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Dr. Kaushik
Dr. Kaushik, Psychiatrist
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Experience:  MD Psychiatry
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Hi Dr. Kaushik~I thought that I had better start a new thread

Resolved Question:

Hi Dr. Kaushik~I thought that I had better start a new thread again~thanks for the understanding answer~maybe after these two blisters are done in two weeks and I do okay I could ask my Doctor to raise it to the 300mg al the time~ would this make sense~I recently read about agoraphobia and this seems to explain my symptons~although how was I able to work at a Bank for 30 years and at one time love to shop and so on~can this disorder come on later in life~ due to a tragedy or what I recently experienced~I was functioning okay for a while after the death and then this came on me gradually~would Wellbutrin help me in this area if this is what I have??I hope marijuana did not cause this~

Submitted: 11 months ago.
Category: Mental Health
Expert:  Camille-Mod replied 11 months ago.
Hello,
I'm Camille, and I’m a moderator for this topic. I sent your requested professional a message to follow up with you here, when they are back online. Unfortunately I do not know when this may be, as the professionals come on line as they are available. You don't have to stand by, you will get an email telling you when you have received a response. If I can help further, please let me know. Thank you for your continued patience.
Best,
Camille
Expert:  Dr. Kaushik replied 11 months ago.
Greetings !

Well i feel it was because of the absence of the maid plus your soon to start alternate dosing which have clubbed together to cause you this anxiety but i think you should refrain from taking another clonazepam although you may take another one as the total dose will still fall within the normal dose range. However i feel today is one of those days where the good old memories plus absence of company are overwhelming you and causing you anxiety which will pass.

I will again repeat myself that please do not compare yourself with others including your old friend who remarried as situations and love vary from person to person and on top of every thing what you shared wit your husband was very deep love which is hard to find mostly so but obviously it will take a while longer for you to overcome this traumatic life experience , so please be patient.

As far as agoraphobia is concerned your condition simulates it very closely but if we closely evaluate it, then it will show us that you have a sense of social withdrawal and isolation which have been brought about by depression whereas in agoraphobia there is a sense of fear that looms large when person ventures out, this fear is of having to face sudden emergency situations which may leave the person unable to save himself, this is not what you have, so it is not agoraphobia according to me.

I hope this answers all your queries.

Wish you all the best.

Regards
Customer: replied 11 months ago.

Thanks Doctor~I did not know if you had received that part about Agoraphobia~ as the message said it was too long~but reading about it I find it sounds like I am now~ yet normally this comes on earlier in life according to anything I read about it~if I have that I don't know what I will do~there was a woman back home who never left her house for 20 years~if she had to go to a Doctor she had to take a lot of pills~it was so unlike me before my husband died and I was more social than he was and I loved to go out all dressed up~the more people I saw I liked~ especially ones I did not know~ so I could just observe~it comforts me to hear you say that you don't think I have it though~but it sure sounds like it~would Wellbutrin help~if I do~


 


I think that you are right about yesterday~I find and note that men tend to move on faster then women after a death~I hate to say this~ as you may find me too honest~ but I think men miss the sexual part more than women do~I often noticed that when their wife was dying from a terminal disease they even then had someone before the actual death~of course not all men are like this~a woman back home who was my age and her husband also went quickly~ she adjusted quite well and was down helping me sometimes~it had only been a year for her~I felt so inadequate~ but her husband drank his pay cheque often and maybe her case was not like mine~ as I look back and read your notes~she even re~married before I left~the man I spoke about ~ who I called~ his wife had pancreatic cancer and took chemo~ and was very ill~ so in such a case maybe you get a little more prepared when they finally go~it could be a relief to know that they no longer are suffering~


 


I mentioned having a heavy head once to you and you answered that maybe I should take the Wellbutrin everyday~I was on it alternate days then~but I have come to see that I think it was sinus problems I had~Inow take a medication for sinus and allergy~I stated the new 300 mg dose today and I am a bit nervous that I will feel weird or something~would I feel any difference~I guess I am such a nervous person by nature~Thanks again for all your support~Martha~


 


 


 


Expert:  Dr. Kaushik replied 11 months ago.
Thanks for the inputs.

Well i can understand that for a lay person ( please do not mind my saying this) it will be difficult to know the intricacies involved in various psychiatric disorders including agoraphobia, you see it is quite common for this disorder to simulate various other conditions and symptoms but i am quite convinced that you most likely do not have it.

Anyways wellbutrin xl will help you even with this if it came out to be the condition eventually.

It is good to know that you have started on 300 mg, hopefully it will be tolerated well by you and soon you shall be up the dose to regular 300 mg dosing which is where the real healing will start, so to put it simply you are still in the transition phase but you have done well so far and hopefully you will reap benefits soon, so hang in there and do not think too much, just be cautious but not paranoid about the side effects as they are unlikely to develop, but still you keep an eye over the development of rash and report if immediately if at all it occurs.

This is just a precaution as i feel this time there will not be any problem.

The alternate dosing for 2 weeks and more will lead to maintenance of a certain level of this drug in your body thereby bypassing the chance of development of any withdrawal symptom, this is a very commonly carried out strategy to adjust the dose in those who are overly sensitive to drugs, so please do not take stress over it.

I hope this helps.

Wish you all the best.

Regards
Customer: replied 11 months ago.

Thanks Doctor~I am almost through the day and had no feelings of being different thus far~I was nervous that I would take sick or something~as the dose was doubled really~I think when I got up~ and really before the drug would be in my system very long~I had more desire to do things~I might just have been having a good day~no anxiety either~ although I took the pills prescribed~I just hope and pray that I do not have that Agoraphobia~ that does not sound very good and yet is a lot like I am now~I know that you explained before about serotonin~this drug does not give it to you~but over all I think you said it would help~in this area~how long does a person have to stay on such mediction~Martha~

Expert:  Dr. Kaushik replied 11 months ago.
Well it is good to see that your day has been going fine on this increased dose, lets hope that in days to come you become even more better.

You see as such different duration of intake of this drug is designated to different individuals depending upon the response of that particular individual however usually 6 months course is required for complete recovery. You see the symptoms get managed much earlier within 12 to 18 weeks by this drug but for consolidation of symptom free state 6 months course seems plausible so as to avoid any relapse.

I hope this makes sense.

Wish you all the best.

Please kindly leave a Positive rating if you are satisfied with the answer.

Regards
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4053
Experience: MD Psychiatry
Dr. Kaushik and 2 other Mental Health Specialists are ready to help you
Customer: replied 11 months ago.


Hi Doctor~You always make sense~it is probably me that does not~I can't see this new pill helping that much after only taking it a short time before I got up~unless it is the 150 dose kicking in~ Finally~ I will see how tomorrow goes and I hope that I have not got my hopes up and be down tomorrow~ should I be feeling any side effects from doing this alternate thing~ today I had none to speak of~ yet on Mr. Google you see lots of negative comments~I was afraid that I even would imagine being dizzy or something~yet I got through the day kind of feeling a bit more on the up side~I would not mind taking a drug for life~if it helps~does anyone need to do this~I feel I may be such a person~I seem to have something wrong with my head~I am too precise about everything~this can be hard on a person~I so much want the courage to go out~I need to get a Driver's Licence and get to an Eye Specialist sometime soon~you give me some hope that I do not have that disorder~Thanks for always being here for me and my complaints~I bet that you are glad that you don't have to live with me~ :-) I did not even have to take a PRN today~you are far enough a way too to not have to visit in person with me~you probably would give up your Practice out of frustration~you probably don't have as hopeless ones as me~you are such a nice Doctor however~I only wish I could visit your office in person~I read people very well by observing and listening~I think that you are a very serious man~you take your work very seriously and Doctors like you are few and far between~ Martha~

Expert:  Dr. Kaushik replied 11 months ago.
Greetings !

Well first of all thanks for the kind words that you have ushered on me, i really do not know whether i deserve these nice comments from you or not as i am doing what any doctor would do when he/ she is dealing with a complaint from a patient of his/her. Yes along the way as a doctor you develop empathy for your patients and the therapeutic alliance called as rapport becomes stronger, if that is happening between the two of us then i am really glad and this always helps the cause.

Well yes i am very serious about my profession and it really pains me when i look at some professionals dealing with their patients with a callous and insensitive approach but then i am no one to comment on others as they have a right to choose a path in life as i have the same right to serve my patients with honesty as long as possible.

Anyways coming to your main question, well i do not think this alternate patter of dosing will cause any sort of untoward side effect or a withdrawal side effects but still as a precautionary measure you shall be vigilant and immediately report if there is any new symptom that develops or if their is worsening of symptoms, again i will reiterate that this is a precaution measure only.

Well most patients are brought off the drug after they become and maintain symptom free but yes i have had few of my patients who have been using this drug for 1-2 years without any side effects and have been maintaining well and they along with me have reached a consensus to maintain on this drug if the benefits of this drug over-rule the dis-benefits which are almost nil.

I hope this encourages you to carry on with this drug ad dosing pattern, my prayers are always with you and as i said earlier i have many alternative plans of action to help your cause if this one does not work out for you but i feel that this will not let that happen and it will work in this attempt, so just stay positive and leave the rest to God's will.

Wish you all the best.

Regards
Customer: replied 11 months ago.

Hi Dr.Kaushik~ I felt good all day yesterday~ but I cannot say it would be from just one 300 mg of the Wellbutrin~the first one I took~ would it be possible that the 150 was just kicking in maybe~ and that would have been enough~I have to admit I woke up at 2: 30 in the morning and could not go back to sleep~is this normal with the added amount~does it cause insomnia I mean~ I also read that it can cause hair loss~I hope that this is not true~maybe I did not give the 150 mg enough time to work~ it was four weeks full time~I think that you said some people just need that amount~ would I know if the extra amount is too much~my I have lots of questions and I am so glad that I met a Doctor who genuinely wants to help me~ some I dealt with just seemed to want to give basic answers and then want you to push the Button~ parts of my questions were not even addressed~you are a Rare Breed~I think such drugs take four weeks and more before they kick in anyway~that is why I wonder if the original amount would have done it~as I said with the added drug in just that short time~I can't see it making a difference~I took the 150 today ~ I sure do not want my sleep affected~would the extra amount harm me in any way~if I did not need it I mean~


 


I also realize that after I Retired when I went anyplace my husband always was with me and I hardly drove then~is it possible it is this companship I miss and thus do not want to go out ~I feel so discouraged about this~I should have been more independent~I guess this is another reason I miss him so much~he Retired first and thus did all the shopping for groceries and so on~whereas when I was divorced and alone with my son I did everything~I even took him to Church twice on Sundays~I suppose I had more support too~ as my parents were still living and it was my home Town~I guess my main question today is do you think I should have increased the dosage after four weeks or tried the 150 a bit longer~I would not mind if I felt like yesterday all the time and I can't see~ as I said above~that one dose of 300 mg would help make the difference~ what do you think~I hardly needed much as clonanzapam either as other days~not many patients have a Doctor who prays for them either~I sure need it!!!


 


I find it rather odd when I woke up I was sure the cat was meowing and I got up to give him treats~of course it was dark and I could not see him~but I noticed it was not him at all and he was asleep in his own bed~I must have been dreaming~ which seems rather strange~ then I could not go back to sleep as I normally can~Martha~PS If I forgot to push the excellent button please remind me~

Expert:  Dr. Kaushik replied 11 months ago.

Well first of all i am happy to know that you had a good day yesterday. Now coming to your main question, well i feel that 4 weeks on the 150 mg dose was a good enough time that you gave the drug to show it's affect and yes it takes 4-6 weeks usually for the drug like this to act to it's peak potential but i believe going up the dose will not bring in any side effects if that is what you are primarily concerned about ans secondly the increased dose will only bring in more improvement than before, may be you start getting days like yesterday everyday on the increased dose , basically what i a trying to say here is that you have waited enough for the dose to act and even if the drug has started to show it's affect now still going up the dose is going to make things better plus we do not know if the improvement that you noticed yesterday was because of the dose increment as it is sometimes seen that there is a spike in improvement in symptoms on the very first day of increasing the dose of a drug.

 

Anyways i will encourage you to stay on this course of alternate dosing, please do not be afraid that this increased dose will bring in some side effects , it will not since you have tolerated a lower dose quite well and by now the drug has adjusted well in your body. As far as insomnia is concerned that you witnessed yesterday well that could be a one of a case scenario and cannot be attributed to dose increment as this sort of sudden insomnia with dose raise does not occur.

 

And anyways insomnia with this drug is not that common plus you take the drug in the morning time which further weakens the possibility of insomnia. So do not worry about the dosing and insomnia, any sort of improvement shall be taken as an encouragement to stay on the track,i wish you steady recovery.

 

I hope this makes sense and eases your nerves.

 

Wish you all the best.

 

Regards

Customer: replied 11 months ago.


Hi Dr. Kaushik~ I thank you for making me feel better about increasing the drug~ as knowing me I was concerned I might have felt just as well on the lower dose~I had another good day today~I took a 150 today~ if taking the second dose will make me feel even better then that is what I want~I was afraid that it interfered with my sleep last night~ on top of all the medication I take~it is interesting to hear that even one dose could make me feel better the first day~I knew as soon as I got out of bed that something was different~I guess you know me well and that I would worry about side effects~ taking it in the Morning makes sense about sleep~


 


I may not sleep tonight~ my son was after me to get my Driver's Licence changed~ I managed to get there once and I did not have a marriage certificate with me~I thought mine from New Brunswick expired the end of my Birthday month~ but I see that it was on my Birthday actually and my son is driving my vehicles~I don't know how that will affect everything and it kind of bothers me~ here today I did not take a PRN again~ now I am feeling sick over this~I thought that I would not care to drive in a City~ as compared to where I lived ~ so was not all that concerned~plus I find it so hard to go out~ I hope this does not affect my health~since the vehicles are mine I am not sure how all this will work if I don't have a Driver's Licence~I am hoping that he can sort of be my driver~he tries to shield me from certain worries and then all of a sudden I find out and it is worse~


 


Does this drug cause hair loss like I have read~the patients that you have on this drug~ do many do well on just the one dose~or do most also increase theirs~maybe the one would have worked okay in another week or so~if I have side effects~ perhaps I could just drop it down to the 150 again~as that one did not seem to bother me~do you ever use the SR version~ funny how that re~ acted on me like that~ yet this one did not~ one Pharamist told me since it is the same drug~ I would thus have the same side effects~maybe you are right and it was something else~I remember it started with what seemed like a bug bite on one hand~I kept scratching it~finding it odd one would be in the house~maybe something did bite me and I took a reaction to it~ just a thought~ Martha~

Expert:  Dr. Kaushik replied 11 months ago.
Well first of all it is really nice to know that you have been doing fine so far on this alternate dosing strategy and this gives us a sense of encouragement for fighting out your condition.
So it is my humble request to you that you stay focused and continue on the drug regime of alternate dosing as this is what we have in mind to use against your condition.

So even if the 150 mg dose has started to act at it's potential and making good improvements but we should maintain you on a higher dose of 300 mg after we are done with your titration because that is what will help us to find a permanent solution to your condition.

I have had many of my patients who after being on 150 mg dose initially but with little improvement when titrated up the dose to 300 mg dose showed a major improvement in the symptoms so I am really counting on the proposed higher dose of 300 mg.

I have so far not seen either rash or hair fall in any of mine patients over so many years of use of this drug. Also I still feel that it was not wellbutrin sr which caused the rash at the first time and it was something else, plus this version is far better in efficacy and much less in terms of side effects because of it's longer half life.

I hope this helps.

Wish you all the best.

Please kindly leave a Positive rating if you are satisfied with the answer.

Regards
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4053
Experience: MD Psychiatry
Dr. Kaushik and 2 other Mental Health Specialists are ready to help you
Customer: replied 11 months ago.

Dear Dr Kaushik~I have been having problems with my Monitor~ my son got me a new larger one~ I am not sure if I like it though~I am used to a smaller window and this is a 24 inch~so you thus got a break from me~ anyway I was anxious to tell you that because of this licence thing~if I did not have a valid Driver's Licence my Insurance may not have covered my son driving my vehicles~even using them to drive me~so I made myself get dressed all up~ as he said the Office at the Driver's place said I could not get one~ as it expired on my Birthday~which was last week~this sickened me~ I decided to go down anyway~ and that information was not right~where I came from they gave you the whole month of your Birthday~ here apparently you have a year ~ but they needed a Marriage Licence~ along with my Birth Certificate~so I brought it~ but they need a Government one and this was from the Church~so all I have to do is order one and it looks like they will give me an Ontario Driver's Licence~I felt NO anxiety at all during all this~ my son was actually acting more stressed~ we told the Insurance company and they were okay with this and David can drive my vehicles and be covered~


 


I then wanted to go shopping at a large new store called Target~it actually was over whelming to me~ as I am used to smaller stores~David could not get over how fast I was going around and could not keep up with me~but I knew that we only had a certain amount of time~ we also ate there~ he came home with me and set up the new Monitor~I still felt fine~ I think this may prove that I don't have Agorphobia~ I am fine today~only stressed that he did not get speakers with it~I guess he thought they came with it~now when you suggested last week that I go with him I would not have been able to~I don't know what happened~Prayers along with the pills????~BUT I was anxious to tell you~for a change my message is more Positive~I just hope it continues~my son has to go a way for two days with his son for Hockey~ so I may feel stress~I did not yet today take a PRN either~Thanks for guiding me in the Right direction~Martha~ xoxo

Expert:  Dr. Kaushik replied 11 months ago.
Greetings !

Well it is really nice to know that after all things are beginning to change for good and perhaps it can be attributed to both prayers and wellbutrin xl, so please continue with this drug and please do make efforts like this to venture out more often with your son so that you become less anxious with every new visit plus exchanging few words with strangers may actually act as a therapy in it's own right.

This recent trip of yours validates what i have told you that you do not have agoraphobia.

I hope this helps.

Wish you all the best.

Regards.
Customer: replied 11 months ago.


Hi Doctor~ I wonder just because I went out this time and was fine~ how does this really prove that I don't have agoriaphobia~of course I am hoping that you are right~these people must have to go out occasionally also~hopefully I was just not having a good day~I don't want to sound negative here~ but realistic~ is that a Disorder that one has for a long time~I noticed this started happening to me before I left my Home Province~I was okay for a while and then I could not even go for the mail at the end~I had a woman come in to help me~but did not have that problem when I worked in the Public for 30 years~anyway my main question being~is this a disorder that can occur later in life and not be there for previous years~my cousin even had to go and get my Driver's Licence that expired with a note saying I was not well~once in a Lifetime this was allowed ~ without appearing in person~yet I had gone down to that Office shortly after my husband's death to get the vehicles changed into my name only~how do people like that cope in life~Martha~PS~I had asked you before and I don't know if you had answered~did or do you ever use the SR version of Wellbutrin~if you do not then the rash could be explained~as it was quite bad~my hands and arms were especially bad~personally I always preferred to talk to strangers more than people I knew~as they did not keep me~ whereas working in a public place in a small area I knew so many or they knew me~

Expert:  Dr. Kaushik replied 11 months ago.
Let me answer your second question first, yes i have used SR version in many patients but i prefer XL version because it has longer duration of action, it has to be taken only once a day as opposed to two doses of of SR version and lastly it is much less like to develop any side effects as compared to SR version because of gradual release of drug in the body over long time. However in those patients in whom i have used SR version ( more than 100 patients ) none of them had rash and i must inform you that. I do not know what caused the rash, whether it was allergic rash or due to the drug, it is still a mystery and my inability to have a direct evaluation of you person to person restricts my diagnosis about what could have caused the rash.

Now as far as agoraphobia is concerned, yes this disorder can occur at any age and it need not be present right from early life, however if you had this condition then it would not have been possible for you to venture out and do as many tasks as you mentioned on that day, this goes against this diagnosis.

I hope this helps.

Wish you all the best.

Regards

Customer: replied 11 months ago.

Hi Dr. Kaushik~ I have a couple of questions~ what else is new~anyway why would you even give the SR version to patients when you like the XL better~ gosh 100 Patients is a lot~ my Doctor only has 5 on it here~ she seems very smart~ but very young and apparently she is new here~she examined me and saw my rash~ even taping my skin it showed up on my arms~so seeing me in person I don't think you could figure it out either~ maybe God just wanted me on the XL version which you admit is better~anyway you once said that this drug would not have been your first choice for me and you mentioned other anti~ depressants~but you said it was the safest one and you seemed confident that it would work~ all your Patients that are on it~ have they also got problems in that they cannot take the others as well or do you know which drug suits a certain disorder~in other words maybe you did not think it was the best one for my symptons~ but had no choice because of my eyes~it sounds as though you have been in Practice for some time~counting your education you must be some wheres around middle aged~:-)~as no doubt you also would have more patients on other drugs~the more popular ones~I am a bit down today ~ but my son is out of Town~ I was so encouraged when I felt so good last Wednesday~also my family are writing how they are cooking and shopping for Christmas~and mine is so alone now~ our 30th Anniversary is also coming up~would this do it~Martha~

Expert:  Dr. Kaushik replied 11 months ago.
Well yes many of my patients who were put on wellbutrin xl were those who could not possibly take other anti depressants owing to poor tolerability towards the side effects making a clinical scenario much like yours and therefore I chose this drug ahead of other anti depressants because it is safest and if you remember I had asked you to use wellbutrin xl and not welbutrin sr due to longer duration of action and fewer side effects associated with the xl version.

And of course I am very much well versed with the knowledge about which drug is the best for which disorders and what alternatives can be used if the first choices can not be used because of safety reasons.

I hope this helps.

Wish you all the best.

Please kindly leave a Positive rating if you are satisfied with the answer.
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4053
Experience: MD Psychiatry
Dr. Kaushik and 2 other Mental Health Specialists are ready to help you
Customer: replied 11 months ago.


Thanks Doctor~ I am feeling not as good today~ as I told you~ but I must have at least more energy~as I did quite a bit of cleaning~ like Crystal lamps and so on~things that were starting to get dusty~no doubt people have good and bad days on any drug~ it seems for a while I was really feeling good~ would my son being out of Town affect me~it can get very lonely without your mate~especially on special occasions~I suppose you don't know how long your Patients took to heal~ going through what I am~everyone would be different~but the fact I went out shows that I must be improving some what~I don't know if I could today though~ that Phillipine woman has not contacted me for a while this week~ so I don't know if she is coming tomorrow~I think that she is upset to see what happened in her Country~I find Sundays extra hard~ my husband and I always did something special~


 


I found it hard to get up today and felt tired~so slept in later~ is that the medication working~ as you said it improves your sleep~thanks for your patience with me~I was so anxious to tell you what a good day I had Wednesday~no anxiety what so ever~ yet today I have it~could I stay on this drug regime for quite a while~do any of your Patients stay on it for long periods~Martha~PS You must find it hard to deal with your own Patients and then people like me~you are kind to give your time like this~do you get any rest???

Expert:  Dr. Kaushik replied 11 months ago.
Greetings !

Well you see good and bad days as you rightly said are expected to occur while being on any drug regime especially when you are making adjustments to the dose and titrating the dose like we are doing in your case. We shall expect more consistency in maintaining of good mood and anxiety free state once your dose gets stabilized on 300 mg / day. Yes the longer sleep that you had implies some improvement that has taken place over a period of this drug's use. I will also like to bring to notice that it is the drug's affect only that in the absence of your son you are managing yourself pretty well , yes some underlying anxiety will be there, but this sort of calm and composed demeanor that you are portraying is leaps and bounds more than if the same scenario was exposed to you sometime back when you were not on this drug where in you would have thrown a panic attack.

All i am trying to make you realize that the drug is surely working, for a person who is observing you everyday, to me you look improved in many ways than one such as your demeanor and thought process have become more optimistic than ever before, you have started to venture out and stay positive even when under stress and more importantly you have adopted patience, this may be due to your own will to improve plus drug's affect, anyways things are improving and i must say that this is just the start.

And yes i do get rest but a doctor's life is a bit more hectic due to emergencies but i love what i do so i feel happy working with my patients and with you and as long as one enjoys doing his job, it is not tiring at all.

Wish you all the best.

Regards
Customer: replied 11 months ago.


Thanks Dr. Kaushik for writing such nice words~ones that are encouraging to me~I am amazed that you can see improvement~ even though you are so far a way from me~you must have a good memory as well to remember how I Once was~I wish my Doctor would up the dose now~ but I guess after she saw me that day she is taking extra precaution~my hands and arms were especially a mess~I am experiencing a bit more anxiety however today~ I don't know why that would be~ for one thing that Phillpine woman did not come and she just told me last night by e~mail~ she had to do some Test for her Driver's Licence~ I suppose that disappointed me~ as David was a way as well~it can get so lonely~everyone seems so busy today~especially the ones who work~I wish David at least had a nice wife~ as he does also~


 


I am amazed at how you say that you really like what you are doing~ as it must get very Discouraging at times ~ or most of the time~ to see depressed people~maybe seeing them get well helps make your job more rewarding~ do most people come out of it~my brother now did not and is worse~he is Bipolar and on dialysis~ it seems after his last shock treatment something must have went wrong~ as he never was the same after~at least before he worked and most of the time was well~ unless he would go off his lithium~that eventually destroyed his kidneys~he hardly talks now and can't do much~ his wife is very good to him~seeing him scares me~ as I would not have anyone to look after me~


 


I wonder why last Wednesday I was so well ~I thought I finally made it~ to only feel anxiety again~I think I had two or three days in a row where I felt good~I must have more energy though~ to take on these extra chores~my cat is discouraging~you would agree with me that it is hard when he wakes me up at odd hours~even if I shut my door he meows and wakes me~yet cats sleep a lot during the day~a cat is hard to train~


 


I sometimes check the time in India and I notice that you are working at late hours at times~you thus must get tired~yet you always show such Patience~and Understanding~ do you Truly feel that I will make it~and if so how long would I have to be on these drugs~some people have a stigma about such medication~ but is it any different than when a diabetic has to take insulin and so on~or people who take blood pressure pills~the list goes on~ it seems Christians are against these drugs that pertain to depression~I guess they feel that they are addictive~they only agree with them if a person has a chemical imbalance~would I have that??~Martha~

Expert:  Dr. Kaushik replied 11 months ago.
Thanks for the inputs.

Yes people who have underlying condition like yours do make it and become completely symptom free, i have had a lot of patients like that who now are doing absolutely fine without drugs and i have high hopes that one day you shall also become symptom free and shall not need the drugs or my advice any longer. We shall wait until that happens.

You got to take the drug regime for at least 4-6 months for attaining and then maintaining symptom free state because it may so happen that after becoming symptom free you shall again fall into the same state because of early stopping of this drug regime, therefore it is important to stay on the drug regime for a longer time so that relapse can be prevented.

Your brother's condition is different as he is Bipolar which is a chronic, long lasting condition often spanning over one's entire lifetime, but you have a different condition which we shall name as Reactive Depression since your depression started after an unexpected tragedy struck your paradise but if you see from a psychiatrist's perspective your condition is much easier to treat than your brother's.

I respect all faiths including Christianity so i will not like to comment on what the Christian beliefs say about use of psychotropic medications but i will like to present my case by saying that my motive at the moment is to see you fully recovered from a roadblock called as Depression and to be able to do that i will like to offer my expertise in a field in which i have taken rigorous training and in which i specialize, so for me psychotropic medications for now seems to be the best ploy to counter your underlying condition plus results have begun to show. You not feeling well today is expected since as i had mentioned before this sort of fluctuation is expected when we are in the transition phase of settling the person on a particular dose. Also how can we discount the fact that you do not have your son as well as the lady to accompany you which but naturally is adding a bit more stress and anxiety to your underlying state.

I hope this helps.

Take care.

Regards.

Customer: replied 11 months ago.

Thanks Dr. Kaushik~ I find that you always make a lot of sense~I feel often times so inadequate in comparison to other people I talk to~a former classmate as an example~who I once dated~ has re~ married and is happy in Life~ he had a lot of support however~and his wife had pancreatic cancer and died a slow death~ when he writes I just feel so weak~ as they are travelling all around and yet he would not have the money I do~I sometimes feel that the majority of these people~ who act like they care and want to help ~ do not really when it comes down to it~instead they rather brag about their famalies~I notice though they never tell the negative parts~I had mentioned him before~ but I just heard from him again~I need a friend who understands~ even my son does not~ as he is so unhappy in his marriage~that woman who comes can't see it either~ as she has to work so hard as a Nanny and then she sees me seem so fortunate~my son however does so much for me~ I pay him and he drives my vehicles~ so I think it breaks out even~I wonder if I am making sense to you~


I phone my Christian Prayer line and they always tell me that taking these drugs are wrong~as I told you except for a chemical imbalance~I feel God works through Doctors~ so I get confused and guilty~I would not mind taking these drugs for life ~if they make me feel better~ as all my life I really had some sort of problem with perfection~which is very hard on a person~my son is rather scatter brained and has not a good memory~ he lost my car keys as an example~ he is so unlike me~ but that type of person seems to have an easier life~I have to even look nice when I know no one will see me and never can just let my hair down~ so to speak and be casual~so I must have some disorder~ I always made good marks in school~only because I did not have the fun the others did~is it possible that some people such as myself would take drugs for life and you say I am not on a high dose~I would never sleep otherwise~ as my brain keeps working~ maybe now you can understand why marijuana was such a relief to me~it made me more like normal people and more relaxed~I noticed the big difference~that a person such as yourself~ who no doubt is normal~would know~although you seem very against it~ maybe now it would not help me with anxiety~I did not have that before~ as you worded it so well~I was in Paradise~


I always worry about the What IF,S~ what if I take sick or go blind and so on~ I always had this problem~ maybe now you will pick up that I do in fact have some disorder~not Manic however~ as I never go High~maybe that would be better~ as my sister seems more like that and acts very child like and celebrates her Birthday for a week and so on~on mine I hardly get acknowledged~nor do I care~sorry for talking so much~ but there has to be that one person who would care to listen to me and not always be about themselves~I feel so lonely most of the time~ even though there are many people I could call~but then they put pressure on me to go places~ Thanks for listening~Martha~PS~I know some people also abuse the kind of drugs I am on~have you heard of this~ prescription drugs I mean~it is harder now however with computers and Pharmacies can check~Elvis Presley was one such person~as an example~ he felt if one pill helped two would be better~


 


Expert:  Dr. Kaushik replied 11 months ago.
You make a lot sense and I must say that you always express yourself well which is a rare but much cherished quality that any doctor would wish to have in his or her patients.

I feel that you may perhaps be having an underlying condition called as Hypochondriasis which is characterized by interpretation of minor symptoms by the person as something very serious thereby making the person to think of the most dreadful and rarest complication of a trivial bodily complaint for example a hypochondriac would take minor headache too seriously and would start making hasty assumptions of equating the same with something as serious as brain tumour. Also such individuals tend to worry almost all the time of contracting a seriously debilitating illness although often it is found that their constant worries have no basis. So you perhaps fall in this category of Hypochondriasis which is a long standing condition but treatable with the help of CBT counseling sought from a clinical psychologist. You may seem this therapy later once the current drugs make you significantly symptom free so much so that you reach a state where you can venture out and meet a therapist without getting overly anxious, plus the current drug wellbutrin xl shall also help you in this regard. This condition is not that serious like bipolar disorder and mostly gets overlooked due to it's lack of affect on one's functional life.

As far as your friend is concerned he may perhaps be telling you only about the good things in his life which I must say is the right way to take on life hurdles that is to see glass half full instead of seeing it as half empty, if possible try to communicate with him as he seems like a positive person and interaction with him may rub some positivity on you as well.

Lastly I shall admit that there are many patients who continue to take such psychotropic medications life long because for them these medications provide them with quality of life which seems to be lacking when they are off them, however for you I have a plan to bring you off all the drugs once you become symptom free and are capable of sustaining symptom free state without drugs.

I hope this helps.

Wish you all the best.

Please kindly leave a Positive rating if you are satisfied with the answer.

Regards
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4053
Experience: MD Psychiatry
Dr. Kaushik and 2 other Mental Health Specialists are ready to help you
Customer: replied 11 months ago.


Hi Doctor~I know what that disorder is and it is often made fun of~if it is the one I am thinking about~I don't let on to others however~many symptons can be like a terminal illness~but are not always~I guess I am not a Positive person~I hope Wellbutrin can help all of what I have~ I don't think it is wise to have that much contact with this man~ as I sent a picture of me being out~I had an ivory cape on with fur trim and it was his wife who answered~ I noticed when he eventually wrote back he was rather on the cool side~ so her knowing about me in his past may cause problems~I never took to him in that way~ but he was almost obsessed with my going with him~ so I went to our Graduation Dance with him and he took it more seriously~until I finally had to end up being blunt and no doubt hurt him~he still remembers everything about my past~like my old address as a girl growing up and my old phone number and the list goes on~ he sure would NOT want me in the state I am in now~I think that you will get my meaning~


I find the ones who do think positive now end up with a serious illness~like the lady next door~ she kept saying she was sure it was not cancer~but it was~ I seem to be so hopeless and I can't see me off medication~I guess to I may think realistically~ which ever way you look at it~I see that you are up late~ you will get sick if you don't get more rest and I need you~as no doubt many many do~


I think it would be hard to be friends with a married man~yet I get along better with men than women it seems~ but I am NOT interested in a relationship~ever~so I am kind of stuck~I don't feel too badly now today for some reason~ Martha~

Expert:  Dr. Kaushik replied 11 months ago.
I believe you are the best judge about your ability to have a meaningful relationship with any person at this point of life where you are still not over your husband. Anyways you got it wrong as I did not mean to say that you start a relationship with this man, I just was referring towards having a friendship with this man so that you can digress your attention to other things in life and start getting refreshed in your mood after friendly talks. I feel that you need friends at this point but not a relationship at this point.

I feel that when you laugh everyone laughs with you but when you cry nobody cries with you , instead people start making fun of. such people and their miseries thereby making their lives even more miserable, to find. trusting confidante and well wisher nowadays have become almost impossible, therefore I always ask you to make yourself stronger emotionally and I am sure you have it in you to face this world on your own as you have single handedly raised your son , it is just that your husband's death has jolted you to the core plus you had been subjected to new environment and surrounding which did not help either but I have hopes for your recovery and I encourage you to share my this belief.

Wish you all the best.

Regards
Customer: replied 11 months ago.


Thanks for the Kind and Wise words once again~I know that a friendship with a married man is not a good idea~ in my situation you are almost like alone in a crowd~I guess another widow is the best one to have as a friend~but they would not maybe fit in with my type of life~ they would want to go out places and do things that I do not care doing~I just don't know anymore~the widows I met here ~only once~ were widows for many years and were much older than me~they seem to think~ just get over it~plus they never heard of anyone taking medication before~ it thus makes me feel weak~but for anyone to completely understand they almost have had to walk in your shoes~ some of the calls I got back home were so stupid~like my first Mother's Day alone two months after the death~one woman left a real Happy message asking what I was doing this Mother's Day~or last Xmas one writing saying that knowing me I would be all decorated and sitting back listening to Xmas music and having a glass of wine~ and I was so sad~my first Xmas alone~people seem to annoy me most of the time~when I brought up my son alone I was in my Home Town and much younger~ age 29~ plus my parents were alive there~ they were not that much help however~ as Divorce was frowned on back then~I also was working~ I hope that I did not offend you in any way when I spoke of my Christian Faith~as I feel that this is not your Way~ I too respect all Religions~I don't consider myself in a Religion but in a Relationship with the Lord~I guess there are many people who are not my way~we are made fun of ~ just like when we cry~


I think also I offended many people back home by not having a Viewing or Funeral~but this is what we Both always wanted and talked about~ it was all done Privately~as mine shall be~we did not want cremation either~I had always hoped that I would go first~we had our plot and Stone ready~ my husband actually picked it with The Last Supper on it~I found it a bit too expensive~ but I am glad he chose it~many people attend such events out of duty and I often heard people complain how they felt they had to go~he was in a Vault too for over two months and I was getting weaker by then to have a Graveyard Service~only me and my son attended~I don't know why I am boring you with this~ as so many have these big funerals~ plus have to greet everyone after~I don't know how they do it~I would not have been able to~David also knew he would not want that either if I went first~so many are just curious how you are handling it~I do see many are doing it my way now though and things are changing~your Country may be different~Thanks again for Caring~Martha~

Expert:  Dr. Kaushik replied 11 months ago.
I do feel that you are quite reasonable in your perception and actions, you must always have been like this, it is just that you had to loose your husband unexpectedly that you could not come to terms with the idea of living all alone, but i feel you are beginning to cope well now and soon you will become as resilient emotionally as this tough world wants you to be, so have hope for a symptom free, pain free future and cherish the wonderful partnership that you shared with your beloved husband.

Wish you all the best.

Regards
Customer: replied 11 months ago.


Thanks Doctor~ You are the ONLY one who gives me Hope~I personally don't feel that I will ever be Happy again~I just wish I would go also~I don't seem to be like other people~as I once told you~I March to a Different Drummer~my cousin ~ who was so good to me at the end of my time at my Home~ just wrote and wondered how I was doing~I honestly do not know what to tell her~ she has not heard from me in ages ~she is a person who I would love to be like~ she is from my father's side~ and her father did not have any Mental Disorders~ but her mother was always very sick it seems on and off~she was my father's sister~ of course like me she had shocks~like losing her first child to Spinal Bifia and then her husband was killed in the War soon after~ I am always afraid to end up like her~Gail is always so up beat and thinks Positive~I would almost have to call her~ as I would not know where to begin and where we left off~but I think that you would agree that someone like her would be encouraging perhaps to me~to have fellowship with~moreso than someone's husband~

I hate to mention Religion to you~ but as a born again Christian I should be more accepting of my fate in Life and Trust God to bring me through Triumphantly~and to be an Eagle once again and not a chicken~Eagles fly alone and chickens just scratch around in the dirt and run when the storms come~Eagles face Adversity head on~I know all the answers ~I am just having a hard time to apply them to my life~ yet if it was someone else in my position I would know what to say~but I should practice what I would Preach~does this make sense~you probably think that you are dealing with a real nut case here~

I wish my sister was close to me~ but for many reasons we have drifted apart~but she a least has the same belief system as me~ Gail's only son just married another man~ yet Gail accepts this so naturally~ as if nothing was different about it~I personally think it is a sin~ according to the Bible~yet I have suspects about my sister ~ this I should not even say unless I was sure~ but I am smart and picked up many signs over time~yet she is a born again ChristXXXXX XXXXXke me~I hope that I am wrong~but perhaps this is one reason she avoids me~

I feel personally that I would have to be on Wellbutrin the rest of my life~if it works~as you feel it will~I do see improvement in myself~I have more energy and ambition~I have no anxiety today~ but no doubt I will be disappointed and have it tomorrow~I think you said it does not in itself help anxiety~ but working with clonanzpam it would help~I did not take a PRN today~no rash yet either~I find that very odd that only me out of your 100 or so patients had that~on the SR version~no wonder that you think it is from something else~I don't know when you rest~as I know the time in India and you are up all hours~Martha~PS I was talking to my cousin tonight and told her about the rash~I do notice this XL pill has Wellbutrin written on it~ whereas the SR had another name and when I asked you ~I think they call this a copy of the original ~ there is a name to that~which I cannot spell or think of at this time~ you told me it was Wellbutrin though~do you suppose I was allergic to the compounds that it was made up of~ my cousin came up with this~

 

 

 

Expert:  Dr. Kaushik replied 11 months ago.
Greetings !

Well i agree with you that being in the company of your cousin can be a positive influence on you and help you to look to the positives in life and become more adaptable to your circumstances. She seems to have endured a great deal of agony herself but she has been able to keep herself upbeat about the periodic life setbacks and that is a sort of person who can help you to deal with your own tragedy. I will encourage you to talk to her, it does not matter where you left off last time, what matters is that you two can from an alliance of sort to help each other by sharing each other's sorrows and lending moral support to each other when faced with adversities. So she definitely looks like a person who can provide you tranquility and hope for future and help you to look at the brighter side of life plus you may too become her comforting soul which in a way will boost your confidence further when you shall find yourself in a position to lend a shoulder of support to another person.

I know that you are worldly wise as is apparent from your thought process and your opinions but it is just that you are dealing with a rough patch right now because of known reasons but as soon as you recover you will be able to apply all those things which you preach.

Lastly, thank you for being concerned about my health, i must inform you that i do take adequate rest per day despite my busy schedule, so no issues here.

Wish you all the best.

Regards
Customer: replied 11 months ago.

Thanks Doctor~ What did you think of Gail's idea for the rash~the real Wellbutrn versa the other~it is in my PS above~Martha~

Expert:  Dr. Kaushik replied 11 months ago.
Well i must admit that if the SR version was a non-branded local/ generic version of wellbutrin then it could have resulted in rash, since purity of generic versions have many times been put to question.

I hope this answers your query.

Regards.
Customer: replied 11 months ago.


Hi Dr. Kaushik~I think the name on the pills was Bupropion and when I asked you if that was the same as Wellbutrin you said it was~I was concerned~ being me~that it was not the same thing~ is that a generic of the real thing~Martha~

Expert:  Dr. Kaushik replied 11 months ago.
You see wellbutrin has bupropion as the chemical, so wellbutrin is brand of bupropion chemical , but I believe what you had was the generic version of bupropion and it was not the branded version wellbutrin sr , so this could have lead to a rash because of inferior quality of the generic version that you had as opposed to wellbutrin.

I hope this helps.

Wish you all the best.

Please kindly leave a Positive rating if you are satisfied with the answer.

Regards
Customer: replied 11 months ago.

Hi Doctor Kaushik~I wonder then if this caused my rash~do you think~ I called the Pharmacy and they said it was the generic version of Wellbutrin SR I was on~ I told them no doubt that caused my rash~ they said at times even the real version can also have fillers that cause rashes~they said my Insurance or any of them do not cover the real brand of Wellbutrin SR~ but do with the ones I am now on~ I am afraid that they will change this too~ what would I do and of course this stresses me~Martha

Expert:  Dr. Kaushik replied 11 months ago.
Well you see as such rash is not a usual side effect of bupropion even the generic version ,so it was shear bad luck of yours that you developed rash on the previous version and I shall mention here that while rash may rarely occur even with the branded wellbutrin version of bupropion but generic version has more risk than the better quality branded version to lead to rash.

Anyways why do you worry now because you have been taking wellbutrin xl which by your admission is covered by insurance and is way safer in terms of rash due to it's brand quality.

So do not worry you are in safe hands now and so you shall continue with this drug and stop making hasty assumptions as they only bring stress and do nothing for the underlying cause.

Wish you all the best.

Please kindly leave a Positive rating if you are satisfied with the answer.

Regards
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4053
Experience: MD Psychiatry
Dr. Kaushik and 2 other Mental Health Specialists are ready to help you
Customer: replied 11 months ago.

Hi Dr. Kaushik~ I guess that you must know my personality by now~that is I am worrying about something that may not even happen~ I would pay extra~ or it all~ if I felt that they would change the XL version now to a generic brand~I never took many drugs in my life~ so I am not used to this problem happening~but I often heard of people complaining about it~are you saying that even if they did~ it might be okay~I wish that my Doctor would start me full time on the 300 mg~if we know what the cause of the rash was~ but I guess we do not know that for certain~I have been on the alternate for two weeks now and I admit that I seem to feel better~so even on this plan maybe it is helping~sorry I am so Negative~Martha

Expert:  Dr. Kaushik replied 11 months ago.
Well you see personally I will like to see you on the branded wellbutrin xl 300 mg dose, if that is not available in your area then you shall ask your doctor to prescribe you 2 doses of 150 mg wellbutrin xl to be taken at a time so that total dose comes out to be 300 mg per day which is desired.

And if for some reason this is also not possible then you may consider use of generic version. at 300 mg per day, so you see this is my priority list. I am not saying that generic version can cause rash but when you c. avail a better option then you shall use that only.

I hope this makes sense.

Wish you all the best.

Regards
Customer: replied 11 months ago.

Hi Dr. I am on the 300 mg of Wellbutrin every second day now for two weeks~ so I would not have to take two 150's~you wanted or suggested to do this only for 10 days ~ alternate that is~ maybe you forgot~so my Doctor agreed ~ but she felt safer doing this for a month~ you found that too long~ but what can I do~ when it is her writing the prescription for me~the Pharmacy is making up my blisters today and asked about the dose~I have to do as my Doctor says~ as you are not here~but at least I am getting a 300 every second day of the Wellbutrin brand~ the real one~ that is what I am afraid they will eventually change ~like the SR version~ does this make sense~two weeks should go by fast~hopefully~then she no doubt will feel better about raising it~since thus far no rash has appeared~ Martha~PS I feel that the extra amount every second day is making some difference~ as I was able to go out~do you agree???

Expert:  Dr. Kaushik replied 11 months ago.
Well i suggest that you do as your doctor says because at least she has been kind enough to pay attention to what our discussions had lead to and in your improvement her part is equally important because she has been listening to your suggestions.

So kindly continue taking the alternate dosing for another 2 weeks and then she shall raise the dose to 300 mg dose daily.

Yes i agree that the 300 mg dose that you take every alternate day is making the improvement and that is the reason why i wanted you to go up the dose.

Anyways all in all you have to play according to the doctor's rules and hopefully she will raise the dose to 300 mg after 2 weeks which shall make a huge impact on your recovery. But until that happens you shall continue to follow her strategy and appreciate the steady improvement that you are having.

I hope this helps.

Wish you all the best.

Regards
Customer: replied 11 months ago.

Hi Dr. Kaushik~ I agree that it is nice that my Doctor listens to what you say~ she has always done this and I am so glad she does~ maybe not all Doctors would~they would have their own opinion~my son noticed this also~so I don't want to push her~I suppose she saw the rash and is being extra careful~I assume after this is finished that she will up the dose to the 300 mg everyday~I will be anxious also to hear her opinion about the generic brand of Wellbutrin in the SR~now I am on the real thing~ I also think that you like the XL better yourself for your Patients~when I started a way back they did not have a smaller dose in XL than 150 mg is why I had to take the SR in the first place~you felt changing it in the middle might cause side effects moreso and it thus was better to stick with the SR twice a day~so I was actually on less making it 200 and now I will be on 300~if my Math is correct~I also remember you originally wanted me started on 75 mg in the XL~but they did not have that dosage in Canada in XL~only 100 SR~I may be wrong here~but would 300 mg of XL be better than two 100 SR's~no rash yet either and yet I am on a higher dose~ very confusing~ Thanks again for your input~ we have spent a lot of time together~ but maybe seeing I am listening to you and doing as you suggest~makes your time more worth while~Martha~

Expert:  Dr. Kaushik replied 11 months ago.
I must acknowledge and appreciate your sincerity with which you have listened to my suggestions even when we are staying across different continents and i believe your impeccable compliance of drug regime makes my job to guide you much easier. You deserve to get well as you have done the hard work and have remained consistent all throughout this despite having to endure the symptoms. So kindly stay on the drug regime as you re doing right now, follow your doctor's advice judiciously as she is the one who is going to prescribe drugs and so far she has been more than accommodating to my advice which needs to be appreciated and respected.

You see she is the one who saw the rash and so it is quite justified for her to feel doubly cautious plus this is all for your sake so just keep yourself close to her and do not push her too much.

You see wellbutrin Xl was the one which I had recommended initially if you may remember because it was my first choice and not wellbutrin sr since the former is more effective for your underlying condition and has much fewer side effects. It was unfortunate that 75 mg dose in wellbutrin Xl was not available otherwise you would not have tried sr in the first place and would have escaped all this difficult phase.

Yes you are right now at a higher dose of wellbutrin xl as opposed to the dose of wellbutrin sr and still you are tolerating it well , this encourages for further use of is drug.

I hope you continue to recover steadily and continue to follow your doctor's advice and tolerate the dose well.

Wish you all the best.

Please kindly leave a Positive rating if you are satisfied with the answer.

Regards
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4053
Experience: MD Psychiatry
Dr. Kaushik and 2 other Mental Health Specialists are ready to help you
Customer: replied 11 months ago.

Hi DR. Kaushik~ I too am glad that my new Doctor here took your advice~some Doctors may not want to do this~you said that some of your Patients found the 150 XL enough~I may have too ~ as the first day I took a 300mg I felt better~ maybe that was just in my mind and it was the 150mg finally kicking in~ as it had been four weeks and a fifth with alternate doses of it~I guess we really will not know~ but I think you did say 300mg would make me feel better~I shall be anxious to get on it full time and hope she will give it to me~ besides it is the real brand name besides~Wellbutrin~ and not a generic like the SR was~ if it makes me feel real well is it possible to stay on this drug plan for many years~maybe I am a type who needs this~ I find it sort of like marijuana in that it keeps me more calm and focused~is that what it is supposed to do~ Martha~

Expert:  Dr. Kaushik replied 11 months ago.
It is good news then that not only you have with you the branded version of wellbutrin xl at 300 mg but also your doctor is kind enough to consider the suggestions.

Well wellbutrin xl is a very safe drug and it usually can be taken for 6 months to 1 year duration for conditions like yours but in some cases it may be taken for years together if the user finds it's use to be more beneficial than it's absence.

I hope this answers your query.

Wish you all the best.God bless.

Regards

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