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MatGMax

When to end the taper and jump to zero?

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rapunzel2
On 9/3/2017 at 4:25 PM, rapunzel2 said:

what's the jumping off dose for seroquel? I'm planning it to be 2,25mg. I wonder in what dose others have jumped off?

just letting people know that my jump off from 2,25 was successful. jumped off in Feb 2018, and withdrawal wasn't particularly more bad than usual. Felt great for some time - reduced need for sleep and increased feelings and creativity. then withdrawal kicked in but after that subsided, I'm feeling so much better without seroquel. and I'm sleeping much better now, it's kind of a natural sleep. 

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Terry
On 12/22/2014 at 8:01 PM, MatGMax said:

Here is an example of the output for a 20mg taper (though just an example!!)

Month Dose

1 20.0

2 18.0

3 16.2

4 14.5

5 13.0

6 11.6

7 10.4

8 9.3

9 8.2

10 7.3

11 6.4

12 5.7

13 4.9

14 4.3

15 3.7

16 3.2

17 2.7

18 2.2

19 1.8

20 1.5

21 1.1

22 0.8

23 0.6

24 0.3

25 0.0

This wouldn't be a 10% taper.

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Gridley
18 minutes ago, Terry said:

This wouldn't be a 10% taper.

 

No, it isn't.  It starts off that way but is a good bit faster.  The drops at the end are way too fast (going from 0.6 to 0.3 is a 50% drop).  

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brassmonkey

First off this post is over five years old, we've come up with a lot of better information since then.  Yes it is not a 10% taper.

 

The easiest way to calculate a 10% taper is to multiply your current dose by 0.9.  This will give the weight of your next does. Continue on building each calculation on the last to get the complete story.  OR

 

https://www.survivingantidepressants.org/topic/9167-how-to-calculate-dosages-and-dilutions-spreadsheets-and-calculators/

 

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ChessieCat

Putting this here FYI:

 

37 minutes ago, Adrian65 said:

Alix

 

I was on Mirtazapine for 2+ years. Started out at 15 mg, dropped to 7.5 mg with no significant side effects but then tried to drop to zero, which turned out very unpleasant. It was at this point that I found SA and tapering. Going back on Mirtazapine I managed to stabilise at 5 mg and then over 6/7 months steadily reduced the dose down to 1 mg. After a month at 1 mg I was not sure what to do and so jumped off. First couple of weeks was ok but then my sleep began to get squeezed, long time to get to sleep and early awakenings. Couldn’t cope with the insomnia and went back onto 1 mg for a further month. Stabilised very quickly and was pretty surprised how much 1 mg could impact my well-being. After another month at 1 mg I jumped off again and this time was ok. Still have 2-3 day bouts of insomnia and cns isn’t always great but I am now 12months off Mirtazapine. 

 

In retrospect I wish I had gone down further from 1 mg and tapered for longer. At the time I was really wanting to come off but taking a longer perspective a few more months of a very low dose would have been very little time in the grand scheme. 

 

Best set of luck with your taper. 

 

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Rhiannon
On 11/12/2017 at 12:07 AM, KarenRose said:

Brassmonkey, thank you very much. What you said here gives me a lot of hope and clarity, something that has been sorely missing in my life since beginning SSRIs.

 

I think this ultra slow end of taper is a great strategy that many people might benefit from - I would have saved years of suffering had I known years ago, so thank you to you and this forum.

 

Best wishes to you and everyone here. Karen

 

Thanks for your input Karen it's been very reassuring to me and seeing that you are now down and came off at a teeensy dose is also reassuring. I jumped off citalopram after a very long taper (although I was tapering faster at the end) at 0.1 mg, had no acute symptoms that I could notice, but got hit at 3 months out, which was typical for me back in the old days when I was trying to get off SSRIs without much of a taper at all.

 

I've reinstated at 0.05 and plan to go down to below 0.01 and then try again.

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KarenRose

Rhiannon, thank you so much. So glad you are taking care to go as low and slow as your body tells you to. I am about 3 months in now and while I am not doing great, I am SOOO much better than all the other times I have come off. I am functioning and even able to make art. I wish you the best. You too have been such a huge inspiration for me. 

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Rhiannon
2 hours ago, KarenRose said:

Rhiannon, thank you so much. So glad you are taking care to go as low and slow as your body tells you to. I am about 3 months in now and while I am not doing great, I am SOOO much better than all the other times I have come off. I am functioning and even able to make art. I wish you the best. You too have been such a huge inspiration for me. 

 

Keep me posted. You've done so well. I bet once you ride this out you're going to feel great.

 

I didn't tell my care provider that I had gone back on 0.05 because...well, you know how they are, they think we're making it all up. It's so helpful to know someone else who is as sensitive to low doses and dosage changes as I am.

 

What kind of art do you do?

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KarenRose

❤️ Rhiannon, thank you for your words of encouragement. I am holding that same vision for you. After years of being in this med-induced nightmare our relationships and mutual support are gold. I hear you about not telling your provider. I didn’t either. The possible benefits of doing so simply did not match the potential draw backs and discouragement of hearing that I am too sensitive/imagining things/hysterical/the only one who feels this way....So, in my personal opinion, you are doing the right thing in acting on your intuition here.

 

I make visual art of all kinds, very intuitive. I send you much support for the last part of your taper...Art has helped me a lot to get through this. 

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Rhiannon
On 10/16/2019 at 10:43 AM, KarenRose said:

❤️ Rhiannon, thank you for your words of encouragement. I am holding that same vision for you. After years of being in this med-induced nightmare our relationships and mutual support are gold. I hear you about not telling your provider. I didn’t either. The possible benefits of doing so simply did not match the potential draw backs and discouragement of hearing that I am too sensitive/imagining things/hysterical/the only one who feels this way....So, in my personal opinion, you are doing the right thing in acting on your intuition here.

 

I make visual art of all kinds, very intuitive. I send you much support for the last part of your taper...Art has helped me a lot to get through this. 

 

Thanks for the support, Karen. When I think about where I might be if not for this forum and the support and information I have gotten here...I don't think I would have the life I have today. I am so grateful.

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Rhiannon

Over my very many years of tapering, I have gone from being focused on getting all the way off meds to being focused on feeling good and enjoying my gains. I know that most people here are not going to find that approach satisfactory for themselves, but I also know that there will be people who will read what I'm saying and find it reassuring, so I'm saying it. The longer I've been around here and the more stories I've read, the more I've come to realize how remarkable it is that someone like me, with 20 years of being on and switched around on multiple meds, with lots of withdrawal chaos, and finally ending up on five meds when I started tapering -- how remarkable it is that I've managed to get back so much of my mental health and my ability to enjoy life and my original personality.

 

My taper is much more about "take the drugs enough to prevent withdrawal while still letting the doses drift down" than it is about "push towards a final goal." For the alprazolam and citalopram, I am pretty sure I am experiencing minimal psychiatric disruption or toxicity from the drug dose itself, and they are primarily just allowing me the comfort of having minimal withdrawal symptoms while I live my full and challenging and often stressful life. 

 

I still struggle with agoraphobia, and I suspect the 1 mg of diazepam I am still taking contributes to that, and I'm looking forward to seeing how much that improves as I manage to come down slowly. I suspect the lamotrigine and diazepam both are causing some cognitive blunting, but that area is so much improved over even five years ago that I am pretty okay with it.

 

I just focus on trying to be grateful for how far I've gotten and that I have even gotten anywhere. 

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Windsor77

I’m currently at 1.7ml (3.4mg) of citalopram liquid.  My last drop of .1 ml has been very full of anxiety and feeling ill and low.   Feeling really discouraged. since 5mg I have been dropping and stabilizing for a month or so after each drop before starting again.   But this is the first time that I’ve felt this bad for this long (over a month) from just .1 ml drop.  Very frustrating.  Like @Rhiannon- I am focused on having as much healing as possible as opposed to rushing to quit.  I’ve paid for many fast tapers.  From 5mg to now, I’ve gone really slow and it’s been much more tolerable with more windows than waves.  But each new drop seems to be harder.  Perhaps I should shrink to .5ml drop.   That puts my eventual cessation of the drug like 10 years away, but if I feel better, it’s definitely an option. 

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Gridley
15 minutes ago, Windsor77 said:

But each new drop seems to be harder.

 

At what rate are you tapering?  Are you tapering by percentage of current dose or a straight .1ml per month?  What is .1ml in mg?

 

It's at the really low doses that a slow taper is especially important.  Reducing your drop to 0.5 is certainly an option.  Holding longer between drops is also a possibility.  If you're feeling very bad at the moment, I wold hold until you feel better.  We always say here to listen to your body rather than be guided by a schedule.

 

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Windsor77

Tapering at .1 ml drop.  .1 ml is .2 mg., which is about 5.5% of previous dose.  I’m averaging a drop every month and a half for the past 6 months.  Just dropped from 3.6mg to 3.4mg last month.  Feel lethargic.  Anxious.  Had my usual parasthesia flare up. It’s now gone.  Some toe tingling and more muscle twitches and minimal myoclonic jerks.   They all usually subside after a bit.  Then I have another go.  I’m sure it will pass. 

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Giulietta
2 hours ago, Gridley said:

If you're feeling very bad at the moment, I wold hold until you feel better.  We always say here to listen to your body rather than be guided by a schedule.

 

I made what I think were mistakes when decreasing - too fast - and didn't hold for long enough - even though I modified the plan to make it gentler.  I have been paying what I think is a price for this since September 2019. Speaking from my experience I second @Rhiannon and @Gridleys advice.

 

 

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Rhiannon

Windsor, I find that I need intermittent longer holds. I think healing isn't necessarily linear; some adjustments happen faster and some take longer. Taking the occasional longer hold I think might give our systems time to catch up with some of the slower processes that can't get completed in a month.

 

The fact that so many people get hit with WD three months and nine months out from a CT or fast taper indicates, to me, that there may be some processes involved that play out over longer periods of time. Unfortunately nobody is really doing the research on this, so we can't point to anything and say "there it is." But people spend years recovering after withdrawal, so there are clearly some things that need to happen during the process that can't be finished in a month.

 

What seems to work for me is taking a three-month or four-month hold from time to time. I usually find myself feeling much better after that time frame. You might want to just try giving your system a break for a while, you've been dropping doses steadily for a while now. Your CNS may be wanting or trying to do some repairs that it can't quite get done in the time frame it's been getting between drops. Just a thought. If you're not in a rush, it's worth trying, IMO.

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marie123

I found that a couple of long holds at the very end helped alot. Withdrawal was able to catch up so I was able to walk off at about .1 mg trazodone. I noticed symptoms but did not have any acute stuff. At 6 months off I got a medium wave, but after that it's been mostly smooth.

 

Marie

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Colonial

 

From Brass Monkey's Paper, Part 2:

 

"...Part of why it takes so long is simple mathematics. When you add it up a 10% taper every 6 weeks starting at 40mg and ending at the currently accepted jumping off point of 0.016mgai will take about five and a half years...."

 

2 quick questions, does anyone know:

 

1.Is this 0.016mgai jumping off point for Paxil?  And:

 

2. How do I convert what the "mgai" is equal to ml in the liquid solution?

 

I "think" He was on Powder at that point, and I'm trying to figure out how to convert what that would equal to in mgs.

 

I'm currently 3 weeks into a decrease that has me at 0.16 mgs, or 0.08 mill...

I am using a 0.5 ml syringe, and that still constitutes the bottom 4 lines on the syringe...

But it's difficult to get an exact dosage with this syringe, as it's the same color as the liquid,orange.  (Not helpful)

Just trying to get an understanding where that dose is in relation to 0.016mgai.

 

Thank You!

 

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brassmonkey

0.016 mgai is a generic jumping off point that is the target for most tapers.  Because of the number of drugs and the variety of relative strengths we work with it is practically impossible to work out an exact jump point for each one. It makes it so that some people come off at a slightly stronger dose than someone on a different drug, but by the time a dose gets that small, if the taper has been managed properly, the jump point is really a non event. For most people it is the smallest amount that is practical for them to work with.

 

Yes, I used powder for my entire taper and actually went to a smaller dose then this.  But I have plenty of practice working with the equipment and the small amounts necessary. For people using liquids, by working with the dilution ratio they can refine their dose to an incredibly tiny amount.

 

You are already converting mgai into mL. Mgai stands for Milligrams Active Ingredient.  This is the strength of the dose. Above you noted that your dose is  "0.16 mgs, or 0.08 mill. "  The 0.16mgs being the strength of the dose and the 0.08mL being the volume.  When working with weights we like to refer to the strength of the dose as mgai.  This differentiates fit from the weight of the dose which is referred to as mgpw, Milligrams Pill Weight.

 

Your liquid has an AIC Active Ingredient Concentration of 2/1 meaning you get 2mgai for every 1mL of liquid. It's a simple ratio that can be used to calculate the strength for any given volume of that liquid. Following through with the calculation if the dose has a strength of 0.016mgai then it would have a volume of 0.008mL.  Which would be one maybe two drops.

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Colonial

"...You are already converting mgai into mL. Mgai stands for Milligrams Active Ingredient. Your liquid has an AIC Active Ingredient Concentration of 2/1 meaning you get 2mgai for every 1mL of liquid...."

 

Perfect, thank You so much...

So the lowest dose I could conceivably measure on this 0.5 syringe would be 1 line. 

Since I am currently at 4, which represents 0.16 mgs...

1 line would then equal: 0.04 mgs of mgai of Paxil.

Think I got it. 😎

 

 

 

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Frogie
19 minutes ago, Colonial said:

"...You are already converting mgai into mL. Mgai stands for Milligrams Active Ingredient. Your liquid has an AIC Active Ingredient Concentration of 2/1 meaning you get 2mgai for every 1mL of liquid...."

 

Perfect, thank You so much...

So the lowest dose I could conceivably measure on this 0.5 syringe would be 1 line. 

Since I am currently at 4, which represents 0.16 mgs...

1 line would then equal: 0.04 mgs of mgai of Paxil.

Think I got it. 😎

 

 

 

When I was tapering my Lexapro, and got down to 1 ml (I also used liquid), I asked the pharmacy for a pediatric liquid syringe and it’s 1 ml. Made my tapering so easy then.

 

The one my pharmacy had was clear. I know you can get them on Amazon also.

 

 I hope that helps.

 

Take care,

 Frogie xx

 

 

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Colonial

Thanks Froggie!  Good to see Ya! 😃

 

Unfortunatley, the smallest syringes any of the pharmacies here have are 1 ml, so I had to order these 0.5 ml off Amazon ( I think)...

Problem is the 0.5 ml, at least at the time, only came in orange.

 

"They" do make 0.3 ml ones, If I wanted to "Make" one last dose drop below the 1 line of the 0.5 syringe level. 

1 line of the 0.3 syringe would be a 60% drop of 1 line of this 0.5 ml syringe.

So, the smallest "dose" by syringe I could make, with a 0.3 syringe, would be about 0.024 mgs, as apposed to 0.04 mgs on the 0.5 syringe.

 

Thanks again!

 

 

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Frogie
4 minutes ago, Colonial said:

Thanks Froggie!  Good to see Ya! 😃

 

Unfortunatley, the smallest syringes any of the pharmacies here have are 1 ml, so I had to order these 0.5 ml off Amazon ( I think)...

Problem is the 0.5 ml, at least at the time, only came in orange.

 

"They" do make 0.3 ml ones, If I wanted to "Make" one last dose drop below the 1 line of the 0.5 syringe level. 

1 line of the 0.3 syringe would be a 60% drop of 1 line of this 0.5 ml syringe.

So, the smallest "dose" by syringe I could make, with a 0.3 syringe, would be about 0.024 mgs, as apposed to 0.04 mgs on the 0.5 syringe.

 

Thanks again!

 

 

Good to see you too!

 

Bummer they are orange. That makes it hard to see. 
 

I jumped off at .05 ml on Lexapro, but I don’t know anything about Paxil. Brassmonkey is the expert.

 

 I know I got a couple from my vets office too at one point. Maybe check there. Even if you don’t have a pet they might sell you a clear one.

 

You’re on the home stretch. So happy for you😊

 

Take care,

 Frogie xx

 

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Gilla999

Reading through this thread as I was looking for advice on what point to jump off my Mirt and I've found it very helpful. I'm also taking Escitalopram and happy to drag that out forever but the weight gain with the Mirt is what is making me so, so desperate to come off it. I'm eating barely nothing (literally I'm eating about half what I used to pre Mirt) and still weigh 2 stone more than I did when not taking it. It feels like my life can't ever really get back to normal until I feel like myself again with my weight. But @Rhiannon I found what you wrote very helpful and could really relate. It's so easy to get caught up on a magic drug free end goal and reading your words reminded me to be grateful for what I have right now - great sleep and mental health. Whenever I'm tempted to jump off early becsuse of this horrible weight gain I am reminded here what I know deep down which is that it just isn't worth it!! 

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Hibari
2 minutes ago, Gilla999 said:

Reading through this thread as I was looking for advice on what point to jump off my Mirt and I've found it very helpful. I'm also taking Escitalopram and happy to drag that out forever but the weight gain with the Mirt is what is making me so, so desperate to come off it. I'm eating barely nothing (literally I'm eating about half what I used to pre Mirt) and still weigh 2 stone more than I did when not taking it. It feels like my life can't ever really get back to normal until I feel like myself again with my weight. But @Rhiannon I found what you wrote very helpful and could really relate. It's so easy to get caught up on a magic drug free end goal and reading your words reminded me to be grateful for what I have right now - great sleep and mental health. Whenever I'm tempted to jump off early becsuse of this horrible weight gain I am reminded here what I know deep down which is that it just isn't worth it!! 

 

Gilla999,  when I started taking Mirt, I gained 30lbs very rapidly and no matter what I did during my taper, I could not move the weight.  I ate really well, tried a couple of healthy diets and could not shed a pound.   When I got of the medication, I lost 25lbs in two months.  It was like the puffy, fluffy medication weight just came off of me. 

 

There are others that have lost the medication weight too when they came off Mirt.   Keep the faith that it will change.

 

Hibari

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marie123

I

Quote

I have just started with the Mirt taper and from what I've learned by my previous w/d's I fully intend to taper it to .1 mg. No way I will jump earlier. I've gained plenty of weight too. I just think to myself that I'll get healthier and healthier by taking less and less med. I have my eye on the prize and I'm hopeful that I'll get there. I wish you luck Gilla. Marie.

 

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Gilla999

Thank you @marie123 And @Hibari I really appreciate the moral support! I know rationally that nothing is worth giving myself WD for it's just so disheartening to have your body feels so alien. @Hibari did the weight come off only once you had fully stopped taking it? I'm just wondering (praying/hoping) that it will start to shift a bit when I get down to 2mg or 1mg (currently on 3.6mg).

 

@marie123 you are 100% right and I am also a huge advocate of the slow approach, having suffered horrendous 

WD myself when trying to taper too fast previously. I just seem to have a wobble (no pun intended!!) every now again because of the weight thing which has/is really affecting my self confidence. But speaking to others here helps remind me of why it's so important to go slow.

 

Thanks both for your moral support, sending good vibes your way also

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Hibari
4 hours ago, Gilla999 said:

Thank you @marie123 And @Hibari I really appreciate the moral support! I know rationally that nothing is worth giving myself WD for it's just so disheartening to have your body feels so alien. @Hibari did the weight come off only once you had fully stopped taking it? I'm just wondering (praying/hoping) that it will start to shift a bit when I get down to 2mg or 1mg (currently on 3.6mg).

 

@marie123 you are 100% right and I am also a huge advocate of the slow approach, having suffered horrendous 

WD myself when trying to taper too fast previously. I just seem to have a wobble (no pun intended!!) every now again because of the weight thing which has/is really affecting my self confidence. But speaking to others here helps remind me of why it's so important to go slow.

 

Thanks both for your moral support, sending good vibes your way also

I started noticing I felt smaller when I got lower.  I can't remember the dose but definitely below 10mgs.  

 

I was so uncomfortable with the weight, so I really understand that feeling.  Yes I wanted to be healthy but I was so puffed up and it bothered me.   I made me feel as disconnected from who I was as the Mirt did.  

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Giulietta
On 12/22/2014 at 9:01 PM, MatGMax said:

WARNING: DO NOT GO COLD TURKEY AT THE END OF YOUR TAPER

 

Cold turkey is cold turkey. Even though you might be down to a tenth of your original dosage, quitting suddenly may still be too much for your nervous system

 

Hello - and sorry if this has been addressed before. I've searched the thread and not found best next steps. @Gridley@brassmonkey @Rhiannon - tagged in case you can weigh in.

 

I looked at the Horowitz concentration and levels in the bloodstream after skipping days as a way to get off.

 

I have been on 1 bead (.2 mg) of duloxetine for 9 weeks. Today I stopped that bead and was thinking to do every other day so I didn't have to jump - and then maybe every 3 days. I am having a lot of symptoms 5 hours after skipping the dose.

 

I'm going to take one bead now and hope things improve extremely soon.

 

In meantime I have to get this s### at some point and I don't know when or how. I also need to start a clon taper I think soon. Will post onmy thread but any comments gratefully appreciated.

 

Thanks and trying to be calm

G.

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Gridley
21 minutes ago, Giulietta said:

 

I'm going to take one bead now and hope things improve extremely soon.

I do too.  It's good you caught it that fast.  Things should stabilize reasonably quickly after just a 5 hour delay.

 

Looks like you need to stabilize on that 1 bead every day for a while longer.

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Giulietta
26 minutes ago, Gridley said:

Things should stabilize reasonably quickly after just a 5 hour delay.

 

Looks like you need to stabilize on that 1 bead every day for a while longer.

 

Thanks. I'm starting to see improvement.

 

A spec of fentanyl can (or does) kill people. Look at one bead of duloxetine does to you. The WD symptoms seemed to have returned more intensely.

 

Is that because of the percent drop? I think it may be 50%?

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Gridley
2 minutes ago, Giulietta said:

 

Is that because of the percent drop? I think it may be 50%?

Unless I'm misunderstanding, the drop was 100%, from one bead to zero.  The skipping days aspect didn't have a chance to come into play.

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Gilla999

Hi all - hope everyone is surviving these crazy times!

 

As you can see from my profile, I've been tapering off Mirtazapine since this time last year (after only two weeks on it I still had huge WD when I tried to come off too quickly). I've pushed myself to be patient with a 10% reduction, despite the horrid weight gain that has knocked my self confidence and sense of self so badly, but now I'm here in the low doses at 2.55mg or .17ml of the Mirt liquid I take. (Incidentally... because I couldn't find any answers to this when searching/asking, just adding in case it's useful to someone else that at the start of 2020 I started to notice a small but gradual decline in the weight gained - I've lost about 9 pounds since Jan. Still another 14 or so to go to get back to my pre-Mirt weight, but those 9 pounds have helped me feel I'm on the right track).

 

My question here is at what point is a reasonable low dose to jump off the Mirt. I'm now dropping by .01ml each time because that's the least you can do. Do I really need to wait another 15 months, to drop to .01ml and then jump off there? It does seem like a crazily slow taper... not even sure you will even get any liquid up the syringe at numbers like .02! Also becaue of the way the bottle and syringe are shaped it's already getting very difficult to be able to see the dose I'm measure out (using a .50ml syringe which is the smallest you can buy I think). 

 

If there's anyone out there who has had experience with Mirtazapine specifically that could share their stories of low tapers it would be much appreciated! Although I know by now that people who have had good/fine/easy experiences often tend not to post on websites 🤔

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Erell

Hello @Gilla999

 

Brassmonkey just wrote a great article about this issue, it may answer your questions

 

 

Take care ❤️

 

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