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Medical Forum / Diseases and Disorders / Sinusitis / April 2004MRSA-Sinusitis
I have chronic sinusitis and recently I have tested positive to MRSA (Methicillin Resistant Staphylococcus Aureus) in my nose. Staph. Aureus is a common cause of sinusitis, treatable by antibiotics. A sinusitis caused by MRSA is not easily treated by antibiotics. (The few antibiotics which eradicate MRSA are understandably not being used for non-critical patients). I have two questions 1) If my chronic infection is MRSA-Sinusitis, is there any hope of eradicating this ? 2) A consultant is recommending FESS (ethmoidectomy) - is such an operation sensible when the area of the operation carries MRSA. Thanks a lot ~ Neil > I have chronic sinusitis and recently I have tested positive to MRSA > (Methicillin Resistant Staphylococcus Aureus) in my nose. If the culture is truly from your nose rather than from near your sinus ducts, then the MRSA may be a false lead. The bacteria in your nose are different from those deep in your sinuses. And MRSA, like any other staph, can live in the noses of healthy people. But assuming that your physician did take the culture from inside your nasopharynx near your sinus ducts, then it might be the cause of your problems after all. > I have two questions > [quoted text clipped - 4 lines] > sensible when the area of the > operation carries MRSA. Did your physician say there was anything wrong with your sinuses besides the infection? (Such as polyps, cysts, other kinds of physical blockages or abnormalities) If not, then you really should try an antibiotic and save yourself the surgery. Suggest to your physician that he consider a nebulized form of the antibiotic--SinuNeb. It's an aerosol that is sprayed, via a nebulizer, directly into your nasal passages, rather than being taken by mouth and going into your GI system where antibiotic resistance frequently forms. http://www.sinuspharmacy.com/ I believe that SinuNeb already has made up nebulized vancomycin for some sinusitis patients here in America, for exactly the problem you have. (They can nebulize most other antibiotics too.) When antibiotics fail, sinus surgery on an infected patient is often the only way to clear the acute infection. A good surgeon is accustomed to operating thru pus. What I'm concerned about, though, is that usually here in America, they prescribe post-operative antibiotics to prevent further infection after surgery. Is your surgeon telling you that he won't prescribe vancomycin or any other antibiotic post-op? [Disclaimer: I am not affiliated with that company in any way] -- Steven L. Disclaimer: I am not affiliated with that company in any way] Steven, don't you think an even more important disclaimer is that you're not a doctor and have no medical training whatsoever? > Disclaimer: I am not affiliated with that company in any way] > > Steven, don't you think an even more important disclaimer is that you're not > a doctor and have no medical training whatsoever? Oh, please. Everybody on this NG offers advice to newbies who ask for advice. That's true for other support NGs as well, like alt.support.cancer, alt.support.asthma, etc. We would have to put a disclaimer about being a layperson on nearly every post. When a newbie has specifically asked for the advice of DOCTORS, I have identified myself as not being a doctor. -- Steven L. True, most people give their opinion about what worked or didn't work for them or share what they know, but that's not really your style, and I just think it's important to point out to new people that you're not medically trained. > > Disclaimer: I am not affiliated with that company in any way] > > [quoted text clipped - 15 lines] > > -- Steven L. >True, most people give their opinion about what worked or didn't work for >them or share what they know, >but that's not really your style, and I just think it's important to point >out to new people that you're not medically trained. No opinions given here, by doctors or others, are medical opinions. They are just general comments that the person may find helpful in pursuing the problem with his own doctors and otherwise. It would be unethical for a doctor to issue a diagnosis on the scant information in a news posting, so posts here by doctors are not definitive. We should not assume that a comment by a doctor is more helpful than that by anyone else. This thread is a perfect example. The original poster's doctor failed to explain that the presence of Staphylococcus usually indicates little. So Steven's comments may be more helpful than those of his doctor. "We should not assume that a comment by a doctor is more helpful than that by anyone else." Amen to that! I still think a little too much authority is being put into some of the posts here. > >True, most people give their opinion about what worked or didn't work for > >them or share what they know, [quoted text clipped - 15 lines] > explain that the presence of Staphylococcus usually indicates little. So > Steven's comments may be more helpful than those of his doctor. >"We should not assume that a comment by a doctor is more helpful than that >by >anyone else." > >Amen to that! I still think a little too much authority is being put into >some of the posts here. I think that a repeated series of questions and answers to a given poster to track down a problem may indeed be treacherous. The bandwidth is just too narrow and error-prone.... > >"We should not assume that a comment by a doctor is more helpful than that > >by > >anyone else." > > > >Amen to that! I still think a little too much authority is being put into > >some of the posts here. > I think that a repeated series of questions and answers to a given poster to > track down a problem may indeed be treacherous. The bandwidth is just too > narrow and error-prone.... Thank you for wording this better than I. You pinpointed one of the things I'm referring to - the question and answer thing that is better left to a GOOD doctor. I also find it misleading in that it gives new posters and lurkers the impression one is more educated than is the case. Bandwidth is not only narrow and error- prone, but it would be difficult for a truly educated and well informed doctor to diagnose online, let alone the average Joe. >>>"We should not assume that a comment by a doctor is more helpful than > [quoted text clipped - 23 lines] > referring to - the question and answer thing that is better left to a GOOD > doctor. Point taken. A better way to deal with that is to suggest that the person find a doctor who is willing to take a detailed patient history, which includes such a list of questions. And to volunteer such information if the doctor fails to ask. However, I will say this: Where sinusitis is concerned, the operative word in what you said above is "GOOD" [doctor]. With all due respect, I've been on this NG longer than you have. And in that time, I have seen sad posts from many folks indicating how they were treated poorly by their doctors. We've seen the whole list of misdiagnoses, undertreatment, mistreatment, botched surgeries, questionable judgment calls, the whole nine yards. And I will make sure that in the future I will not give anyone the impression that I'm a doctor--I will speak with more humility rather than authority. :-) But I will continue to second-guess the doctors, because it's not enough to just tell a patient to see a doctor or get a second opinion--if the second opinion turns out to be as poor as the first. The person needs to know how to tell if his doctor is giving him the state-of-the-art in sinusitis care--all too frequently, they aren't. And we on this NG, despite being laypersons, do know something about that. I've frequently referred posters to www.sinuses.com which is a doctor's website and is kept up-to-date with the latest medical knowledge for treating sinusitis. -- Steven L. >But I will continue to second-guess the doctors Me too - In those cases where there are indications that they may be wrong. This is not a problem for the doctor-patient relationship since the patient will already be giving a great deal of deference to the doctor. > because it's not enough >to just tell a patient to see a doctor or get a second opinion--if the >second opinion turns out to be as poor as the first. The person needs >to know how to tell if his doctor is giving him the state-of-the-art in >sinusitis care--all too frequently, they aren't. And we on this NG, >despite being laypersons, do know something about that. Steve, you many not be a licensed MD but I for one have found your advice excellent and I usually have nothing more to add after you have given your recommendations. In addition your suggestions are of value because you have nothing to sell you are not on an ego trip you don't dissolve into senseless namecalling. I for one appreciate you being here. Murray Grossan, M.D. http://www.ent-consult.com > Disclaimer: I am not affiliated with that company in any way] > > Steven, don't you think an even more important disclaimer is that you're not > a doctor and have no medical training whatsoever? If they wanted a doctors opinion they wouldn't be posting here. > If they wanted a doctors opinion they wouldn't be posting here. Not true, Knob. Many posters have come and even directed their questions ONLY to doctors who may be posting here, much to the chagrin of people like Don Brady and myself. >>If they wanted a doctors opinion they wouldn't be posting here. > > Not true, Knob. Many posters have come and even directed their questions > ONLY to doctors > who may be posting here, much to the chagrin of people like Don Brady and > myself. And when they have done so, I always reply with "I'm not a doctor myself, but I would like to comment anyway...." So that they know I'm not a doctor. -- Steven L. Thanks a lot for your reply. I realise that the MRSA may not be the cause of my problems. I am however rather uncomfortable about the jump from "may not be" to "is not" which I am hearing from various medics here in Switzerland. No real explanation is forthcoming, they simply "believe" that it is not due to the MRSA. Yet normal SA is often cited as one of the most common (if not the most common bacterial cause of sinusitis). Is there any evidence that the mutation to Oxacylin-resistance is also associated with an elimination of the sinusitis-infectiousness ? I do have polyps which have been treated (rather unsuccessfully) with nasal steroids during the last 3 years and I do have a blockage in the ethmoid and accretion of matter in the sphenoid and frontal sinuses (MRI-based diagnosis). The MRI does not allow for determination of the type of matter but a tumour seems unlikely. As stated in another of my replies within this thread, I have now had recurring sinusitis for the last six months, more than 12 courses of antibiotics have eased the symptoms but after stopping the antibiotics, the sinusitis is quickly back. I have been taking Cortisone 10mg/day for the last two months in addition to my nasal cortisone and although I have improved, I am far from healthy. I do seem to have a mechanical problem (lack of drainage) with the frontal and ethmoid sinuses in particular, I have ordered a hydro pulse as a non-surgical possibility to improve the drainage. This may allow my body to clear the infection itself. If not then certainly your suggestion to clear the infection with a nebulised antibiotic is very, very interesting to me. I assume that my sinuses must be pretty clear before using a nebulised antibiotic, otherwise the antibiotic won't circulate through my sinuses and come in contact with the infection. This is of course the case with all topical approaches to easing the infection. Clearing the blockages is certainly my priority. Since my original posting I have been informed that vancomycin would be recommended pre-op to clear up the MRSA-Infection in my nose if I go ahead with FESS. ~ Neil Neil Wheatley wrote: > I have chronic sinusitis and recently I have tested positive to MRSA > (Methicillin Resistant Staphylococcus Aureus) in my nose. If the culture is truly from your nose rather than from near your sinus ducts, then the MRSA may be a false lead. The bacteria in your nose are different from those deep in your sinuses. And MRSA, like any other staph, can live in the noses of healthy people. But assuming that your physician did take the culture from inside your nasopharynx near your sinus ducts, then it might be the cause of your problems after all. > I have two questions > [quoted text clipped - 4 lines] > sensible when the area of the > operation carries MRSA. Did your physician say there was anything wrong with your sinuses besides the infection? (Such as polyps, cysts, other kinds of physical blockages or abnormalities) If not, then you really should try an antibiotic and save yourself the surgery. Suggest to your physician that he consider a nebulized form of the antibiotic--SinuNeb. It's an aerosol that is sprayed, via a nebulizer, directly into your nasal passages, rather than being taken by mouth and going into your GI system where antibiotic resistance frequently forms. http://www.sinuspharmacy.com/ I believe that SinuNeb already has made up nebulized vancomycin for some sinusitis patients here in America, for exactly the problem you have. (They can nebulize most other antibiotics too.) When antibiotics fail, sinus surgery on an infected patient is often the only way to clear the acute infection. A good surgeon is accustomed to operating thru pus. What I'm concerned about, though, is that usually here in America, they prescribe post-operative antibiotics to prevent further infection after surgery. Is your surgeon telling you that he won't prescribe vancomycin or any other antibiotic post-op? [Disclaimer: I am not affiliated with that company in any way] -- Steven L. >>I do have polyps which have been treated (rather unsuccessfully) with nasal steroids during the last 3 years and I do have a blockage in the ethmoid and >>accretion of matter in the sphenoid and frontal sinuses (MRI-based diagnosis). Well, this could certainly be contributing to your many sinus infections. If mucous is unable to drain and remains inside the sinuses, it can easily become infected. Depending on what your sinuses look like as far as being blocked, sinus irrigation may not be able to clear out the matter completely. Sounds like you need surgery to get rid of the polyps and clear the blockage. Thanks for the reply This is the first positive opinion about further surgery that I have received. Initially I was positive about surgery as a way to open up my sinuses / remove the smaller ethmoid cells and allow easier drainage and irrigation. However since surgery was suggested I have had various advice (also from ENT-specialists) that further surgery has little prospects of solving my sinusitis (typical recurrence of symptoms after 1-2 years). There are plenty of qualitative opinions but no-one is willing to commit themself to a percentage. This suggests that rather more effort is placed in the doing and rather less in the evaluating of the results (which mirrors my experience). I shall be pressing the consultant-surgeon for some percentage indication next week although he was also rather vague at our last appointment. I am certainly not opposed to further surgery but I do want a clear recommendation from the surgeon with good prospects of success before I take this option. ~ Neil >>I do have polyps which have been treated (rather unsuccessfully) with nasal steroids during the last 3 years and I do have a blockage in the ethmoid and >>accretion of matter in the sphenoid and frontal sinuses (MRI-based diagnosis). Well, this could certainly be contributing to your many sinus infections. If mucous is unable to drain and remains inside the sinuses, it can easily become infected. Depending on what your sinuses look like as far as being blocked, sinus irrigation may not be able to clear out the matter completely. Sounds like you need surgery to get rid of the polyps and clear the blockage. It may be difficult to come up with a percentage since everyone responds differently and has unique problems with this. I'm willing to bet you, however, that there's a great chance that your problems will continue with these recurring sinus infections without the surgery. Either I glossed over it, or it wasn't clearly stated in your earlier posts that you have polyps that did not respond to steroids (respond meaning shrink). You also now clearly stated you have drainage problems caused by mechanical problems. Imagine how good you'll feel when you add saline solution to the mix and find that it may not be draining quickly or properly either. If it were me (and it has been me since I've had sinus surgeries in the past), I'd get a second opinion from a top notch ENT. If you live in IL, I can give you the name of the best. If you're near Don Brady (sorry, Don - can't recall where you are - is it PA?) then he can give you the name of a top ENT. I'd get a second opinion from a top notch ENT and if he or she can explain why surgery is needed in a way that makes sense to you, then I'd schedule it as soon as possible. Irrigation is wonderful, but it doesn't help with blockage caused by mechanical issues - and polyps themselves can leave you feeling exhausted and ill. My .02. > Thanks for the reply > [quoted text clipped - 33 lines] > polyps and clear the > blockage. Thanks a lot for the advice. I am in Bern, Switzerland. ~ Neil It may be difficult to come up with a percentage since everyone responds differently and has unique problems with this. I'm willing to bet you, however, that there's a great chance that your problems will continue with these recurring sinus infections without the surgery. Either I glossed over it, or it wasn't clearly stated in your earlier posts that you have polyps that did not respond to steroids (respond meaning shrink). You also now clearly stated you have drainage problems caused by mechanical problems. Imagine how good you'll feel when you add saline solution to the mix and find that it may not be draining quickly or properly either. If it were me (and it has been me since I've had sinus surgeries in the past), I'd get a second opinion from a top notch ENT. If you live in IL, I can give you the name of the best. If you're near Don Brady (sorry, Don - can't recall where you are - is it PA?) then he can give you the name of a top ENT. I'd get a second opinion from a top notch ENT and if he or she can explain why surgery is needed in a way that makes sense to you, then I'd schedule it as soon as possible. Irrigation is wonderful, but it doesn't help with blockage caused by mechanical issues - and polyps themselves can leave you feeling exhausted and ill. My .02. > Thanks for the reply > > This is the first positive opinion about further surgery that I have received. > Initially I was positive about surgery as a way to open up my sinuses / remove > the smaller ethmoid cells and allow easier drainage and irrigation. > > However since surgery was suggested I have had various advice (also from > ENT-specialists) that further surgery has little prospects of solving my > sinusitis (typical recurrence of symptoms after 1-2 years). There are plenty of > qualitative opinions but no-one is willing to commit themself to a percentage. > This suggests that rather more effort is placed in the doing and rather less in > the evaluating of the results (which mirrors my experience). I shall be > pressing the consultant-surgeon for some percentage indication next week > although he was also rather vague at our last appointment. > > I am certainly not opposed to further surgery but I do want a clear > recommendation from the surgeon with good prospects of success before I take > this option. > [quoted text clipped - 6 lines] > nasal > steroids during the last 3 years and I do have a blockage in the ethmoid and > >>accretion of matter in the sphenoid and frontal sinuses (MRI-based > diagnosis). [quoted text clipped - 4 lines] > Depending on what > your sinuses look like as far as being blocked, sinus irrigation may not be > able to clear out > the matter completely. Sounds like you need surgery to get rid of the > polyps and clear the > blockage. Oops! My apologies, Neil. I see I've missed another important detail - location! > Thanks a lot for the advice. > > I am in Bern, Switzerland. > > ~ Neil Is that near Pennsylvania? MB <g> > Thanks a lot for the advice. > [quoted text clipped - 82 lines] > > polyps and clear the > > blockage. > Thanks for the reply > [quoted text clipped - 11 lines] > pressing the consultant-surgeon for some percentage indication next week > although he was also rather vague at our last appointment. Have you given any consideration to using a SinuNeb nebulizer to deliver nebulized vancomycin to your sinuses? -- Steven L. Thanks Steven No, I haven't but I am very pleased to have your suggestion. I live in Switzerland and from what I understand the use of vancomycin is quite restricted (critical hospitalised patients and pre-op for MRSA carriers). There is a general attempt to use fewer antibiotics but use of "last line of defence" antibiotics (such as vancomycin) is being treated with particular care. By using vancomycin sparingly it is hoped that the occurence and proliferation of vancomycin-resistant bacteria will be delayed. I guess that you already know all this, I am sceptical that I will be able to get such a treatment here in Switzerland but I will certainly ask around about this. It is very good to know of this option, if my problems remain then maybe I can follow up this treatment in the U.K. (my original country) or the U.S. Do you know about restrictions on access to vancomycin in the U.S. Is it possible to buy nebulisable vancomycin retail ? (antibiotics are not available over the counter in Switzerland (or the U.K.) however in Spain they are available without prescription over the counter in any Pharmacy store (like cough sweets)). My ethmoid sinus (where the infection seems to be) is full of gunk (MRI-scan cannot define what material) this blockage would prevent the air-bourne vancomycin coming into proper contact with the infection wouldn't it ? Is this a problem ? If I can get my sinuses less blocked (and the infection therefore more accessible) then I am certainly very keen on your suggestion of nebulised vancomycin to remove the MRSA. ~ Neil Neil Wheatley wrote: > Thanks for the reply > [quoted text clipped - 11 lines] > pressing the consultant-surgeon for some percentage indication next week > although he was also rather vague at our last appointment. Have you given any consideration to using a SinuNeb nebulizer to deliver nebulized vancomycin to your sinuses? -- Steven L. > Thanks Steven > [quoted text clipped - 12 lines] > > Do you know about restrictions on access to vancomycin in the U.S. AFAIK, the Centers for Disease Control can only make recommendations on restricting vancomycin use--they cannot force a hospital not to use it against the hospital's best judgment. here in america, I think most doctors would prefer to try vancomycin rather than doing surgery. Because surgery is always risky, and in the event of a post-op MRSA infection, you'll need vancomycin anyway. > Is it > possible to buy nebulisable vancomycin retail ? The nebulized form only works with the SinuNeb machine. And it requires a prescription. As soon as they get the prescription from your doctor, they can ship the nebulized vancomycin. > My ethmoid sinus (where the infection seems to be) is full of gunk (MRI-scan > cannot define what material) this blockage would prevent the air-bourne > vancomycin coming into proper contact with the infection wouldn't it ? Is this > a problem ? I don't know. That's a good question for the SinuNeb people. Maybe a decongestant could open up the sinus ducts long enough for the Vancomycin to get in there. > If I can get my sinuses less blocked (and the infection therefore more > accessible) then I am certainly very keen on your suggestion of nebulised > vancomycin to remove the MRSA. If you could avoid surgery, then why not? -- Steven L. "Neil Wheatley" <wheatleyneil@bluewin.ch> said: >Thanks for the reply > [quoted text clipped - 15 lines] >recommendation from the surgeon with good prospects of success before I take >this option. If by "success" you mean an absolute cure of your sinusitis - in my opinion, it won't happen. You are prone to sinusitis. Blockages can be removed surgically and subsequently managed by your daily care and attention **for the rest of your life**. Inflammation will constantly be there unless you are the only lucky person I ever will have heard of to find and avoid whatever it is in your environment which is causing it. :( By the way - I hear that a relatively new drug usually prescribed for asthma/allergy is now being touted as reducing nasal polyps: Singulair. Perhaps this might be of benefit for you. Thanks for the reply For me success means losing less than two months a year to the deep mind fog which isolates me from my emotions, my friends and loved ones. The fog removes large pieces of my life. It's become increasingly difficult to fulfill the expectations at work (I have an analytical job by a telephone carrier). The non-fogged times of my life (about 20% in the last three years) are used to catch up on all the paperwork etc. that I have found impossible to deal with whilst unable to concentrate through the fog. I have had almost no time for living (no catching up, no fog) for many years now. Because the condition has slowly got worse and worse, I have compensated, using flexible working hours and holiday to cope with the bad fog times. The only comparison I can make is to being really drunk. How many people could fill in their tax returns whilst really drunk, how many people would trust the information that they filled in on those returns whilst in a drunken haze. During the last 5-6 years I have spent months and months each year in that drunken haze of sinus mind fog. My professional life has slowly disintegrated. I have spent the last 4 months in a fog (the longest so far) and I am now slowly able to think again. My hope is to have 6 months or more each year with a clear head to be able to laugh and love. More than this would be wonderful and less flu-symptoms would also be a bonus :-) I would like to find some regime (combination of nasal steroids, sporadic systemic steroids, anti-allergy in the pollen season, irrigation, nebulised antibiotics ? ...) which can keep the really bad times at bay, particularly if the more aggressive parts of the regime (systemic steroids for example) can be kept to a minimum. I don't expect to ever become well in the sense that I never need to do anything more to stay well (which is probably true of health generally isn't it). My experience is that chronic sinusitis and feeling ill is bad, but the stress which arises from my inability to cope with normal life during the really bad fog times is also a big problem (being behind with tax issues, my company paperwork etc). It's particulary problematic because bad sinusitis isn't visible, you just have to cope as if you were healthy and well. I have also decided to change my life style completely so that even if my sinusitis remains unchanged, my life will be less stressful with these symptoms. Mostly it's about reducing my interaction with organisations/authorities (which cannot understandably be flexible to my clear times). So I shall be closing by company, I shall be stopping regular work, reducing my living costs to a minimum and become semi-retired. I hope to be able to earn some money during the times when I am capable. I also intend to move to a more sinus-friendly climate (warm, stable temperatures, near the sea, moist air, clean air) since Switzerland is not. I am also considering a mobile life (caravan) as a way to be able to change location seasonally to optimise my climate (and minimise certain allergy/pollen problems at certain times of the year). This can only reduce the unnecessary stress and leave me lots of time to be able to care for my health (and be with the woman I love). I realise that my postings are rather longer than other in the group, but I figure it may help someone else who has a similar experience and it helps me to formulate things for the decisions to come in the next month or two. I have tried singulair but I stopped after side effects cropped up (in particular twitching muscles and really itchy skin) it may be that these were due to a combination effect with other medication but the effects did go away after I stopped the singulair. ~ Neil "Neil Wheatley" <wheatleyneil@bluewin.ch> said: >Thanks for the reply > [quoted text clipped - 15 lines] >recommendation from the surgeon with good prospects of success before I take >this option. If by "success" you mean an absolute cure of your sinusitis - in my opinion, it won't happen. You are prone to sinusitis. Blockages can be removed surgically and subsequently managed by your daily care and attention **for the rest of your life**. Inflammation will constantly be there unless you are the only lucky person I ever will have heard of to find and avoid whatever it is in your environment which is causing it. :( By the way - I hear that a relatively new drug usually prescribed for asthma/allergy is now being touted as reducing nasal polyps: Singulair. Perhaps this might be of benefit for you. > I have chronic sinusitis and recently I have tested positive to MRSA > (Methicillin Resistant Staphylococcus Aureus) in my nose. [quoted text clipped - 18 lines] > > ~ Neil Neil, I suppose that I will draw some heat for this but I have a suggestion. Try SinoFresh. It kills MRSA in vitro. We haven't tested it specifically in vivo yet but will in the future. I will tell you up front that I am with the company but on the research side not the sales and marketing side. It is over the counter and available in most chain pharmacies. You can look up our website and call me directly if you have any further questions. It may save you alot of discomfort and expense. Just a thought. Bill Thanks for your reply. I am grateful for your suggestion. I shall certainly look into this. In common with other methods to kill bacteria in the sinuses, it seems that access to those bacteria is the inital issue. I hope to use a nasal irragator to ease the blockages and then after I see how my health improves (or not) then progress to trying various anti-bacterial therapies. Would a sinus-flooding procedure (as has been suggested with hydrogen peroxide) a possible use of SinoFresh ? ~ Neil > I have chronic sinusitis and recently I have tested positive to MRSA > (Methicillin Resistant Staphylococcus Aureus) in my nose. [quoted text clipped - 18 lines] > > ~ Neil Neil, I suppose that I will draw some heat for this but I have a suggestion. Try SinoFresh. It kills MRSA in vitro. We haven't tested it specifically in vivo yet but will in the future. I will tell you up front that I am with the company but on the research side not the sales and marketing side. It is over the counter and available in most chain pharmacies. You can look up our website and call me directly if you have any further questions. It may save you alot of discomfort and expense. Just a thought. Bill |
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