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Dr. Bob is Robert Hsiung, MD,
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Posted by Squiggles on November 13, 2005, at 17:58:07
In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 17:47:39
> Opiates can profoundly, if only temporarily, help depression, and the depressive phase of bipolar disorder.
>
> Their long term safety or efficacy however, has never been shown.
>
> They work in depression, because they directly activate the pleasure centres of the brain, like all other agents of abuse, something that other antidepressants don't do.
>
> Another consideration is that, while virtually all antidepressant compounds to date promote neurogenesis, the opiates do not, infact they tend to lead to brain atrophy.
>
> The neucleus accumbens has incredably effective homeostatic mechanisms.
>
> If tollerance to the effects are slow, then it is highly likely that the withdrawl effects will be long lasting.
>
> LinkadgeWell, its efficacy does sound ambiguous
(how is "profoundly" to be compared to
other antidepressants or treatments?)
for different kinds of depression,
but it may be worth a try if a doctor
approves and can monitor the addiction.If it is very powerful in lifting depression
it may also be a good substitute to
ECT. I have read the arguments that
make this possibly equally ambiguous
treatment justifiable on the grounds
of its speed of reversing suicidal
depression.Squiggles
Posted by jerrympls on November 13, 2005, at 18:08:44
In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 17:47:39
> Opiates can profoundly, if only temporarily, help depression, and the depressive phase of bipolar disorder.
>
> Their long term safety or efficacy however, has never been shown.
>
> They work in depression, because they directly activate the pleasure centres of the brain, like all other agents of abuse, something that other antidepressants don't do.
>
> Another consideration is that, while virtually all antidepressant compounds to date promote neurogenesis, the opiates do not, infact they tend to lead to brain atrophy.
>
> The neucleus accumbens has incredably effective homeostatic mechanisms.
>
> If tollerance to the effects are slow, then it is highly likely that the withdrawl effects will be long lasting.
>
> Linkadge
>
>How long is temporarily? A couple months? a year? 2 years? OH and I did stop taking the hydrocodone for a week without any withdrawl symptoms. Not sure why you're making such generalizations. And for someone like me who has been through the gauntlet of med combos - I would gladly take being on an opiate to my only other option (according to my docs) brain surgery.
Many antidepressant meds do not have long-term safety & efficacy data - and the withdrawl from some SSRIs can be just as bad as a controlled substance.
Link - why are you so negative about the use of opiates for depression? I'm not saying that everything you've posted is wrong or that one shouldn't take into consideration before starting an opiate (under a doctor's care). But you just seem against it.
And like I've always said - opiates are not a cure and they don't fix everything. They do, however, work with dopamine, NE and other neurotransmitters in the brain. When I take the hydrocodone, I do not feel high or buzzed - I feel almost clost to "normal."
I'm interested in how opiates lead to brain atrophy? Do you have any info you can share on that?
Thanks
Jerry
Posted by jerrympls on November 13, 2005, at 18:15:40
In reply to Re: Opiates for depression?, posted by Squiggles on November 13, 2005, at 17:58:07
Here's an interesting article I found that suggests watching TV causes the same amount of brain atrophy as opiates do:
Posted by linkadge on November 13, 2005, at 18:21:45
In reply to Re: Opiates for depression? » linkadge, posted by jerrympls on November 13, 2005, at 11:28:57
>Also - Do you have the research that lists the >rate of tolerance for various opiates?
Not specifically, but there is a lot of research done on the effects of opiate tollerance. Methadone, for instance is used as a subsitute for heroin because of the difference in tollerance rates. Most users know, however, that methadone is no less addicting.
The following article is about vicodin, and how tollerance seems to develop more slowly (at least in animal models) to the euphoria, and analgesia.
http://opioids.com/hydrocodone/vicodin.html
>I find it hard to believe that scientists know >the exact time it takes for anyone taking >opiates to develop tolerance.
They don't know specifically, (ie. for any one individual), but opiate tollerance has been one of the biggest pharmacudial issues, in search for effective nonadicting painkillers. Comparisons are made between opiates, in terms of their euphoriant properties, their painkilling properties, and their latencies for tollerance. Some of those proceedures are listed in the above article.
>But I could be wrong. And what do you mean by >saying sometimes tolerance to drugs does not >appear in the form one might expect?
Tollerance can be measured by the degree severity of withdrawl. Ie, missing your 2nd dose would be much easier than missing your 365th dose.
If a particular opiate has a slow tollerance latency, then it is harder to be attuned to the signs.
>Sorry if I come across a bit defensive but I get >the feeling - and correct me if I am wrong - ?>that you are trying to negate my experience. All >I can say is that opiate therapy works for me >and works well - and that I am not the only one >by a longshot. I haven't developed tolerance >after a year - but that's not to say I will >never develop tolerance. Also, I am not an >addict (not that you said that) and never have >had a problem with addiction to anything.It will come down to what your definition of addicting is. In my definition, something is addicting if missing it would cause significant imparment to your daily functioning.
I'm not trying to negate what you are saying, but I would be concerned for the long term mental health of anybody who used opiates for the treatment of a mood disorder.
Linkadge
Posted by linkadge on November 13, 2005, at 18:27:16
In reply to Re: Opiates for depression?, posted by Squiggles on November 13, 2005, at 17:58:07
By profoundly, I mean that opiates can reverse a suicidal depression in minautes. Mind you, that suicidal depression didn't go anywhere.
So, perhaps in an emergency, opiates could prevent suicide.
But keep in mind, there was an article released in the Toronto Star 6 months ago about people jumping off bridges when they could not find their oxycontin in time. People without previous histories of mental illness.
Linkadge
Posted by jerrympls on November 13, 2005, at 18:27:55
In reply to Re: Opiates for depression?, posted by Squiggles on November 13, 2005, at 17:58:07
IN my opinion, opiate therapy is by far much safer than ECT. It is known that ECT causes brain damage. And I think that if someone were treatment-resistant and had the choice between the two, they should go with opiate therapy first.
My doctor didn't just come in one day and say "Hey let's put you on an opiate!" I had to dig up some research first. He then took a week to confer with a group of his colleagues and some pain med specialists.
After going over the possibilities of tolerance, addiction,withdrawl, etc. and promising to stop the opiate therapy if any of the above happened - only then did I get to try adding an opiate to my other meds.
I also brought up the point to my doc that tolerance, addiction, abuse, withdrawl are factors of both benzos and stimulants and that those are usually freely prescribed for paitents with depression.
Onoe could also argue that benzos cause brain atrophy and stimulant use could causde receptor burnout - only making depression worse. So I don't see why opiates should be called out as such a risky treatment.
My doctors - since starting the opiate - have watched my case very closely for ANY signs of abuse and tolerance. And thank God -being on an opiate for a year now I have NOT had any problems with abuse or tolerance.
I don't think that opiates are as bad as they're made out to be and that pdocs should look at them more as a treatment adjunct in special cases.
Jerry
Posted by linkadge on November 13, 2005, at 18:36:17
In reply to Re: Opiates for depression? » linkadge, posted by jerrympls on November 13, 2005, at 18:08:44
I don't personally know how opiates supress neurogenesis, but the connection is being researched.
Drugs of abuse, such as opiates, THC, ethanol, and nicotine, are known to decrease the number of new hippocampal cells. We are exploring if all drugs of abuse, regardless of their mechanism of action, similarly alter adult hippocampal neurogenesis, and in delineating the cellular mechanisms underlie the ability of drugs of abuse to alter adult neurogenesis. For example, how do opiates alter the cell cycle of hippocampal progenitors? Do opiates act directly on the progenitors to alter the cell cycle, or do opiates alter hippocampal growth factors, and thus indirectly alter the cell cycle? We are using both traditional and novel approaches to cell cycle analysis to address these questions.
Linkadge
Posted by jerrympls on November 13, 2005, at 18:38:27
In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 18:27:16
> By profoundly, I mean that opiates can reverse a suicidal depression in minautes. Mind you, that suicidal depression didn't go anywhere.
>
> So, perhaps in an emergency, opiates could prevent suicide.
>
> But keep in mind, there was an article released in the Toronto Star 6 months ago about people jumping off bridges when they could not find their oxycontin in time. People without previous histories of mental illness.
>
> LinkadgeOk, but in regards to the pepole jumping off bridges because they ran out of oxycontin is a completely different subject because they were severe addicts. I'm talking about using opiates as adjunct therapies to other depression treatments.
Not everyone is an addict or becomes an addict. What's the difference between the addictive nature of stimulants and benzos and that of opiates?
Posted by jerrympls on November 13, 2005, at 18:42:15
In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 18:21:45
> >Also - Do you have the research that lists the >rate of tolerance for various opiates?
>
> Not specifically, but there is a lot of research done on the effects of opiate tollerance. Methadone, for instance is used as a subsitute for heroin because of the difference in tollerance rates. Most users know, however, that methadone is no less addicting.
>
> The following article is about vicodin, and how tollerance seems to develop more slowly (at least in animal models) to the euphoria, and analgesia.
>
> http://opioids.com/hydrocodone/vicodin.html
>
> >I find it hard to believe that scientists know >the exact time it takes for anyone taking >opiates to develop tolerance.
>
> They don't know specifically, (ie. for any one individual), but opiate tollerance has been one of the biggest pharmacudial issues, in search for effective nonadicting painkillers. Comparisons are made between opiates, in terms of their euphoriant properties, their painkilling properties, and their latencies for tollerance. Some of those proceedures are listed in the above article.
>
> >But I could be wrong. And what do you mean by >saying sometimes tolerance to drugs does not >appear in the form one might expect?
>
> Tollerance can be measured by the degree severity of withdrawl. Ie, missing your 2nd dose would be much easier than missing your 365th dose.
> If a particular opiate has a slow tollerance latency, then it is harder to be attuned to the signs.
>
>
> >Sorry if I come across a bit defensive but I get >the feeling - and correct me if I am wrong - ?>that you are trying to negate my experience. All >I can say is that opiate therapy works for me >and works well - and that I am not the only one >by a longshot. I haven't developed tolerance >after a year - but that's not to say I will >never develop tolerance. Also, I am not an >addict (not that you said that) and never have >had a problem with addiction to anything.
>
> It will come down to what your definition of addicting is. In my definition, something is addicting if missing it would cause significant imparment to your daily functioning.
>
> I'm not trying to negate what you are saying, but I would be concerned for the long term mental health of anybody who used opiates for the treatment of a mood disorder.
>
>
> LinkadgeThanks for the link and the info.
As far as your statement on addiction, if I miss a dose or two - or even decide to take a day off from the opiate - I do not feel any negative effects. In fact I took 2 weeks off of taking my opiate (because of a script problem). I was worried about withdrawl, however, I didn't experience any.
Many negative things can be said about the use of opiates, but the same can be said of benzos, sleeping meds, and stimulants - yet they are used all the time in psychiatric medicine.
I strongly believe opiates have a place in psychiatric medicine.
Jerry
Posted by Squiggles on November 13, 2005, at 18:44:02
In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 18:27:16
> By profoundly, I mean that opiates can reverse a suicidal depression in minautes. Mind you, that suicidal depression didn't go anywhere.
You are speaking of your own experience? But
I don't doubt it and minutes is much better
than 24 hrs., which is what lithium took for
me. Speaking of lithium, the manic side
is as bad as the depressive, though not
necessarily suicidal.
>
> So, perhaps in an emergency, opiates could prevent suicide.That would be very good, and would
appease those who fear addiction as
it could be used temporarily at least.
>
> But keep in mind, there was an article released in the Toronto Star 6 months ago about people jumping off bridges when they could not find their oxycontin in time. People without previous histories of mental illness.One more question, do you know if opiates can
be *added* to an AD, or if a doctor decided it
was OK to give an opiate for depression, would
the patient have to be taken off the AD.The time a drug is taken can make a big
difference in the and is a "high-maintenance" kind of treatment which may be problematic for
a variety of reasons.Tx for your interesting presentation on
this topic.Squiggles
Posted by linkadge on November 13, 2005, at 18:45:09
In reply to Re: Opiates for depression?, posted by jerrympls on November 13, 2005, at 18:27:55
No, I am not trying to attack you personally.
You are right, that other treatments for psychiatric disorders carry similar risks, namely the benzo's and the stimulants.
You are also right that opiate therapy is safer than ECT.
I'd be hard pressed to agree that it is a safe treament for depression, but I wish you recovery, in any form that it takes.
Linkadge
Posted by linkadge on November 13, 2005, at 18:47:30
In reply to Re: Opiates for depression? » linkadge, posted by jerrympls on November 13, 2005, at 18:38:27
There is no difference between the addictive potential of opiates, and benzo's or stimulants.
Significant depression can be a symptom of opiate withdrawl, regardless of weather one considers themselves an addict or not.
Linkadge
Posted by jerrympls on November 13, 2005, at 18:47:45
In reply to Re: Opiates for depression?, posted by Squiggles on November 13, 2005, at 18:44:02
> > By profoundly, I mean that opiates can reverse a suicidal depression in minautes. Mind you, that suicidal depression didn't go anywhere.
>
> You are speaking of your own experience? But
> I don't doubt it and minutes is much better
> than 24 hrs., which is what lithium took for
> me. Speaking of lithium, the manic side
> is as bad as the depressive, though not
> necessarily suicidal.
> >
> > So, perhaps in an emergency, opiates could prevent suicide.
>
> That would be very good, and would
> appease those who fear addiction as
> it could be used temporarily at least.
> >
> > But keep in mind, there was an article released in the Toronto Star 6 months ago about people jumping off bridges when they could not find their oxycontin in time. People without previous histories of mental illness.
>
> One more question, do you know if opiates can
> be *added* to an AD, or if a doctor decided it
> was OK to give an opiate for depression, would
> the patient have to be taken off the AD.
>
> The time a drug is taken can make a big
> difference in the and is a "high-maintenance" kind of treatment which may be problematic for
> a variety of reasons.
>
> Tx for your interesting presentation on
> this topic.
>
> Squiggles
>
>Hi Squiggles-
I don't know if you've been reading any of my posts - but I am on an opiate for depression. The opiate (hydrocodone) was added to my other depression meds, including Lexapro, Adderall & ativan. So YES, opiates can work with antidepressants.
Jerry
Posted by Squiggles on November 13, 2005, at 18:50:57
In reply to Re: Opiates for depression? » Squiggles, posted by jerrympls on November 13, 2005, at 18:47:45
...
> Hi Squiggles-
>
> I don't know if you've been reading any of my posts - but I am on an opiate for depression. The opiate (hydrocodone) was added to my other depression meds, including Lexapro, Adderall & ativan. So YES, opiates can work with antidepressants.
>
> JerryI did not read that Jerry. Thanks - that's
very good and I will suggest to my friend
that she consult her doctor about that -
you may recall the problem we are dealing
with (witht the present tricyclic) is anhedonia.Thanks for that bit of info.
Squiggles
Posted by linkadge on November 13, 2005, at 18:52:29
In reply to Re: Opiates for depression? » linkadge, posted by jerrympls on November 13, 2005, at 18:42:15
It is very rare for somebody not to experience withdrawl effects from abruptly stoping a strong opiate, but you know yourself better than I.
Linkadge
Posted by linkadge on November 13, 2005, at 18:58:02
In reply to Re: Opiates for depression?, posted by Squiggles on November 13, 2005, at 18:44:02
Depending on the dose and onset of an opiate, I have no doubt that an opiate can relieve depression immediately.
They provide a rapid, dose dependant feeling of well being.
Yes, they can generally be safely be combined with most AD's. Not the MAOI's.
Linkadge
Posted by jerrympls on November 13, 2005, at 18:58:10
In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 18:47:30
> There is no difference between the addictive potential of opiates, and benzo's or stimulants.
>
> Significant depression can be a symptom of opiate withdrawl, regardless of weather one considers themselves an addict or not.
>
> LinkadgeI totally agree that increased depression can and is part of opiate withdrawl - and it's something I worry a little about if & when I have to go off the opiate I am taking.
I think in many cases of treatment-resistant depression, one's reward system is "damaged." Right now there are not many choices to help fix the reward system in psychiatric medicine and the use of opiates may be just a temporary and crude fix --what I'm getting at is that more attention needs to be focused on the reward system instead of the basic serotonin/NE imbalance. Perhaps someday they'll be able to synthesize a med that balances out the reward system and that doesn't cause addiction or withdrawl.
Interesting excerpt from one of the links you posted:
"Depressive and dysthymic people often suffer from a dysfunctional opioid system and anhedonia - an incapacity to experience pleasure. Sometimes orthodox "antidepressants" may even make them feel worse. Yet controlled clinical trials of designer narcotics for refractory and/or melancholic depression, let alone their use by "normal" people with "ordinary" mood-disorders, are not imminent."
Posted by jerrympls on November 13, 2005, at 19:04:13
In reply to Re: Opiates for depression?, posted by Squiggles on November 13, 2005, at 18:50:57
> ...
> > Hi Squiggles-
> >
> > I don't know if you've been reading any of my posts - but I am on an opiate for depression. The opiate (hydrocodone) was added to my other depression meds, including Lexapro, Adderall & ativan. So YES, opiates can work with antidepressants.
> >
> > Jerry
>
> I did not read that Jerry. Thanks - that's
> very good and I will suggest to my friend
> that she consult her doctor about that -
> you may recall the problem we are dealing
> with (witht the present tricyclic) is anhedonia.
>
> Thanks for that bit of info.
>
> Squiggles
>
>Here's some research on opiates you may want to take to the doctor. It's what I took to mine. I also have one more really interesting study showing how a doc used oxycontin with success in some patients with treatment-resistant depression.
1: J Clin Psychiatry. 2001 Mar;62(3):205-6.Treatment of refractory major depression with tramadol monotherapy.
Shapira NA, Verduin ML, DeGraw JD.
Publication Types:
Case Reports
LetterPMID: 11305709 [PubMed - indexed for MEDLINE]
2: Aust N Z J Psychiatry. 2000 Dec;34(6):1032-3.
The efficacy of intramuscular tramadol as a rapid-onset antidepressant.
Spencer C.
Publication Types:
Case Reports
LetterPMID: 11127616 [PubMed - indexed for MEDLINE]
3: Am J Psychiatry. 1999 Dec;156(12):2017.
Treatment augmentation with opiates in severe and refractory major
depression.Stoll AL, Rueter S.
Publication Types:
Case Reports
LetterPMID: 10588427 [PubMed - indexed for MEDLINE]
5: Biol Psychiatry. 1996 Jun 15;39(12):989-90.
Buprenorphine for depression: the un-adoptable orphan.
Callaway E.
Publication Types:
EditorialPMID: 8780832 [PubMed - indexed for MEDLINE]
6: Am J Psychiatry. 1996 Jun;153(6):843-4.
Mood alterations and tramadol.
Pinkofsky HB, Woodward RA, Reeves RR.
Publication Types:
Case Reports
LetterPMID: 8633712 [PubMed - indexed for MEDLINE]
8: Biomed Pharmacother. 1996;50(6-7):279-82.Treatment of depressive syndromes in detoxified drug addicts: use of
methadone.Laqueille X, Bayle FJ, Spadone C, Jalfre V, Loo H.
Service Hospitalo-Universitaire de Sante Mentale et de Therapeutique,
Centre
Hospitalier Specialise Sainte-Anne, Paris, France.Depressive syndromes are very frequent in drug-addicted patients. Their
study is particularly difficult on account of the toxic intake which disturbs
the clinical analysis. Methadone has improved our understanding of these
pathologies. In fact, methadone permits treatment of some depressive
disorders typically linked to addiction, such as a motivational symptoms and
depressive mood following intoxication. It brings to the fore the other mood
disorders which are often associated with drug intake.Publication Types:
Review
Review, TutorialPMID: 8952868 [PubMed - indexed for MEDLINE]
9: J Clin Psychopharmacol. 1995 Feb;15(1):49-57.
Buprenorphine treatment of refractory depression.
Bodkin JA, Zornberg GL, Lukas SE, Cole JO.
McLean Hospital, Consolidated Department of Psychiatry, Harvard Medical
School,
Belmont, MA 02178, USA.Opiates were used to treat major depression until the mid-1950s. The
advent of opioids with mixed agonist-antagonist or partial agonist activity, with
reduced dependence and abuse liabilities, has made possible the reevaluation of
opioids for this indication. This is of potential importance for the population
of depressed patients who are unresponsive to or intolerant of
conventional antidepressant agents. Ten subjects with treatment-refractory,
unipolar, nonpsychotic, major depression were treated with the opioid partial
agonist buprenorphine in an open-label study. Three subjects were unable to
tolerate more than two doses because of side effects including malaise, nausea,
and dysphoria. The remaining seven completed 4 to 6 weeks of treatment and as
a group showed clinically striking improvement in both subjective and
objective measures of depression. Much of this improvement was observed by the end of 1 week of treatment and persisted throughout the trial. Four subjects
achieved complete remission of symptoms by the end of the trial (Hamilton Rating
Scale for Depression scores < or = 6), two were moderately improved, and
one deteriorated. These findings suggest a possible role for buprenorphine
in treating refractory depression.Publication Types:
Case Reports
Clinical TrialPMID: 7714228 [PubMed - indexed for MEDLINE]
11: Int Clin Psychopharmacol. 1988 Jul;3(3):255-66.Current and historical concepts of opiate treatment in psychiatric
disorders.Weber MM, Emrich HM.
Max-Planck-Institut fur Psychiatrie, Munchen, Federal Republic of
Germany.In recent years psychiatric research has rediscovered the theoretical
and clinical importance of opiates, especially for the understanding of
depressive disorders. However, opiate treatment is not a new therapeutic concept
in psychiatry. The use of opium for "melancholia" and "mania" may be traced to ancient classical medicine. After Paracelsus and Sydenham, the psychiatry of the German Romantic Era widely discussed therapeutic opium use with the Engelken family going on to develop a structured opium treatment of depression in the first half of the nineteenth century. Although the underlying scientific problems of psychiatric opium therapy were never solved, it gained an outstanding position as a practical treatment for over 100 years.Publication Types:
Historical ArticlePMID: 3153713 [PubMed - indexed for MEDLINE]
Posted by jerrympls on November 13, 2005, at 19:06:31
In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 18:52:29
> It is very rare for somebody not to experience withdrawl effects from abruptly stoping a strong opiate, but you know yourself better than I.
>
> LinkadgeI swear to you I did not - except for that it probably made me a little bit more depressed - but other than that there were no physical symptoms. Not that I'm proud of that or anything - I'm just stating what happens to me and I would never give false information - because there is no reason to.
Posted by jerrympls on November 13, 2005, at 19:08:24
In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 18:58:02
> Yes, they can generally be safely be combined with most AD's. Not the MAOI's.
>Actually, only Demerol is contrindicated. I was on Dilauded and then later hydrocodone after a surgery a couple years ago - and I was taking Nardil at the time.
Posted by linkadge on November 13, 2005, at 19:10:06
In reply to Re: Opiates for depression? » linkadge, posted by jerrympls on November 13, 2005, at 19:06:31
I'm not saying you're not telling the truth. I'm just saying you're atypical.
Linkadge
Posted by linkadge on November 13, 2005, at 19:11:08
In reply to Re: Opiates for depression? » linkadge, posted by jerrympls on November 13, 2005, at 19:08:24
Tramadol may be contraindicated too. I believe it acts as a reuptake inhibitor so SE/NE.
Linkadge
Posted by jerrympls on November 13, 2005, at 19:12:39
In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 19:10:06
> I'm not saying you're not telling the truth. I'm just saying you're atypical.
>
>
> LinkadgeI know-- I didn't mean to insinuate that you were saying I was not telling the truth.
Posted by linkadge on November 13, 2005, at 19:13:59
In reply to Re: Opiates for depression? » linkadge, posted by jerrympls on November 13, 2005, at 19:08:24
The SSRI's are not anhedonia busters.
You are right, more focus needs to be put on dysfunctional reward systems. And why they become so dysfunctional in the first place.
Linkadge
Posted by linkadge on November 13, 2005, at 19:20:47
In reply to Re: Opiates for depression? » linkadge, posted by jerrympls on November 13, 2005, at 19:12:39
I discovered the antidepressant properites of codiene, after I had my wisdom teeth extracted.
I am *very* sensitive to opiate withdrawl. I experienced the most profound exasperation of my depression during codiene withdrawl.
I don't need to say much about the situation, but I am lucky I am still alive.
I just would not want anyone else to have to go through a similar situation.
Linkadge
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Dr. Bob is Robert Hsiung, MD,
[email protected]
Script revised: February 4, 2008
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