Question:

The outrageous allegations made by CBI on this news group, suggesting that I am deliberately trying to deceive the readers on this group are patently false and clearly intended to discredit the Buteyko movement of which I am a vocal advocate. not at all Peter…they are patently true and given even more proof by your own misleading post, whether mistaken or dishonest…I still haven’t made up my mind whether you are a fool or a fraud…

My impression is the latter. I think he has let fervent believe and hope cloud his judgement. – Hide quoted text — Show quoted text – From Sher, assistant clinical professor of medicine and pediatrics, Case Western reserve school of medicine. Cleveland , Ohio (Ref 2:) " The  acute form of  HVS, which represents 1% of patients with the syndrome, is readily diagnosed because of its characteristic presentation, including carpopedal spasm, extreme anxiety, impressive hyperpnea, tetany and parasthesias.  The chronic form  may present with  bizarre and often unrelated symptoms that may affect any organ system.  The prevalence is reported between 6% to 11% depending on the patient population." [And just in case you are speed reading Chris,  1% of HVS is ACUTE and that means 99% is CHRONIC] would the chronic form be somebody who has chronic episodes of acute hyperventilation?…that’s how it reads to me…in other words there are three options ordinary HVS, acute HVS and chronic acute HVS…the latter being somebody who has acute HVS frequently…it doesn’t seem to imply the existence of a low level chronic HVS at all

Exactly my interpretation. — CBI, M.D.

Response:

I have asthma and my name is Jennifer. How can I learn more about HVS

Response:

– Hide quoted text — Show quoted text – The outrageous allegations made by CBI on this news group, suggesting that I am deliberately trying to deceive the readers on this group are patently false and clearly intended to discredit the Buteyko movement of which I am a vocal advocate.  The dishonesty he has demonstrated is all the more despicable considering that doctors automatically have a credibility advantage by virtue of their position.  He has blatantly abused that position and I’m now going to expose it.  Chris knows full well that the average reader on this news group is not going to check on the references, but will simply take his word for it, because after all he is a doctor and people expect doctors to be honest.  It makes them feel insecure to think they can’t trust their doctor. I have used the medical literature to make specific points to demonstrate that Buteyko’s theory has a basis in medical literature. But I have no doubt that even the hyperventilationists would be surprised at the results achievable with  Buteyko’s treatment.  I’m sure none of them would have expected that asthma could be reversed by reversing chronic hyperventilation as universally as the anecdotal evidence suggests. At the center of our dispute is the question of whether or not chronic hyperventilation syndrome actually exists in the community.  My position has consistently been as follows: 1. The condition does exist in the community 2. It is associated with a large number of  bizarre symptoms 3. It is very poorly understood by most of the medical community 4. The anecdotal evidence brought about by Buteyko’s treatment supported by the Brisbane clinical trial findings  suggest that even the small section of the medical community who understand the disorder have understated its significance. CBI contends that chronic hyperventilation does not even exist and that I have deliberately misrepresented the literature.  He recognises only  that the acute form of the disorder exists and can  trigger asthma attacks.

At least he has finally stopped misquoting me. To follow the ensuing argument it is importent to realize that for a long time there has been a hyperventilation syndrome known in psychiatry. It is a form of panic attack. It used to be considered that it was always acute and self limiting. The old fashioned treatment was to breath into a paper bag. More recently people have come to understand that while the respiratory component is acute and short lived the effects of the anxiety disorder can persist and cause longer lasting symptoms, hence the term chronic hyperventilation syndrome. There is no data to suggest that the respiratory component is chronically abnormal. It has nothing to do with the coincidentally (?) named disorder sited by Buteyko supporters. I’m now going to quote  *verbatim*  from the literature, most  of which I have been referencing for a very long time.  I will omit Nixon’s very substantial and outstanding contribution.

For good reason. Everytime you reference him someone brings up the rather annoying fact that he has been exposed as a fraud. From Cluff  (Ref 1): "Hyperventilation or (over breathing)  is a perfectly normal reaction to stress, and a large proportion of people have at some time experienced some of its effects, eg. the racing heart, weak knees and ‘butterflies’ in the stomach so often felt before examinations.  But these symptoms normally disappear once the stressful situation is over".

Did you read the part about the symptoms being related to acute episodes of stress, not chronic? I would also point out that the referenced article is a "discussion paper," i.e. no new data presented. Ruff does not appear to have any other publications indexed on medline on any topic . "Between one-half and two thirds of patients over breathe consistently, so that the PCO2 is continuously below the normal range (36-44mmHg = 4.8-6.0 kPa), a condition of respiratory alkalosis, or hypocarbia." [Did you pick up on that Chris?  The word is *consistently*]

He said consistently, i.e. every time they have an acute episode of stress. He has said nothing about the chronic baseline state. Since the paper is not an original research paper it might be interesting to know what he was quoting and look at the original data. Since it was published before 1984 I doubt the data shows chronically lowered pCO2’s or you would have brought it up by now. From Sher, assistant clinical professor of medicine and pediatrics, Case Western reserve school of medicine. Cleveland , Ohio (Ref 2:) " The  acute form of  HVS, which represents 1% of patients with the syndrome, is readily diagnosed because of its characteristic presentation, including carpopedal spasm, extreme anxiety, impressive hyperpnea, tetany and parasthesias.  The chronic form  may present with  bizarre and often unrelated symptoms that may affect any organ system.  The prevalence is reported between 6% to 11% depending on the patient population." [And just in case you are speed reading Chris,  1% of HVS is ACUTE and that means 99% is CHRONIC]

Yes, but by HVS he means anxiety. When he refers to chronic HVS he is refering to chronic anxiety and the seemingly unrelated somatic complaints that can accompany it. Even if you dispute what the author meant, he still has not presented data supporting chronic hypeventilation. Again, you are confusing psychiatric terms with physiologic ones. "Hyperventilation is known to cause asthma and may further reinforce symptoms of HVS.  In such a setting HVS and asthma may feed back upon themselves"

Translation: Panic/anxiety and exersize can trigger asthma. Still no data on respiration. "Hyperventilation syndrome (HVS) is a fairly common and occasionally disabling condition that  in its chronic form may be extremely difficult to diagnose." "In summary, HVS is a common though often unrecognised disorder" [Note, Chris,  Chronic Hyperventilation is often unrecognized!!!!!!!]

No, Chronic hyperventialtion syndrome, which in the psychiatric literature refers to chronically recurring episodes of panic, is often missed. Still no data on respiration. Here’s one I haven’t used before from Malmberg: (Ref 3) "When hyperventilation occurs chronically or in recurrent episodes and is associated with somatic (respiratory, neurological, intestinal) or psychological (anxiety) symptoms, the clinical entity is called hyperventilation syndrome (HVS)" [Note Chris,  only when it is chronic or recurrent is it called HVS] "The correct diagnosis of HVS is of great clinical importance since at least 5-10% of general medical outpatients have been reported to suffer from this syndrome and, due to a variety of somatic symptoms, the risks of misdiagnosis are considered to be high."

This is the start of the referenced article. "BACKGROUNDHyperventilation syndrome (HVS) is a common disorder which is difficult to diagnose because of somatic symptoms and its episodic nature. In previous studies respiratory alkalosis in arterial blood was often found during orthostatic tests in patients with HVS. The purpose of this study was to assess these orthostatic changes by non-invasive pulmonary gas exchange measurements and to evaluate whether these responses discriminate patients with HVS from healthy subjects." You will note that the author states the disorder is episodic, i.e. not chronic. This was a study to see if they could provoke hyperventilation by inducing orthostatic changes in susceptible people. It is also noted that before the provocation, while at rest, the parameters were the same between the two groups. In other words, there are only acute differences during the test, there were no differences at other times. Please accept this as one of the requested examples of literature you have intentionally misrepresented. You quoted a passage about CHVS and stated that it supports your contentions when, in fact, the author clearly states that the measurable abnormalities (overbreathing) are episodic. Or did you just not read it carefully? And Gardner: (Ref. 4) "Hyperventilation is a confused and poorly documented subject and the publication of this paper provides an opportunity to review some of the particularly controversial aspects of this subject." [The whole paper deals with just how confused the subject is]

This is an editorial in the same issue of Thorax as ref #3. There is no abstract and I have no access without paying $25 or going to the library at the hospital, which I am not committed enough to this argument to do. The quote you have given does not make any statement one way or the other. You don’t really expect me to just take your word for it do you? – Hide quoted text — Show quoted text – And here, once again, is the list of symptoms that have been attributed to Hyperventilation Syndrome.   This time I have not referred to Nixon’s papers  and indicated precisely which reference the information was derived from.  Incidentally, Professor Nixon has had papers published long after the notorious court case.  He is obviously still being taken seriously. SYMPTOM Hypophosphatemia  (Ref.:2)) Accommodation to low CO2  (Ref.: 5, 2) Electrolyte changes  (Ref.:5 ) Poor oxygenation due to Bohr effect(Ref.: 5, 2 ) Effect on mycordial cells(Ref.:5, 2 ) Palpitations  (Ref.: 5,2,1,6) Cardiac neurosis  (Ref.: 1,6) Mitral prolapse  (Ref.: 1,6) Tachycardia  (Ref.:2,1) Arrhythmias  (Ref.:5,1) Cerebral vascular constriction (Ref.: 2) Stenosis of coronary artery  (Ref.: 5, 2) ECG: Flat of inverted T-wave  (Ref.:5, 2) Vasoconstriction  (Ref.: 5,2,1) Da Costa’s Syndrome  (Ref.:2 ) Genito-urinary

… read more »

Response:

if anyone finds Peter Kold at all convincing but has so far not bothered to check the arguments in detail, please try to find the time and concentration to go through the whole of this post…I’ve tried as far as I am able to explain why his use of medical references is misleading…I’ve tried to steer clear of jargon The outrageous allegations made by CBI on this news group, suggesting that I am deliberately trying to deceive the readers on this group are patently false and clearly intended to discredit the Buteyko movement of which I am a vocal advocate.

not at all Peter…they are patently true and given even more proof by your own misleading post, whether mistaken or dishonest…I still haven’t made up my mind whether you are a fool or a fraud…but given the number of times you have contradicted yourself, the number of times that you have totally misinterpreted medical references, and the number of times you have quoted selectively out of context, the one thing certain is that you are NOT telling the truth  The dishonesty he has demonstrated is all the more despicable considering that doctors automatically have a credibility advantage by virtue of their position.  He has blatantly abused that position and I

Question:

Hi, all!! I was wondering if someone could answer this for me.  I was diagnosed with cough-variant asthma about 1 and half years ago.  I was taking my Pulmicort to reduce the coughing whenever it flared up.  This past week, I’ve been suffering from a bad flu.  It’s only today that I’m able to actually get to the computer.  For the past few days, I’ve had a terrible headache, and a high fever.  My husband took me to the hospital last night, as my fever was still relatively high.  The doctor said that the flu had triggered my asthma, and made it worse.  He told me to increase my Pulmicort to two puffs, four times a day.  He also perscribed Prednisone while the puffers were taking affect.  I have to take 40 mg/day, for four days.  I am quite aware of the effects of the drug.  I was just wondering if anyone had any experience with taking it for a short time, and what side effects did they have, if any?  Thanks!! Frances O’Rielly

Response:

perscribed Prednisone while the puffers were taking affect.  I have to take 40 mg/day, for four days.  I am quite aware of the effects of the drug.  I was just wondering if anyone had any experience with taking it for a short time, and what side effects did they have, if any?  Thanks!!

Most people experience no noticeable side effects when taking prednisone for such a short period of time. Others may experience some relatively mild side effects, like an somewhat increased appetite.  But again, four days is a very short course of pred. Most pred side effects occur either at higher doses or when the pred is taken for a longer timeframe. SW.

Response:

Most people experience no noticeable side effects when taking prednisone for such a short period of time.

My experience has been the same, except I usually start to feel really great, terrific, after the second day.  My question about this:  when- ever I have to take prednisone for severe colds or bronchitis my doc- tor prescribes 60 mg for two days, 50 mg for the next two days, then two days of 40 mg, etc, down to 10 mg for the last two days.   This means I’m on pred for 12 days which is fine with me as it means the cold/bronchitis symptoms will have completely disappeared by the time I stop taking it.  I’m a bit surprised by this dose of 40 mg for four days — is that long enough to really make a difference?  Also, my doc is very concerned about the tapering off period — but if you only take it for four days, even at 40 mg, can you skip the tapering off period? Most pred side effects occur either at higher doses or when the pred is taken for a longer timeframe.

What exactly constitutes a "high dose" of prednisone?   And one other question, please:  I have a friend with asthma whose doc- tor told her to carry 60 mg of prednisone with her at all times in case she has an asthma attack.  Does this make sense?  How quickly does pred work if what you’re taking it for is an asthma attack?  If I’m taking it for bronchitis, it takes 36-48 hours before I start to notice any differ- ence.

Response:

My experience has been the same, except I usually start to feel really great, terrific, after the second day.  My question about this:  when-

Er, really great and terrific in terms of the asthma, or in terms of emotionally? For short bursts the most common side effects seem to be: increased appetite, weight gain, water retention, and mood swings [which can be positive or negative or both ].  People’s threshold at which they will have and notice side effects varies — some people don’t notice any until they hit 60mg/d, others may notice them at 20mg/d…   Keep in mind also that a person might be having side effects but might not really realize that that is what they are experiencing.  For example, the mood swings may be though to be part of being sick, increased appetite because you are feeling better.  Weight gain may be small enough that you don’t even realize it occurred.  Etc… The duration of the pred course also plays a role; the longer it is, the more likely you are to *notice* the side effects [e.g. you won't necessarily notice an increased appetite if it is only increased for a couple of days, especially if you haven't been feeling great and haven't been eating as well, and are now feeling better and are also now hungirer again...  but chances are you would notice it if it lasted for a couple WEEKS...]. I stop taking it.  I’m a bit surprised by this dose of 40 mg for four days — is that long enough to really make a difference?  Also, my

It can be, yes.  See below; the burst doses recommended are typically 40-60mg/d for 3-10 days, no taper. doc is very concerned about the tapering off period — but if you only take it for four days, even at 40 mg, can you skip the tapering off period?

From the current US guidelines, p.86: "The burst should be continued until patient achieves 80% PEF personal best or symptoms resolve. This usually requires 3-10 days but may require longer. There is no evidence that tapering the dose following improve-ment prevents relapse." The burst doses they are talking about are 40-60mg/d. The Canadian guidelines state that while tapering has been popular in the past, it is not necessary when the course of treatment is 15 days or less. There are some people who have problems coming off of steroids even when the course of treatment is short; so some people do need a taper. And some MDs either don’t know about the new guidelines, or even if they do, still feel a taper is appropriate as a general rule.  But using a taper as a matter of course for <15 day courses of treatment at ‘normal’ burst doses is not longer thought to be necessary. And one other question, please:  I have a friend with asthma whose doc- tor told her to carry 60 mg of prednisone with her at all times in case she has an asthma attack.  Does this make sense?  How quickly does pred

Depends on her history and what her asthma acts like.  Obviusly her MD feels it is appropriate.  Does she also carry a rescue inhaler? because the pred is going to do absoluely nothing for her in the short term…  What is HER undestanding of why she is to have it??  Based on everything I have read about asthma treatment, carrying pred like that doesn’t make sense except in perhaps a really exceptional case [e.g. if one is going backpacking for a few days, it would make sense to bring pred, and it would naturally live in your backpack which would be carrying it with you.,... but it woudn't be on your person 24/7 even then...]. Most people who have been given pred to have on hand have it at home and don’t carry it with them.  Immediate use of pred is not part of the US guidelines’ recommended home treatment of acute flares plan — pred is brought in once the initial bronchodilators have been used and the response to them is determined.  Early use of pred IS in the hospital treatment guidelines. See below for how long pred takes to kick in… it certainly won’t help her immediately… Does she have an action plan? work if what you’re taking it for is an asthma attack?  If I’m taking it for bronchitis, it takes 36-48 hours before I start to notice any differ- ence.

Pred takes several hours to start to kick in [IIRC, 6-8 hours+], and should show noticeable effects within 48 hours [many people who have been on pred have probably experienced this -- you still feel horrible for the first couple days, then after about 2 days you start feeling MUCH better...]. SW. THIS IS NOT MEDICAL ADVICE.

Response:

Prednisone takes at least a few hours to have much effect on asthma. This is all relative, but anything over about 40mg/day in an adult is a large dose. Some people need 2-3 days worth while others require a week or more. Tapering isn’t needed for short courses at least as far as adrenal suppression is concerned but I sometimes taper doses so I can detect if the patient has improved enough to tolerate the lower dose before letting the drug run out completely. Sometimes this helps blunt the relapse a patient might have if they stopped cold turkey too early. If you knew exactly how long the steroids would be needed though you could do the same dose up until that day. Most people require less therapeutically though near the end of a course compared to what they needed at the start of a course and the lower the side effects so lowering the dose when the higher dose isn’t needed can be helpful in this respect. One other note though is about the various "dose packs". Always ask your doctor for plain generik prednisone instead of a dose pack. Some dose packs increase the cost by up to 5 or 10 fold – better to just write out on the prescription how to take the drug without buying all that fancy packaging. – Hide quoted text — Show quoted text – Most people experience no noticeable side effects when taking prednisone for such a short period of time. My experience has been the same, except I usually start to feel really great, terrific, after the second day.  My question about this:  when- ever I have to take prednisone for severe colds or bronchitis my doc- tor prescribes 60 mg for two days, 50 mg for the next two days, then two days of 40 mg, etc, down to 10 mg for the last two days.   This means I’m on pred for 12 days which is fine with me as it means the cold/bronchitis symptoms will have completely disappeared by the time I stop taking it.  I’m a bit surprised by this dose of 40 mg for four days — is that long enough to really make a difference?  Also, my doc is very concerned about the tapering off period — but if you only take it for four days, even at 40 mg, can you skip the tapering off period? Most pred side effects occur either at higher doses or when the pred is taken for a longer timeframe. What exactly constitutes a "high dose" of prednisone?   And one other question, please:  I have a friend with asthma whose doc- tor told her to carry 60 mg of prednisone with her at all times in case she has an asthma attack.  Does this make sense?  How quickly does pred work if what you’re taking it for is an asthma attack?  If I’m taking it for bronchitis, it takes 36-48 hours before I start to notice any differ- ence.

– Don Elton Columbia, SC http://www.midcarolina.org

Response:

You may not get any side effects. Commonly people complain of trouble with sleep (too much energy); some folks get an upset stomach, others can get a high blood sugar if they have any tendency for this. Most just note their asthma gets better than they’re used to seeing. – Hide quoted text — Show quoted text – Hi, all!! I was wondering if someone could answer this for me.  I was diagnosed with cough-variant asthma about 1 and half years ago.  I was taking my Pulmicort to reduce the coughing whenever it flared up.  This past week, I’ve been suffering from a bad flu.  It’s only today that I’m able to actually get to the computer.  For the past few days, I’ve had a terrible headache, and a high fever.  My husband took me to the hospital last night, as my fever was still relatively high.  The doctor said that the flu had triggered my asthma, and made it worse.  He told me to increase my Pulmicort to two puffs, four times a day.  He also perscribed Prednisone while the puffers were taking affect.  I have to take 40 mg/day, for four days.  I am quite aware of the effects of the drug.  I was just wondering if anyone had any experience with taking it for a short time, and what side effects did they have, if any?  Thanks!! Frances O’Rielly

– Don Elton Columbia, SC http://www.midcarolina.org

Response:

One other thing that might be mentioned is time-of-day of dosage.  Split doses tend to increase side-effects with less effective results.  Taking pred in the morning better suits the body’s own cortisol production. I have had occasion to taper too quickly in the past, and it’s rough.  I ended up with crushing headaches and myalgia/arthralgia.  They actually did a bilateral temporal artery biopsy (ouch! For giant cell arteritis) until they figured out that it was a ‘hit the wall’ pred withdrawal.  There can be some nasty sequelae from pred, not the least of which is avascular necrosis… – Hide quoted text — Show quoted text – Prednisone takes at least a few hours to have much effect on asthma. This is all relative, but anything over about 40mg/day in an adult is a large dose. Some people need 2-3 days worth while others require a week or more. Tapering isn’t needed for short courses at least as far as adrenal suppression is concerned but I sometimes taper doses so I can detect if the patient has improved enough to tolerate the lower dose before letting the drug run out completely. Sometimes this helps blunt the relapse a patient might have if they stopped cold turkey too early. If you knew exactly how long the steroids would be needed though you could do the same dose up until that day. Most people require less therapeutically though near the end of a course compared to what they needed at the start of a course and the lower the side effects so lowering the dose when the higher dose isn’t needed can be helpful in this respect. One other note though is about the various "dose packs". Always ask your doctor for plain generik prednisone instead of a dose pack. Some dose packs increase the cost by up to 5 or 10 fold – better to just write out on the prescription how to take the drug without buying all that fancy packaging. Most people experience no noticeable side effects when taking prednisone for such a short period of time. My experience has been the same, except I usually start to feel really great, terrific, after the second day.  My question about this:  when- ever I have to take prednisone for severe colds or bronchitis my doc- tor prescribes 60 mg for two days, 50 mg for the next two days, then two days of 40 mg, etc, down to 10 mg for the last two days.   This means I’m on pred for 12 days which is fine with me as it means the cold/bronchitis symptoms will have completely disappeared by the time I stop taking it.  I’m a bit surprised by this dose of 40 mg for four days — is that long enough to really make a difference?  Also, my doc is very concerned about the tapering off period — but if you only take it for four days, even at 40 mg, can you skip the tapering off period? Most pred side effects occur either at higher doses or when the pred is taken for a longer timeframe. What exactly constitutes a "high dose" of prednisone? And one other question, please:  I have a friend with asthma whose doc- tor told her to carry 60 mg of prednisone with her at all times in case she has an asthma attack.  Does this make sense?  How quickly does pred work if what you’re taking it for is an asthma attack?  If I’m taking it for bronchitis, it takes 36-48 hours before I start to notice any differ- ence. — Don Elton Columbia, SC http://www.midcarolina.org

Response:

My experience has been the same, except I usually start to feel really great, terrific, after the second day.  My question about this:  when- Er, really great and terrific in terms of the asthma, or in terms of emotionally?

Both. For short bursts the most common side effects seem to be: increased appetite, weight gain, water retention, and mood swings [which can be positive or negative or both ].  People’s threshold at which they will have and notice side effects varies — some people don’t notice any until they hit 60mg/d, others may notice them at 20mg/d…  

Why water retention?  My doctor told me predisone acts as a mild diruretic and my own personal experience bears this out, especially at 40 mg/day. The duration of the pred course also plays a role; the longer it is, the more likely you are to *notice* the side effects [e.g. you won't necessarily notice an increased appetite if it is only increased for a couple of days, especially if you haven't been feeling great and haven't been eating as well, and are now feeling better and are also now hungirer again...  but chances are you would notice it if it lasted for a couple WEEKS...].

The longest I’ve taken pred is 40 mg for a couple of months followed by 20 mg for two more months followed by 10 mg for two weeks.  My doctor told me to cut down on sodium (hmmm water retention….) so I tried to eliminate as much salt as I could; he also told me to up my intake of potassium and calcium so I ate more bananas and drank more milk in addition to the regu- lar vitamins I take.  I’ve never felt hungrier than usual nor have I gained weight with predisone but 4.5 months isn’t all that long.   There are some people who have problems coming off of steroids even when the course of treatment is short; so some people do need a taper. And some MDs either don’t know about the new guidelines, or even if they do, still feel a taper is appropriate as a general rule.  But using a taper as a matter of course for <15 day courses of treatment at ‘normal’ burst doses is not longer thought to be necessary.

Well, he’s better than he used to be, five years ago I’d have to go lessen the dose by .5 mg until I was down to .5 mg, then I would have to take .5 every other day for four days…. And one other question, please:  I have a friend with asthma whose doc- tor told her to carry 60 mg of prednisone with her at all times in case she has an asthma attack.  Does this make sense?  How quickly does pred Depends on her history and what her asthma acts like.  Obviusly her MD feels it is appropriate.  Does she also carry a rescue inhaler?

Yes, double strength something or other plus she takes Serevent. because the pred is going to do absoluely nothing for her in the short term…  What is HER undestanding of why she is to have it??  Based on everything I have read about asthma treatment, carrying pred like that doesn’t make sense except in perhaps a really exceptional case [e.g. if one is going backpacking for a few days, it would make sense to bring pred, and it would naturally live in your backpack which would be carrying it with you.,... but it woudn't be on your person 24/7 even then...].

I’ve wondered if it’s not psychological.  My friend didn’t have her first asthma attack until she was in her mid-30’s.  For the next year, she was in the ER every other month with major attacks.  It’s finally under con- trol now but for awhile she was afraid to go anywhere except to her job and the grocery store.  She has gradually started doing things again in- cluding bicycling and taking craft classes (which is where we met).  I suspect her doctor told her to carry it with her at all times so she would have the confidence to start living her life again.  I’ve refrained from telling her that I don’t think it would do much good if she had a severe attack. Does she have an action plan?

I have no idea.  What is an action plan? Pred takes several hours to start to kick in [IIRC, 6-8 hours+], and should show noticeable effects within 48 hours [many people who have been on pred have probably experienced this -- you still feel horrible for the first couple days, then after about 2 days you start feeling MUCH better...].

Do you know why it takes so long before you start to feel better?  In general, I have to be pretty sick with bronchitis before I start taking it despite knowing that the symptoms won’t start to go away for another two days.  I don’t want to start taking it every time I have cold or flu symptoms but I’m sure tempted to.

Response:

—cut—  The doctor said that the flu had triggered my asthma, and made it worse.  He told me to increase my Pulmicort to two puffs, four times a day.  He also perscribed Prednisone while the puffers were taking affect.  I have to take 40 mg/day, for four days.  I am quite aware of the effects of the drug.  I was just wondering if anyone had any experience with taking it for a short time, and what side effects did they have, if any?  Thanks!!

The standard burst dose of prednisone is 40-60 mg for 3-10 days (my doctor goes with 40 mg). So this is well withing the current guidelines. I notice an increase in energy while on the pred; the biggest side effect is the day you go off the pred; it can be a real downer, as your body adjusts. It’s no longer recommended that short doses of pred be tapered, as was common in the past. The reason is tapering tends to increase the total dose of pred, and steroids should always be taken in the minimum dose to solve the problem. Ellis

Response:

—cut—–  My question about this:  when- ever I have to take prednisone for severe colds or bronchitis my doc- tor prescribes 60 mg for two days, 50 mg for the next two days, then two days of 40 mg, etc, down to 10 mg for the last two days.   This means I’m on pred for 12 days which is fine with me as it means the cold/bronchitis symptoms will have completely disappeared by the time I stop taking it.  I’m a bit surprised by this dose of 40 mg for four days — is that long enough to really make a difference?  Also, my doc is very concerned about the tapering off period — but if you only take it for four days, even at 40 mg, can you skip the tapering off period?

For severe asthma exacerbations a burst dose of pred of 40-60 mg per day for 3 to 10 days is recommended (my doctor goes with 40 mg). Tapering is no longer recommended for such bursts, since tapering increases the total amount of prednisone used, increasing potential side effects. These are in the 1997 NHLBI Expert Panel Report 2 Asthma Guidelines. Most pred side effects occur either at higher doses or when the pred is taken for a longer timeframe. What exactly constitutes a "high dose" of prednisone?

Actually it’s the total dose taken [dose per day times days] that causes the more serious side effects like osteoporosis. ‘High Total Dose’ is a relative term; some are more susceptible to the side effects, especially those with soft bones to begin with. For example postmenopausal women of N. European ancestry are susceptible and should probably have bone densitometer tests if having to use pred often. And one other question, please:  I have a friend with asthma whose doc- tor told her to carry 60 mg of prednisone with her at all times in case she has an asthma attack.  Does this make sense?  How quickly does pred work if what you’re taking it for is an asthma attack?  If I’m taking it for bronchitis, it takes 36-48 hours before I start to notice any differ- ence.

Carrying prednisone only makes sense if you plan on being gone from home overnight; prednisone is not a rescue drug as it takes several hours to take effect. Ventolin (albuterol) should be carried at all times; a good steroid inhaler is also advisable tho I usually leave mine at home since it’s normally only used morning and night. Ellis

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Question:

In response to your question about Flovent, I can tell you that Flovent or fluticasone(its chemical name) is a corticosteroid inhalent used in patients with moderate asthma.  It is used as maintaenance therapy in asthma and not to be used for acute relief like how your wife probably uses her albuterol. Unlike the albuterol which should be used on an as needed basis, Flovent would have to be taken everyday.  Flovent comes in three different strengths, and your wife’s dosage would be determined by how severe her asthma is.  It’s most common side effects include headache and sore throat.  Also, since Flovent is a corticosteroid, it is necessary that you rinse your mouth with water after using it to prevent oral fungal infections.  If you want more information, try looking in these websites: www.thriveonline.com and www.virtualdrugstore.com/airway/fluticasone.html.  I hope the information I suggested will be helpful to you, but I cannot make any guarantees as to its accuracy, completeness, usefulness, or relevance to your particular situation. There is no substitute for havinh an ongoing, two-way dialogue with a licensed health professional who you know and trust.  Good luck. Farheen Ahmed Pharm D. Candidate, Class of 2001 University of Illinois, Chicago College of Pharmacy – Hide quoted text — Show quoted text – Hello, My fiance is a long-time asthma sufferer and she currently uses albuterol. She and I are trying to gather information about Flovent and the pluses and minuses.  If anyone knows of any information or where to obtain more on the web, it would be greatly appreciated if you would e-mail us.  Please e-mail Thank you! Matt Diroff

Response:

heather, you write a good program for any patient, maybe it is text, maybe it is not , but it is through and readable for all ages, nice post. frannymae

FRAN’SHOME

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Hello, My fiance is a long-time asthma sufferer and she currently uses albuterol. She and I are trying to gather information about Flovent and the pluses and minuses.  If anyone knows of any information or where to obtain more on the web, it would be greatly appreciated if you would e-mail us.  Please e-mail Thank you! Matt Diroff

Response:

Hello, My fiance is a long-time asthma sufferer and she currently uses albuterol. She and I are trying to gather information about Flovent and the pluses and minuses.  If anyone knows of any information or where to obtain more on the web, it would be greatly appreciated if you would e-mail us.  Please e-mail Thank you! Matt Diroff

As you may know, there are two types of medications used to treat asthma, quick-relief medications, such as albuterol, and long-term controllers, such as Flovent.  The quick-relief drugs are used when a person is experiencing an asthma attack and they help to open airways and improve breathing.  When someone experiences attacks or symptoms on a regular basis, a long-term controller or maintenance medication, like Flovent, can be used to prevent future asthma attacks.  These long-term controllers are used on a daily basis to prevent symptoms and cannot be used for an acute attack, as they will have no immediate effects. Flovent is a good choice to maintain control of asthma.  This drug belongs to a class of medications known as inhaled corticosteroids.  Corticosteroids are found naturally in the body and are not related to anabolic steroids.  These corticosteroids help to prevent inflammation in airways which can lead to narrowing of airways and asthma symptoms.  The benefits of this medication are pretty straight forward.  By using this medication daily, the frequency and severity of asthma symtoms will decrease.  Ideally, asthma attacks will be prevented and an individual could enjoy a more normal and active lifestyle. Using this medication will reduce the need for quick-relief drugs like albuterol and help to prevent development of a tolerance to this medication. Like many drugs, there are a few possible side effects.  The side effects experienced with Flovent are mainly related to accumulation of the drug in the mouth, causing a fungal infection commonly known as thrush, and on the vocal cords causing pain or difficulty in speaking.  The good news is these side effects are relatively rare and preventable.  By rinsing the mouth and inhaler mouthpiece with water after the use of the Flovent inhaler, the chance of oral side effects is decreased.  If your fiancee uses a spacer device with her inhaler, the risk is even lower.  Some people may experience a cough after the use of Flovent.  The cough is rare as well and due merely to irritation of the throat by the medication.  Overall, the risks associated with inhaled corticosteroid therapy are minimal compared to the use of corticosteroid pills, even at high doses.  These risks can be further minimized by using the lowest possible dose. The information I passed on to you came from reports on asthma published by the National Institues of Health (NIH) and Glaxo Wellcome, the makers of Flovent. Here are a few websites to check out for more asthma info: www.nhlbi.nih.gov/nhlbi/nhlbi.htm (national guidelines on the treatment of asthma) www.aafa.org www.HELIX.com (website for consumers from Glaxo Wellcome) I hope the information I suggested will be helpful to you, but I cannot make any guarantees as to its accuracy, completeness, usefulness, or relevance to your particular situation.  There is no substitute for having an on-going, two-way dialogue with a licensed healthcare professional (doctor, pharmacist, etc.) who you know and trust.  Good luck. Heather Pharmacy Student UIC-College of Pharmacy .

Response:

My fiance is a long-time asthma sufferer and she currently uses albuterol. She and I are trying to gather information about Flovent and the pluses and minuses.  If anyone knows of any information or where to obtain more on the web, it would be greatly appreciated if you would e-mail us.  Please e-mail Thank you!  Matt Diroff

Albuterol is the short-acting rescue drug for asthma. Current guidelines are if it needs to be used more than once/day, a long-acting preventor drug, typically inhaled steroids, like Flovent, need to be added. Failure to treat the inflamed bronchial tubes with a preventor drug can result in ‘remodeling’ of the lungs (permanent damage). Side effects of inhaled steroids like Flovent are minimal in most at Low to Medium doses. At High doses, some start to suffer some of the systemic effects of oral steroids. However failure to treat the asthma can result in permanent lung damage. Note that steroids should always be used in the lowest dose to control the problem. A peak flow meter and Action Plan to adjust drugs can expedite this. A good book on the subject is ‘The Asthma Sourcebook’, Francis Adams, MD Links: http://www.cs.unc.edu/~kupstas/FAQ.html Allergy & Asthma  FAQ kupstas http://www.cs.unc.edu/~kupstas/FAQ_web.html   Allergy and Asthma FAQ – Other Web Sites http://www.radix.net/~mwg/asthma-gen.html   alt.support.asthma FAQ http://www.ama-assn.org/special/asthma/newsline/conferen/jointmtg/dec… Accelerated, Irreversible Lung Function Decline Seen In Asthmatics Excerpt: ""Rather than simply making patients feel good today, we need  to look ahead," Dr. Yates told Reuters Health. "Inhaled  corticosteroids probably should be prescribed universally  very early on. And if you tell patients that this will help  them do better over the long term, you will probably improve  compliance." Dr. Yates speculates that longterm inflammation in asthma leads to scarring, "which can’t be fixed. If we can prevent the scarring, then perhaps we can prevent the extent of lung function decline.""

Question:

Read the inhailer insert a little bit closer.  I don’t know what kind of medical education you have, but you are wrong.  It specifically says, "not for use in an acute attack", that means a sudden onset. Laura D., CRTT/EMT-B (Certified Respiratory Therapist Tech.)

I don’t have any medical education at all; but I know how to search the web. Searching on maxair pirbuterol: http://www.mmm.com/healthcare/pharm/maxair/home.html Maxair Autohaler 3M Excerpt: "Quick-relief medications are preferred for relieving a sudden  and severe asthma episode. As with other quick-relief  medications, however, Maxair Autohaler should not be used in  excess. Every-day use of Maxair Autohaler is not recommended." http://www.mmm.com/market/healthcare/pharm/pres/maxauto.html Prescribing Information Prepared for health care professionals and consumers in the  United States to accord with U.S. FDA regulations. MAXAIR

Question:

I would not drink the beer. You may have too much yeast in your system already and treating that would be a good idea. Have you ever taken a lot of antibiotics? Feel worse on rainy days? Allergic to mold? Go on a yeast free diet and find a doctor to treat the candida. If they won’t, there are "yeast fighters" in the health food store.

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You should ask your doctor (and insurance company) about an asthma education class. This can help you learn how to identify your triggers and to make sure that you are using your medications properly. You also might want to ask about monitoring your peak flows. This can help predict the earliest onset of an attack. Penny Gagne Plouff RRT (Registered Respiratory Therapist) – Hide quoted text — Show quoted text – I’ve recently been diagnosed with Asthma (about 2 mnths ago).  I have been prescribed Flovent 110, Serevent, and Accolate; all long term medicines for asthma.  This seemed to have all under contol initially and I was feeling very well.  Also I was exercising about 3x a week. Due to an injury I stopped exercising for about 3 weeks.  Also during this period I resumed to my old self and would have a beer (usually only one) after work.  I would drink the beer immeditely after taking my medications including the accolate in which your not supposed to eat 2 hrs before or 1 hr after.   Last week the asthma returned and started acting up again.  I was very short of breath and had been experiening a nasty taste in the back of my throat.  I had no medication for immediate relief so I went to Emergency.  They said oxygen in my blood was okay and lungs sounded okay.  Anyway they administered albuterol by nebulizer then released me with a prescription for albuterol.  I have since (last 3 days) resumed exercising and use the albeterol as little as possible (about once a day).  Also yesterday I purchased a fairly expensive Honeywell HEPA air filter.   I am beginning to feel somewhat better but not quite as up to par as I was before.  My questions are listed below and I would highly value your opinions? 1.  Do you believe the episode will pass? 2.  Since I am begginning in some aspects to feel better should I hold off on seeing my doctor to my next scheduled follow up which is some 2 months away? 3.  Shall I assume not to drink beer again at all or should I time it better? 4.  When is Asthma an Emergency?  How do I know what severe is?  The last time I had acute shortness of breath, how severe can it get? I know this is quite a bit but I am new to this and any insight is apreciated.

Response:

1.  Do you believe the episode will pass?

Yes.  This is the nature of asthma.   2.  Since I am begginning in some aspects to feel better should I hold off on seeing my doctor to my next scheduled follow up which is some 2 months away?

If you needed to visit the ER, you need to contact your doctor for followup consultation. 3.  Shall I assume not to drink beer again at all or should I time it better?

You may be allergic to one of the components in the beer. Also you are reducing the effectivness of the Accolate by 40% – you need to wait an hour after you take the medication. 4.  When is Asthma an Emergency?  How do I know what severe is?  The last time I had acute shortness of breath, how severe can it get?

Asthma is an emergency if you are caught without your rescue medications (Rule #1: Always have your rescue inhaler available – no matter what!) If you are having an asthma attack and the prescribed treatment is not working, it is also an emergency. Your doctor should provide you with specific instructions regarding what to do such as: When to increase your ‘control’ medications, when to use your rescue inhaler, when to call him, when to go to an emergency room and when to call 911. I know this is quite a bit but I am new to this and any insight is apreciated.

This is why we are here.  We _all_ had questions likle yours when we first came to this newsgroup.

Response:

I think it is also important to discuss a peak flow meter with your physican, and to seek the advice of several allergists. –Jennifer – Hide quoted text — Show quoted text – 1.  Do you believe the episode will pass? Yes.  This is the nature of asthma. 2.  Since I am begginning in some aspects to feel better should I hold off on seeing my doctor to my next scheduled follow up which is some 2 months away? If you needed to visit the ER, you need to contact your doctor for followup consultation. 3.  Shall I assume not to drink beer again at all or should I time it better? You may be allergic to one of the components in the beer. Also you are reducing the effectivness of the Accolate by 40% – you need to wait an hour after you take the medication. 4.  When is Asthma an Emergency?  How do I know what severe is?  The last time I had acute shortness of breath, how severe can it get? Asthma is an emergency if you are caught without your rescue medications (Rule #1: Always have your rescue inhaler available – no matter what!) If you are having an asthma attack and the prescribed treatment is not working, it is also an emergency. Your doctor should provide you with specific instructions regarding what to do such as: When to increase your ‘control’ medications, when to use your rescue inhaler, when to call him, when to go to an emergency room and when to call 911. I know this is quite a bit but I am new to this and any insight is apreciated. This is why we are here.  We _all_ had questions likle yours when we first came to this newsgroup.

Response:

I’ve recently been diagnosed with Asthma (about 2 mnths ago).  I have been prescribed Flovent 110, Serevent, and Accolate; all long term medicines for asthma.  This seemed to have all under contol initially and I was feeling very well.  Also I was exercising about 3x a week. Due to an injury I stopped exercising for about 3 weeks.  Also during this period I resumed to my old self and would have a beer (usually only one) after work.  I would drink the beer immeditely after taking my medications including the accolate in which your not supposed to eat 2 hrs before or 1 hr after.   Last week the asthma returned and started acting up again.  I was very short of breath and had been experiening a nasty taste in the back of my throat.  I had no medication for immediate relief so I went to Emergency.  They said oxygen in my blood was okay and lungs sounded okay.  Anyway they administered albuterol by nebulizer then released me with a prescription for albuterol.  I have since (last 3 days) resumed exercising and use the albeterol as little as possible (about once a day).  Also yesterday I purchased a fairly expensive Honeywell HEPA air filter.   I am beginning to feel somewhat better but not quite as up to par as I was before.  My questions are listed below and I would highly value your opinions? 1.  Do you believe the episode will pass? 2.  Since I am begginning in some aspects to feel better should I hold off on seeing my doctor to my next scheduled follow up which is some 2 months away? 3.  Shall I assume not to drink beer again at all or should I time it better? 4.  When is Asthma an Emergency?  How do I know what severe is?  The last time I had acute shortness of breath, how severe can it get? I know this is quite a bit but I am new to this and any insight is apreciated.

Response:

Question:

I have not responded before.  I’m hoping a very knowledgeable someone will answer me.  I thought I was going nuts about 5 years ago.  I decided it was ob/gyn/hormone related so I ran to a gynocologist who promptly removed my uterus.  I was bleeding at an awful rate during periods.  I got worse after the hysterectomy – palpitations, swallowing too much air causing shortness of breath, pain and discomfort left arm, etc..  A Psychologist friend diagnosed Panic/Anxiety and in tandem with my family dr., put me on Paxil and some Xanax.  I took very little of the Xanax and a regular dose of Paxil and did very well.  The anxiety subsided and I gradually used Xanax not at all.  However, I noticed a complete loss of libido and that is tough for a married lady and her spouse.  My doctor switched me to Effexor about 1.5 yrs ago.  I did o.k. on 1 per day instead of the recommended 2 pills per day.  I have had acute bronchitis on and off for many years.  The last couple of attacks have been quite severe.  Therefore, my family dr. switched me to Welbutrin (2 per day and I only take 1), to stop the smoking which I admit was up to 1.5 pack per day.  The good news is I stopped smoking.  The bad news is I am crying without reason, short of breath to the point of terror, and stressed to the max by things I ordinarly deal with quite well.  I’m well educated and a professional.  Could it be the switch to Welbutrin? Should I take 2?  I did ok on Effexor but I’ve been able to lose some weight on Welbutrin.  The scariest thing is the awful asthma attack like symptoms I’m having.  Breathing is a problem.  I did have a very serious bout of bronchitis and acute life threatening asthma on a trip to Hawaii.  I got out of the hotel room only to go to the doctor.  The wheezing was terrible, both in and out.  I’m back and the antibiotic cleared up the infection.  I’ve had a nebulizer treatment and a steroid shot and the dr. sees no reason for my conviction that I can’t get a full normal breath.  I think I’ve been swallowing air and maybe hyperventilating.  Can this be psychological.  What can I do?  I took some xanax tonite which seems to have helped somewhat.  My pulse was up to 122 today and bp at 140/98.  I have white coat syndrome but I think the struggle for air is raising my bp and heart rate.  My stomach feels tight and pushed out.  My neck and shoulders ache.  I plan on seeing my psychologist but in the meantime do any of you have any words of wisdom. This sort of thing runs rampant among my fathers 9 brothers and sisters. They all have some problems.  My mothers side has also had some problems but they are less clear to me and have never been diagnosed or treated.  I would be very relieved to get back to the relative normalcy I enjoyed for the past 5 years.  I start crying about this everytime I try to talk about it.  I did the Midwest Stress Center tapes but I gave them to someone who needed help about a year ago and she moved without returning them.  This breathing thing has me frightened and anticipating cancer, heart and stroke problems.  I know I need to focus on something else but I’m floundering or maybe drowning.  It may be amusing to note that the only relief I’ve had is becoming immersed in shopping recently at a mall.  I realized I was breathing fairly normally after awhile.  Of course, noticing that seems to have ruined it when I left the mall.  Also, I own my own insurance agency. I have the best support staff in the free world, but I’ve been hating to get out of bed to go in lately.  Staying in bed seems to be an occupation without fear, stress or depression.  I know that all this is symptomatic of depression/anxiety/panic, etc..  It might help just to hear from someone who can talk me down so to speak.  If you can help me, I can help you.  I am very, very good at dealing with all this with other people.  However, I can’t seem to deal with my own anticipation of horrible diseases, etc..  I have a cousin who has suffered so horribly with this for so many years, through so many medications and so many failures that she is nothing more that an empty sock.  She is one of the most brilliant, talented people I ever knew.  Depression and anxiety is killing her slowly but inexorably. Her spirit is nearly lost to us.  She has seen the most famous professionals in the field to little or no avail.  She is in Texas and I communicate with her very rarely although it helps me to help her in some strange way.  It also hurts me to see her so baffled and buffetted.  I simply can’t let myself go down that road that far.  Please contact me if you can tell me

Response:

Smoking covers up emotions.  That is why so many people don’t want to give it up!

Really?  I have heard of studies of people smoking and it posssibly be linked with depression but seems the opposite for me.  I think about quitting and have several times (as many smokers have), but altho it is not good for me – it can make me feel better.  I know society is looking down on this habit now……but is one of my last vices.  I gave up soooo many even before the PD.  I have never had it cover up any of my emotions, tho – I smoke and cry, laugh, get bored, fascinated or whatever.  Never heard of the emotion cover aspect. Gwen

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- Hide quoted text — Show quoted text – Smoking covers up emotions.  That is why so many people don’t want to give it up! Really?  I have heard of studies of people smoking and it posssibly be linked with depression but seems the opposite for me.  I think about quitting and have several times (as many smokers have), but altho it is not good for me – it can make me feel better.  I know society is looking down on this habit now……but is one of my last vices.  I gave up soooo many even before the PD.  I have never had it cover up any of my emotions, tho – I smoke and cry, laugh, get bored, fascinated or whatever.  Never heard of the emotion cover aspect. Gwen

What’s the longest period you ever went without a cigarette?  Janie. – Hide quoted text — Show quoted text –

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What’s the longest period you ever went without a cigarette?  Janie.

5 months…thought I had it licked too, but BLAM….had ta have one! Gwen

Response:

I have not responded before.  I’m hoping a very knowledgeable someone will answer me.  I thought I was going nuts about 5 years ago.  I decided it was ob/gyn/hormone related so I ran to a gynocologist who promptly removed my uterus.  I was bleeding at an awful rate during periods.  I got worse after the hysterectomy – palpitations, swallowing too much air causing shortness of breath, pain and discomfort left arm, etc..  A Psychologist friend diagnosed Panic/Anxiety and in tandem with my family dr., put me on Paxil and some Xanax.  I took very little of the Xanax and a regular dose of Paxil and did very well.  The anxiety subsided and I gradually used Xanax not at all.  However, I noticed a complete loss of libido and that is tough for a

<snipped for space also hurts me to see her so baffled and buffetted.  I simply can’t let myself go down that road that far.  Please contact me if you can tell me

Hi, Sandy – welcome to ASAP I wouldn’t dare to comment on Welbutrin, not being a doctor, nor having any experience with it but I read your post and have a few observations. One is that you’ve found out the hard way just how much of this disorder is physiologically based and inherited, the other is that (assuming your doctor has been checking your physical condition) you obviously have a lot of physical manifestations of anxiety – breathing difficulties are legion among we anxiety types. My suggestion, FWIW, would be to get an appointment with a psychiatrist who specialises in anxiety disorders. I’m not saying I believe your current doctor isn’t treating you properly, but you’re obviously still suffering badly from this disorder and ISTM that a skilled, independent assessment might be in order. In addition to whatever medications you might be prescribed I would also suggest that you consider seeing a clinical psychologist for some help with Cognitive Behavioural Therapy. Judging by your post, it seems you have at least a tendency towards hypochondria (again, terribly common among us) and CBT is very good with this sort of obsessional thinking. Hope that’s at least a little help — Gary Cooper

Response:

<Beginning snipped Welbutrin (2 per day and I only take 1), to stop the smoking which I admit was up to 1.5 pack per day.  The good news is I stopped smoking.  The bad news is I am crying without reason, short of breath to the point of terror, and stressed to the max by things I ordinarly deal with quite well.

<end snipped Dear Sandy:  I only feel comfortable addressing the quitting smoking part of your posting; I know others will give support to your other issues.  Smoking covers up emotions.  That is why so many people don’t want to give it up!  Hang in there; it will get better, and stay with us, we’ll love you into you feeling better. Janie (recovering nicotine addict)

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Question:

Hello everyone,      Let me introduce myself, my name is Bryn, I am 18 years old, and have been suffering from acute panic attacks for the last couple of months.  I have been looking over this newsgroup for the past couple of days, and decided to post a couple of questions seeing as how everyone on here seems to be pretty supportive and helpful in answering questions.

<huge snip Hello, Bryn. Welcome.  And what a lovely name!  I went to Bryn Mawr College so I like it all the more.  :) I’m really sorry for all the problems you’ve been having.  The onset of panic attacks is a terrifying experience.  I landed in the ER a couple of times too, before I knew what was going on. I mentioned taking medicine the first time I visited him, but he was reluctant to give me medicine because I had only had the disease for a short period of time and he wanted to try to get rid of it without the medicine.

This doesn’t make sense to me — suffering is suffering, whether it’s been going on for days, weeks, or years.  I think you mentioned that this was a psychologist you were seeing?  I was under the impression that psychologists couldn’t prescribe medication.  Is there any way you could get in to see a psychiatrist or p-doc?  I’m not saying that medication is the answer, but it might not be a bad a idea for you to at least discuss your options that way with someone, since you seem willing to explore that option.  Meds have helped lots of people, myself included. Hope you’re able to get some relief soon. — Kathleen — "Hope is the thing with feathers" — Emily Dickinson Delete * in address to reply by e-mail

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Hello everyone,

Bryn…It might be helpful to consider your diet.  Have you had your thyroid checked?  Test for low blood sugar?   From what we’ve learned in this group, St. John’s Wort takes 4 to 6 weeks to start working. Rosemary   – Hide quoted text — Show quoted text – I feel alright(which usually comes at night, or when I am physically active.  I also feel better after I eat…..is anyone else like that?) I would rather have a more natural alternative to make me feel better.  So I guess what all my rambling boils down to is this, does anyone know of a natural herb or vitamin that I could try before I force my phycologist to put me on drugs?  I have been taking St. John’s Wort for a week to try and lift my depression, and I read something about GABA on this newsgroup, but besides that I am in the dark. Sorry for dragging this post on so long, it is a bad habit of mine to write too much. Thanks for any help you guys can give me, and I am looking forward to a responce. ——-Bryn——-

Response:

Bryan,      Do not give up!  Your letter makes me sad because you are so young, yet I understand completely how you feel.  First of all, I am not a doctor but I can tell you I tried the St. Johns Wort and alls it did was increase my anxiety!!!!!!  My doctor told me not to take it because there just weren’t enough  studies on it.  Have you found yourself more anxious in the last week since you started this? I guess that is What I’m trying to get at.  Mine started after I had a major surgery and my doctor almost killed me by stapling my organs together.  Only by the grace of God did I survive just to battle a new disease…ANXIETY  The first mimportant step to me was support.  Do you have a good supportive family or friend, or girlfriend?  When you feel like this, youfeel like no one understands you and everyone thinks your crazy.  Are you overstressed or tired or taking on too much?  I have been battling this for over a year now and I can say that I am pretty much anxiety free.  I get little attacks but nothing like it was.  It was taking over my life.  The way I helped my self was by completely changing my life(which isn’t hard to do when you almost die!) I do not drink-at all!!!  Alcohol can increase anxiety.  I cut out all caffeine from my diet( I was a coffee lover)  No matter how bad I felt I pulled myself up out of bed and started my day.  I made myself go out and do things.  I started walking off my attacks to the point I would just wait for my heart attack to come-but it never did. I guessed I just started realizing after awhile I wasn’t dying physically but mentally.  I  did not want to live the rest of my life like that.  So instead of the disease beating me, I had to beat the disease.  Think Positive no matter how hard it is to do that. Don’t let it overcome you,you have to overcome it. I also put my faith in a power much stronger than ours.  I found a good church and I have been going ever since.  I recently went to my doctors and he told me that the difference between me now and a year ago was incredible!  I am doing great,but it was a long,HARD road. Change your life Brian,and get rid of everything thats causing this anxiety. Please let me know how you are doing and I will pray for you.  YOU CAN BEAT THIS!!!!!

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| But getting something on my stomach almost always makes me feel better, especially when it’s CHOCOLATE! -Mike (a rational chocolate user, fully understanding of it’s effects and side-effects – I could quit anytime – or so I tell myself anyway

Response:

writes: | But getting something on my stomach almost always makes me feel better, especially when it’s CHOCOLATE! -Mike (a rational chocolate user, fully understanding of it’s effects and side-effects – I could quit anytime – or so I tell myself anyway

Well actually my doc said fruits and veggies, but I guess I could convince myself that Chocolate could be a fruit.

Response:

Well actually my doc said fruits and veggies, but I guess I could convince myself that Chocolate could be a fruit.

If it makes you feel any better, my husband is totally convinced that pecan pie is a vegetable.  Bless you! Heidi

Response:

If it makes you feel any better, my husband is totally convinced that pecan pie is a vegetable.  Bless you!

A VEGETABLE???  Just send him down here and I’ll stick him up in the pecan tree before I shake down all the "nuts"  :) Lee May the road rise up to meet you May the sun always be on your back…

Response:

: :

: : Hello everyone, : :      Let me introduce myself, my name is Bryn, I am 18 years old, and have been : suffering from acute panic attacks for the last couple of months. : : <snipped for space : : Hi Bryn,  Glad to have you in ASAP. Your story is so similar to mine. Big : difference was, for three years I did not have a clue what was wrong with me. I saw : Dr. after Dr. and nothing was found. You are not lucky to have PD…but you are : lucky you received a proper diagnoses this early. That being said, I will tell you : kind of what happened to me and you can take from it whatever you want. My main : point without sounding preachy is…Medications have been the only thing that has : really helped me and I hate to see you continue to suffer while there is treatment, : in the form of meds. that will most surly (IMO) help you. : : I am 34, started having panic attacks when I was 19. As I said, went 3 years : undiagnosed. Many trips to the E.R. Those three years really sucked. I just knew I : was dying of some strange illness etc….  Once I finally learned I had panic : disorder (From an ESPN special with Earl Campbell) I went to see my Dr., who did : not know much about PD and he put me on Xanax. That helped for a while but over the : next 10 years I battled this stuff mostly on my own. I realized I was not dying so : that helped, but I would go through times when I might have a couple of PAs a day, : then I might be PA free for a few months or even a year. : : In ‘94 I really started having a bad time. I lost 30 or so lbs in a few months. : Depression was real bad. I could not even mow my lawn without having a PA. I was : very tired all of the time. : : I finally went to a neurologist who put me on Effexor and Buspar. In 2 weeks almost : to the day, I stared feeling so much better. I had my life back (I thought). In : late ‘97 I started having bad PA’s again and the depression thing. That is when I, : like you did a search on the internet and I found ASAP. With what I learned here I : was able to go to my Dr., tell her what I thought would help. She upped the Effexor : and I am also taking Xanax PRN (as needed) when I feel a PA coming on, or just if I : feel a little "fuzzy". At the present, I feel fair. The depression is minimal and : the panic attacks are few. I am not PD "free", but I think I can cope with how I am : doing. : : So….Sorry to go on about what has happened to me, I am hoping maybe you might be : able to pull something from from this that will help you. I would also like to make : a suggestion, one of the best helps I have ever had as far as PD goes; Read ‘Panic : Disorder, the Medical Point of View’  4th ed.  by – Dr. William Kernodle. I hope : you don’t think I am trying to push medication on you, I personally think for us, : who have chronic PD, it is a must to feel better. : : Keep posting if you have any questions. I don’t know much about the natural herbs. : : Take Care, : Scott Hampton Ummm? I am replying to my own post because…I sent the first one at work and it did something weird. Just want to make sure you see this Bryn. To everyone else, sorry for the long reply to myself. Anyone know what I did? I posted it but when I got home I clicked on it and there was nothing there, but I can see it here when I replied. Strange. Scott H.  

Response:

     Let me introduce myself, my name is Bryn, I am 18 years old, and have been suffering from acute panic attacks for the last couple of months.  I have been looking over this newsgroup for the past couple of days, and decided to post a couple of questions seeing as how everyone on here seems to be pretty supportive and helpful in answering questions.  I had my first full blown panic

<snipped for space Hi, Bryn – welcome to ASAP As Kathleen said, I’m also surprised that a psychologist is talking about giving you medications as you need an MD to do that and, generally speaking, psychologists aren’t MDs. Either way, if it were me I would want to get in there and stop this anxiety as fast as I could. One of the worst things about it – at least, one of the most insidious things about it – is that it feeds on itself. The longer it continues, the more it seems to wind its paralysing grip around our lives so, IME, stopping it in its tracks good and early is the way to go. The question is how. Personally, I wouldn’t waste my time and money on herbs. Any substance that works will contain a psychoactive chemical. If I’m going to take a psychoactive chemical I want to know it is safe and effective. That means I will want to know the dose I am taking, that the source is pure and that it has been researched for safety. Anyone who remembers the days when health food cranks were telling people to take comfrey (later implicated in liver cancer) will be as wary as I of some of their claims. If you saw a trained and qualified medical herbalist that would be one thing, but otherwise I wouldn’t bother with it, personally. As for CBT, IMO, I wouldn’t give up on it – especially as you have had some useful results from it. What I would do is try to get medication as well and use the two together to see if that helps. Statistically speaking, it is the most effective combination. I hope that helps – good aluck and please let us know how you get on, won’t you? — Gary Cooper

Response:

Hello everyone,      Let me introduce myself, my name is Bryn, I am 18 years old, and have been suffering from acute panic attacks for the last couple of months.

<snipped for space Hi Bryn,  Glad to have you in ASAP. Your story is so similar to mine. Big difference was, for three years I did not have a clue what was wrong with me. I saw Dr. after Dr. and nothing was found. You are not lucky to have PD…but you are lucky you received a proper diagnoses this early. That being said, I will tell you kind of what happened to me and you can take from it whatever you want. My main point without sounding preachy is…Medications have been the only thing that has really helped me and I hate to see you continue to suffer while there is treatment, in the form of meds. that will most surly (IMO) help you. I am 34, started having panic attacks when I was 19. As I said, went 3 years undiagnosed. Many trips to the E.R. Those three years really sucked. I just knew I was dying of some strange illness etc….  Once I finally learned I had panic disorder (From an ESPN special with Earl Campbell) I went to see my Dr., who did not know much about PD and he put me on Xanax. That helped for a while but over the next 10 years I battled this stuff mostly on my own. I realized I was not dying so that helped, but I would go through times when I might have a couple of PAs a day, then I might be PA free for a few months or even a year. In ‘94 I really started having a bad time. I lost 30 or so lbs in a few months. Depression was real bad. I could not even mow my lawn without having a PA. I was very tired all of the time. I finally went to a neurologist who put me on Effexor and Buspar. In 2 weeks almost to the day, I stared feeling so much better. I had my life back (I thought). In late ‘97 I started having bad PA’s again and the depression thing. That is when I, like you did a search on the internet and I found ASAP. With what I learned here I was able to go to my Dr., tell her what I thought would help. She upped the Effexor and I am also taking Xanax PRN (as needed) when I feel a PA coming on, or just if I feel a little "fuzzy". At the present, I feel fair. The depression is minimal and the panic attacks are few. I am not PD "free", but I think I can cope with how I am doing. So….Sorry to go on about what has happened to me, I am hoping maybe you might be able to pull something from from this that will help you. I would also like to make a suggestion, one of the best helps I have ever had as far as PD goes; Read ‘Panic Disorder, the Medical Point of View’  4th ed.  by – Dr. William Kernodle. I hope you don’t think I am trying to push medication on you, I personally think for us, who have chronic PD, it is a must to feel better. Keep posting if you have any questions. I don’t know much about the natural herbs. Take Care, Scott Hampton

Response:

Hello everyone,     Let me introduce myself, my name is Bryn, I am 18 years old, and have

been <sniped for brevity Being fairly new at this ng too, I’m not ready to tell my whole story as it probably includes a little of every one else’s and yours too. But I wanted to reply to the thing you said about food. My doc also says that I am fine physically, but when I told him that I felt better after I’d eaten something, he thought that I would let my blood sugar get too low also, but later when I was checked I did not have it. At times my panic was so bad I could not eat to feel better. But getting something on my stomach almost always makes me feel better, so there still must be something to it. Anyway, that’s all I wanted to say. ( Except get help for the anxiety soon, because it is never soon enough) Hope all is well with you soon.

Response:

Bryn, A fool is their own doctor. Yes, what you are having are probably full blown panic attacks. What is the best course of treatment for you? I would suggest you sit down and have a long discussion with your doctor about how you are feeling. As a person who has had all your symptoms and lived in a time when medications were not available. I would tend to seriously consider short term medication till you break the cycle of the panic attacks. Then the CBT your doctor  is using to help you cope will be more affective. When you can stop panic in the beginning of the disorder you do not get all the side effects of all the trauma and it is easier to live with. Ex,  if you burn your self on a stove once, you do not want to burn yourself again. but if you continue to burn yourself over a period of time you will not want to even see a stove let alone touch it. This is the same problems you can have letting panic attacks happen to often without intervention. It is called anticipatory anxiety and it is very hard to control. lori – Hide quoted text — Show quoted text – Hello everyone,      Let me introduce myself, my name is Bryn, I am 18 years old, and have been suffering from acute panic attacks for the last couple of months.  I have been looking over this newsgroup for the past couple of days, and decided to post a couple of questions seeing as how everyone on here seems to be pretty supportive and helpful in answering questions.  I had my first full blown panic attack about two or three months ago when I was at work,  and since a lot of my panic, then and now, revolves around my breathing(my chest gets tight and I can’t take full breaths), I thought I was having an asthma attack and used someones inhaler hoping that it would make my chest loosen up.  As you can imagine that was the dumbest thing I could do, that sent my heart rate up even higher and my panic got even  worse.  I left work and went to my local doctor, who basically shook it off and said that my lungs were just tight from my post nasal drip(by the way which I have had for about 10 months now…medications don’t seem to make it go away), and that the other feelings were from the inhaler.  After that I was alright for a while, I had some periods of anxiety but nothing serious.  My second major one was the worst by far, it started when I was getting off of work one day, and the anxiety lasted me all that night and into the next morning.  I was almost positive that I was dying….that night was one of the worst nights I think I will have in my whole life.  The next day I went to the hospital, still feeling anxious and thinking that I was dying. To make a long story short, I was tested for heart problems in the hopital and had blood work done for the following two weeks to see if anything was wrong. Of course nothing was, and meanwhile I was trying to survive the hell that had become my life.  After a lot of research on the web and in the library trying to understand what was wrong with me, I finally decided to see a phycologist, which I have seen twice now in the last two weeks.  He has just been trying CBT on me, and the breathing exercises help reduce the symptoms, but they are still happening, sometimes as many as a couple a day.  I think that with me the anxiety in between the attacks is the worst thing, at least the attacks pass in time.  I mentioned taking medicine the first time I visited him, but he was reluctant to give me medicine because I had only had the disease for a short period of time and he wanted to try to get rid of it without the medicine. Well, lately I have been feeling worse and worse, depression is starting to set in and I don’t enjoy much of life anymore.  I don’t have much agorophobia, but I don’t like going out because I can’t have fun when I am trying to fight off constant panic, and seeing everyone else act normal just makes me more depressed.  I have come to the point now that I know that I need something besides therapy to help me through this.  On my really bad days I would give anything to have some drugs to help me through them, but during the times when I feel alright(which usually comes at night, or when I am physically active.  I also feel better after I eat…..is anyone else like that?) I would rather have a more natural alternative to make me feel better.  So I guess what all my rambling boils down to is this, does anyone know of a natural herb or vitamin that I could try before I force my phycologist to put me on drugs?  I have been taking St. John’s Wort for a week to try and lift my depression, and I read something about GABA on this newsgroup, but besides that I am in the dark. Sorry for dragging this post on so long, it is a bad habit of mine to write too much. Thanks for any help you guys can give me, and I am looking forward to a responce. ——-Bryn——-

Response:

Hello everyone,      Let me introduce myself, my name is Bryn, I am 18 years old, and have been suffering from acute panic attacks for the last couple of months.  I have been looking over this newsgroup for the past couple of days, and decided to post a couple of questions seeing as how everyone on here seems to be pretty supportive and helpful in answering questions.  I had my first full blown panic attack about two or three months ago when I was at work,  and since a lot of my panic, then and now, revolves around my breathing(my chest gets tight and I can’t take full breaths), I thought I was having an asthma attack and used someones inhaler hoping that it would make my chest loosen up.  As you can imagine that was the dumbest thing I could do, that sent my heart rate up even higher and my panic got even  worse.  I left work and went to my local doctor, who basically shook it off and said that my lungs were just tight from my post nasal drip(by the way which I have had for about 10 months now…medications don’t seem to make it go away), and that the other feelings were from the inhaler.  After that I was alright for a while, I had some periods of anxiety but nothing serious.  My second major one was the worst by far, it started when I was getting off of work one day, and the anxiety lasted me all that night and into the next morning.  I was almost positive that I was dying….that night was one of the worst nights I think I will have in my whole life.  The next day I went to the hospital, still feeling anxious and thinking that I was dying. To make a long story short, I was tested for heart problems in the hopital and had blood work done for the following two weeks to see if anything was wrong. Of course nothing was, and meanwhile I was trying to survive the hell that had become my life.  After a lot of research on the web and in the library trying to understand what was wrong with me, I finally decided to see a phycologist, which I have seen twice now in the last two weeks.  He has just been trying CBT on me, and the breathing exercises help reduce the symptoms, but they are still happening, sometimes as many as a couple a day.  I think that with me the anxiety in between the attacks is the worst thing, at least the attacks pass in time.  I mentioned taking medicine the first time I visited him, but he was reluctant to give me medicine because I had only had the disease for a short period of time and he wanted to try to get rid of it without the medicine. Well, lately I have been feeling worse and worse, depression is starting to set in and I don’t enjoy much of life anymore.  I don’t have much agorophobia, but I don’t like going out because I can’t have fun when I am trying to fight off constant panic, and seeing everyone else act normal just makes me more depressed.  I have come to the point now that I know that I need something besides therapy to help me through this.  On my really bad days I would give anything to have some drugs to help me through them, but during the times when I feel alright(which usually comes at night, or when I am physically active.  I also feel better after I eat…..is anyone else like that?) I would rather have a more natural alternative to make me feel better.  So I guess what all my rambling boils down to is this, does anyone know of a natural herb or vitamin that I could try before I force my phycologist to put me on drugs?  I have been taking St. John’s Wort for a week to try and lift my depression, and I read something about GABA on this newsgroup, but besides that I am in the dark. Sorry for dragging this post on so long, it is a bad habit of mine to write too much. Thanks for any help you guys can give me, and I am looking forward to a responce. ——-Bryn——-

Response:

Question:

Wow, thats I lot of meds…I was hoping to reduce the amount of meds I have to take as well as the number of dose a day.  Hmmm I’ll talk to my doc about this but I don’t think they carry all these meds. "listen here ye little children and remember the truth how ever so pain, will set you free." Seek to find the joy in the truth…..

Response:

Isn’t there some redundancy in your recommendation?  Aerobid and tilade are both anti-inflammatories.  Also, the FloVent would replace the AzmaCort, and not be an addition to it.  Perhaps Serevent and AzmaCort (or Servent and FloVent) might be worth considering.  Just my humble opinion.

Response:

You might want to try Serevent, aerobid, tilade, and flovent in a combination.

Response:

I’m curious about my current dosage of Azmacort.  My doc prescribed 4 puffs 4 times a day during cold symtoms and while I get my cough under control and then 4 puffs two times a day.  I tried to stop all my meds and it didn’t work.  So now I’m back on the 4 puffs 4 times a day and haven’t been able to reduce the dosage back to 4 puffs two times a day.I’m also taking Beclonase 2 puffs three times a day.  I’m suppose to reduce that back to two puffs two times a day.  If I start to reduce the dosages then the cough returns with a vengence.  I see big changes in my peak flow but my symtoms don’t seem to correlate with the drops.  I’m on Seravent 2 puffs twice daily.  I hate using the proventil because it makes me jittery and the MDI gives me a terrible headache and ringing in my ears.  I plan to ask for a prescrition for Proventil HFA to try.  I feel like a pack mule carrying the nebulizer around even though its really small.   I have been able to stop the seldane.  I’m asking for advice because I’m going back to the pulmonary doc on friday and he wants to check my progress as well as see my peak flow diary.  I plan to ask him about this stuff as well as a plan for when my symtoms change since I really don’t have one. Thanks in advance. "listen here ye little children and remember the truth how ever so pain, will set you free." Seek to find the joy in the truth…..

Response:

Hi all, Well, my daughter is now having her third asthma attack, and we’re off to see the doc tomorrow.  We discussed nebulizers at our last visit, so I have a feeling that he will prescribe one for her tomorrow. Does anyone have a recommendation?  I would like a portable version, and one that is easy to operate, clean, etc. Any advice is appreciated!! Greta

Greta, There are 4 asthmatics in our family so we opted for an Omron ultrasonic nebuliser after countless hours on our other nebuliser – what used to take up to 20 mins and extremely noisy now takes 7-8 minutes and extremely quiet – no more disturbing the rest of the houshold. We have had ours for a couple of years and not sorry that we made the change. Elizabeth

Response:

Greta, There are a lot out there, from the plug in type to battery operated. If possible visit your Durable Medical Equipment supplier and check out what they have available. On cleaning, for the machine itself, keep the filter clean (if its washable) or change it often. The nebulizer should be rinsed after every use and washed once a day. To disinfect, you can soak the nebulizer and mouthpiece in white vinegar and water, 1 part vinegar and 2-3 parts water will do the trick. Its mild enough not to hurt the plastics and will kill the germs. John Rhoades, RRT Asthma Guide http://asthma.miningco.com Asthma – The Mining Company – Hide quoted text — Show quoted text – Hi all, Well, my daughter is now having her third asthma attack, and we’re off to see the doc tomorrow.  We discussed nebulizers at our last visit, so I have a feeling that he will prescribe one for her tomorrow. Does anyone have a recommendation?  I would like a portable version, and one that is easy to operate, clean, etc. Any advice is appreciated!! Greta

Response:

Well, my daughter is now having her third asthma attack, and we’re off to see the doc tomorrow.  We discussed nebulizers at our last visit, so I have a feeling that he will prescribe one for her tomorrow. Does anyone have a recommendation?  I would like a portable version, and one that is easy to operate, clean, etc. Any advice is appreciated!! Greta

See article on MDIs with spacers vs nebulizers http://www.ama-assn.org/special/asthma/library/readroom/oa4093.htm Excerpt: "Metered-Dose Inhalers With Spacers vs Nebulizers for Pediatric Asthma Katherine J. Chou, MD; Sandra J. Cunningham, MD; Ellen F. Crain, MD, PhD Objective: To determine whether the administration of beta-agonists by metered-dose inhaler (MDI) with a spacer device is as effective as the administration of beta-agonists by nebulizer for the treatment of acute asthma exacerbations in children. Setting: Urban pediatric emergency department (ED) in Bronx, NY. Patients: Convenience sample of 152 children 2 years and older with a history of at least two episodes of wheezing presenting to the ED with an acute asthma exacerbation. Conclusions: These data suggest that MDIs with spacers may be an effective alternative to nebulizers for the treatment of children with acute asthma exacerbations in the ED. (Arch Pediatr Adolesc Med. 1995;149:201-205)" The MDIs with spacers have the advantage of being more convenient. Also current practice is to no longer use short-term bronchodilators like Ventolin on a regular basis, only as needed. The primary long-term control drug for asthma is inhaled corticosteroids, like Vanceril; they have not been approved in nebulized form in the US. If the asthma is mild, the long-term inhalant Intal might be used; it is available in nebulized form as well as MDI. The other similar inhalant, Tilade, is only available as an MDI. Intal is more effective for allergic asthma and Tilade for nonallergic asthma. Ellis

Response:

Hi, I have two children that use nebulizers as well as myself.  We have had just about every nebulizer on the market and currently have gone thorugh four compressor types…The one I like the best for at home is my devil biss…Its a tradional compressor type and gets the job done but is quite slow compared to my Ultrasonic nebulizer.  I just recently purchased and Ultrasonic after months of research and I love my new one…Its AC/DC powered and has a rechargeable battery which makes it ideal to carry around.  it fits in a small case about the size of a small purse.  Easy to clean and has few part to lose or get broken and is really fast.I give a 3cc treatment in 5-6 minutes.  The best thing was the price.  All the other machines I looked at were in the $300 and up range for ultrasonics or even traditional compressors with batteries.  I found this one for $149 plus shipping.  The company has a web site and is located in Florida.  i did everything via phone and fax.  I was well treated. and got my unit in a matter of days.  Price was real important to me cause our insurance was not paying for this.  Here is the web site:  www.icelbr.com.  You’ll find a phone number to call the company in florida.  The model is the PU 12300. It is imported from Brazil.  This maybe a good option for you if you want ultrasonic.  If you insurance will pay then you could go for the Devil biss models they have an ultrasonic traveller and a traditional compressor traveller. There are also some other brands on the market:  Omron makes one with we didn’t like..too many small parts that are expensive to replace and the mask has to be held to the face, no face strap.  It is very small but just wasn’t suitable for small children.  The mist is also pretty harsh and the clean ing was too complicated and intense for me traveling with two small children.  E-mail if I can be of assistance.  Good luck with your search. "listen here ye little children and remember the truth how ever so pain, will set you free." Seek to find the joy in the truth…..

Response:

Hi all, Well, my daughter is now having her third asthma attack, and we’re off to see the doc tomorrow.  We discussed nebulizers at our last visit, so I have a feeling that he will prescribe one for her tomorrow. Does anyone have a recommendation?  I would like a portable version, and one that is easy to operate, clean, etc. Any advice is appreciated!! Greta

Response: