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Dr. Bob is Robert Hsiung, MD,
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Posted by galkeepinon on August 30, 2003, at 20:24:47
In reply to Topamax/Headaches??-Wellbutrin, posted by Bear on August 29, 2003, at 15:25:54
.........took action, and sounds like you found some answers:-)
YOU were the one who was proactive, my friend;)
Good luck:-)> > But another side effect Im noticing. Headaches.
> >
> > I have headaches every day now. Im also taking Wellbutrin twice a day. But I have crashing terrible headaches everyday, like right above my ears, going backwards (sometimes in my temples)to the back of my head. I read somewhere Topamax can cause Glaucoma, and now of course, Im thinking the worst and thinking it's that.
> >
> > Does anyone else get terrible headaches??
> >
>
> It's the Wellbutrin!! I just read an article on Wellbutrin. It causes Hypertension and migraines. I have a history of hypertension and you'd THINK my doctor would know that and not give it to me but he did!! Ive had crashing headaches, and had one that lasted 27 hours and prob. had high BP blowing out the top of my skull! GEEZ!
>
> Im not taking it anymore. I could have a stroke. Now wonder I feel like poop. My BP is probably sky high and Wellbutrin causes migraines. Someone else on here said they were taking Wellbutrin and Topamax, beware!! Wellbutrin causes a host of side effects:
>
> Hypertension (high blood pressure), in some cases severe, has been reported in patients
> taking WELLBUTRIN SR alone and in combination with nicotine replacement therapy (for
> example, nicotine patch). Monitoring of blood pressure is recommended in patients who
> receive a combination of WELLBUTRIN SR and nicotine replacement.
> The most common side effects of WELLBUTRIN SR in clinical studies were: At 300 mg/day:
> loss of appetite, dry mouth, skin rash, sweating, ringing in the ears, and shakiness. At 400
> mg/day: abdominal (stomach) pain, agitation, anxiety, dizziness, dry mouth, difficulty sleeping,
> muscle pain, nausea, rapid heart beat, sore throat, sweating, ringing in the ears, and
> urinating more often.
> If you have nausea, you may want to take your medicine with food. If you have difficulty
> sleeping, avoid taking your medicine too close to bedtime.
> The most common side effects that caused people to stop taking WELLBUTRIN SR during
> clinical studies were skin rash, nausea, agitation, and migraine (a severe type of headache).
>
> This board is a God send....
>
> Bear
>
Posted by Wrain on August 30, 2003, at 20:31:03
In reply to Re: The benefits of Topamax (more) » phillybob, posted by Bob on January 10, 2001, at 15:42:33
Wow, I too am on Topamax, 300mg's a day and have never experienced any of the side affects that you are describing. I have a drink every now and then and have never felt anything funny nor does it curb my appetite.
My med combo is as follows....1 500mg Depakote, 1 100mg Topamax and 2 25mg CR Paxil in the morning. At night I take 2 500mg Depakote and 2 100 Topamax along with a 150mg Trazadone.
Also, I still have times where I rapid cycle so my meds are still not straight, my mind wonders all over the place and I wish it would just stop.
Posted by galkeepinon on August 30, 2003, at 20:49:31
In reply to Re: The benefits of Topamax (more), posted by Wrain on August 30, 2003, at 20:31:03
Hi, have you ever been diagnosed with OCD? Just wondering because you sound like me-my mind never stops racing and the hamsters up there just keep spinnin their wheels! I was diagnosed with rapid cycling in 1997 but the Lamcictal has helped that in the past and I just recently went back on it- S l o w l y!!!Have you ever tried Luvox???
Hang in there!!!
> Wow, I too am on Topamax, 300mg's a day and have never experienced any of the side affects that you are describing. I have a drink every now and then and have never felt anything funny nor does it curb my appetite.
>
> My med combo is as follows....1 500mg Depakote, 1 100mg Topamax and 2 25mg CR Paxil in the morning. At night I take 2 500mg Depakote and 2 100 Topamax along with a 150mg Trazadone.
>
> Also, I still have times where I rapid cycle so my meds are still not straight, my mind wonders all over the place and I wish it would just stop.
Posted by falconetti on September 5, 2003, at 13:18:19
In reply to Re: Recently Started on Topamax, posted by dawn setzer on April 20, 2001, at 12:14:08
Has anyone used Topamax for peripheral neuropathy? I am starting today at 25 mg for one week, increasing to 50 mg for the 3 following weeks. My neurologist is conservative therefore the low starting doses.
The side effects for this drug sound scary.
Falconetti
Posted by zenith on September 6, 2003, at 23:56:17
In reply to Re: Topamax Weight Loss Advice?????, posted by LBcats on July 11, 2003, at 22:06:28
as far as the omega 3s - yeah they are great for anyone, have especially important potential for a bipolar. you don't have to take the horse capsules. you can buy it in liquid form. nor do you have to take it plain, i use it instead of olive oil on salads - it's quite good with a nutty taste. it can't be heated - but otherwise can be used cold mixed in anything.
as far as meds go had some problems with tegretol including weight gain and my pdoc just started me on topamax. we'll see. i functioned quite well being stoned before so i'm not sure how the cognitive side effects will compare or what kind of effect they will have on me individually. he mentioned trileptal which just has an oxygen attached to the carbamazepine however preliminary studies have indicated some positive effects or should I say lack of side effects...the nutrition route i'd say is a mandatory without being obsessive- it's the one thing that is "controllable" and staying otherwise as healthy as possible I figure can only make things better not worse right? but you just keep going. yoga is outstanding for anyone interested, i would i highly recommend it as an adjunct therapy AND as a way to move thereby keeping the waistline a bit trimmer...
peace
zenith
Posted by teachersher on September 7, 2003, at 21:09:59
In reply to Re: The benefits of Topamax (more) » Wrain, posted by galkeepinon on August 30, 2003, at 20:49:31
Help-what kind of doctor prescribes this for weight loss and how much is the best price for this?
Posted by Wrain on September 8, 2003, at 8:51:22
In reply to Re: Tomamax for weight loss, posted by Bear on August 28, 2003, at 12:02:19
How much Topamax do you take a day? Milligram wise? I have been taking 300 milligrams for about a year now and I have lost weight but I don't think it is from the Topamax. Also, the Wellbutrin/Topamax combo and doctor not listening messing with your head....you either need to make him listen or find another doctor..this is nothing to play with lets keep this board going and not let it get 2 years old. We need this. Will be anxious to hear back from everyone.
Paige
> > He also wouldn't listen to me when I said that I thought the Wellbutrin/Topamax combo he had me on was really messing with my head. >
>
> I dont even know if anyone willl read this because I notice most of the messages are 2 years old. But....
>
> I became disabled from an accident in 2000 and since that time I am in desperate pain and became VERY depressed and also gained about 60 lbs. LONG story short, I was on all kinds of meds which made me balloon up, hence the 60 lbs. I recently was put on a combo of Wellbutrin/Topamax. I have NO IDEA on God's green Earth what they are supposed to do for me, no one explained anything to me. All I know is I feel no different, no better. Just TIRED all the time. Also, I havent lost an ounce. Im taking them about 2 weeks.
>
> Im reading these posts and this one jumped out at me because it's the same combo Im taking. Im a little nervous now. What will it do to me? Im almost positive he gave them to me to lose the weight because I told him I was on every diet plan on the market and that's true. Weight Watchers, LA Weight Loss, Atkins, everything and nothing worked. I havent lost an ounce on this med and I truly dont feel any different.
>
> Any advice and I thank you.
>
> Bear.
>
>
Posted by Wrain on September 8, 2003, at 8:54:04
In reply to Re: The benefits of Topamax (more) » Wrain, posted by galkeepinon on August 30, 2003, at 20:49:31
No, I have never heard of that, I am going to have to ask my doctor about it. Can you tell me more?
Posted by galkeepinon on September 8, 2003, at 23:53:52
In reply to Re: The benefits of Topamax (more), posted by Wrain on September 8, 2003, at 8:54:04
Here is some good info on Luvox for ya:-)
http://www.ocd.nami.org/helpline/luvox.htm
> No, I have never heard of that, I am going to have to ask my doctor about it. Can you tell me more?
>
Posted by galkeepinon on September 8, 2003, at 23:59:03
In reply to Re: The benefits of Topamax (more) » Wrain, posted by galkeepinon on September 8, 2003, at 23:53:52
This is what was to supposed to show up but didn't for some reason:-)
Luvox (fluvoxamine maleate) is a selective serotonin reuptake inhibitor (SSRI) marketed jointly by Solvay Pharmaceuticals, Inc., and the Upjohn Company. Luvox was approved by the U.S. Food and Drug Administration in 1993 for the treatment of obsessive compulsive disorder (OCD), a biological illness involving an imbalance of a brain chemical.
Luvox has been shown to effectively reduce the symptoms associated with OCD, an anxiety disorder affecting an estimated five million Americans. OCD is characterized by obsessions (unwanted, recurrent and disturbing thoughts) and compulsions (repetitive, ritualized behaviors that the person feels driven to perform in order to lessen the anxiety produced by the obsessions).
Current theories indicate that OCD is a biological illness involving an imbalance of a naturally occurring brain chemical called serotonin, which sends impulses from one nerve cell to another. It is this serotonin imbalance that is linked to OCD. Luvox works by improving this imbalance and reducing the obsessions and compulsions associated with OCD.
Physicians and the millions of Americans with OCD have, with Luvox, a new option in drug treatment. Patients who have not benefitted previously from medication may respond to Luvox.
Studies show that Luvox is effective for elderly patients as well as young persons. The safety and effectiveness of Luvox have not been established for those under 18 years of age. Luvox should be used cautiously in patients with a history of mania and/or seizures. Nursing mothers and women who become pregnant during therapy with Luvox should consult a physician about continuing treatment.
A recent nationwide survey of more than 1,000 adults found that over half of the respondents were not aware that medications exist to treat OCD. Luvox represents another pharmacotherapy option in therapy that may help to clear up this misperception and increase the number of people being successfully treated for OCD.
Luvox is available by prescription and comes in 50 mg and 100 mg tablets. The recommended starting dose is 50 mg, taken as a single daily dose at bedtime. The dosage may be increased in 50 mg increments every four to seven days until maximum therapeutic benefit is achieved. The dosage should never exceed 300 mg/day. For doses over 100 mg/day, it is recommended that Luvox be given in divided doses. If the doses are unequal, the larger dose should be given at bedtime. Try to be patient the first few weeks of treatment. Improvement may occur only after several weeks or months.
There are several medications that should not be taken in combination with Luvox. These medications include the prescription antihistamines Seldane and Hismanal as well as any MAOI (monoamine oxidase inhibitor) medication, such as Parnate, Nardil, or Marplan. Patients should notify their physicians if they are taking or plan to take any other medications with Luvox because there is a potential for harmful interactions.
It is also advisable to avoid alcohol while undergoing treatment with Luvox.
As with any medication, there are some side effects associated with Luvox in certain individuals. The most commonly observed side effects include insomnia, sleepiness, nausea, weakness, sexual dysfunction, nervousness, dry mouth, and constipation. Also, caution should be taken by patients who drive or operate machinery because Luvox may impair judgment, thinking, or motor skills.
The effectiveness of Luvox for long-term use has not been studied extensively. Therefore, patients taking this drug for extended periods of time should be monitored closely by a physician and re-evaluated over time.
Posted by California_Princess on September 12, 2003, at 1:15:04
In reply to Re: Topamax Weight Loss Advice????? » LBcats, posted by galkeepinon on July 17, 2003, at 14:32:32
Hello All,
I've just spent about two hrs reading through old posts about Topomax.I was just diagnosed with Bi-Polar Disorder so I've been doing research on the different kinds of meds the psychiatrist might put me on. The only two that I’ve found that I will THINK about taking are Topomax (Topiramate) or Lamictal since the others have such horrible side affects.
Do to my compulsive eating during manic phases I am about 130 pounds over weight, so naturally the Topomax caught my attention.
However it seems that the weight loss only comes while taking doses at 200mgs or higher a day and there are some substantial side effects, like memory and thinking ability being impaired, kidney stones, mouth and gum problems and tingling.
I am currently not on any drugs but have been bi-polar all my life. I’ve just tried to deal with it since I am sooo afraid of taking drugs. I was on Zoloft for a while because of deep depressions, but even the Zoloft stopped working after a while.
What is the overall feeling about Topomax’s effect on depression? Taking one med is bad enough, (for me) but if I have to take two or a cocktail of meds I think that will be too much.
Has anyone had any success with taking Topomax and Lamictal together? I know Lamictal can cause a rash and in some cases a VERY bad rash that can be fatal. Has anyone had any bad experiences with that?
Thank you for your help. I’m so confused and want to get all the information I can before I see my psychiatrist on the 22nd.
Melissa
California_Princess
Posted by galkeepinon on September 12, 2003, at 1:34:41
In reply to Re: Topamax Weight Loss Advice?????, posted by California_Princess on September 12, 2003, at 1:15:04
>>>What is the overall feeling about Topomax’s effect on depression?
I think it made my depression worse.
>>>Has anyone had any success with taking Topomax and Lamictal together?
I'm on Lamictal now, but discontinued the Topamax, so I never had a chance to see any, if any success taking them together.
>>>I know Lamictal can cause a rash and in some cases a VERY bad rash that can be fatal. Has anyone had any bad experiences with that?
Nope never got the *fatal rash*
Best of luck with your psychiatrist appt:-)
Posted by merryann on September 12, 2003, at 3:59:55
In reply to Re: The benefits of Topamax (more), posted by Wrain on September 8, 2003, at 8:54:04
I have just started taking Topamax in a small dose to be built up gradually. I will also be taking wellbutrin in the am as well as celexa with the topamax in the pm. I have had depression that is resistant to treatment. I have had depression all of my life. It is believed to be a chemical imbalance brought about in my case from long term highly stress inducing childhood abuses. It is thought that in some children while your brain is growing that things can really get out of wack when dealing with over the top stuff that even adults wouldn't be able to handle. I am hopeful that this will help me. I am also a binge eater and have had manic episodes that have caused me to really pack on the weight and my medications in the past have worked against me. At present I am off the scale at the doctors. (350+) And It has been my experience in the past with wellbutrin to be able to lose weight almost without effort. So I am really hoping with the wellburtin and the topamax on board I will have sucess both in my emotions and in my body. God willing. I hope he is.
I will keep others updated if they are interested. Any questions please ask. I need to talk and I need to listen.
Posted by California_Princess on September 12, 2003, at 12:49:49
In reply to Re: The benefits of Topamax (more), posted by merryann on September 12, 2003, at 3:59:55
Posted by Wrain on September 12, 2003, at 20:07:14
In reply to Re: The benefits of Topamax (more) » Wrain, posted by galkeepinon on September 8, 2003, at 23:53:52
Thank you very much, I am going to look into that.
Kym
Posted by Wrain on September 12, 2003, at 20:14:04
In reply to Re: The benefits of Topamax (more), posted by merryann on September 12, 2003, at 3:59:55
MerryAnn,
I am here for you..I know how bad this depression can be and when we have it there is no situation we can be in that will make us feel any better. We could be married to the richest person in the world and have everything our hearts desire and if the chemicals in our brain are out of balance we will still be depressed. Then, if we are carrying added weight on top of that the depression is worse and keeps us from doing any physical activity because we are to depressed, how crazy is that?
It is all just a matter of being focused on the two most important things right now....YOU and getting your Meds straight. There is a combination out there for you, you and your doctor just have to be willing to work towards finding the perfect combination.
Hang in there girl...I will keep you in my prayers.
Wrain
> I have just started taking Topamax in a small dose to be built up gradually. I will also be taking wellbutrin in the am as well as celexa with the topamax in the pm. I have had depression that is resistant to treatment. I have had depression all of my life. It is believed to be a chemical imbalance brought about in my case from long term highly stress inducing childhood abuses. It is thought that in some children while your brain is growing that things can really get out of wack when dealing with over the top stuff that even adults wouldn't be able to handle. I am hopeful that this will help me. I am also a binge eater and have had manic episodes that have caused me to really pack on the weight and my medications in the past have worked against me. At present I am off the scale at the doctors. (350+) And It has been my experience in the past with wellbutrin to be able to lose weight almost without effort. So I am really hoping with the wellburtin and the topamax on board I will have sucess both in my emotions and in my body. God willing. I hope he is.
> I will keep others updated if they are interested. Any questions please ask. I need to talk and I need to listen.
Posted by Wrain on September 12, 2003, at 20:17:52
In reply to Re: Topamax Weight Loss Advice????? » California_Princess, posted by galkeepinon on September 12, 2003, at 1:34:41
> >>>What is the overall feeling about Topomax’s effect on depression?
>
> I think it made my depression worse.
>
> >>>Has anyone had any success with taking Topomax and Lamictal together?
>
> I'm on Lamictal now, but discontinued the Topamax, so I never had a chance to see any, if any success taking them together.
>
> >>>I know Lamictal can cause a rash and in some cases a VERY bad rash that can be fatal. Has anyone had any bad experiences with that?
>
> Nope never got the *fatal rash*
>
> Best of luck with your psychiatrist appt:-)
>
I have never heard of Lamictal. I think the one thing that we, the patient, and the doctors need to realize is that people in our situation need the doctors to work closly with us, we need our bloodwork drawn alot and our meds watched very closly. They are to expensive and we don't want to spend alot unnecessary time trying to find the "right" combination.I would love to hear how everyone's relationship is with their psychiatrist.
Wrain
Posted by galkeepinon on September 13, 2003, at 1:36:53
In reply to Re: Topamax Weight Loss Advice?????, posted by Wrain on September 12, 2003, at 20:17:52
>>>>>I would love to hear how everyone's relationship is with their psychiatrist.
I am very blessed with a not only a good psychiatrist, but he is also a good man!
I respect him and I hope he respects me, which I believe he does, I think he really wants to see me get back on my feet. From what he has shown, he is a very, very, very patient doctor!!!!!I am blessed.
How about your relationship with your psychiatrist, may I ask?:-)
Posted by California_Princess on September 13, 2003, at 12:56:06
In reply to Re: Topamax Weight Loss Advice????? » Wrain, posted by galkeepinon on September 13, 2003, at 1:36:53
Hello All! I hope you are all having a great weekend so far.
I certainly understand about working closely with the Dr.s regarding meds and blood work. You are right about being expensive, especially if you’re low-income and have crappy insurance, like me. :O)
As far as my relationship with my psychiatrist, the 22nd is the first time that I will meet him. I don't even know if it's a man or a woman yet. I am really hoping that he/she is good and will really help me. I've seen my therapist once and she seems to be a nice lady. Talkative, but mostly about herself.... I'm new to this sort of stuff so I don't know if other therapists are that way. I really hope I can get some help and finally feel normal and LOSE THIS WEIGHT!!!
Melissa
Posted by Bear on September 13, 2003, at 13:09:52
In reply to Re: Topamax Weight Loss Advice?????, posted by California_Princess on September 12, 2003, at 1:15:04
> However it seems that the weight loss only comes while taking doses at 200mgs or higher a day>I think you're right there. Im on 100mgs a day and it's not really going anywhere. My hunger is diminished but not anywhere where there's dramatic weight loss. Nowhere near it. MAYBE 5 lbs. MAYBE. I understand that it takes 5-6 weeks to take effect? Is that true? Im seeing the dr. Monday so Im going to aks him to up it. I have only 25 mg pills and Im running out quickly because he told me to take 50mg in the am and 50 mg in the pm and I keep running out. I think the pharmacy is suspicious! ha. ANyway, DOES it take like 5-6 weeks to kick in? I dont get hungry till about 4-5 in the afternoon, then i feel guilty eating! ugh. help!
Bear
Posted by Wrain on September 13, 2003, at 17:44:47
In reply to Re: Topamax Weight Loss Advice?????, posted by California_Princess on September 13, 2003, at 12:56:06
Hi Melissa,
First off, the thing to remember with the Dr. is that it is YOUR care so ask him to do the bloodwork to keep your levels checked, if you don't feel right or better on the meds, tell him. To begin, I would have my blood work done at the start, then again in a month if the starting meds seem to do ok, even if he does not order it, ask him to order it, usually they will.
As far as the therapist....if she keeps talking about herself...send her a bill for YOUR time..not suppose to work that way.
Keep us posted.
Wrain
Posted by LBcats on September 14, 2003, at 9:09:23
In reply to Re: Topamax Weight Loss Advice?????, posted by Wrain on September 13, 2003, at 17:44:47
Well guys I've been taking Topomax now for seven months along with effexor (150mg) and although I lost about 20 lbs and I feel good, people tell me I act very differently. I am very irritable and want to be very much in control of everything. I don't know how to relax and also I've can't articulate and organize myself anymore and it progressively got worse. I came very close to losing my job. I will be asking my doc to take me off of topomax as much as I loved the weight loss, it's not worth it to me. I just thought I'd let some of you know that for me it worked for awhile and now it's time to change. I'll probably switch back to depakote.
LB
Posted by Wrain on September 14, 2003, at 12:06:32
In reply to Topomax made me manic, posted by LBcats on September 14, 2003, at 9:09:23
> Well guys I've been taking Topomax now for seven months along with effexor (150mg) and although I lost about 20 lbs and I feel good, people tell me I act very differently. I am very irritable and want to be very much in control of everything. I don't know how to relax and also I've can't articulate and organize myself anymore and it progressively got worse. I came very close to losing my job. I will be asking my doc to take me off of topomax as much as I loved the weight loss, it's not worth it to me. I just thought I'd let some of you know that for me it worked for awhile and now it's time to change. I'll probably switch back to depakote.
> LBI hear you, Relax, what does that mean?? Organized, I forgot that word even existed but I never really thought that it was the Topamax, guess I need to read up more on it. I am taking Depakote, Topamax and Paxil...To me it seems that one of those should not be there but I am not sure. Another thing I seem to have alot of problems with is making a decision, I can't even trust my own decisions anymore. I don't know guys...I just don't know what to do anymore.
Posted by Wrain on September 14, 2003, at 12:17:18
In reply to Re: Topamax Weight Loss Advice?????, posted by Bear on September 13, 2003, at 13:09:52
>
> > However it seems that the weight loss only comes while taking doses at 200mgs or higher a day>
>
> I think you're right there. Im on 100mgs a day and it's not really going anywhere. My hunger is diminished but not anywhere where there's dramatic weight loss. Nowhere near it. MAYBE 5 lbs. MAYBE. I understand that it takes 5-6 weeks to take effect? Is that true? Im seeing the dr. Monday so Im going to aks him to up it. I have only 25 mg pills and Im running out quickly because he told me to take 50mg in the am and 50 mg in the pm and I keep running out. I think the pharmacy is suspicious! ha. ANyway, DOES it take like 5-6 weeks to kick in? I dont get hungry till about 4-5 in the afternoon, then i feel guilty eating! ugh. help!
>
> Bear
>Bear,
Like I said in a previous post, I have been taking Topamax, 300mg a day for a year now and I have not noticed any weight loss due to the Topamax. I changed the way I ate about 3 years ago because my husband was on a scale from 1-10 a 9 for a heart attack and the doctor told us that he had to cut out the white bread, rice, corn products, potatoes, etc...I do a slim fast in the morning and wheat bread, brown rice, sweet potatoes diet drinks and lots of water for 3 years. In the last year I have not seen my weight loss go up any while on the Topamax. Actually if anything, for the past year my weight has been holding steady and going up and down. I was in the hospital last September for the BiPolar and one of the counselors told us about the importance of breakfast. We have always heard that breakfast was the most important meal of the day, but up until that counselor I never really understood why. He said
Within the first (3 THREE) hours after you wake it is VERY important to get some kind of food in your system. If you DO NOT get food in your system withing the first THREE hours, your body thinks you are going to STARVE it and therefore EVERYTHING you eat the rest of the day, it will store it as fat so that it won't STARVE. If you DO eat within the first THREE hours, your body will not be afraid it will STARVE and will then process the food you eat throughout the day normally and not store as much of it as fat.
So, I have just made it a habit to wake every morning and take my morning meds with a slimfast. It works for me as far as the breakfast thing because I am NOT a breakfast person.
I hope this helps.
Please keep us informed.
Wrain
Posted by tees on September 14, 2003, at 18:21:40
In reply to Re: Topamax Experiences?, posted by Lexie on January 22, 2001, at 19:57:02
I am new to this forum so i hope my comments on topomax is not out of line. I have just recently been taken off of Topomax (400mg) at night along with (Nardil 60mg)day. I suffer from Social Axniety Disorder. While i was on Topomax i suffered from low blood pressure, shortness of breath, numbness in hands and feet, sensitivity to light, sexual dysfunction, depression, blurred vision, memory loss, body shakes and uncontrollable thoughts running in my head. It was a nightmare for me being on this drug. I have been off of it for about a week and all these symptoms have dissapeared, maybe it just reacts differently for each idividual. I know i was on Effexor a few years back and had results similar to this, in fact when i came off of the effexor it made me very violent. Again being new to the forum, i apreciate the chance to contribute and have enjoyed the posts very much.
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Dr. Bob is Robert Hsiung, MD,
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