Dr. Jay Goldstein's Rapid Remission ME/CFS Treatments.

[Sidereal]

Just an update/FYI I have continued trying to contact him but as of yet I'm still unsuccessful.

Also, I've been politely contacted by other members but I should be clear that I do not have a direct relationship with the Doctor or his family so there's only so much o can do at this point...

How are you doing @Thomas after your IV experiment?

 

[Thomas]

How are you doing @Thomas after your IV experiment?

Thanks for checking in. The worst of it is over -- on the bright side at least I can finally cross IV Vitamin C off the treatment list.

 

[Violeta]

Maybe someone should put a disclaimer about Dr. Goldsteins's claims at the beginning of the thread.

 

[nandixon]

I also felt much worse on ranitidine but get good control of HSV and VZV symptoms with cimetidine. The problems with cimetidine are reduction of stomach acid (some of us are low to begin with) and blockade of the H2 receptor which, for me at least, results in more histamine binding to H1 which results in an awful flare of mast cell activation symptoms.

Also, cimetidine slows down the metabolism of some drugs so be careful if using other stuff at the same time. I developed toxic reactions to a drug I was already on when I first used cimetidine.

@Sidereal, what dose of cimetidine were you trying and what time(s) of day were you taking it at relative to food?

I notice that the original poster, @faith.hope.love, of the first thread on Phoenix Rising about cimetidine, in 2010, said that the dosing that worked for her was just a single 200mg amount every other day. (My dosing of 2 x 50mg every day, averages out to that same total amount.) I think she did that because she was worried about stomach acid and medication interactions as well. See her thread: Tagamet (cimetidine) for CFIDS (worked for me)

The pharmacokinetics of cimetidine are such that a 200 mg dose no longer has an acid-reducing effect after 10 hours. So cimetidine might be doable for some people by dosing at night two or three hours after eating and having the acid reducing effect occur during sleep. Personally, I seem to need to take it twice a day in a smaller amount to have better energy.

If you're feeling like there's extra H1 histamine sensitivity from the cimetidine, which might be increased IgE production, perhaps a low enough dose of cimetidine taken away from food, i.e., the bedtime dosing, might help with that, too. Also, taking an H1 antihistamine, e.g., diphenhydramine (Benadryl) seems like it might possibly be helpful with that problem. Maybe you've already tried those potential workarounds, though.

 

[Sidereal]

@Sidereal, what dose of cimetidine were you trying and what time(s) of day were you taking it at relative to food?

I was taking 200 mg a day in the morning, a few hours before my first meal.

The pharmacokinetics of cimetidine are such that a 200 mg dose no longer has an acid-reducing effect after 10 hours.

Interesting, thanks for this information.

Also, taking an H1 antihistamine, e.g., diphenhydramine (Benadryl) seems like it might possibly be helpful with that problem. Maybe you've already tried those potential workarounds, though.

Yes, unfortunately that's the drug that I developed toxicity to. I posted about my experience with this combo a few pages ago on this thread.

I notice that the original poster, @faith.hope.love, of the first thread on Phoenix Rising about cimetidine, in 2010, said that the dosing that worked for her was just a single 200mg amount every other day. (My dosing of 2 x 50mg every day, averages out to that same total amount.) I think she did that because she was worried about stomach acid and medication interactions as well. See her thread: Tagamet (cimetidine) for CFIDS (worked for me)

Like all immune modulators it seems to make me worse if I take it every day. I think I'm going to try a pulsed schedule once the allergy season is over.

And here's another thread of an ME/CFS patient improving on cimetidine for those interested.

http://forums.phoenixrising.me/inde...zantac-tagament-to-boost-immunity-help.37427/

I Love Tagamet! I must say.
After a few months of horrible horrible EBV and a progression of the Virus
The Tagamet has been only thing to get my body to get this virus and symptoms tolerable and resolving.
Its a miracle actually. I don't know if this will help anyone else with this virus when it reactivates but
maybe this posting will help someone else.

My doctor now prescribes it and two of my doctors are recommending to stay on it.

It has not been just me playing around as I have been getting guidance and help from multiple doctors

 

[Violeta]

I was taking 200 mg a day in the morning, a few hours before my first meal.



Interesting, thanks for this information.



Yes, unfortunately that's the drug that I developed toxicity to. I posted about my experience with this combo a few pages ago on this thread.



Like all immune modulators it seems to make me worse if I take it every day. I think I'm going to try a pulsed schedule once the allergy season is over.

And here's another thread of an ME/CFS patient improving on cimetidine for those interested.

http://forums.phoenixrising.me/inde...zantac-tagament-to-boost-immunity-help.37427/

What is the antiviral property of Tagamet?

 

[Sidereal]

What is the antiviral property of Tagamet?

It's unknown. Some have put forward its ability to suppress Tregs as an explanation. Have a look at Hip's post on the previous page.

 

[Violeta]

It's unknown. Some have put forward its ability to suppress Tregs as an explanation. Have a look at Hip's post on the previous page.

Okay, thanks

 

[zzz]

@zzz, Have you ever tried cimetidine (Tagamet) yourself? I saw where you're having some success using low dose valganciclovir (Valcyte) and I'm curious how cimetidine and Valcyte might compare as immunomodulators.

@nandixon, sorry for the long delay in my reply. Things have just gotten away from me a bit recently.

However, I keep learning more about the way Valcyte works, so I have a little more to offer than when you made this post.

I have never tried cimetidine myself. Your experience and that of @Sidereal and the threads she references are probably the most useful information here.

As for Valcyte, the two effects that would apply here would be its anti-inflammatory and immunomodulatory effects, both of which have been confirmed by Dr. Montoya. The most specific comments I have seen him make on the immunomodulatory effects of Valcyte are noted in the thread CDC PCOCA conference call on 2/23/2015 with Dr. Montoya and Dr. Unger:

Valgancyclovir – we discovered this drug has immunomodulatory abilities that were not known before our work at Stanford. These include a temporary but significant decrease in circulated monocytes and a shift towards a TH1 profile.

We believe that immunomodulation not only could partially explain the benefit of Valgancyclovir, but could easily turn out to be crucial in the treatment of ME/CFS. In fact, our cytokine data and that of others support this view.NK cell function: we’ll apply novel technology to the NK cell deficiency in ME/CFS shown by several groups

Now the interesting thing here is that while Dr. Montoya notes some of the immunomodulatory effects of Valcyte, he does not speculate on their mechanism. From my own work with low dose Valcyte and from what I have heard from others, however, there are some tantalizing hints.

I have noticed that at whatever dose the anti-inflammatory effects of Valcyte kick in (and these tend to manifest as an improvement in various neurological symptoms, from cognitive dysfunction to dysautonomia), the immunomodulatory effects tend to kick in either at the same time or shortly thereafter. The immunomodulatory effects may be mild, and may manifest as a gradual lessening of infectious symptoms, or they may be stronger, manifesting as a full blown immune reaction, sometimes complete with an IRIS response. I have experienced responses all along this spectrum during the years I have taken Valcyte.

The fact that the emergence of the immunomodulatory effects of Valcyte always seems to occur right around the time of the emergence of the anti-inflammatory effects suggests the possibility that these two types of effects may be linked. Dr. Goldstein certainly made it clear in his writings that he believed that the immune system dysfunction so commonly found in ME/CFS was a result of brain dysfunction, and so this would simply seem to be an example of the principles that he espoused. As Dr. Goldstein writes in the section "Pathophysiology of Neurosomatic Disorders: A Summary" in Betrayal by the Brain:

Chronic Fatigue Syndrome is a disorder of the management of sensory input by the brain. Information from inside and outside the body is misperceived... If input is dysregulated, output will be also, because the brain will make regulatory decisions based on improper "data processing"

Microglial inflammation is quite possibly the ultimate cause of this disorder of the management of sensory input. Whereas the drugs that Dr. Goldstein used worked on specific neural networks, and were therefore each only effective in a subset of his patients, Dr. Montoya has found that Valcyte works on microglial inflammation, which seems to be the source of problems in all neural networks in this disease where dysfunction of these networks manifests.

If Valcyte works on the immune system indirectly in the manner implied by Dr. Goldstein, then what is happening here is not that individual parts of the immune system are being targeted by the drug, or that Valcyte specifically causes a Th2 =>Th1 shift, but that the inhibition of microglial inflammation allows the brain to resume its normal operation, and in doing so, allows the immune system simply to resume working normally as well. This theory is consistent with Dr. Montoya's findings, as cited above.

One implication of this theory is that in addition to resulting in immune system activation when appropriate, or a shift from Th2 to Th1 emphasis when appropriate, autoimmune disorders that accompany ME/CFS may be equally treatable by Valcyte, as they represent just one more type of immune dysfunction. In fact, there are some hints that this is indeed the case, though I would not qualify them as hard data at this point. I think that these disorders and their treatment with Valcyte are certainly an area that merits investigation, though.

What is the potential that Valcyte has in healing the immune system? In just my own experience (which has often consisted of using Valcyte in unconventional ways), I have found it capable of stopping not only active herpes infections, but viral infections of various kinds, and recently, even a long-term bacterial gut infect that was responding only incompletely to antibiotics. Furthermore, during one of the times Valcyte activated my immune system to fight off a viral infection, much to my surprise, it also completely eliminated a large HPV wart on my index finger that I'd had for forty years - since I was eleven years old. It is well known that immune system function declines with age, and from this incident and others, it appears that it may be possible to at least partially reverse that aging effect with Valcyte. This makes sense if you consider that many aging effects are essentially inflammatory, and Valcyte (especially when used at low doses) appears to be an especially potent anti-inflammatory drug.

If this were the case, then you would expect to see such anti-aging effects from Valcyte in the neurological realm as well. In fact, I and others have experienced something along these lines. This is a whole subject of its own, though, and I will have to get into it in more depth at a later time.

From my own experience and that of many other, I have found that the differences between the operation of Valcyte at standard doses and at low doses (1/16th of a tablet or less) are vast, and really deserve a thread of their own. I have started writing the initial entry for such a thread, and plan to post this entry once I understand a bit more about the operation of low dose Valcyte (LDV), and have a bit more data from people about its operation to back up my hypotheses. But one thing I have found so far is that contrary to people's experience with standard dose Valcyte, those people who persevere with LDV have so far always found a dose that works for them, and gives relief from neuroendocrineimmune symptoms. This is not a lot of people so far, and no one has even come close to being cured of their symptoms by LDV, but the benefits of LDV were discovered only earlier this year, and its use is still very much in its infancy. The potential here seems great.

 

[nandixon]

Thanks @zzz, that is quite interesting.

I was asking if you'd compared cimetidine (Tagamet) to Valcyte because I've been wondering if they could both be having a similar end result, i.e., achieving some degree of immune restoration (from what I think may be a type of immune suppressed state in ME/CFS), and possibly by the same broad mechanism - namely a reduction of regulatory T cell (Treg) numbers or activity, which is a peculiar ability cimetidine has in addition to its better known stomach acid-reducing effect.

You've probably seen in the literature that cimetidine has the capability to achieve similar results to what you've experienced using Valcyte, with respect to repressing/clearing various viral infections, including herpes forms and HPV warts.

I've just posted a new thread that describes my current thinking on this, including the use of very low dose cyclophosphamide as the potential "immunorestorant" instead of cimetidine (or Valcyte):

Treg-related immune suppression theory for ME/CFS and the use of very low dose cyclophosphamide

 

[Gingergrrl]

@nandixon I read your other thread tonight and although most of it is way over my head I am fascinated by the prospect of micro low doses of things for those of us like me who cannot tolerate full or even close to full doses of meds.

I can't contribute much but will keep reading this discussion as I am in the micro dose camp!

 

[Thomas]

I had my consultation at the local pain clinic today for IV Ketamine/Lidocaine. They didn't really buy my neuropathic pain story but agreed to try it on me anyways as I confessed that I just heard these drugs can be helpful for a variety of symptoms and have the potential to relieve my suffering.

I'm not sure what the exact doses are but they're probably less than Goldstein was using. He was doing 25mg - 100 mg but usually 50 mg of Ketamine as per in TTB but I believe the clinic uses 15mg. As for lidocaine it's based on weight but I didn't get that far yet. They're pre-mixed with no preservatives. My appointment for the infusion is next Friday. As per their rules I must have someone drive me home from the appointment.

Here's the only problem: they infuse it over 45 minutes which is a big no no for Dr. Goldstein who says it must be infused over 2-3 hours, otherwise adverse affects may arise and the drugs may not be useful again. I told them I was super sensitive and if they wouldn't mind stretching it to 2 hours. They said "don't worry you'll be fine". I didn't want to make a big deal about it however when I arrive next week I will ask again or just lie and tell them I'm feeling weird during the infusion so they slow it down. But I may just have to risk it no matter what and just do the infusion whether they agree to slow It down or not. Seems worth the risk.

Thoughts?

@zzz @Hip @Sidereal

 

[zzz]

Seems worth the risk.

Not to me - and I'm sure that Dr. Goldstein would tell you the same. There are three reasons for this: 1) At that infusion rate, it will not give you any benefits; 2) It is very likely that you would get some significant side effects that would make you much worse for a while; and 3) You would never be able to use either of these IV drugs successfully again.

Number 3 is most important by far. All three put together means that you would be doing a useless treatment that could harm you, and it would permanently eliminate your options for doing this treatment properly and receiving any benefit from it. As these are Dr. Goldstein's top two treatments, I would think it inadvisable to do something that is virtually guaranteed to make them unavailable to you for life.

The two hours is an absolute minimum; you may need more. For lidocaine alone, you can derive Goldstein's formula of one hour per 100 mg. The ketamine would seem to make it longer; I would not do a mixture of these two drugs in any less than three hours.

I didn't want to make a big deal about it however when I arrive next week I will ask again or just lie and tell them I'm feeling weird during the infusion so they slow it down.

That's not going to work. Either the damage will have been done by the time you protest, or they won't believe you and they will keep the infusion going, reassuring you that nothing can possibly be going wrong, or they may stop the infusion if you protest enough, but again, the damage may very likely have been done at that point. Certainly, you would receive no benefit, and yet you would risk ruining these two treatments for life.

In 1993, I had an operation on my ankle under local anesthesia to remove a supposed bone spur that the doctor thought was causing my pain problems. (It wasn't). During the operation, he started twisting my foot in a way that I knew would be deadly. I told him not to do that; he told me he had to do it to perform the surgery. I told him he should still not do that under any circumstances, and it would make me far worse; he told me that I would be fine, and that he was increasing the amount of local anesthesia so that I couldn't argue any more, which he did.

Not only did the surgery not relieve my pain, but as a result of what that doctor did, despite my warnings, I spent the next 11 years on crutches. My ankle still has not fully recovered, 23 years later.

So don't assume that the staff is going to follow any directions you give them if it goes against what they want to do. Vague assurances are not enough. Once you're on that table, they're going to do it their way, regardless of its effect on you. Please don't let them.

If you believe Dr. Goldstein, then what you are being offered is far worse than no treatment at all, and you should skip it. Unfortunately, the "don't worry you'll be fine" statement is just another way of saying, "Don't worry, the doctor knows best," even when he doesn't. But doctors have drilled into them in medical school that they always know better than patients, and almost all of them believe it, and act accordingly.

 

[Thomas]

Not to me - and I'm sure that Dr. Goldstein would tell you the same. There are three reasons for this: 1) At that infusion rate, it will not give you any benefits; 2) It is very likely that you would get some significant side effects that would make you much worse for a while; and 3) You would never be able to use either of these IV drugs successfully again.

Number 3 is most important by far. All three put together means that you would be doing a useless treatment that could harm you, and it would permanently eliminate your options for doing this treatment properly and receiving any benefit from it. As these are Dr. Goldstein's top two treatments, I would think it inadvisable to do something that is virtually guaranteed to make them unavailable to you for life.

The two hours is an absolute minimum; you may need more. For lidocaine alone, you can derive Goldstein's formula of one hour per 100 mg. The ketamine would seem to make it longer; I would not do a mixture of these two drugs in any less than three hours.


That's not going to work. Either the damage will have been done by the time you protest, or they won't believe you and they will keep the infusion going, reassuring you that nothing can possibly be going wrong, or they may stop the infusion if you protest enough, but again, the damage may very likely have been done at that point. Certainly, you would receive no benefit, and yet you would risk ruining these two treatments for life.

In 1993, I had an operation on my ankle under local anesthesia to remove a supposed bone spur that the doctor thought was causing my pain problems. (It wasn't). During the operation, he started twisting my foot in a way that I knew would be deadly. I told him not to do that; he told me he had to do it to perform the surgery. I told him he should still not do that under any circumstances, and it would make me far worse; he told me that I would be fine, and that he was increasing the amount of local anesthesia so that I couldn't argue any more, which he did.

Not only did the surgery not relieve my pain, but as a result of what that doctor did, despite my warnings, I spent the next 11 years on crutches. My ankle still has not fully recovered, 23 years later.

So don't assume that the staff is going to follow any directions you give them if it goes against what they want to do. Vague assurances are not enough. Once you're on that table, they're going to do it their way, regardless of its effect on you. Please don't let them.

If you believe Dr. Goldstein, then what you are being offered is far worse than no treatment at all, and you should skip it. Unfortunately, the "don't worry you'll be fine" statement is just another way of saying, "Don't worry, the doctor knows best," even when he doesn't. But doctors have drilled into them in medical school that they always know better than patients, and almost all of them believe it, and act accordingly.

You make a very good point. And I'm really sorry to hear you were on crutches for 11 years. What a jerk. This is another reason why I've been trying to get Dr. Goldstein back on the phone but have been unsuccessful. I will try tomorrow as perhaps Sunday may be a better time. I would like to ask him this question (among others).

I'm going to try and speak to my family doctor next week and see if he'll call the clinic and ask them to accommodate my request -- he's more open minded. If they still won't then you're right I should probably hold off. Hmmm.

Damn. So close to getting the top two treatments yet so far far away.

 

[Thomas]

Also, why am I seemingly one of the few people here actually pursuing this treatment which if all goes well can bring on instant remission from all symptoms? Are there no pain clinics in most cities in the U.S. that offer this IV treatment? I'm a little confused...

Plus I am in Canada (Toronto) where access to medication and off label treatments is typically much stricter than in the U.S.

My guess is because ketamine is highly controlled in the U.S. And that other members of this forum from Europe may not have access to this treatment at all.

 

[Hip]

Also, why am I seemingly one of the few people here actually pursuing this treatment which if all goes well can bring on instant remission from all symptoms? Are there no pain clinics in most cities in the U.S. that offer this IV treatment? I'm a little confused...

My suspicion is that a tolerance may often build up to ketamine when this drug is used for pain relief. See this post:

1st day was great , then it worked a lot less for pain, ever day and by 2 weeks it was useless.

I got tolerance quickly. I wrote to Dr Goldstein and he said to stop taking it as a nasal spray and take it by mouth instead.

 

[Sidereal]

The peer-reviewed literature on the effect of IV ketamine on treatment-resistant depression shows that its effects last only 7-10 days. I'm not aware of any studies on ketamine in ME/CFS but I would imagine a similar timeframe applies. This treatment just isn't feasible long-term.

 

[Thomas]

I fear there may have been a worsening in Dr. Goldstein's condition as many attempts to reach him have been unsuccessful. I'm really debating whether to go ahead with this IV treatment on Friday or at least delay it.

I pasted the chart below from an archived page on Dr. Goldstein's old website -- https://web.archive.org/web/20030711184705/www.drjgoldstein.com/frames/03about.html

Notice #33 and #34 (lidocaine and ketamine IV's respectively) -- he notes the infusion rate is between "2-3 hours".

Do you think 2 hours would be safe? I'm having difficulty getting them to agree to keep me there for 3 hours, but 2 might be possible...

A Typical Neurosomatic New Patient Treatment Protocol:


Agents, Tried Sequentially Onset
of Action Duration
of Action
1 Naphazoline HCI 0.1% gtt † OU 2-3 seconds 3 - 6 hrs
2 Thyrotropin releasing hormone nasal spray 500 units in 9ml NS. About 2 units per spray in a spray bottle. One spray in each nostril 1:10. 15 seconds 6-8 hrs
3 Thyrotropin releasing hormone ophthalmic solution 1:10 2-3 seconds 6-8 hrs
4 Ketamine 50 mg/ml ophthalmic solution 1:100, 1:50, 1:25, 1:10, 1:5 in artificial tears. Gtt † OU q 15 minutes of each dilution until maximal response occurs without concomitant adverse reactions. 30 seconds 6-8 hrs
5 Ketamine 50 mg/ml nasal spray 1:25 and 1:10 (All nasal sprays may be used as oral swirls) 30 seconds 6-8 hrs
6 Ketamine 80 mg/Gm in PLO gel 2-3 inches 15 minutes 12-24 hrs
7 Dopamine 40 mg/ml opthalmic solution 1:10 2-3 seconds 4-6 hrs
8 Dopamine 40 mg/ml nasal spray 1:10 and 1:5
(Adverse reactions to dopamine solutions may be counteracted by haloperidol 5mg/ml solutions, 1:25 or 1:10. Haloperidol solutions usually make such patients more alert, and may be used chronically. Extrapyramidal reactions have not occurred, probably because the dose is so low.) 30 seconds 4-6 hrs
9 Nitroglycerin 0.04 mg sublingual 2-3 minutes 3-6 hrs
10 Nimodipine 30 mg po 20-40 minutes 4-8 hrs
11 Gabapentin 100-800 mg po 30 minutes 5-9 hrs
12 Baclofen 5-10 mg 30 minutes 8 hrs
13 Lamotrigine 25-50 mg first dose 30 minutes - 4 wks 24 hrs
14 Guanfacine 1mg 30 minutes 24 hrs
15 Hydergine 2 mg 30 minutes 8 hrs
16 Tramadol 50-100 mg 30 minutes 4-6 hrs
17 Oxytocin 5-10 U IM QD or BID 15 minutes 12-24 hrs
18 Pyridostigmine 30-60 mg po 30 minutes 4-6 hrs
19 Modafinil 200 mg 45 minutes 24 hrs
20 Riluzole 25-50 mg
(Modafinil increases Glutamate secretion and Riluzole decreases it. If a patient has an adverse reaction to one, it can be reversed by the other. Modafinil will usually counteract an adverse reaction to Ketamine, as well.) 45 min - 4 wks 12 hrs
21 Mexiletine 150-300 mg po 30-45 minutes 6-8 hrs
22 (a) Tacrine 10-20 mg (works better than b) or (b) Donepezil 5 mg HS po 30 minutes 4-6 hrs
23 Risperidone 0.25-0.5 mg 45-60 minutes 12-24 hrs
24 Pindolol 2.5 mg (brand name Visken works better) 15-30 minutes 8 hrs
25 Papaverine SA 150-300 mg BID po 30 minutes - 4 wks 12 hrs
26 Ranitidine 150 mg 1 hour - 1 wk 12-24 hrs
27 Phentermine 8 mg 30 minutes 8 hrs
28 Cycloserine 50-250 mg, a partial NMDA agonist (use when Ketamine worsens symptoms) 15-30 minutes 24 hrs
29 0lanzapine 2.5-10 mg or quetiapine 25-300 mg 45 minutes 24 hrs
30 Topiramate 25-50 mg 45 minutes 12-24 hrs
31 Tolcapone 100 mg 30 minutes - 4 weeks 8-12 hrs
32 Hydralazine 10-25 mg po 30-60 minutes 6-12 hrs
33 Lidocaine 240-480 mg in 500 ml normal saline infused over 2-3 hrs immediate - 48 hrs 2 hrs - 2 wks
34 Ketamine 25-100 mg in 500 ml normal saline infused over 2-3 hrs immediate - 48 hrs 2 hrs - 2 wks
35 Thyrotropin releasing hormone 500 units in 9 ml normal saline by slow IV push immediate 1 day - 3 wks
36 Honey bee venom 25-100 mcg SQ 10 minutes 1 day - 1 wk
37 Ascorbic acid 25-50 gm + Ca gluconate 1Gm+ MgSO4, 1 gm in 400 ml normal saline infused over 2-3 hrs immediate - 1 day 1 day - 1 wk
38 Adenosine 3mg/ml solutions (nasal and oral) 1:10 and 1:1 (Opposite in action to milrinone solutions.) 30 seconds 3-4 hrs
39 Milrinone 1mg/ml solutions (nasal and oral) 1:10 and 1:1 (Milrinone is a phosphodiesterase III inhibitor which increases cyclic AMP.) 30 seconds 3-4 hrs

 

[Hip]

I fear there may have been a worsening in Dr. Goldstein's condition as many attempts to reach him have been unsuccessful.

You ought not to be badgering the poor man if he ill. I am sure he would help if he could.

 

[Thomas]

You ought not to be badgering the poor man if he ill. I am sure he would help if he could.

The last thing he told me was "make sure you call me back" after I said that I didn't want to bug him. And Dr. Hyde said that I made him feel a lot better by the complements I gave him.
I'm not sure that's considered badgering, but thank you for bringing it to my attention.