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        New Message Board Archives >> 2004 Cluster Headache Specific Posts >> VIOXX
        
(Message started by: Chronic on Jul 14^th, 2004, 1:08pm)

Title: VIOXX
Post by Chronic on Jul 14^th, 2004, 1:08pm

Don't know if this is going to help others...but Ijust read a new article in shape magazine of all places.

Vioxx has been approved for use with Migraine sufferers.

Well, I just started that whole thread about Prednisone and how I had enough of it. After reading this blurb, i titrated down on Prednisone and took Vioxx instead.

No headaches in 3 days.

I'm going to see my neuro tomorrow, so I'm going to have a long discussion with her. Others might have already posted this in the past, but I'd much rather be on VIOXX than Prednisone. I'll post an update as soon as I can.

PF days to all.

Title: Re: VIOXX
Post by E-Double on Jul 14^th, 2004, 1:09pm

As a preventative??

Title: Re: VIOXX
Post by Chronic on Jul 14^th, 2004, 1:29pm

E -

Yes as a preventative.

Also, just read your post about a NY doctor. I live in NY and have been going to Dr. Ian livingstone in Princeton NJ. It's a freaking trek, but he's been great for the last 12 years.

Recently I have had the awesome luck of potentially turning Chronic. Dr. Livingstone wanted me to get a 2nd opinion so he is sending me to Dr. Mark Green at Columbia Prespreteria in NYC. He's supposed to be tops in the field. It may be tough to get an appointment with him, but their is another Neuro who works with him Dr. Remmes. She is good too.

Just a suggestion. I've never heard of the doctor you asked about.

Title: Re: VIOXX
Post by floridian on Jul 14^th, 2004, 1:50pm

Cyclooxygenase 2 (cox2) is involved in many inflammatory responses. Here's research that shows that cox2 inhibitors can reduce two of the bad actors associated with clusters - substance P and CGRP. It also reduces nitric oxide. In the first abstract, nerve injury resulted in increased SP and CGRP, but cox inhibitors brought things back closer to normal.

There are many dietary substances that are natural cox2 inhibitors - cherries, turmeric, green tea, conjugated linoleic acid, resveratrol (in grape seed, peanuts, polygonum herb root) all turn down cox2. The second article evaluated anthocyanidins (the pigments that give plants their color) and catechins (found in green tea, some other plants).

On this board, JMorgan has long argued that a 'detox diet' helps with clusters. The more I read, the more I start to think he is right. Eating a diet composed largely of fruits and vegetables can have the same effect as downing Vioxx or Celebrex, with fewer side effects.

A choline deficient diet increases cox2 activity. We know that choline levels are low in clusterheads, although it may be from metabolic problems, not diet. But choline supplements might turn down cox2 gene activity. Choline is also the building block of the neurotransmitter Acetylcholine, which is anti-inflammitory and can reduce some of the bad actors in CH. The choline deficiency in clusters was described in 1984, but never followed up with any Einstein experiments to see if taking a choline supplement might improve things. Doh!

Quote:

Neuroscience. 2003;121(3):681-90.

Intraplantar injection of a cyclooxygenase inhibitor ketorolac reduces immunoreactivities of substance P, calcitonin gene-related peptide, and dynorphin in the dorsal horn of rats with nerve injury or inflammation.

Ma W, Eisenach JC.

We previously reported that partial sciatic nerve ligation (PSNL) dramatically up-regulates cyclooxygenase 2 (COX2) in injured sciatic nerve, and local injection of the COX inhibitor, ketorolac, reverses tactile allodynia and suppresses increased phosphorylation of the transcription factor cAMP responsive element binding protein [Eur J Neurosci 15 (2002) 1037]. These findings suggest that peripheral prostaglandins (PGs) are over-produced and contribute to the central plasticity and the maintenance of neuropathic pain after nerve injury. PGs, particularly PGE2, are well known to facilitate the release of the pro-nociceptive neuropeptide substance P (SP) and calcitonin gene-related peptide (CGRP) from primary sensory afferents. Thus, suppressing peripheral PG over-production may inhibit the release of these two neuropeptides from primary afferents and thereby increase the content of these neuropeptides remaining in afferent terminals in the dorsal horn.
...
Five days following intraplantar injection of ketorolac, CGRP- and SP-IR in the ipsilateral and contralateral dorsal horn were dramatically reduced compared with saline-injected PSNL rats. Local ketorolac also suppressed PSNL-induced increase in dynorphin-IR in dorsal horn neurons.
...
These findings are in contrast to our hypothesis, suggesting that peripherally over-produced PGs following nerve injury and inflammation possibly contribute to the production of SP and CGRP in primary sensory neurons, to the up-regulation of dynorphin in the dorsal horn neurons, and finally to the mechanisms of neuropathic and inflammation pain.

Quote:

Nutr Cancer. 2003;46(1):101-6.

Inhibition of proliferation of human cancer cells and cyclooxygenase enzymes by anthocyanidins and catechins.

Seeram NP, Zhang Y, Nair MG.

Bioactive Natural Products and Phytoceuticals, Department of Horticulture and National Food Safety and Toxicology Center, Michigan State University, East Lansing, MI 48824, USA.

The widespread consumption of diets rich in anthocyanin and catechin content prompted the evaluation of their in vitro inhibitory effects on cyclooxygenase (COX) enzymes and on the proliferation of human cancer cell lines. Five anthocyanidins consisting of cyanidin (1), delphinidin (2), pelargonidin (3), peonidin (4), and malvidin (5) were tested for COX-1 and -2 enzyme inhibitory activities at 40 microM. Eleven catechins consisting of (+)-catechin (6), (-)-catechin (7), (+/-)-catechin (8), (+)-epicatechin (9), (-)-epicatechin (10), (-)-epigallocatechin (11), (-)-gallocatechin (12), (-)-epicatechin gallate (13), (-)-catechin gallate (14), (-)-epigallocatechin gallate (15), and (-)-gallocatechin gallate (16) were tested for inhibitory effects of COX-1 and -2 enzymes at 80 microM. Of the compounds tested, the galloyl derivatives of the catechins 11-15, cyanidin (1) and malvidin (5), showed the best COX inhibitory activities compared with the commercial anti-inflammatory drugs ibuprofen (at 10 microM), naproxen (at 10 microM), Vioxx (at 1.67 ppm), and Celebrex (at 1.67 ppm). Inhibition of the proliferation of the human cancer cell lines MCF-7 (breast), SF-268 (central nervous system, CNS), HCT-116 (colon), and NCI-H460 (lung) was evaluated at concentrations between 100 and 6.25 microM compared with the commercial standard, adriamycin (doxorubicin) at 6.25 microM. ... {deleted due to space limits}

Title: Re: VIOXX
Post by E-Double on Jul 14^th, 2004, 1:57pm

I was using Vioxx along with abortives originally(goes to show ya what some docs do as compared to others).
If ever read some of my posts the med thing is still new to me.....

Anyway good to know about the NY thing. Appreciate it.
Went to a new guy this morning and appeared to know his stuff (atleast based on what I read here and the research I've done) Posted a med question (on the other board though)

Are ya in Manhattan?

Good luck!!
Eric

Title: Re: VIOXX
Post by eyes_afire on Jul 14^th, 2004, 6:58pm

Floridian,

I have long been curious about acetylcholine and CH and have expressed it on this board. Ever since I saw the reports from an Italian friend who had hopes that Aricept may ultimately be useful for CH. He used to post it on this board several years ago. Do you know how Aricept effects acetylcholine? From what I know, it kinda acts like 'an acetylcholine reuptake inhibitor'... but I could be wrong. If I'm not mistaken, acetylcholine works in balance with serotonin. I'm not entirely convinced that serotonin is the main culprit in CH. I also have much interest in 'acetylcholine and sleep and CH and fat metabolism and vitamin A'. I usually hate to speculate without a solid theory. Are you aware of anymore reports of clusterheads trying Aricept?

--- Steve

Title: Re: VIOXX
Post by Kris_in_SJ on Jul 14^th, 2004, 9:27pm

As always, your research is really appreciated Floridian. I'm wondering though, if Vioxx might be yet another med that works for some but not for others?

I've been on Celebrex for the past 2 years for an injury and subsequent arthritis in my hip (which is greatly exacerbated by sitting all day at a computer).

Despite this, I still had a virulent CH cycle, that was only shortened by my cluster cocktail (Verap & Pred). And I still had plenty of kip 10's that required Imitrex.

So maybe it works for some, but not all?

Kris

Title: Re: VIOXX
Post by floridian on Jul 15^th, 2004, 9:09am

Quote:

I'm wondering though, if Vioxx might be yet another med that works for some but not for others?

That's likely. While the pain is similar in most of us, the way we get there varies. Lithium is great for some, does nothing for others - and the presence of a single gene is 90% accurate in predicting lithium response. Melatonin helps around half of us, does nothing for the others.

Aricept (donepezil) has been shown to prevent migraines (see abstract below). That doesn't prove it will help with clusters, but it is encouraging. Aricept is a cholinesterase inhibitor - it blocks the enzyme that breaks down acetylcholine. This means that when a nerve secretes acetylcholine, it stays around longer and has more effect. Aricept is a reversible inhibitor (which is good) - several pesticides and nerve agents are irreversible cholinesterase inhibitors. There are some irreversible inhibitors that are used as medicines, but controlling the dose is critical and the risk of side effects are greater.

Quote:

Headache. 2002 Jul-Aug;42(7):596-602.

Central cholinergic challenging of migraine by testing second-generation anticholinesterase drugs.

Nicolodi M, Galeotti N, Ghelardini C, Bartolini A, Sicuteri F.

Interuniversity Center, Neurochemistry and Clinical Pharmacology of Idiopathic Headache, Viale G. Pieraccini 18, 1-50139, Florence, Italy.

The antinociceptive activity of donepezil, a novel cholinesterase inhibitor, was investigated in the mouse hot plate test. Donepezil (5 to 10 mg kg(-1) i.p.) induced a dose-dependent antinociception that reached its maximum effect 15 minutes after injection. Donepezil antinociception was prevented by the antimuscarinic drug scopolamine. At analgesic doses, donepezil did not alter gross animal behavior. These results indicate that donepezil is endowed by muscarinic antinociceptive properties, suggesting this compound as a potential therapeutic approach for the treatment of painful pathologies. Therefore, we investigated donepezil's effect in migraine. Donepezil (5 mg per os, evening assumption) was effective as a prophylatic agent in patients suffering from migraine with or without aura by reducing the number of hours with pain, the number of attacks, and the severity of the pain attack. The efficacy of donepezil was compared with that of the beta-blocker propranolol (40 mg bid per os), showing higher activity. Response rates of a large-sized open study devoid of entry criteria regarding migraine subtypes suggest the drug as an excellent prophylactic compound for migraine in general practice. Clinical results also indicate that the activation of the cholinergic system can represent a novel prophylactic approach to migraine.

Title: Re: VIOXX
Post by seannap on Jul 19^th, 2004, 5:13am

I too have been on Celebrex for the past couple of months, and it has severely minimized my HA... the ones that I do have are mild on the kip, with only a few in the 7-8 during "that time"...

I sugest that anyone try it... as the side effects are relatively low - especially in comparasin to some of the other stuff that seems to be part of the cocktails around here. The good thing about Vioxx and Celebrex - you don't need to take it but once or twice to know if it does or doesn't work for you. It will let you know!

My doctor (GP) actually has a number of CH patients. All but one or two of them are on celebrex.

Title: Re: VIOXX
Post by don on Jul 19^th, 2004, 7:30am

The active ingrediant in Vioxx is rofecoxib, an anti inflammatory.

Ch begins in the hypothalamus gland and effects the trig. nerve and dialates blood vessels. Nothing to do with infamed tissues or muscles.

Vioxx may help you deal with an attack but I highly doubt it's effectiveness as a preventative or abortive either 1,2, or 3 line.

Quote:

After reading this blurb, i titrated down on Prednisone and took Vioxx instead.

No headaches in 3 days.

My guess is the prednisone has worked well for you.

Title: Re: VIOXX
Post by floridian on Jul 19^th, 2004, 1:44pm

Quote:

Ch begins in the hypothalamus gland and effects the trig. nerve and dialates blood vessels. Nothing to do with infamed tissues or muscles.

By that logic, lithium should not work because clusters have nothing to do with manic depression, depakote should not work because clusters are not epileptic siezures, and olanzapine should not work because we are not atypical psychotics.

Cox2 inhibitors can inhibit substance P and CGRP. They help with migraines. Those facts make cox2 drugs worthy of research on clusters. We don't know that they are what helped Chronic stay PF 3 days after the taper off - as you said, it could just be the prednisone. It could be randomness. But this is the type of anecdotal evidence that could be useful.

Give us an update, Chronic?

Title: Re: VIOXX
Post by Kris_in_SJ on Jul 19^th, 2004, 8:35pm

Wouldn't it be nice if CH were kind of like Otitis Media? If Ampicillin didn't work, then probably Tetracycline or a Sulfa drug would?

The more I read, the more confused I become. I guess I'm just grateful that my particular "cocktail" works for me. My wish is that it would work for everyone.

Still much research to be done .....

Kris

Title: Re: VIOXX
Post by E-Double on Jul 19^th, 2004, 9:07pm

Quote:

Dr. Mark Green at Columbia Prespreteria in NYC

The psychologist I've been seeing suggested him and was trying to pull some strings. I guess I'll give him a shot if I can get on his list

E

Title: Re: VIOXX
Post by don on Jul 19^th, 2004, 9:48pm

Quote:

Again I believe that those meds that you have mentioned only help the suferer to deal with the pain with the possible exception of the lithium. I doubt they have any preventative or abortive value.

Title: Re: VIOXX
Post by floridian on Jul 21^st, 2004, 10:51am

Although not investigated and not proven, its plausible to think that cox2 inhibitors might act as preventive meds for cluster headaches.

Specifically, cox2 inhibitors reduce production of Prostaglandin E2. PGE2 stimulates CGRP release. CGRP is involved in the vascular changes in both migraine and clusters. Can cox2 inhibitors prevent cluster headaches? Dunno. Maybe in some people. Only time will tell.

Title: Cox2 inhibitors and paroxysmal hemicrania
Post by floridian on Jul 21^st, 2004, 3:45pm

Cox2 inhibitors can prevent paroxysmal hemicrania headaches.

Quote:

Headache. 2002 Jun;42(6):530-1.

Hemicrania continua responds to cyclooxygenase-2 inhibitors.

Peres MF, Silberstein SD.

Jefferson Headache Center, Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, Pa., USA.

BACKGROUND: Hemicrania continua is a primary headache disorder defined by its absolute responsiveness to indomethacin. We report the treatment response to two cyclooxygenase-2 inhibitors, celecoxib and rofecoxib, in a series of patients with hemicrania continua. METHODS: Fourteen patients were treated, 9 with rofecoxib and 5 with celecoxib. RESULTS: Three patients in each group had a complete response to treatment. CONCLUSION: The cyclooxygenase-2 inhibitors may represent an alternative to indomethacin in the treatment of hemicrania continua. Their mechanism of action for this potential indication is unknown.

Quote:

Cephalalgia. 2004 May;24(5):414-5.

Seasonal episodic paroxysmal hemicrania responding to cyclooxygenase-2 inhibitors.

Siow HC.

Jefferson Headache Center, Department of Neurology Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA. charles.siow@mail.tju.edu

At minimum, some people with very cluster-like symptoms may have paroxysmal hemicrania. At the heretical extreme, maybe CH & PH (and migraine?) are all part of the same disorder:

Quote:

Arq Neuropsiquiatr. 2001 Dec;59(4):944-7.

Episodic paroxysmal hemicrania with seasonal variation: case report and the EPH-cluster headache continuum hypothesis.

Veloso GG, Kaup AO, Peres MF, Zukerman E.

Department of Neurology, Federal University of Sao Paulo, Sao Paulo, SP, Brazil. germanyveloso@hotmail.com

Episodic paroxysmal hemicrania (EPH) is a rare disorder characterized by frequent, daily attacks of short-lived, unilateral headache with accompanying ipsilateral autonomic features. EPH has attack periods which last weeks to months separated by remission intervals lasting months to years, however, a seasonal variation has never been reported in EPH. We report a new case of EPH with a clear seasonal pattern: a 32-year-old woman with a right-sided headache for 17 years. Pain occurred with a seasonal variation, with bouts lasting one month (usually in the first months of the year) and remission periods lasting around 11 months. During these periods she had headache from three to five times per day, lasting from 15 to 30 minutes, without any particular period preference. There were no precipitating or aggravating factors. Tearing and conjunctival injection accompanied ipsilaterally the pain. Previous treatments provided no pain relief. She completely responded to indomethacin 75 mg daily. After three years, the pain recurred with longer attack duration and was just relieved with prednisone. We also propose a new hypothesis: the EPH-cluster headache continuum.

Quote:

Clin Otolaryngol. 2002 Dec;27(6):472-9.

Paroxysmal hemicrania and cluster headache: two discrete entities or is there an overlap?

Fuad F, Jones NS.

Department of Otorhinolaryngology, Head and Neck Surgery, University of Nottingham, Nottingham, UK.

Paroxysmal hemicrania has been described as an excruciating unilateral pain, which is usually ocular and frontotemporal with short-lasting (2-45 min), frequent attacks (usually more than five per day); with marked autonomic features (rhinorrhoea, nasal congestion, conjunctival injection, lacrimation) and unilateral to the pain. A response to indomethacin is essential using the current criteria for the diagnosis. It is a rare condition but when it occurs it is misdiagnosed as being due to sinusitis. A retrospective analysis of 11 patients seen in the period 1995-2001 suggests that there is an overlap between paroxysmal hemicrania and cluster headache. Four patients had all the characteristics of paroxysmal hemicrania and responded to indomethacin. Four other patients fulfilled the criteria except for the frequency and length of the attacks. They only had one attack per day and these lasted more than 2 h. Another patient had all the symptoms of paroxysmal hemicrania and did not respond to indomethacin, but responded to triptans and pizotifen. Patients with cluster headache typically respond to these. Two patients were unable to continue taking indomethacin owing to severe gastrointestinal upset. In the same period, we also had 30 patients with cluster headaches. There is increasing evidence that paroxysmal hemicrania and cluster headache share a similar pathogenesis and that they may not always be so discrete in either their response to indomethacin or their periodicity.

Title: Re: VIOXX
Post by pam s on Jul 24^th, 2004, 12:32am

on 07/14/04 at 21:27:35, Kris_in_SJ wrote:

As always, your research is really appreciated Floridian. I'm wondering though, if Vioxx might be yet another med that works for some but not for others?

Kris

AFAIK, Vioxx did nothing for me.

Title: Re: VIOXX
Post by pam s on Jul 24^th, 2004, 12:38am

on 07/19/04 at 13:44:24, floridian wrote:

Floridian, IIRC, lithium, depakote, the benzodiazapines, as well as lamictal, seroquel, skullcap, among other things, all protect the brain by suppressing glutamate, increasing GABA, and thereby preventing cell death. Also, IIRC, overproduction of glutamate is associated with CH -- is that right? I've taken a benzodiazapine and depakote before, with little effect.

Pam

Title: Re: VIOXX
Post by pam s on Jul 24^th, 2004, 12:42am

on 07/19/04 at 13:44:24, floridian wrote:

Title: Re: VIOXX
Post by pam s on Jul 24^th, 2004, 12:43am

on 07/14/04 at 21:27:35, Kris_in_SJ wrote:

As always, your research is really appreciated Floridian. I'm wondering though, if Vioxx might be yet another med that works for some but not for others?

Kris

AFAIK, Vioxx did nothing for me.

Title: Re: VIOXX
Post by floridian on Jul 24^th, 2004, 9:39am

on 07/24/04 at 00:42:51, pam s wrote:

Pam,

I see your point. There is a cascade of chemicals that flow in a cluster (glutamine, serotonin, cgrp, nitric oxide, interleukins, etc). Stopping only one of them might be like putting a dam over the middle 20% of a flooding river. But some of these chemical are probably the triggers for others - some meds do work.

My point in this thread is not to be the devil's advocate - I said "Although not investigated and not proven, its plausible to think that cox2 inhibitors might act as preventive meds for cluster headaches." I don't know if they help - I am simply arguing against dismissing COX2 inhibitors because of theory. The fact that they help with migraine is enough to give them some consideration, given the similarities between migraine and cluster, and the fact that many migraine meds help with clusters. The fact that some people here seem to improve when taking them is also worth considering, although it could be random variation in the course of the headaches.

Ultimately, the proof is in the pudding.

Title: Re: VIOXX
Post by pam s on Jul 25^th, 2004, 2:21am

on 07/24/04 at 09:39:37, floridian wrote:

I see your point.

Amazing, considering how I garbled it -- I was actually just checking with you to see if what I had gleaned was correct. Reading pub med abstracts is like teaching myself Greek. (Some of those words are not in the dictionary, you know!)

I do think it is silly, with all the off-label applications of meds, to assert, despite evidence to the contrary, that they cannot work for anything other than what they were initially used for!

I have a book on alternative COX2 inhibitors I am planning to wade through soon. (But if I make my husband take any more supplements he's going to bolt.)

Pam

Title: Melatonin blocks cox2, 5-LO
Post by floridian on Jul 26^th, 2004, 2:16pm

Among other things, melatonin blocks cox2, nitric oxide, and 5-LO (5-lipoxygenase, an inflammatory enzyme similar to cox2). It could be co-incidental, or it could part of how melatonin works.

Quote:

Prostaglandins Leukot Essent Fatty Acids. 1999 Apr;60(4):249-53
Role of centrally administered melatonin and inhibitors of COX and NOS in LPS-induced hyperthermia and adipsia. Raghavendra V, Agrewala JN, Kulkarni SK.

World J Gastroenterol. 2003 Jun;9(6):1307-11.
Effects of melatonin on the expression of iNOS and COX-2 in rat models of colitis. Dong WG, Mei Q, Yu JP, Xu JM, Xiang L, Xu Y.

Title: Re: VIOXX
Post by brokenfingers on Jul 30^th, 2004, 12:37pm

It seems that there can be some very bad side effects as a result of using Vioxx, see below

http://www.mn015c1411.pwp.blueyonder.co.uk/Lawsuit_Vioxx.htm

Title: Re: VIOXX
Post by eddie on Aug 12^th, 2004, 11:10pm

my neruo gave me
vioxx and effexor {slept 2 hrs a night NOT ME }
made me feal like crap
effexor is one thing that had me so messed up
and vioxx didnt even hit any pain i had
effexor is dangerous its serintonin reuptake
and earaches i have are killer and it made
those whorse
thats why i dont see him anymore
i had bad head trauma in a head on wreck
as a child my ha and eaches always on the
right side the pain in my ear has cleared up
but the ch are still here i have tried alot of
stuff so much its hard to keep up o2 does
help im learning just like the rest
alot of these meds are bad for us
i can tell what this stuff does to me
and its not good i do try to play ch off
but thats not easy when they grinding
on my head but i do read alot of post
to educate myself

Title: Re: VIOXX
Post by ex_pat_asia on Aug 13^th, 2004, 1:56pm

on 07/30/04 at 12:37:33, brokenfingers wrote:

It seems that there can be some very bad side effects as a result of using Vioxx, see below

http://www.mn015c1411.pwp.blueyonder.co.uk/Lawsuit_Vioxx.htm

NSAIDS are notorious for the list of side affects at the url. Unless I am foregtting something it looks like the usual litany. Yet, that shouldn't prevent digging deeper into the possibilities here.

Quote:

Posted by: floridian Posted on: 07/27/04 at 2:16am
Among other things, melatonin blocks cox2, nitric oxide, and 5-LO (5-lipoxygenase, an inflammatory enzyme similar to cox2). It could be co-incidental, or it could part of how melatonin works.

Floridian, it seems to me then that Melatonin would be a better choice then Vioxx as a starting place for Cox2 inhibition? The latter is also getting a bum rap for high blood pressure (see following)

http://www.reuters.com/newsArticle.jhtml?type=healthNews&storyID=5927928

For me that would be an issue thus leading me back to the melatonin. I had been thinking on giving melatonin a trial but was drawn to it for reasons of sleep regulation rather then cox2 and 5-LO inhibition. Also, I agree with your connect-the-dots to EPH and Migraine. The following connects two of the dots in a single patient:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10759906

I'll start the melatonin tomorrow, adding it to the 480 mg verapamil and the Betamethasone taper.

Immigram and Relpax have all but drifted into irrelevancy for me...Oxy is now the only effective aborter. It is a bloody anchor and I need to get back on the road for my business.

Thanks as always Floridian...superb search skills.