Asthma, or not?

[sunnygal]

Hi.  I have been having trouble breathing for about 5 months now.  I had a bad bout of bronchitis in December 2001.  I had a pulmonary function test done in Feb, came back as dx of asthma.  My problem seems to be expanding my lungs.  It also aches underneath my right and left rib cage.  I went to dr. today, was told my lungs are clear.  I am 25f.  I am afraid that this is neuromuscular in nature, or worse.  I also have GERD.  A pulmonoligist read the pft, which was done only without a bronchial dilator.

[National Jewish]

It is not uncommon to have asthma symptoms following a "bad bout of bronchitis". These symptoms are not necessarily constant and can lead to days where lung function is abnormal and other days when the tests are normal.  In addition, gastroesophageal reflux disease (GERD) is a fairly common aggravating factor for people with asthma. I would follow up with the pulmonologist to have lung function tests before and after a bronchodilator and rule in or out asthma as the cause of your symptoms.

[starion]

I am puzzled as to how your PFT could come back with a diagnosis of asthma without your having used a bronchodilator.  One of the ways asthma is diagnosed is comparing your lung measurements before & after using the bronchodilator.  What steps have been advised and/or taken to help you with your breathing?  Has there been any improvement and/or worsening of your symptoms?  Do you have a peak flow meter?  (Many doctors will give you a free one from a drug company if you ask, otherwise you can get one with or w/o a prescription for about $20 or less, at the drug store or via internet.)
There's lots of good info about asthma at www.NationalJewish.org (particularly their MedFacts, LungFacts, and asthma education, as well as Understanding booklets), but your doctor should be able to help you reduce your symptoms and suggest why you might be having pain and how to minimize it.  If your current doctor isn't able to give you the answers you need & deserve, you may have to consider getting a second opinion from a doctor who can answer your questions.
Best of luck!
Aloha,
Starion

[Concerned lady]

GERD can cause lung damage, if the irritating stomach liquid (or the fumes evaporating off the "reflux material") is "aspirated" (breathed in).

This type of GERD is called LPR/Laryngeal-Pharyngeal Reflux, where laryngeal refers to the larynx (voice box), containing the vocal cords, and pharyngeal refers to the throat.

LPR can also cause VCD/Vocal Cord Dysfunction, which can "mimic" asthma, but isn't asthma: The vocal cords close up (also called a "laryngo-spasm"), with VCD. A good Pulmonologist (lung doc) &/or ENT (Ear, Nose & Throat doc) can help you figure out if you might have VCD. National Jewish Hospital knows the most about VCD, and is most expert at treating VCD.

I agree with Starion--get another opinion from better docs, and read National Jewish Hosptital's excellent website.

You can also see neuromuscular experts, to "rule out" the possibility of neuromuscular problems.

You can email me, if you'd like some Gastric Reflux "tips" that don't include acid blockers. You can check these tips with your docs to be sure they are OK for your specific health situation.

My husband and I were greatly helped by National Jewish Hospital (NJH), with our VCD, so if you can be seen there, in Denver, Colorado, that would be good. NJH is expert, at treating all kinds of respiratory problems, etc., and they recognize the connection between GERD and lung problems, &/or vocal cord problems!

I wish you the best.

Sincerely, Concerned lady
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[sunnygal]

I had a NCV and EMG done on my right arm and related paraspinals that came back normal.  All my blood work is normal, ANA, CK, CBC, Arthritis panels, Lupus panel, etc.  I guess they think all that's left is asthma?

[spicer]

Hi Sunnygal - Did your doctor give you inhalers to use?  If so, do they seem to help?  I have the same problem as you, can't seem to expand my lungs or take a deep breath at times, they diagnosed asthma but sometimes the inhlaers work and sometimes they don't.......

[spicer]

wanted to say too, that I passed the breathing test, it only showed a 15% restriction on inhaling.  Doctor still thought it was asthma.  What I find strange is that I bought a peak flow meter and it says the same thing no matter how I'm feeling, and I know I'm using it correctly.  My 'personal best' is about 390.  I use it 3 times a day and it doesn't matter if I'm having chest tightness or feeling great, it says the same thing - 410 or 420.  My husband says maybe it's because I have a problem on INhaling, not EXhaling.  But if you have asthma, isn't this meter suppose to help you or at the very least, show you a noticeable difference in your numbers?

[Concerned lady]

Dear Spicer,

Have you telephoned the LUNG LINE nurses, yet? They can possibly help you. It's a free call: 1-800-222-LUNG(5864), available between 8am & 4:30pm, Rocky Mountain daylight savings time (Colorado).

I suggest you either go to National Jewish Hospital (NJH) (where the LUNG LINE is located), in Denver, CO, or, find out from the LUNG LINE nurse which docs are in your area, who were trained at NJH. NJH are the best experts at respiratory (& other) problems! :-)

To answer your question on another "thread" here, yes, these comments ARE "for real".

When you get a chance, read my website about VCD/Vocal Cord Dysfunction, because VCD (an asthma "mimic", which can exist without asthma, or along with asthma) usually affects INhaling. My husband & I had VCD, and were greatly helped by NJH. I didn't forget about the ailment, just because I got better. I made a website about it. Here's a link: http://cantbreathesuspectvcd.com

Sincerely, Concerned lady
***@****

[spicer]

I tried to call but couldn't get through so I emailed them instead and asked some questions.  I'm still trying to find someone to answer my questions about the peak flow meter before I go back to my doctor next week.  It seems to be somewhat useless to me as it never changes no matter how I feel.  I don't really see what good it does.  Isn't it suppose to change?  I had a couple bad days this week and it said exactly the same thing it did on my good days.  Very confusing.  
I have already read your website and the other one, some parts of a typical VCD profile don't fit me.  In fact most don't except for the fact that asthma doesn't seem to fit me in certain areas either.  I could answer a questionaire for both and probably fit in about 50% for both.  This is very frustrating for me, to say the least.  I'm 49 yrs. old and petite, only weigh 105 (as opposed to many VCD patients who are obese, according to what I've read).  I have no psychological problems, I'm about as normal and balanced as they come.  I hardly ever get sick, am very healthy and active, and have no reflux or anything of that nature.  This just came right out of left field, was on the treadmill one day and felt like I couldn't swallow so immediately got off.....and it was just downhill from there.  Next day noticed the heaviness in my chest and had trouble breathing.  Day after that was still bad so went to the doctor and felt like I was going to suffocate on the way there, awful feeling.  No wheezing, no coughing, none of the 'usual' asthma symptoms, but that's what everyone seems to think it is.  Sometimes the inhalers help, sometimes they don't.  Right now I feel like too many doctor's have their fingers in the pot, and each one wants to be 'the one' to correctly diagnose me.  I go next week for allergy testing to find out what's triggering 'my asthma'.  I'll be curious to see if it shows anything at all............
I don't usually do these forums like this but sometimes people want to talk to other people with the same symptoms and see what they've found out, kind of like a support group.  Just helps to make one feel better.

[Concerned lady]

Dear Spicer,

Not being a doctor, these are just several ideas, as food for thought:

Having symptoms during the treadmill workout, makes me think of several things, in addition to asthma &/or VCD.

Have you had your heart checked?

Have you had your blood vessels checked for for aneurisms &/or ?

Might you have had a GERD/Gastro-esophageal reflux disease "episode" (very common among athletes & people who exercise), possibly brought on by the treadmill work? A GERD episode can "trigger" an asthma attack, &/or a VCD attack, &/or maybe some esophageal spasms, &/or ???

What was the air quality like, where you were on the treadmill? Might there have been any "irritants" &/or toxic chemicals outgassing in your area? (like from a NEW CARPET, NEW BUILDING MATERIALS, MOLD, extra high levels of carbon dioxide & fumes, where WINDOWS DON'T OPEN, etc.)

Are you possibly taking any meds that have adverse/bad side effects that could be causing (&/or contributing to) your symptoms?

I think that if you could go to Nat'l Jewish Hospital, that they could help you figure out what is going on with you, and what the causes are. Then, you would have treatment options. They work as a team, with many specialists in various fields! And, they are kind, nice, & knowledgable!

I wish you the best. Hang in there!

Sincerely, Concerned lady
http://cantbreathesuspectvcd.com

[spicer]

You are so helpful, I really appreciate your taking time out of your day to try and help me.
The treadmill I was on was my own, it's in one of our bedrooms and I've been using it for years without a problem.
I've had my heart checked by EKG (normal) and echocardiogram (not back yet).  
No medication, no fumes anywhere, no known medical problem that would be contributing to this.  No reflux whatsoever, never have (wouldn't I know?).
Wanted to ask though....what is esophageal spasm and what does it do?  I've never heard of it.
Thanks so much.........

[Concerned lady]

Dear Spicer,

A good GI doc (Gastro-intestinal doc) should be able to examine you, and do tests, to find out if esophageal spasms &/or GERD/Gastro-esophageal reflux disease, are parts of your problem with the treadmill. Esophageal spasms can be related to GERD (gastric reflux).

On Monday, you could telephone the LUNG LINE, at Nat'l Jewish Hospital, and speak to one of the LUNG LINE nurses, who might recognize your symptoms. The LUNG LINE nurse could also tell you which Nat'l Jewish Hospital-trained docs are in YOUR area. Call 1-800-222-LUNG(5864), between 8am & 4:30pm, Colorado time.

If you could be seen at National Jewish Hospital, that would be the best. If not, get doctors' names from them, who they recommend, for additional opinions.

Gastric reflux episodes can sometimes happen without obvious symptoms. I'll post some Gastric Reflux tips below, that you can show to your doc, before trying them, if you are interested, to be sure that they are OK in your particular situation.

I hope you get this figured out soon! By the way, one reason that some VCD patients are overweight, is that the steroids they were on, due to having asthma (or being thought to have asthma)--those steroids caused the weight gain (edema, etc.).
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Some GASTRIC REFLUX TIPS (without acid blockers):

GER=Gastro-Esophageal Reflux. (Gastro=stomach. Esophagus=food tube.)

LPR= Laryngeal-Pharyngeal Reflux. (Larynx=voice box, containing the 2 vocal cords. Pharynx=throat, above the larynx. The larynx is above the trachea/windpipe.)

Reflux=acidic or alkaline stomach material that backs up into the esophagus (food tube), causing any of these problems: VCD/Vocal Cord Dysfunction/Laryngospasm attacks, cough, voice problems, asthma, globus (feeling of lump in throat), constant need to clear throat, worsening of sinus condition, sore throat, pre-cancerous conditions of throat &/or esophagus, etc.

SOME GER/LPR CONTROL THINGS WE DO, that we learned from the excellent book: STOMACH AILMENTS AND DIGESTIVE DISTURBANCES, by Michael T. Murray, N.D. See page 9, References, in my website: http://cantbreathesuspectvcd.com   and, also see GER/LPR info on page 5, and on LINKS page.

PLEASE READ THIS GREAT BOOK. It may possibly be bought on-line, from Michael T. Murray’s website.

Some of the following we learned from people &/or other books, &/or other good websites about voice, GER, etc.

(1) DGL (De-Glycyrrhizinated Licorice) is one of our main methods of controlling the GER/LPR. We use Enzymatic Therapy brand, shortly before meals. The DGL does NOT cause high blood pressure, and does NOT cause fluid retention/edema, because the bad (steroidal) part of whole/crude licorice has been removed, leaving the DGL. DGL is available at most health food stores, and at good pharmacies.
  
The DGL tablet(s) must be chewed, to mix with saliva, to be effective. If it is too dry, one could mash/crush it and mix with a little water, and then chew it up. Chew tablet(s) for a minute or so, to thoroughly mix with saliva, shortly before EVERY meal, and if necessary, between meals (Read label directions).
  
The DGL seems to not only promote healing of throat, esophagus and stomach, but also seems to help prevent OUR reflux.(resulting in no more globus/lump in throat sensation, no more constant throat clearing, excess mucous, excess phlegm, no more NIGHT-TIME VCD/Vocal Cord Dysfunction/Laryngospams attacks, no more laryngitis, etc. for us)

We like the taste of the plain, fructose-free, DGL CHEWABLE tablets, but for those who hate the taste, try mixing the crushed tablet with a tiny bit of mashed organic banana, and then chew thoroughly, to mix with saliva. Avoid any DGL that contains mint. (Mint—in all forms, can cause gastric reflux episodes. AVOID MINT!!).

(2) We use Thayers brand of SLIPPERY ELM Throat Lozenges when we feel the need. (Soothing, coating, healing, nourishing). Slippery Elm (inner bark from a tree) also comes in teabag form, or in bulk, etc. as an herbal supplement.

(3) We drink the occasional small glass of CARROT JUICE (organic, fresh) which soothes, coats, heals the digestive tract, is nourishing, and stimulates the immune system, with beta-carotene, soothing and coating PECTIN (a type of fiber), and other good nutrients. (Carrot soup, cooked carrots are also good. Beta-carotene is heat resistant.) (Beta-carotene later is turned into Vitamin A inside us). Do not overdo. If your skin turns orange, cut back on the carrot juice. Avoid beta-carotene pills -- too potent.

(4) We tried elevating the head of the bed a few inches, by putting 6 inch to 8 inch BLOCKS, ON THE FLOOR, under the head end of the bed. This creates a slant (tilt), where the head is 6 to 8 inches higher than the feet. This helps some people, but not all people. (Check with a pediatric Gastro-enterologist, about raising the head end of a bed of a child, or a crib of an infant). Also, see (16) about a special GERD PILLOW, for adults.

(5) We try NOT TO BEND OVER too often, and we try to AVOID STRAINING (Valsalva maneuver). We AVOID LIFTING HEAVY objects. (No weight lifting!) (at least until after no more reflux symptoms for 3 months).

(a) If CONSTIPATION is causing any straining, see Ref.15,18,23,24,25 on page 9 for ideas about gently treating constipation, including eating whole grains, not white (de-natured ones), etc.  For us, exercise, increased water intake, acidophilus/bifidus, digestive enzymes, avoiding junk food, improved diet, chewing slowly (takes will power!), eating when not under stress or angry, etc., all are helpful.

(6) NO MORE TIGHT pants, belt, corset,--AVOID TIGHT CLOTHING etc.

(7) We try to not eat too much junk food. Some people avoid acidic  food, while others need to eat acidic food, if their stomach is not producing any (or enough) acid. (It is good to avoid acid, if one has an ulcer.) These gastric reflux tips methods often can help to heal ulcers. Some people need betaine hydrochloride supplements, which becomes HCl/hydrochloric acid, or, some use vinegar (acetic acid) in salads, or mixed with water, while others need to avoid eating excess acid. Each person is unique. We avoid all artificial sweeteners. Anyone with diabetes might want to look at the excellent book Reversing Diabetes, by Dr. Julian Whittaker, M.D..

Diet soda pop contains the harmful artificial sweetener Aspartame (Equal/Nutrasweet), which can cause WEIGHT GAIN, HEADACHES, UPSET STOMACH, BLURRED VISION, BLINDNESS, TWITCHING, SEIZURES, BRAIN TUMORS, HYPERACTIVITY, MOOD SWINGS, ETC., and soda pop often has strong acids, plus other harmful artificial ingredients. Plain water, gentle herb teas, certain fruit juices, brown rice-milk, etc. are healthier substitutes for soda pops.

We try to avoid all artificial ingredients, including fake fats (like Olean, Olestra, etc.), because these can destroy the digestive system, and prevent absorption of vital nutrients, such as fat-soluble vitamins (A, D, E, K) from foods. These fake fats also prevent digestion and absorption of needed fats & oils, used to repair myelin nerve cell sheaths (made of fatty material, mostly cholesterol). Hormones are also made of mostly cholesterol.

(8)  We try to drink more water, to prevent chronic dehydration. We like hard (nicely mineralized) well or spring water.
We do not drink distilled water (soft water, no minerals), because it can leach minerals out of our bones, possibly contributing  to osteoporosis. (See Ref.18,23, on page 9.) We avoid water softeners (chemicals) because they can be toxic, and because good minerals help keep us healthy. People with KIDNEY PROBLEMS &/or GLAUCOMA, etc. should ask their docs how much water is safe to drink, since too much water can be dangerous for them! (But, dehydration can cause problems also.)

(9) We use ACIDOPHILUS/BIFIDUS ( edible beneficial bacteria which keep bad YEASTS away, such as Candida Albicans, formerly called Monilia). ACIDOPHILUS/BIFIDUS also can eat or control some bad bacteria, and some viruses. The acidophilus/bifidus are also called PRO-BIOTICS and are beneficial intestinal flora (mainly for the large intestine). We keep the jars refrigerated, but not too cold. These are available at health food stores & pharmacies. (See Ref.14,15,23,24,25, on page 9).

Acidophilus/bifidus can re-populate the large intestine, with good bacteria, after antibiotics &/or steroids, etc. have killed off these good bacteria! Some of us have to continue eating the acidophilus/bifidus (daily, or from time to time), but the results seem worth the effort to us.

Yogurt and buttermilk contain similar beneficial bacteria, but are milk products, so see (11) below about milk products.

(10) We use DIGESTIVE ENZYMES. My husband likes Acid-Ease by Prevail, which contains Slippery Elm (inner bark), Marshmallow Root, Gamma-Oryzanol (from Rice Bran Oil), and the plant enzymes Amylase (digests starch), Lipase II (digests fat), and Cellulase I (digests cellulose from plant cell walls). The Acid-Ease does not contain Protease, which can be very irritating to ulcer/GER folks.

The Acid-Ease is NOT an acid blocker. It is not an antacid. It soothes, coats, nourishes, and promotes healing. Its enzymes help with leaky gut syndrome.

   I use Total Enzymes (which does have Protease, a protein digesting enzyme) by Nutri-West, a company that sells only to health practitioners (Chiropracters, Physicians, and others). One could ask their physician to order, at cost, for them, by having physician call 1-307-358-5066.

   Digestive enzymes are NOT FOR EVERYBODY.

(11)  My husband has found that AVOIDING MILK PRODUCTS helps him feel less congested, with less mucous in throat. Milk and milk products can cause gastric reflux episodes. Brown-Rice Milk (look for gluten-free) can substitute for milk (but not for babies!).

Gluten is in wheat (includes spelt & kamut), rye, oats, barley, & buckwheat. Read labels to avoid hidden gluten, in some soy sauces, gravies, grain alcohols, beer (barley malt), etc. People with Celiac Disease need to avoid all foods containing gluten. BROWN RICE (organic) is gluten-free. Corn is gluten free, but is very allergenic (allergy causing), so avoid corn. Avoid millet, at first, because there is disagreement about whether millet is safe or not, for Celiac patients.

MILK MAY CAUSE MORE ACID to be produced, IN THE STOMACH.

I occasionally eat milk products, like yogurt, cheese, whipped cream, or my ACIDOPHILUS/BIFIDUS, which is mixed with goat milk powder. So, at these times, I take LACTASE ENZYMES, to digest (break down into easily absorbed small molecules) the milk-sugar called LACTOSE. Many people (due to heredity &/or disease) have Lactose intolerance, where the small intestine does not secrete the lactase enzyme. Result is that the milk-sugar (lactose) travels further down the small intestine than it should. Then, bad bacteria eat the lactose, giving off lots of gas (a by-product of the digestion of bad bacteria), and this causes folks to get bloated, gassy, have diarrhea, and cramping. I use Lactaid brand lactase enzymes, and it works for me. Ordering direct from them can save money.

(12) Using the above methods has almost completely freed my husband of needing to use Tums, and seems to be nicely controlling his and my GER/LPR. We have never used acid blockers.

ACID BLOCKERS CAN HAVE DANGEROUS SIDE EFFECTS: Some examples are:

Acid must be present in the stomach, in order for the stomach to make a substance called Intrinsic Factor. Intrinsic factor must be present with Vitamin B 12, in the stomach, for absorption of Vitamin B 12 to happen, I believe, in the ileum (last part of the small intestine).

Acid blockers therefore prevent absorption of Vitamin B 12. Malabsorption (lack of absorption) of Vitamin B 12, causes NERVE DAMAGE (pain, numbness, pins & needles sensation, etc.) in the peripheral nerves (outside the brain & spinal cord). This is called PERIPHERAL NEUROPATHY. For details about this problem, see the Peripheral Neuropathy forum at http://www.braintalk.org

If Vitamin B 12 continues to NOT be absorbed, eventually there can be NERVE DAMAGE to the Central nervous system (brain & spinal cord).

ALSO, the minerals calcium, iron, zinc, other minerals, and important trace minerals, etc. cannot be properly absorbed, when there is no acid in the stomach (due to acid blockers, etc.).

AND, protein does not get properly digested (broken down--eventually into amino acids), in the stomach, when there is no acid in the stomach.

Doctors and pharmacists can advise about gradual(slow) tapering down (weaning) schedules (when and if safe) for the acid blockers. Some acid blockers, when stopped too quickly, can cause rebound acid secretion in the stomach, resulting in excess hydrochloric acid secretion.

ALSO, SOME FORMS OF REFLUX ARE NOT ACID REFLUX, but are ALKALINE REFLUX, (bile is alkaline). Besides refluxed stomach acid (HCl/hydrochloric acid), Pepsin (an acidic proteolytic/protein digesting, enzyme) & bile (alkaline) can irritate & damage: the esophagus, throat, vocal cords, & lungs.

(13) Do not drink ICY COLD DRINKS, and AVOID VERY HOT DRINKS. Use room temperature drinks, or slightly cool, or warm, but not ultra-hot. Extremely cold or hot liquids can irritate the stomach, which is bad for ulcers &/or gastric reflux.

(14) Ask physical therapists, chiropractors, osteopaths, etc. if they know any safe adjustments that might lessen GER/LPR, if you wish.

(15) Read (by Dr. James A. Koufman) PATIENT INFORMATION SHEET ON REFLUX by Center for Voice Disorders of Wake Forest University. Here’s a link:  http://www.bgsm.edu/voice/pt_info.html  Dr. Koufman was a pioneer in showing the connection between stomach reflux (can be acid reflux OR alkaline reflux) and breathing problems!

(16) Some have found a special (large) GERD pillow helpful for preventing GERD episodes while sleeping and while lying down. Here is a link to the Prop up pillow website:  http://www.propuppillow.com

(17) Avoid harmful chemical air pollution, which can aggravate gastric reflux. See page 5 of VCD website for more about this.

(18) Using the above methods, in addition to the SINUS SURVIVAL tips, has helped us to prevent VCD attacks, in us.

(19) Please check with your doctor, in advance, to be sure that it is OK for you to try these tips, in your particular case. Also, please get monitored by your doctor, to be sure that no more damage to the throat, esophagus, stomach, vocal cords, lungs, etc. is happening, from possible SILENT gastric reflux.

Pregnant or nursing ladies should check with their doctors, before trying any of these tips.

Avoid any herbs, foods, etc. that you may be allergic to.

Check with your doctor and pharmacist, to be sure that there would be no harmful interactions between any of your medications, diet that you may be on, and any herbs, foods, etc. mentioned in these tips.

Check with your doctor, to be sure that these tips would not interact badly with any medical condition you may have.

These tips help my husband and me (adults). Some of these tips may be OK for children, and others may not be OK for children. Check with your doctor! Babies with gastric reflux need DIFFERENT treatments, not these tips (except for raising the head end of the crib, if your doctor says it is OK to do this, etc.). Check with your doctor!

Good luck to you.
Sincerely, Concerned lady

[sunnygal]

Thanks for the input.  My ENT dr. is ordering another (2nd) Pulmonary Function Test which includes the Metaclopromide (sp?) challenge.  He says this will tell us if the problem is indeed asthma.  It took me 2 months to get it through the dr's heads that the singulair wasn't doing any good, and the albuterol is giving me major palps without much positive effect.

[RTFLY]

Hi Spicer...I hope you have had some more help in figuring out your dilema. As for the Peak Flow Meter numbers, they may improve, they may not. Generally, PEF measurements improve with bronchdilator therapy if status asthmaticus or severe bronchospasm is the underlying problem. I agree with Starion in saying that I find it hard to understand how a diagnosis of asthma is ascertained on pulmonary function studies without the aid of pre and post bronchdilator therapy testing. A 15-20% increase in FVC and FEV1 lung volumes confirms positive response to bronchdilator therapy in reactive airway disease patients. Asthma is actually an OBSTRUCTIVE disease but can have some restrictive symptoms. It feels like people can't catch their breath or get air into their lungs. So the problem with asthma, like other obstructive diseases is that you can't get air out. Bronchodilators act on the smooth muscle that surrounds your airways and helps them to relax, in turn making airflow more laminar (smooth) and less turbulent. This hopefully makes it easier for you to breathe. As for cardiac function, your EKG will show what the heart is doing at the time the EKG is taken. I'm glad that was normal and hope your ECHO was normal as well. If albuterol (Ventolin) gives you undesirable side effects, maybe check out a drug called levalbuterol(Xopenex). It is basically Ventolin with a slight change in the drug make-up and seems to have less of the "bad" side effects that Ventolin has. I hope all works out for you and would be interested in knowing what your outcome was. Feel free to e-mail me at "***@****" Good luck...
                                       J.C.I., RCP RRT