FYI-Opioid Potentiators

Discussion in 'Fibromyalgia Main Forum' started by hermitlady, Jun 10, 2009.

  1. hermitlady

    hermitlady Member

    Hi All,

    I'm posting this in hopes someone may benefit from this info. I'm not a Dr of course, and am not suggesting everyone try this (but it's helping me).

    I was doing some research today about pain meds, drug interactions, etc and found some good info. This is a paragraph from "The Intractable Pain Patient's Handbook for Survival" by Forest Tennant, MD, DrPH (found at

    I have been on a combo of meds the past 6 mos or so that have improved my quality of life. Instead of having to take Norco every 4 hours, I now take just 10mg Methadone once a day. No more peaks and valleys from the Norco wearing off...but I can still take it for breakthru pain.

    **Now, I know many people are against the use of stimulants, so please don't attack me:)** I also take 30mg Dexedrine ER daily which helps improve my energy level, my cognitive abilities, and also REDUCES MY PAIN! (I have tested this theory out by taking "holidays" from the Dexedrine)

    Well, now I know why...the Dex is a potentiator for Opioid pain meds, meaning it helps boost it's effectiveness and reduces pain! I was pretty sure this was the case, and there are other potentiators listed in this paragraph. Hope maybe it will help someone.....


    The term "potentiator" is one used by physicians and pharmacists to indicate that one medical agent
    makes another more "potent." Here, we are talking about agents that make opioids act stronger and last
    longer. Potentiators allow less opioid to be used and lessen their complications. In this day and age of
    cost cutting, most IP (Irretractable Pain) patients will have to learn to use potentiators because insurance plans will not pay for
    the most effective opioids.
    Additionally, when you wish to decrease your opioids or attempt to withdraw, you will need to use a lot
    of potentiators. Common agents which potentiate opioids and which are commercially placed in some
    opioids are:

    Caffeine, Aspirin, Acetaminophen, and Ibuprofen.

    For example, Vicodin®, Percocet®, and
    Darvocet® contain acetaminophen. Fiorinal® contains caffeine and aspirin. Vicoprofen® contains ibupro-

    Other agents including some muscle relaxants and stimulants potentiate opioids. IP patients should
    take a variety of potentiators to determine which ones make your opioid more effective. IP patients must
    especially learn to take a potentiator with their breakthrough opioids since a potentiator can help break a

    Here is a partial list of some potentiators which may boost your breakthrough opioid:

    Caffeine Tablet

    You should systematically try potentiators one at a time to determine how best to control breakthrough
    pain without the benefit of expensive commercial opioid preparations such as fentanyl (Actiq® or Fen-

  2. gapsych

    gapsych New Member

    I have noticed that when I take provigil my pain decreases. It is theorized that our pain is neurological and originates in a dysfunctional part of the brain/nervous system.

    While this is my experience, anecdotal. I would love to see a study on this, this theory may make sense.

    When people take stimulants for ADD, it has a calming effect on the nervous system and you can focus better.

    The way it was explained to me it is like setting a thermostat too high and the furnace will need to run longer to stop than if the thermostat is set at a lower temperature. Humans have a built in mechanism to help them concentrate despite all the "noise" going on around them.

    People who have ADD or other neurological problems may have their thermostat set higher before their body settles down. Thus stimulating that part of the brain, starts the mechanism to calm down.

    This is why especially with younger children with ADD are literally bouncing off walls, running around, their body seeking the stimulation to reach the higher setting to calm down.

    Wrapping a child in a blanket, we used to call it the "hot dog" game when I was teaching, provides proprioception, "The unconscious perception of movement and spatial orientation arising from stimuli within the body itself." Websters dictionary. The feedback which kind of "grounds" the brain from over firing and a lot safer than bouncing into walls.

    When people without our DD and others, are, for example, punched in the arm, it will hurt but eventually stop. For us, the brain keeps sending the message (over firing)that we are still in pain long after it should stop as our bodies are figuratively speaking are on a higher setting.

    This is why some people like to wrap something tight around their bodies which can help the pain, provided you can stand anything to touch your body. Unfortunately, this may only provide temporary relief.

    Counterintuitive I know.

    Does this apply to us? I am not sure. But I think it could.

    I may be a bit unclear on the above as it is the short version and I am not a Neurologist. If anyone can explain this better, I would appreciate it. The fog may be interfering today.

    Then again, it could all be coincidence, LOL!!


    ETA. I take Lamictal which potentiates my AD while also helping the effects of the AD wearing off after a time.[This Message was Edited on 06/10/2009]
  3. Janalynn

    Janalynn New Member

    Wow - very interesting! I appreciate you providing this information. this is something I will definitely be giving to my Dr.

    Gap - Doc just added or wants to add Abilify to the lamictal for energy - ever hear of that?
    I am just SO sick of taking this or this, that or that....and half or more don't seem to do anything! What is provigil?

  4. Janalynn

    Janalynn New Member

    Is Dexadrine like Dexatrim? Is it you just purchase OTC?

    I'm too afraid to take anything else without asking my Doc - but as I said, I'm definitely going to mention.
    I have ZERO energy.
  5. gapsych

    gapsych New Member

    Lamictal is used for a lot of things. I have not heard about the energy boost, but if it is poteniating your AD, I guess it could.

    If I did not emphasize this enough, don't take my word for this, talk to your doctor or neuropsych.

    Provigil has really helped me. So if the provigil does not work for people, maybe it will not work for pain.

    Again this is my experience and may not pertain to others.

    [This Message was Edited on 06/11/2009]
  6. DemonFairy

    DemonFairy New Member

    Simply Juice Grapefruit Juice, in the refrigerated section, potentiates as well as anything I've ever found. And, it tastes good. The Ocean Spray (which is from concentrate) is kind of gross tasting, but will do in a pinch. But, the Simply Grapefruit Juice is great. Also, for some reason, since I've started to drink more of it, I've had more energy and use fewer pills. I don't know if it's the potassium or the magnesium...or the sugar, heh, but when I drink a lot of the juice, not only do I need fewer pain pills (I'm not advocating it for people on heart meds or other life-saving meds like that, *just* pain meds...and try it with less than your normal dosage first), I feel better in general. It's not the cheapest stuff in the world, but it's often on sale and it's really quite tasty, unlike the skunkiness/bitterness of Ocean Spray white grapefruit juice. Their Ruby Red is fine, but the potentiating is much less.

  7. hermitlady

    hermitlady Member

    Gapsych...I do believe I have ADD, just not the H type...I think back on how hard it was for me to stay focused in college, now it makes sense. I benefit from the Dex because it's helping me in more than one area, pain, energy and mental focus. Thanks for the explanation, my son has ADD inattentive type and we haven't found the right med to help him yet. At least there are lots of options these days.

    Janalynn...Hi ya! Dexedrine is an rx stimulant, one of the "controlled" classes of meds due to possible addiction, selling etc. It's one of the old original ADD meds, like Ritalin (ring a bell?) My BIL was in Viet Nam and he said the Army handed out Dex like candy to keep everyone alert. I think they still use it in the military when they need to stay awake.

    Provigil is a non stimulant med prescribed for narcolepsy or other sleep disorders to keep people awake. Ins. cos often won't cover it for off label use (expensive-$10 per 200mg pill in CA), I had to order generic Modafinil online (per my dr's advice). I've also used it, in fact for a couple of yrs off and on. Worked pretty well, but started to lose it's effectiveness so Dr switched me to Dex Extended Release (he also said Dex would help brain fog and pain). Many Drs won't rx stimulants due to the possible addiction qualities, just like pain meds I guess. I've skipped days and just felt sluggish and tired (my norm), didn't make me feel really sick or withdrawals (but pain levels did increase as I said before).

    Glen.....I take the generic Dex ER version, along w methadone or Norco...that's the combo I personally know of. Also I think the Dex helps w pain because I am more active and move around more to keep things loosened up. I know if I'm flared and laying around, my aching gets much worse.
    Another nice thing is I've lost almost 40 lbs since last August, the extra weight that past AD meds had packed on me! Just does enough to kill my appetite a bit...instead of sitting on the couch eating chocolate all day cuz I was so depressed;)

    DemonFairy......I always heard Grapefruit juice and meds were a bad combo. In fact I know some of my mother's meds specify NOT to drink GF juice. Interesting, I'll have to read back thru this article and see if it's mentioned as a potentiator. Good for you if it works. I can't touch the stuff, too acidic for my mouth and stomach, ow.

    Glad some of you found this interesting. Take Care......Hermit
    [This Message was Edited on 06/11/2009]
  8. gapsych

    gapsych New Member

    I am not supposed to eat grapefruit with my cholesterol med. There was a warning sticker on the bottle for a while but it is now not.

    I don't know if the recommendation has changed or what. However, I see my PCP next week and will ask her.


  9. cynicaldog

    cynicaldog New Member

    The warning label should really still be on your bottle of cholesterol meds, Gapsych. It can be dangerous to potentiate medications that affect your heart, blood pressure, blood thinners, etc., because tiny adjustments in those meds can make a huge difference to your body. I'm not sure what sort of safety window you'd need between taking your cholesterol pills and drinking grapefruit juice, or if there even is one -- I've read statements from some people who claim that the juice potentiated their pain meds for a full 24 hours after they first drank it. For safety's sake, you should probably continue to avoid grapefruit, but it's definitely something you can ask your doctor about.

    To add to the discussion about stimulants and pain reduction, I've definitely noticed a reduction in my pain when I take either Provigil or reboxetine. Reboxetine is marketed as an anti-depressant, but it's pretty similar in composition to Strattera. My problem is that I no longer tolerate stimulants well. I used to feel like Provigil was a miracle drug, and if forced to choose between my pain meds and the Provigil, I would have chosen the latter because it helped me in so many ways. Unfortunately, my anxiety levels have been through the roof for the past few months, and I think my Hashimoto's is causing my thyroid to go into temporary overdrive, so stimulants are the last thing I need.
  10. Leaknits

    Leaknits New Member

    So far I don't see any mention of medicinal use of cannnabis products.

    As with some items mentioned, it's an adaptogen...kicks other medications into a slightly "higher gear," absolutely no pun intended because the stuff is medicine, not a paper-wrapped party.

    One doesn't get high on medicine. Period.

    It's also good on its' own for intractable pain, nausea, migraines, arthritis, anorexia, etc.
  11. AuntTammie

    AuntTammie New Member

    This is quoted from Mayo clinic's site.....(note it also says that waiting to take the meds does NOT help).....

    " chemicals in grapefruit juice and grapefruit pulp interfere with the enzymes that break down (metabolize) various drugs in the digestive system — including certain calcium channel blockers and cholesterol-lowering drugs. The result can be excessively high levels of these drugs in the blood and an increased risk of potentially serious side effects. Pomelos and Seville oranges, a type of bitter orange often used to make marmalade and compotes, may have a similar effect.

    Here's a sampling of drugs known to have potentially serious interactions with grapefruit products:
    Drug name Type of drug
    Amiodarone (Cordarone) A drug used to treat and prevent abnormal heart rhythms (arrhythmias)
    Buspirone (BuSpar), sertraline (Zoloft) Antidepressants
    Carbamazepine (Carbatrol, Tegretol) An anti-seizure medication
    Cyclosporine (Neoral, Sandimmune), tacrolimus (Prograf) Immunosuppressant drugs
    Felodipine (Plendil), nifedipine (Procardia), nimodipine (Nimotop), nisoldipine (Sular) Calcium channel blockers used to treat high blood pressure
    Saquinavir An HIV medication
    Simvastatin (Zocor), lovastatin (Mevacor), atorvastatin (Lipitor) Statins used to treat high cholesterol

    If you're concerned about the effect grapefruit juice may have on your medications, talk to your doctor or pharmacist. In some cases, it may be important to avoid grapefruit and grapefruit products, as well as pomelos, Seville oranges and products made with these fruits. Waiting to take these medications — even up to 24 hours — after you drink grapefruit juice won't prevent an interaction. In other cases, it may be possible to switch to an alternative medication that won't interact with these fruits. "
  12. ilovepink4

    ilovepink4 Member

    I am so excited about this because I have suspected there is something good about this....I take oral percocet and the fentanyl patches....a couple summers ago, I was having trouble staying awake all day to monitor our sons activities while hubby was, i tried taking a caffeine pill called Jet Alert....just a generic type of Vivarin or No helped me was weird....

    then, a couple summers later, my doc RX'ed phentermine for me, to help me with my sluggish weight loss....well, surprise, surprise! The phentermine lowered/got rid of my all over flu like pain....i was filled with energy and mentally I felt like doing things rather than curling up on the bed all day.....That summer, I took our sons to a local outdoor lumbercamp museum, to the DQ, to the beach, shopping for school supplies, the greenhouse and worked in my garden...

    It worked for pain, energy, got me to talk more and feel more social....but, when it wears off I crash BIG BIG BIG time!!!I end up in bed for a week if I really overdid it....

    but, it is a glorious discovery if you can learn how to control it....oh, and I have problems with anxiety so I was definately reaching for the XANAX while taking the phentermine.....

    If you take it on a regular basis or for any length of time, you have to have your blood pressure taken on a regular basis. I didn't take it much due to the awful crashes-I tend to overdo it every time! but if you had a big day, like a wedding you had to go to, or a trip you needed to make, this is a big help!

    Regarding weight loss, I did make me forget about craving food and I didn't feel hungry....this stuff is like a wonder drug....definately dangerous if you can ignore the warnings....

    I have mentioned this in many of my posts but haven't run into anyone else that mentioned they were taking some type of a stimulant and were getting positive results!! I want to find that pamphlet you mentioned so I can make some copies. Thanks for bringing this up!
  13. gapsych

    gapsych New Member

    Thanks for the information. I was surprised to see Zoloft. However, since the warning about cholesterol drugs I do not eat or drink grapefruit.

    Someone mentioned getting super energetic when on a stimulant. With the provigil, which has a stimulating effect, not a true stimulant but close, I do not get super energetic, I just feel almost normal energy-wise, for about six hours. It does not make my heart race or anxiety level increase. If it did, I would not be on it. I also have several sleep disorders.

    If you are getting too much energy, or having to take meds. to counter this, you might want to mention this to your doctor. These may be symptoms that the med. is not good for your body or you are getting too much. They should make you feel "normal", whatever that is and not super energetic.

    When I taught, sometimes I would see students on an ADD med. and become more hyper or very irritable. This can be a sign that you are on too much.

    Relying on caffeine, energy drinks, can also be detrimental to your health and can cause you to crash.

    The bottom line is that you need to be monitored closely to take these drugs.

    Just wanted to throw this out there as an extra bit of information.

    Geese, having too much energy as a problem, that's a laugh.

    Take care.

  14. vivian53

    vivian53 Member

    There is lot of good information here. I also take Provigil 200 mgs q d. I have been on it for 2 months and I can't tell a difference in my wakefulness or energy level. I am so dissappointed because when I had taken it about a year ago, it helped.

    The other bad part is that my insurance won't cover it. It is $360 for 30 pills. I am giving it until the rest of the month to help and then I am asking for something else. The insurance company is suggesting I try Adderall (?).

    It would be so great to find something that decreased my pain, increased my energy, facilitated weight loss and didn't interfere with my sleep or cause anxiety.

    Dexedrine (white crosses) Whoa. When I was in school we would take it to stay up all night and study for exams. Unless the extended release is easier on the CNS I don't think I could handle that much energy. Plus it would make me so tense and I would grind my teeth. I am afraid it would increase my pain. I am glad it is working for others though.

    Each one of us reacts so differently. I wonder if a little dose of a diet pill, like the phentermine mentioned here would work for me?

  15. ilovepink4

    ilovepink4 Member

    There are many forms of "uppers" that we could try....some over the counter....Heck, I bet Excedrin would work because it HAS caffeine in it plus it is a pain reliever anyways!

    Like I said earlier, Jet Alert....which is just a generic type of vivarin helped me but I felt guilty to take it year round...i just took it in the summer to try to stay awake all day while hubby was at work and the kids were at home all day for summer vacation....It was just a lucky discover that it helped my pain....

    and the phentermine was prescribed to help me with weight doc felt guilty that he had pushed me to stay on cymbalta even though I was distraught over the weight when i put my foot down and got off the cymbalta, i started Weight took me forever to lose just 15 of the 50 lbs i had gained from the cymbalta....the first time I asked him if i could try phentermine for weight loss, he said no....on my next check up, he saw that i had lost 15 lbs and was trying but having trouble, he said yes, I could take the phentermine

    then, i found out that it gave me energy and REDUCED MY PAIN!!!! the bad part is that i don't pace myself very well and tend to overdo it.....then I crash and feel awful.....

    if i take it on a day that i feel horrible already, it doesn't help the pain as definately won't help with energy if i am already a mess.....

    now that there is evidence that this really does work it seems like it is okay....that i am not a sneaky druggie that is taking uppers to try to feel normal....

    i will experiment with taking my phentermine every day and i will go very , very slowly increasing my activity levels until i get to be able to stay out of bed most of each day....right now, without the phentermine, i can only be up long enough for a shower or maybe an hour getting the kids to bed and reading to them, etc....

    i just am excited that there is someone looking into this...maybe this could be a start to a cure....i believe the theory that we don't make enough dopamine due to chronic stress....the jolt from the stimulant type meds really makes me think that is the answer....

  16. gapsych

    gapsych New Member

    is to not take an OTC stimulant. First since the industry is not regulated you do not know how much you are getting or necessarily what the fillers are. Also you may be dosing at the wrong strength.

    If you are taking the Tylenol regularly this can effect the liver, big time. There are also stomach issues. So let your doctor know how much you are taking.

    I just want to reiterate that you really need to be discussing this with your PCP. These drugs are not to be played around with.

    If you are crashing on Provigil or other prescription drugs, that may mean that you might want to take less.

    Make sure you read the pamphlet or look online for a more detailed account of side effects of a prescription drug. There are medical conditions where it is not advisable to take these type of drugs.

    Remember ephedra(SP?).

    Sorry to harp on this but would hate to see people taking meds. when they can be harmful. You need to balance the risks and benefits with your doctor. These drugs are not a cure. It can he helpful or harmful depending on the circumstances. You need to be monitored to see if your blood pressure is increasing on the medication as well as liver functions or any other tests your doctor orders. If you are bipolar you also need to be careful.

  17. hermitlady

    hermitlady Member

    I haven't checked in for a couple of days and was glad to see some more replies. Yes, when using stimulants you have to be careful not to overdo. Also, somedays they help, others they don't...yesterday was one of those days for me, no matter what I took I still felt awful.

    Leaknits-I am a believer in medicinal mj, I know it helps from personal experience, but I'm hesitant to ask my doc for an rx. Too bad there's such a stigma attached to it, lots of folks could benefit from it's use. I do.:)

    Phentermine was nasty for me personally, and I tried a few other stimulants before settling on Dex ER. With the ER, the med is slowly released in your system so the lift/crash is much more subtle. I have also taken Excedrin Migraine, 1 pill has the same amt caffeine as a cup of coffee, that's enough for me. Took Vivarin and it was too much, I think it's like 2 or 3 cups of coffee in one pill...shaky shaky!

    We all have to do what feels right for ourselves. As we know, there are so many mixed opinions about all of the meds we take. I just figure that my quality of life is important to me. If I feel so terrible that I can barely stay on my feet for the majority of the day, that is not the way I want to live. I see my dr once a month and he keeps a close watch on how I'm doing. The Dex is controlled so I have to get a new rx written every month, no refills are allowed.

    Anyway, I thank you all for your input and hope everyone finds a way to feel better. We need to be able to LIVE our life, not just watch it pass by.

    Love to all.......Hermit
  18. Leaknits

    Leaknits New Member

    Dear HL, thank you very much for your response. Trust me please, I totally understand it's hard sometimes to have some fraction of a life AND get here on any sort of regular basis.

    Like you I have not asked my dr for a prescription for mj. There is a so-called "potdoc" here in Lake County CA where I live and, for (last time I checked...prices may have gone up) $175 cash a person will be given a cursory examination...."You breathing? Okay, we're done, here's your prescription, come back in 6 months and I'll examine you again but it will 'only' cost you $160."
    Dr continues: "No, you cannot buy your supplies here, you have to go to a dispensary and register and then you can buy there."

    Right. Sure. Uh huh. No Flippin' Way! I'm already a "sitting duck" due to being in this power chair if I have to travel more than a block.
    Now see me exiting a dispensary when everyone hanging around would KNOW that I was in possession of some sort of mj.
    I'm not really fond of being assaulted in order to be stolen from.

    I don't have PotDoc's demanded cash. (I spent it on mj so I could get some adaptogen-type pain help).

    I feel that Big Gov't already knows too __________ much of my business. I'm on lists for supposed low cost housing which is assuredly not low cost, I'm dependent on my SSDI check for subsistence, I'm on yet another list as a pain patient who GASP uses Oxycodone 10/325 4 times in 24 hours so as to avoid jumping off a bridge to end my pain permanently, I'm an online activist when I can sit up long enough to bat out a treatise on the latest idiocies foisted on the general public by Big Gov't so undoubtedly I'm being censored for that, and on and on.

    To those who can handle prescribed stimulants as a possible adaptogen for THEIR pain med, more power to y'all. My dr yells at me if I drink more than 2 cups of coffee in 24 hours.
    You see, I have Chronic Heart Failure and really shouldn't be using mere caffeine at all, much less Dexedrine, Methamphetamine, Biphetamines, etc.
    Besides I yelled back at him when he apparently forgot to glance at my file...he asked me if I wanted Ritalin to attempt to cut the exhaustion we all deal with all the time...and I had to remind him "Uh, Ron, you do know I have CHF, right? I don't sleep properly as it is now and you want me to take speed??"

    And: as a possible final word from me re MJ but I'm not promising, lol, one does NOT need to smoke the stuff, which can cause talk among ones' neighbors and a possible knock on the door by a khaki- or blue-clad Authority Figure at a very inconvenient moment.

    Brownies. Stir the stuff into applesauce , peanut butter, bake muffins, sprinkle it on your cereal or omelette, go to your health store and buy empty gelatin capsules you can load with Your Determined Dosage to be swallowed like vitamins, WHATEVER.

    It's not for everyone. It is for me . It helps with the anxiety, pain, and exhaustion of these d'ds!

  19. hermitlady

    hermitlady Member

    I'm smiling ear to ear:D....Thanks for a great post!

    Gosh, I haven't tried eating anything spiked w mj since the 70's when my sister made brownies for us to eat at SeaWorld w our boyfriends! That whale show sure was funny......

    Don't you have to use more if you ingest it rather than inhale it? I use no more than a pinch a day in a b--g, that's all I need. Oh, you mentioned you wouldn't sleep on stims? I actually sleep better when I take mine, just can't take it late in the day of course. I think I move about more thus making me more physically tired so I sleep more soundly.

    I had to laugh at your comment,
    "one does NOT need to smoke the stuff, which can cause talk among ones' neighbors and a possible knock on the door by a khaki- or blue-clad Authority Figure at a very inconvenient moment."..... My closest neighbor across the street is a cop, but I know him well and seriously doubt he'd care, he knows about my health problems...he drinks beer all the time when out working in his yard, what's the diff?

    Have you seen the short video that Drew Carey did to support med mj? It was great, I found it on YouTube...check it out, hopefully it's still floating around somewhere on the net. I posted about it here a yr or so ago and it mysteriously disappeared, so don't know if this will stick for long...hope you see this.

    I just got back from my Dr visit, just my usual check in appt. He assured me that I'm OK to stay on my current med cocktail, since I don't have any other health concerns that would cause problems. Sorry to hear about your heart problems, that's scary. Isn't fibro enough on it's own??

    So, you're in CA Lake Co up around Grass Valley? I went to college in Sacramento and have friends and family scattered about Central, Bay Area and No CA. I'm in So CA but would much rather be up north, it's kind of a drag here in the smoggy summertime. But I moved here to get married and be w dh, 24 yrs ago this month. Good choice:)

    I have some gelatin caps that I may have to try using like you said. I just wonder how much is the right amt, don't want to waste any of my precious commodity. Last me a looonnnnggg time as it is, much cheaper than some of my prescriptions, that's for sure.

    Gotta go, take care...Herm
  20. Leaknits

    Leaknits New Member

    Hi, LADY!

    Oh I'm so glad that parts of what I wrote were interesting and/or funny. I do try...when I have what a friend calls the "N R G." ("Sound out" the letters, as we used to be told by parents and teachers alike...).

    I've no way to tell you what your proper dosage in gel cap would be because the differing effects between eaten and set-on-fire mj are so, well, different.
    It seems your consumption amount and mine are identical. Nowadays due to high-techery of growers it doesn't TAKE much.
    One thing I noticed and thought was odd: If I ate the stuff I spiked a fever. Rule One about how Everybody's Different rules again.

    Clearlake, Lake County CA is not horribly far from the Grass Valley area if one has a car. Try might give you an idea.

    Congrats on the nearly a quarter-century with your hubby; could you start planting ideas as to how "The air up north is cleaner and drier?" I shudder to think of living in precise downtown LA CA which I once did. Never again.
    I don't like to see the air I'm breathing.

    Thank you very much hug, HL, for your concern re "Isn't FM enough?" Yes it is. So are ME/CFS, CHF, 2 sorts of Arthur, and living in a new apartment building to which I moved because it was supposed to be Low Cost, Lots of Peace and Quiet. I've seen precious little of the latter.
    The stomping, shouting, banging doors and reverberating so-called music are enough to drive a person mad who has anything approaching normal hearing. Which I do.

    No, I did not know about the Drew Carey vid but will go look for it later. Thanks for the FYI.

    Hugs again and take care of you,