laparoscopy. Retrieved from http://hcp.obgyn.net/laparoscopy/content/article/1760982/1894615, 6105 PEACHTREE DUNWOODY ROADBUILDING B, SUITE 230ATLANTA, GA 30328PHONE: 770-913-0001FAX: 770-913-0005. 2013 Mar;121(3):526-531. doi: 10.1097/AOG.0b013e318283fcca. Recruitment manoeuvres (RM) consist of a ventilatory strategy that increases the transpulmonary pressure transiently to reopen the recruitable lung units in acute respiratory distress syndrome (ARDS). You should also be aware that some pain medications may cause nausea, so make sure to notify your physician. From its origin, the phrenic nerve descends vertically caudad and adjacent to the internal jugular vein. In fact, the acid milieu created by the dissolution of CO. 2. gas causeperitoneal irritation and phrenic nerve After surgery, you may feel sleepy, so you should try and take frequent naps. However, it is usually temporary and can be eased with simple analgesics. Postoperative analgesic efficacy of single-shot and continuous transversus abdominis plane block after laparoscopic cholecystectomy: A randomized controlled clinical trial. The PFT results and respiratory discomfort assessed by a modified Borg's scale were not different significantly between the groups. A total of 63% of the patients h This soreness is caused by gas in the shoulder joint, which will go away in two to three days. How do you stop shoulder pain after surgery. Background: Post-laparoscopic shoulder pain (PLSP) frequently follows a laparoscopic cholecystectomy. shoulder pain. Even though the CO2 is removed following surgery, the gas can become trapped against the diaphragm, causing pain and discomfort that can then radiate into the shoulder because of pressure on the phrenic nerve. The most common symptoms of nerve damage after surgery are usually numbness, tingling, burning, muscle weakness or atrophy. For general information, Learn About Clinical Studies. Pain after laparoscopic surgery can be divided into: There is marked interindividual variability of post-operative shoulder-tip pain following laparoscopic surgery. Careers. A proposed mechanism for PLSP is the irritation or injury of the phrenic nerve by the CO 2 pneumoperitoneum during laparoscopic surgery. To suffer shoulder tip pain due to internal bleeding, you would have remain. Heat packs and moving around should help to relieve the pain. Although this pain is often not a serious side effect, it can be bothersome. To minimize the pain, they can elevate their head with pillows and avoid lying flat on their back. Our Customer Services Team are here to help with all of your inquiries during institute opening hours. Phrenic nerve irritation, following a laparoscopic surgery, can impact both motor and sensory functions. In addition, scar tissue can form in the neck and compress the nerve. EDITOR: Shoulder pain after laparoscopic surgery has been thought to be due to the irritation of the phrenic nerve, which may be mainly caused by insufflated carbon dioxide .However, shoulder pain can be caused by stretching of the shoulder, which is constrained by many muscles and ligaments .We investigated postoperative shoulder pain in 72 patients who underwent gynaecological laparoscopy by . Phrenic nerve irritation, following a laparoscopic surgery, can impact both motor and sensory functions. A small amount of it dissolves in the moisture on the surface of the The risk of shoulder pain after laparoscopic surgery for infertility is higher in thin patients. It may also settle up under the diaphragm, where the CO2 will cause irritation to the chest. The hypothesis of post-operative shoulder-tip pain is that carbon dioxide induced phrenic nerve irritation causes referred pain to C4. Thoracic surgeons treat patients who require surgical solution to diseases and disorders of the chest, including disorders of the diaphragm. 2008 May;111(5):1155-60. doi: 10.1097/AOG.0b013e31816e34b4. This article will discuss how to relieve phrenic nerve pain after surgery. You may also be prescribed anti-inflammatory medication. Its a type of nerve pain that feels like pins and needles. Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number): Why Should I Register and Submit Results? Listing a study does not mean it has been evaluated by the U.S. Federal Government. Provided for educational purposes only. However, one disadvantage of the procedure is that patients are more likely to experience shoulder pain. Whether it is diving the ocean, and seeing creation beyond my imagination, or being in the pit of the quarry with not even a shadow in sight, knowing that there is light to cover the expanses of darkness. The Phrenic nerve arises on each side of the neck, from the 3rd, 4th and 5th cervical spine roots. Data were . You have reached the maximum number of saved studies (100). Based on the current evidence, safety and possibility to implement the technique in daily practice, pulmonary recruitment manoeuvre can be recommended to reduce both the incidence and severity of shoulder pain. 2000 Apr;55(4):205-10 The pain tends to be at the tip of the shoulder. American Society of Anesthesiologists(ASA) physical status of patient classification I-II. 2020 May 29;13(2):45-49. eCollection 2020 May. The incidence of such pain varies from 35%-83% across patient populations, ranging from mild to severe, and in some cases, the pain has been reported to last even longer than 72 hours post-operatively (though this is less common).1 Moreover, in nearly 70% of cases studied, patients experienced the worst pain not immediately post-operatively - but up to 24 hours aftertheir surgery.2 Read on to find out why this occurs - and what we have been doing for years at our Center to help effectively reduce and diminish this pain in our own patients.To begin, during Laparoscopy,CO2 (carbon dioxide) gasis injected through a special needle inserted just below your navel. Methods This prospective cohort study recruited 218 patients who underwent hepatic resection at our hospital from June to September 2022. WE ARE PLEASED TO HAVE THE ICONIC QUEEN BUILDING LIT IN YELLOW ANNUALLY TO HONOR THE ENDO COMMUNITY. Please do not contact our surgeons or staff via text/SMS on their personal cell phones or by social media/messenger. Irritation to the diaphragm may cause a person to feel pain in the shoulder area. Federal government websites often end in .gov or .mil. The result is irritation of the phrenic nerve and diaphragm, causing referred pain in the . There are 11 strategies that are used to minimize the pain after laparoscopic surgery. Its a SEVERE stabbing pain in the right shoulder/neck/arm due to damage or scarring on your diaphragm. Phrenic nerve pain can be associated with a variety of different surgical procedures. Hohlrieder M, Brimacombe J, Eschertzhuber S, Ulmer H, Keller C. A study of airway management using the ProSeal LMA laryngeal mask airway compared with the tracheal tube on postoperative analgesia requirements following gynaecological Laparoscopic surgery. The phrenic nerve arises from the neck (C3-C5) and innervates the diaphragm, which is much lower. In severe cases, it can even result from a spinal cord injury. World Laparoscopy HospitalCyber City, Gurugram, NCR Delhi INDIA : +919811416838World Laparoscopy Training InstituteBld.No: 27, DHCC, Dubai UAE : +971525857874World Laparoscopy Training Institute8320 Inv Dr, Tallahassee, Florida USA : +1 321 250 7653, Paid Online Consultation From Our Surgeon, shoulder pain, as the gas can irritate your diaphragm (the muscle you use to breathe), which in turn can irritate nerve endings in your shoulder. Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01433874. Current Weight: 178 lbs. The nerve run downs the neck to the diaphragm, but also branches out to the left shoulder - so the feeling of pain is mistakingly referred out there when the diaphragm . It feels like someone is stabbing me with a piece of rebar (the metal poles in concrete) and just . Simply stated:when the CO2 gas irritates the diaphragmatic nerves, that pain is referred upwards through nerve connections, eventually landing in - and aggravating - the shoulder.To be more specific: the diaphragm and shoulder share some of the same nerves; predominantly, the Phrenic nerve. Elevating your head on a pillow can reduce pain. It can result from a partial or complete transection of the nerve. In some cases, it has been reported to last more than 72 hours after surgery. Talk to a doctor now. Shoulder arthroscopy is a minimally invasive procedure that treats shoulder impingement and rotator cuff tears. Please enable it to take advantage of the complete set of features! If you have a question, no matter how big or small, and it is outside of opening hours use the email below and we will do our best to get back to you as soon as possible. Belly button pain after laparoscopic surgery. This means that the degenerative damage in your neck can significantly impact the function of one or both vagus nerves. Cellular Death a normal, regular process by the body to deliberately get rid of unwanted cells, C02 a colorless, odorless gas comprised of one carbon and two oxygen atoms abdominal cavity, Laparoscopy - a minimally invasive surgical procedure used to diagnose and treat endometriosis (among many other disorders), Peritoneal tissue the membrane that forms the lining of the abdominal cavity, Phrenic Nerve innervates the diaphragm and is responsible for, among other functions, breathing, Pneumoperitoneum - surgical creation of a distended abdomen to lift and separate organs (non-surgical pneumoperitoneum = free air in the peritoneal cavity; this is a secondary health concern not addressed or in any way referred to within this article), 1., 4., 5. I am currently continuing at SunAgri as an R&D engineer. -, Br J Anaesth. pain in one or both of their shoulder. Obstet Gynecol. (Clinical Trial), Maneuvers to Decrease Upper and Shoulder Pain After Gynecologic Laparoscopic Surgery, Experimental: Pulmonary recruitment maneuver, Experimental: Intraperitoneal normal saline infusion, 20 Years to 80 Years (Adult, Older Adult), Contact: Yi-Jen Chen, M.D.,Ph D. 886-2-2875-7566. Warm bath and hot drink. Your doctor may order an X-ray to determine the cause. Try using two heating padsone on the front and one on the back of the affected shoulder. Shoulder pain after laparoscopy is very common. 2006 Nov;30(11):1969-73. doi: 10.1007/s00268-005-0752-z. Pulmonary recruitment manoeuvre: Recruitment manoeuvres (RM) can be defined as a voluntary strategy to increase the transpulmonary pressure (PL) transiently with the goal to reopen those alveolar units that are not aerated or poorly aerated but reopenable. The phrenic nerve is a bilateral, mixed nerve that originates from the cervical nerves in the neck and descends through the thorax to innervate the diaphragm. It can result from irritated diaphragmatic nerves. The upper part of the abdominal cavity was evenly and bilaterally filled with the 0.9% normal saline in the amount of 500cc. View this study on Beta.ClinicalTrials.gov. Evidence suggests that shoulder pain after laparoscopy mainly occurs due to the irritation of the afferent nerve fibers of the diaphragm phrenic nerve, induced by the residual CO 2 , blood, or . If youre able, try to listen to music during your procedure. The site is secure. Nerves Regulate Breathing The phrenic nerve is actually a pair of nerves, the right and left phrenic nerves, that activate contraction of the diaphragm that expands the thoracic cavity. You can also use a heat pack on your lower abdomen to help with the pain. Combined low pressure pneumoperitoneum and intraperitoneal infusion of normal saline for reducing shoulder tip pain following laparoscopic cholecystectomy. If you are unable to tolerate the pain, you can ask a nurse to provide you with a narcotic analgesia that will make you sleep. Prevention of postlaparoscopic shoulder and upper abdominal pain: a randomized controlled trial. For a few days after the laparoscopic surgical procedure, many patients likely to feel some pain and discomfort, which in turn can irritate the nerve endings in the diaphragm resulting in referred pain in shoulder. This gas can irritate the nerve and cause pain in the chest and shoulder areas. You can also try placing a drain underneath your diaphragm. Pain in the right shoulder and arm is often due to muscle or tendon damage. Multiple research studies have hypothesized that PLSP is due to phrenic nerve irritation at the diaphragmatic level , creating referred pain sensations around the shoulder unilaterally or bilaterally. -, Reg Anesth Pain Med. Multiple research studies have hypothesized that PLSP is due to phrenic nerve irritation at the diaphragmatic level , creating referred pain sensations around the shoulder unilaterally or bilaterally. Anesth Pain Med. EMSJen. The phrenic nerve is an important part of the diaphragm, so understanding its anatomy is important. Danelli G, Berti M, Casati A, Bobbio A, Ghisi D, Mele R, Rossini E, Fanelli G. Eur J Anaesthesiol. Although it is generally temporary, shoulder pain may persist for a few weeks or even months. Epub 2007 Apr 17. If you are having laparoscopic surgery, you may experience gas pain in your shoulder. lost a significant amount of blood, filling the whole of the abdominal cavity, Once you are fully awake, youll receive post-operative instructions, including how to keep the wounds clean and when to come for follow-ups. A phrenic nerve that does not respond to stimulation can indicate the cause of paralysis of the diaphragm. If you can, listen to music with headphones. Martinez-Barenys C, Busquets J, de Castro PE, Garcia-Guasch R, Perez J, Fernandez E, Mesa MA, Astudillo J. Eur J Cardiothorac Surg. This electrode is connected to a radiofrequency receiver which is implanted just under the skin. Management: . to help. This gas can irritate the diaphragm and the phrenic nerve, which has nerve endings in the shoulder. This nerve has sensory, motor, and sympathetic functions. Home Contact Us Privacy Policy Ad Policy DisclaimersStatement of Diversity & Inclusion:The Center for Endometriosis Care (CEC) fosters a culture of opportunity and mutual respect. Severe ISP can cause ineffective breathing and impair shoulder mobilization. The residual CO2 causes pressure on the nerve, which in turn, causes the pain. What caused it? The incidence of shoulder pain varies from 35% to 80% and ranges from mild to severe. You may also want to ask the hospital to give you hot packs, but be sure not to put them on your skin. Your doctor will switch you to a different pain medication if necessary. The phrenic nerve is critical to the function of the diaphragm to ensure breathing. Another easy way to alleviate the gas pain is to apply a heat pack to the abdominal area. Ipsilateral shoulder pain after thoracotomy surgery: a prospective, randomized, double-blind, placebo-controlled evaluation of the efficacy of infiltrating the phrenic nerve with 0.2%wt/vol ropivacaine. Later, a pulmonary recruitment maneuver consisting of five manual pulmonary inflations was performed with a maximum pressure of 60 cmH20. Sci Rep. 2021 Jan 13;11(1):1052. doi: 10.1038/s41598-020-80289-y. The .gov means its official. The upper part of the abdominal cavity was evenly and bilaterally filled with the 0.9% normal saline in the amount of 500cc. Usually, this is caused by severed, stretched, or compressed nerves. The hypothesis of post-operative shoulder-tip pain is that carbon dioxide induced phrenic nerve irritation causes referred pain to C4. Why Does your shoulder hurt after a laparoscopy? Is this common? 3 Interscalene brachial plexus block is the most common regional anesthetic technique; however, phrenic nerve palsy and hemidiaphragmatic paresis have traditionally been inevitable consequences, which limit its utility in the . Has anyone dealt with, dealing with phrenic nerve pain? weakness and shortness of breath. We will leave the fluid in the abdominal cavity. Gas left in the abdomen after laparoscopic surgery can irritate the peritoneum. Therefore, the investigators should try to do is that if the investigators could reduce carbon dioxide retention in the pelvic cavity. Phrenic nerve irritation, following a laparoscopic surgery, can impact both motor and sensory functions. Excess fluid or blood clots trapped in the upper abdomen and between the diaphragm and right . The anesthesiologist held the fifth positive pressure inflation for approximately 5 seconds. The primary outcome measure of this trial is the severity and frequency of shoulder and upper abdominal pain after laparoscopic surgery. Here, we investigated whether a phrenic nerve block (PNB), performed under ultrasound guidance, could reduce the incidence and severity of PLSP after . A proposed mechanism for PLSP is the irritation or injury of the phrenic nerve by the CO2 pneumoperitoneum during laparoscopic surgery. If you are suffering from shoulder pain, you should consult your doctor about treatment options. Phrenic nerve irritation If your phrenic nerve becomes irritated or damaged, you may lose the ability to take automatic breaths. A laparoscopic procedure leaves a residual amount of gas in the abdomen. This pain can last several days. 2010 Sep-Oct;35(5):455-7 Score: 5/5 (66 votes) . I was discharged and they told me it was an intercostal, Mesenteric lymphadenitis is a common cause of right-sided abdominal pain in children, that mimics appendicitis. The Use of Massage Therapy as a Nonpharmacological Approach to Relieve Postlaparoscopic Shoulder Pain: a Pediatric Case Report. However, this pain should pass on its own in a couple of days. after a few days. Muscular disorders, such as muscular dystrophy. Patients should follow a rehabilitation plan that includes physical therapy and exercise. Your doctor may use dissolvable stitches to close the incisions. . Additionally, hot tea can stimulate gastrointestinal motility and help you relieve painful gas pains. Flying after laparoscopic surgery. -, Anesth Pain Med. Up to 80% of these women may experience shoulder-tip pain (STP), which may be very painful and lead to longer stays in hospital and even having to go . This is an important piece of information for the health care team to know because they need to know whether your intestines are working properly and whether or not POI is occurring. Abdominal Pain Forum | Post Your Health Question & Get Answers Here, Mesenteric Lymphadenitis - Causes, Symptoms, Diagnosis and Treatment. described above. In the neck and upper thorax, the left phrenic nerve tracts proximal to the subclavian artery. After four hours, you can begin walking or at least climbing stairs. A heart attack is a medical emergency. Lastly, you may want to consider using abdominal support pillows. Do you have some pictures or graphics to add? 2017 Jun;39:146-151. doi: 10.1016/j.jclinane.2017.03.050. Based on these findings, ultrasound-guided PNB can prevent or reduce the PLSP without clinically significant respiratory discomfort. You may also find it helpful to walk for a few days following the operation. Yang L, Zuo Y. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. Bookshelf (You can preview and edit on the next page), Help Keep This Site GoingDonate To Show Your Support, Return To Home Page from Shoulder Pain After Laparoscopy Page, YOUR GUIDE TO CAUSES AND TREATMENT OF ABDOMINAL PAIN, Upload 1-4 Pictures or Graphics (optional), Hi, About 18 months ago I had to call an ambulance as I had severe pain in my abdomen on the left side. The phrenic nerve originates from the anterior rami of C3 through C5 and traverses the neck, heart, and lungs to reach the diaphragm. HHS Vulnerability Disclosure, Help The Phrenic Nerve Program is a collaboration between Reza Jarrahy, MD at the UCLA Division of Plastic & Reconstructive Surgery and Matthew Kaufman, MD at the Institute for Advanced Reconstruction. One suggested cause of pain after laparoscopy is the peritoneal insufflation with CO. 2 . The authors describe the anatomical, physiologic, and clinical principles relevant to phrenic nerve palsy in this context and present a comprehensive review of the strategies for reducing phreno-nerve palsy and its clinical impact while ensuring adequate analgesia for shoulder surgery. It may also help to rock your knees from side to side. You can also try leg exercises to stimulate your bowels. var months=new Array(13);months[1]="January";months[2]="February";months[3]="March";months[4]="April";months[5]="May";months[6]="June";months[7]="July";months[8]="August";months[9]="September";months[10]="October";months[11]="November";months[12]="December";var time=new Date();var lmonth=months[time.getMonth()+1];var date=time.getDate();var year=time.getYear();if(year<2000)year=year+1900;document.write("
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