a bottle of Nexium 40mg

Medications such as omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid) and many others are termed proton pump inhibitors (PPIs). They shut down cells in the stomach that produce acid. This can reduce the problem of acid reflux, and as a result these drugs are often prescribed for GERD (gastroesophageal reflux disease) and Barrett’s esophagus.

Nevertheless, PPIs are not entirely benign. Many nutrients are best absorbed when there is some acid in the stomach, so long-term PPI use can lead to deficiencies. Stomach acid is also somewhat protective against bad bacteria entering the body; shutting it down so efficiently increases the risk of intestinal infections and pneumonia.

Getting Off PPIs:

Perhaps the most troubling problem, though, is that getting off PPIs can be very difficult. Rebound heartburn may be mis-interpreted as a continuation of the original problem and is often so painful that it is no wonder people start right back taking their medicine. Many are hoping for help in withdrawing from the drugs, just as this reader does.

Q. What can I do? I have been on PPIs for 15 years. The doctors say that getting off this medicine is too hard, so I’ll have to stay on.

I have told three family practice doctors and three gastroenterologists that I do not like the long-term effects of PPIs have and they all poo-hoo that. I have asked each one about coming off PPIs, and they poo-hoo that too. Now I am having real trouble with my intestines and I still got the poo-hoo!

I am so disappointed in all these doctors not listening to me that I have changed doctors again. I need help getting off the PPI.

A. It certainly can be difficult to stop taking a proton pump inhibitor (PPI) drug for heartburn. Research has shown that sudden discontinuation of a drug like esomeprazole (Nexium) results in rebound reflux that lasts several weeks (Gastroenterology, July, 2009).

Useful Strategies for Withdrawal:

There are some strategies that can be helpful, however. Reducing the dose gradually may be wise (Medical Hypotheses, Sep., 2011).  Using DGL (deglycyrrhizinated licorice) before meals to ease heartburn can help, and so can munching a few almonds after the meal. We are sending you our Guide to Digestive Disorders with other suggestions to help you get off a PPI and manage your symptoms more naturally, such as with persimmon-ginger tea.

Long-term use of PPIs can raise the risk of diarrhea, pneumonia, fractures and vitamin B12 deficiency and should be reserved for people with serious digestive problems that don’t respond to other treatments (Therapeutic Advances in Gastroenterology, July, 2012).

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  1. BEVERLY
    TEXAS
    Reply

    I have a condition that has mystified about 20 doctors. Years of taking powerful drugs for Sarcoidosis has totally screwed up my stomach. I have a small hiatal hernia. Endoscopies do not indicate any serious problems but several times a year I get sick and stay sick for most of the year. It is almost like silent reflux but no heartburn or regurgitation. I have a discomfort right below my breasts in the middle of my upper stomach. I get severe bloating and belching. Then over a period of time I start getting a lung infection and have severe breathing problems, and my oxygen levels sometimes get in the upper 80’s.

    No doctor has diagnosed it or fixed it so I usually have to resort to a few months of prednisone which is like pouring fuel on the fire. My last gastro doctor tried to put me on dexilant, and I said no. My new gastro doctor from Baylor also recommended the same thing. This time I agreed to take it. After one week I was hungry all the time and gained five pounds. My vertigo got worse. I had strange pains in the side of my head. My vision got fuzzy, and it did not help my stomach issue.

    So I stopped it, and the last few days I have felt like crap with headaches, a bad, bad, bad episode of belching and lung congestion; and today I feel like I have bugs crawling all over me. Think I will stick to gaviscon, DGL and baking soda.

  2. Mae
    Colorado
    Reply

    I started with Tagament and progressed to Protonics. I had been on these meds for almost 20 years. Tried to come off and always felt pain within 24 hours. Worked with a nutritionist and still had problems. Then I read an article about healing your gut with juicing, mostly vegetables. So, I started juicing (and that’s all I ate for 30 days). I took the protonics while juicing for the first week. I came off of it and had no pain. Continued the juicing for a complete 30 days to allow for full healing. I have been off of any meds for 8 years. Found out that I wasn’t producing enough acid, which can leave you not feeling well. If I feel like I’m having GERD (this is a rarity). I take some apple cider vinegar and it goes away.

  3. Anne
    South Carolina
    Reply

    I have been on PPI’s since 1995. Started on Prilosec and ultimately taking Aciphex 20mgs. In the last few months I have been feeling the burn for a few hours after taking the Aciphex. I was also recently diagnosed with low thyroid function and put on Synthroid 25mcgs, which badly burns my esophagus and causes a lot of light-headedness. Adding to my problems, I have bi-lateral deafness, inner ear vestibular disturbance, constant tinnitus, and dry macular degeneration in my right eye. I am so miserable since starting the Synthroid, as it makes the Aciphex cause unbearable burn and bloat.

    I have decided to try to slowly work off of the Aciphex, so have been skipping every other day. Meantime, because of the added burn from the Synthroid, I am now taking an H2 blocker twice daily on my off day and once daily on the Aciphex day. However, I am burning so badly, and this tends to elevate my BP, which is scary, as I am on a BP med (Cozaar 50mgs). I would like to find Slippery Elm powder, as my parents always had that around when I was growing up in Scotland. I read that this, in the USA, is not very palatable. The one we used was made using milk and was pleasant to take. It effectively coats and heals the digestive tract, as well as being nutritious. I can order it on the internet from UK but am unsure how long delivery will take. Meantime, I have no idea where I could find the more unpalatable kind here in the USA? I am miserable and don’t know if I will always have a burning reaction from the Synthroid, but I desperately want to be able to come off the PPI, as I also now have both osteoarthritis & osteoporosis.

    Any suggestions that may help me get through this very difficult time? So many Drs poo-poo the dangers of PPI’s but over a year ago, when I visited a specialist for a different problem, he warned me of them and told me that I could not stop them cold turkey but had to wean off of them. I wish that I had listened back then.

  4. Gerald
    London, UK
    Reply

    Ive been on Paxil for 21yrs and Prilosec for 20yrs, the last few years had problems with gluten and dairy allergy, maybe a leaky gut and gallbladder polyps and fatty liver and so been tapering off the meds, the Paxil of course made me feel stress and anxiety much more and had to stop the taper, the prilosec has been okay from the GERD point of view but my duodenum/small intestine aches and so may have to go back on it for a while, also have lots of stress at home with 3 young kids and looking after my father who has dementia and can hardly walk with arthritis, he is also very grumpy at times so I have to manage my stress as well, some of the ideas here sound good, the Ginger tea sounds good but I heard it increases acid production.

  5. Suniya
    Rajasthan
    Reply

    I have been taking pantoprazole with domperidone…does that worsen the side effects..pls help

  6. Julie
    Ohio
    Reply

    Here’s my situation. I started taking Prevacid, 40 mg, back in the mid 90’s (?) and it was a Godsend, after taking Pepsid AC sometimes 3 times a day and still having that burning sensation. Then I started hearing about fractures, and ironically, did fall and badly fracture my left ankle. I stopped for a while, but just couldn’t abide how I felt. I guess somewhere I had switched to just 20 mg a day, and it worked fine. Over the years, I have tried many times to stop, do for a while but can’t stay off them long. Rantinidine, which helps some, just isn’t enough. I had gotten my doctor to lower the dose to 10 mg, which works almost as well as 20 mg, but I still worry. I stopped again recently, and as always, with the rantinidine, it works for a time, although I have to take 150 mg of that often 3 times a day to feel good. So, yesterday, after feeling like food was stuck in my gullet for the whole day, feeling awful, I took my omeprazole again. I took another today, and feel good. What in the heck are we supposed to do???

  7. Abby
    Massachusetts
    Reply

    Prescribed total 80mg/day of generic lipitor one year ago with no instruction as to duration I would need. Without knowledge that it “was over the top” -I followed my intuition and discovered I was being WAY overmedicated. Originally perscribed for erosive gastritis – which is now worse. Went on line and discovered a website: Extra Virgin Syberian Pine Nut Oil. Used for centuries in Europe and Russia – 3 teaspoons a day before eating – have done this for five days, feel better – tapering off Prilosec – now have “red zone” osteoporosis. There must be some way to make these docs and pharmacies who honor these outrageous perscriptions responsible for the HARM done done to our bodies !!

  8. Daniel
    IL
    Reply

    I’m currently undergoing a cold turkey attempt at eliminating PPIs. I’m on day 4 and my acid has started to come back, but not as bad as I thought. I’m able to drink water, milk, or eat something like a banana, Apple, or some almonds to ease the pain. It isn’t a constant burn. I’ve dealt with acid reflux for about 20 years now. I haven’t taken PPIs for the entire time. I took prescription Nexium at first, until the insurance stopped covering it, then I was just using pepcid complete from the local drug store. It helped, but there were some bad days. I actually ended up ridding myself of the reflux in my late teens by quitting smoking and exercising. It came back after I started smoking again and eating very poorly. I gained a bunch of weight back and started popping pepcid.

    Few years back I realized Nexium was OTC available, so I started taking it religiously. I’ve been steadily taking it ever since. It has worked wonders for my acid reflux, but about 6 or 7 months ago, I started having violent bouts of diarrhea…. Painful and just awful altogether. I always knew that Nexium could cause things like diarrhea and nausea, but this was just way too intense. I never went to the doctor for it. I kinda just chalked it up to a wicked stomach virus, which I now know could have been C. Diff. A very nasty stomach infection.

    My bowels eventually went back to normal, but I did have flare ups. Just recently I started researching all the nasty side effects of long term PPI use and was terrified and disgusted. I will not go back, no matter how bad my rebound reflux gets. I’ll just supplement with pepcid complete and continue to eat healthy until the rebound subsides. It can be done. Acid reflux or GERD is not a life long disease. It can be controlled. You just have to change your diet and have some will power. Natural remedies are a God send, literally. Weight loss, supplementing with less dangerous antacids (only when absolutely needed), natural remedies and a strict, acid reflux friendly diet will work eventually. You just have to stick with it.

  9. Saf
    MD
    Reply

    I have been patient of GERD for several years since 1997. I have been using PPI since and also have Hiatus Hernia. I recently read about CKD ( Chronic Kidney Disease) or Acute Kidney Failure.
    I went to the Doctor and she put me to wean off this with Zantac 300 twice a day with 20mg Nexium (I am on 40mg Nexium). Then after two weeks i will quit 20mg nexium (OTC) and only use 300 mg Zantac twice for two weeks and then reduce to one pill a day and so on.

    I am keeping my finger crossed and see what will happen. I am 45 year and did not like kidney failure side effect of these pills. She told me that I will be on some kind of H2blocker due to my Hiatus Hernia. I have done all the tests back in 2005 but no positive result except Hiatus Hernia.

    Thanks for all the honest input and comments. Please pray for me and I will try to get back.

    • Nancy
      Las Vegas
      Reply

      How did you do with the weaning? Am in the same position.

  10. T
    Ontario
    Reply

    One word for all you on this journey…
    Ginger…

    Dehydrated or Dried…
    Fresh root boiled into a tea.
    Candy made with real ginger “strong stuff, like gin gins”

    1TBS worth of ginger per day in the morning and be amazed.

    Gingerale dont work. you need real ginger, a solid amount.

    • M
      BC
      Reply

      I am wondering if T from Ontario was sucessful in getting off the PPI using his MD’s method?

  11. Julie
    Ohio (OH)
    Reply

    Personally, I am mad. I have been on PPI’s since the early 90’s, or thereabouts. I was feeling fine. Sure, I have post menopausal aches and pains, but to be able to eat and not suffer the burning, acidy, misery was wonderful. Mind you, my doctors wrote the prescriptions, and the pharmacy filled them, every time. Now, all of a sudden, they are this lethal drug that we must fear, and all the healthy food I have been eating is doing me no good? I am not getting proper nutrition? Also, in all those years, I have not had pneumonia, or stomach problems, diarrhea, or anything like that. I have been now, due to my doctor not wanting me to continue, on rantinidine, and it works for a while, but today especially, I woke up with an acidy stomach, have had to chew antacids twice, and also broke down and took an omeprazole and am waiting for it to kick in. Maybe they need to do more research.

  12. Diane Cole
    Orange Park, FL
    Reply

    I was diagnosed with acid reflux 15 years ago. My first medication was Nexium and later Prilosec. At one point I tried to stop taking it but had too hard of a time with doing so. Since taking this medication I have been diagnosed with rheumatoid arthritis, osteoarthritis,stage 3 kidney disease and had hip replacement surgery. After hearing about the side effects of these PPI drugs have now become determined to wean myself off of it once and for all. Currently into my second week and it is going smoothly but know it may get worse before getting better. I am taking Pepcid not Nexium or Prilosec every 3rd day and am hoping to wean myself completely off any digestive drug permanently. Also am taking Aloe Vera Distilled Liquid 2 times daily, in the morning and at night. For indigestion flare ups during the day taking 1 – 2 teaspoon of apple cider vinegar with water. Eating an apple relieves fare ups as well. Also have stopped eating chocolate, caffeine, alcohol, fried foods, processed foods and limited sweets. My hope is to eventually lean towards a vegetarian diet. Desperate people do desperate things. I am sincerely desperate to be healthy and am finally feeling empowered to take control of my health. Best of luck to all on this journey to rid yourselves of this dangerous drug.

    • Judy
      Reply

      How long did it take Diane. I’m only on second week cold turkey. Your account could have been written by me. Situation so similar but I have developed three spinal fractures. Thanks.

  13. jay
    india
    Reply

    Useful.

    • Tyr
      iceland
      Reply

      When you stop them try this: have baking soda (sodium bicarbonate) on the side. It nutralizes the acid, and it’s good for the kidneys, as well. Just do half a teaspoon, and drink plenty of water when heartburn comes

    • Sue
      Missouri
      Reply

      I was prescribed Prilosec several years ago and I took it off and on until just recently.

      Several things helped wean me off it: When I feel heartburn coming on, I eat a piece of crystalized ginger. I keep a jar of it around at all times. I’ve also cut way back on meat. I don’t know if I’ll ever become a vegetarian, but we’ll see. I also take a couple tablespoons before meals of an aloe drink which also contains ginger, fennel, mint, and some other things.

      I’m not sure I can mention the name, but it comes in a white bottle and it’s sold at health food supermarkets. Lately I’ve been making fruit and veg smoothies with nuts and I’ve seen a marked decrease in heartburn because the stomach doesn’t have to work so hard to digest the fiber.

      I highly recommend getting one of these machines–don’t get a juicer which strains out the fiber, use one that pulverizes everything. I make sure I have a little kefir every day and when drinking non-fermented milk, I substitute almond milk. Finally, I take enzymes with my evening meal which I get at a health food store. I’m not sure if one of these things works, or they all work together, but so far things have been pretty good.

  14. Donna
    Florida
    Reply

    I had terrible heartburn years ago that had greatly irritated my esophagus. My GI doctor told me I was at risk for Barrett’s Esophagus and esophageal cancer, so he started me first on Pepcid. That didn’t help… too much break through, so he had me try RX Prilosec. Didn’t work either.

    Then he prescribed Nexium, which I took for years with success; however, in the interim, my osteopenia worsened and I lost 2 inches of height! Eventually, I started having breakthrough of acid while on the Nexium and now take Dexilant. It works just fine, but I have lost another inch and a half of height!

    My family doctor told me to stop the medication. He didn’t discuss tapering off or other options. I tried to go off cold turkey and ended up feeling as if my stomach lining was on fire! Not to mention how irritated my esophagus felt. After reading various comments of remedies that have helped others, I am going to try to taper off the Dexilant (It is terribly expensive), and try some of the remedies that those people have had success with. As a retired RN, I know the best medication list has the fewest prescriptions. This is definitely one I’d like to finally get off of!

  15. Thai
    California
    Reply

    I was on 40 mg. Protonix once a day for several months for GERD, and the med, along with avoiding foods and beverages that irritate me worked wonders. Knowing PPI’s aren’t a good long term solution I began taking two DGL tablets for acid after meals and using Slippery Elm Bark powder in cooked oatmeal or water several times a day. The natural food dept. of a good grocery store can order it in 1 lb. bags. I used about 1 T. per dose. Yes, it tastes like tree bark and I don’t like it at all, but it’s so mucilaginous in the gut it works wonders. It helped me wean off the Protonix while gradually cutting the days I took the PPI’s. BTW, my Internist first prescribed Prilosec, which was worse on my gut than the IBS I was also experiencing at that time. When I went to a GI doctor, he said he never starts patients on Prilosec, as Protonix is more effective and less irritating to the gut. Huge difference, relief at last!

  16. Julie R.
    Modesto, Ca 95355
    Reply

    I had a Dr. tell me to drink Apple Cider Vinegar. The brand he said was Bragg (with the Mother) raw organic. Any thoughts or info?

    • Judy
      Reply

      Yes before meals. Dilute it. A few tsp to start with water. Increase to 1-2 Tbls with water. Eat slowly

  17. MARY
    HICKORY NC
    Reply

    My doctor recommended protonix after I had a perforated ulcer “just in case”. I took them even though I had no GERD when I started. After a year with no symptoms, we decided I could stop the protonix. I asked if I should taper and he said no, just stop.

    I had serious rebound heartburn, and had to go back on the meds for 2 weeks. I got the People’s Pharmacy paper on digestive disorders and decided to taper. I reduced 1 dose every 2 weeks and used licorice before meals. After 14 weeks I was successfully off protonix, never to return. Thanks, People’s Pharmacy.

  18. Marilyn
    WA
    Reply

    After over 15 years of taking Prilosec (omeprazole) I got myself off of it by taking one pill every other day for a week, then one every two days for another week, then one every third day for a week. After the beginning of the fourth week I no longer needed them. To ease the early symptoms of heartburn I took a few small pieces of candied ginger and it stopped the pain immediately.
    I got myself into this situation because I was allergic to the pain medications given to me after my knee replacement and was told to take ibuprofen in large doses (prescribed by the doctor, for a couple of weeks); but since it was OTC there was no warning label. Another doctor later told me to take all medications WITH FOOD, (which could be as little as a glass of milk or a few crackers), except those like my thyroid medication and Prilosec which had to be taken on an empty stomach each morning; then took ibuprofen immediately after my meal. I had had an endoscopy prior to starting the Prilosec.

  19. BETH M.
    Reply

    After using omeprazole given to me by my doctor 30years ago I gradually became more unwell and many many complaints. Then I decided to tell a surgeon that is going to do surgery on me and she was also concerned about this drug so she wrote to my doctor and asked for me to be removed from it and put me on zantac.

    Dc put me on small dose in the morning of the omeprazole to withdraw from this but I’ve managed most days just to have my one tablet of zantac late evening.
    Bone problems have settled and sweating stopped so I feel good for that.
    what you can also do is buy a small zantac and use that in the a.m. then continue with the larger one given on prescription stick with it I have and I feel so much better for it.

  20. LW
    illinois
    Reply

    After several failed attempts, I got off PPIs after a nasty bout of stomach flu with lots of vomiting. I decided that since my GI tract clearly had to rebalance itself after this indignity, I would stop the PPI during recovery. Boom. No rebound heartburn (which had been horrible during previous attempts at weaning). I never took one again (and never will!)

  21. Helen M
    Modesto, CA
    Reply

    Getting off is not impossible – poo-hoo to those doctors that refuse to consider a way to help! Hey, that’s their job; but who today does a job as well as people did 50 years ago? Anyway, I used to call myself the heartburn queen of the world, kept the Tums right by my bedside and fell asleep with one in my mouth. Yes, you learn how without choking. When my doctor gave me protonix I was in heaven, no more heartburn. I took it for several years, then, because of cost, decided I needed to use less. I bought something OTC, this was 2010, and began to skip protonix a couple days a week, substituting the OTC. Eventually I was only on the OTC, which was not as strong as protonix, with no heartburn. So I began skipping that now and again, then every M, W, F. Then taking it on M, W, F. This was over the course of about half a year. Then I took my fears by the throat, and began dropping the OTC one day a week, until about a month later, I was off and I did not have heartburn anymore.

    During the course of this time, I stopped eating ice cream and lost over 20 pounds, which may have been contributing factors. However, I am here to say I did it, others will come aboard to say the same.

    BTW, tho I did not connect the dots until I read about it here: I fell at an airport and broke three ribs while on this medication, and I had been taking it for several years at that point. It was about a year later that I began my withdrawal from the med.

  22. wendy
    Reply

    I had acid reflux beginning about twenty years ago, and just lived with it until someone told me about Digestive enzymes. I began taking them right before meals
    ( I used Absorbaid, because it’s pretty full-spectrum) and have never had a problem since. Wouldn’t that work for other people, as well?

  23. Liz
    Maryland
    Reply

    I successfully got off my PPIs. I used the People’s Pharmacy guide but honestly found that 1% milk was a godsend. It took about 9mos for the rebound acid to subside. Stick to quitting and know that it will get better. I drank milk every time I felt acid creeping up and also right before bed. Also drink water or milk about 15mins before eating; I found it helped having something in my stomach prior to a meal. Good luck! You can do this!!!

    • Kathy
      Denver
      Reply

      Thank you for the encouragement. I have started the withdrawal from PPIs.The mornings are fine but the afternoon and evenings are horrible. I am 1 week into it and have wanted to go back to PPI. am going to try the licorice or slippery elm for the flare ups and hope to be able to get off ppi for good,including this zantac. Thanks for the comments

  24. DS
    TX
    Reply

    Getting off PPIs is extremely painful and damaging to the esophagus. That the FDA allows them to be sold at all and now over the counter is very troubling. Please keep warning people about the dangers of these drugs. I think any doctor who says ” you do not need stomach acid” should be made to take a PPI for several years. People should know that HCI is necessary for digestion and that indigestion is just that–discomfort from the absence of digestion. Digestive bitters can help by stimulating all of the bodily secretions needed for digestion.

  25. Heather
    Australia
    Reply

    I take Nexium for acid reflux. I was on 40 mg. but started drinking ginger tea 4 times a day and 1 month later am now down to 20mgs nexium.

  26. Kathleen
    California
    Reply

    I was on Protonix for years and my Osteoporosis was getting worse, which is a typical side-affect. I decided to go the natural route and found an Aloe Vera treatment that worked wonders. I gradually went off the Protonix over two or three weeks while I was taking the Aloe product. When I finally started taking just the Aloe, I was able to even cut down on that after a month or so as I believe it was healing the problem. Now I just take a small amount of it every day and I feel fine.

  27. Lindsey
    Wilson, NC
    Reply

    GERD is primarily a manifestation of OSA [obstructive sleep apnea]. All hormone systems in the body are disrupted by OSA and the gastrin, VIP, GIP etc of the GI tract is also part of this disruption. The normal 24 hour acid production is doubled in individuals. Most stomach acid is normally produced between 10PM and 2AM each day. Your comments in today’s column are correct about having to wean from PPI’s gradually. Replacement with H2RA is also a solution. Most important, evaluation of an underlying sleep disorder is very important. Other suggestive symptoms: nocturia, lower extremity edema (84% of CHF is caused by OSA), depression, htn (OSA is the number 1 contributing factor to htn), glaucoma, erectile dysfunction, snoring, excessive daytime somnolence, difficulty initiating or maintaining sleep. There are approximately 12 other cardinal symptoms.

    • John
      New York
      Reply

      The previous post is nonsense. GERD is absolutely not primarily a manifestation of OSA. GERD has several causes as most of us chronic GERD sufferers know and is usually a result of a dysfunctional lower oesophageal sphincter muscle at the gastric junction. OSA may contribute to GERD in some people but it certainly isn’t the primary cause and spreading mis information like that is irresponsible.

      • June
        Calgary
        Reply

        A lack of calcium effects the sphincter muscle, allowing the acid to enter the esophagus. You need high acid levels to digest your foods, especially meat protein. Take a good quality calcium magnesium supplement daily. Use digestive enzymes before meals, and finish off with apple cider vinegar in water to help digestion. Use probiotics and replenish your gut bacteria.

      • Liz
        Reply

        My NHS sleep apneoa doctor says there is an association between sleep anpneoa and acid reflux. I have both these conditions.

        • Helen
          Florida
          Reply

          I have both sleep apnea and GERD. I have been on Protonix 40 mg. for about 9 years. I never wanted to be on any prescription but the Doctor said “just for a while to heal your esophagus” well it turned out there was no damage there to begin with. He just assumed but when he did the tests, all was well. In the meantime I had started the PPI and let me tell you, I LOVED it!

          For the first time in years, I could eat pizza and ice cream and I immediately gained 30 unneeded pounds. Now I am trying to get off of it. I am trying an otc version but at 1/2 the mg. This is my first day. I already feel more full and a little weird.

          Last time I tried cold turkey, and I couldn’t believe the pain in my throat and chest, like a heart attack. I will grab some ginger, slippery elm, aloe drink etc. on my way home from work. I sure hope this works. Thanks for all of the input. I’ll let you know.

    • Judy
      Reply

      Never heard that before

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