![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by ryan_s on August 5, 2002, at 21:37:01
First of all thank all of you for your support over the last four years of my life. These last four years have been extremely difficult. I have been on over twenty different medications without any relief. However, with patience, my hunt for a medication that makes me feel normal and happy has finally arrived. Ondansetron a 5ht antagonist has made a huge difference in my life. The fog has started to lift and this med is allowing me to get back on track with my life. I know that so many of you feel trapped in your current situation. Please Pleas Please, from what I have learned, trust yourself and if a medication does not work, switch medications and do not keep on taking a med b/c your pdoc insists that it will help your in the future. Believe me your will know when a med is making a difference in your life. Also, do not take this the wrong way; I am not fully cured from my anxious situation, but a for the first time in years I feel that I am taking tremendous strides with ondansetron. If any of you have questions please post a reply, and I will get back to you as soon as possible.
Best Regards,
RyanGet busy livin or get busy die--Shawshank Redemtion
Posted by bobbyy on August 6, 2002, at 5:20:25
In reply to Tremendous strides with ondansetron , posted by ryan_s on August 5, 2002, at 21:37:01
wow..i am so happy for you..I never heard of the medication until I just read your post..so I just scanned pubmed...I am bipolar II and come from alcoholic genes...but don't drink..am searching for answers for my extreme anxiety and depression
...am on loads of meds...
so keep on searching...
found this which I found interesting..but again so happy for you...TAKE CARE ..BOBBY
Ondansetron reduces the craving of biologically predisposed alcoholics.Johnson BA, Roache JD, Ait-Daoud N, Zanca NA, Velazquez M.
Department of Psychiatry, University of Texas, Health Science Center at San Antonio, 7703 Floyd
Curl Drive, Mail Stop 7792, San Antonio, TX 78229-3900, USA. bjohnson@uthscsa.eduRATIONALE: Early onset alcoholics (EOA) differ from late onset alcoholics (LOA) by having
greater serotonergic abnormality, familial history, and a range of antisocial behaviors. Previously,
we showed that ondansetron, a selective 5-HT3 antagonist, effectively treated EOA. Proximate
motivational drives such as craving could have determined drinking behavior. We therefore
investigated whether ondansetron treatment would reduce alcohol craving significantly among
EOA. OBJECTIVES: We tested the hypothesis that the craving outcomes of EOA, compared with
LOA, would be differentially improved by ondansetron. We also tested the prediction that craving
would be significantly correlated with drinking behavior. METHODS: We studied a cohort of 253
out of 321 enrolled alcohol dependent subjects. These 253 subjects were entered into a 1-week
lead-in single-blind placebo period followed by 11 weeks of double-blind outpatient treatment. Study
design was a 2 (EOA versus LOA)x 4 medication dose (placebo, or ondansetron 1, 4, or 16
microg/kg b.i.d)x 13 (visits) factorial analysis of variance. Craving was measured at each visit using
seven visual analogue scales. Subjects received 12 weekly sessions of standardized group cognitive
behavioral therapy. RESULTS: Data reduction by factor analysis of the visual analog scale items
yielded one dimension, overall craving. Ondansetron 4 microg/kg b.i.d. reduced overall craving
significantly among EOA. In contrast, ondansetron (1 microg/kg b.i.d.) increased craving
significantly in LOA. Decreased overall craving was positively correlated with reduced drinking and
negatively associated with increased abstinence. CONCLUSIONS: Compared with placebo,
ondansetron (4 microg/kg b.i.d.) was associated with significant reductions in overall craving in
EOA but not LOA, presumably by ameliorating serotonergic abnormality.
Posted by Stan on August 6, 2002, at 5:58:21
In reply to Tremendous strides with ondansetron , posted by ryan_s on August 5, 2002, at 21:37:01
> First of all thank all of you for your support over the last four years of my life. These last four years have been extremely difficult. I have been on over twenty different medications without any relief. However, with patience, my hunt for a medication that makes me feel normal and happy has finally arrived. Ondansetron a 5ht antagonist has made a huge difference in my life. The fog has started to lift and this med is allowing me to get back on track with my life. I know that so many of you feel trapped in your current situation. Please Pleas Please, from what I have learned, trust yourself and if a medication does not work, switch medications and do not keep on taking a med b/c your pdoc insists that it will help your in the future. Believe me your will know when a med is making a difference in your life. Also, do not take this the wrong way; I am not fully cured from my anxious situation, but a for the first time in years I feel that I am taking tremendous strides with ondansetron. If any of you have questions please post a reply, and I will get back to you as soon as possible.
>
> Best Regards,
> Ryan
>_______________________________________________
hi ryan -- glad to hear of your success with ondansetron -- i have a few questions if you don't mind.....i've heard of this med before and i know it was formerly used primarily as an anti-nausea agent until researchers discovered that it can also relieve anxiety and depression for some individuals with mood disorders. i've heard that its main mode of action is to antagonize the 5-HT3 group of serotonin receptors, many of which are found in the gut (thus the antimetic effects), but these receptors are also present in the brain. the only other common antidepressant or anti-anxiety agent that blocks 5-HT3 receptors is remeron, as far as i know, and that one has a "kitchen-sink" approach in some respects in that it interferes with all sorts of brain receptors. ondansetron is intriguing from the standpoint of its specificity of action. but i digress.....on to my questions:
how many milligrams of this are you taking per day? are you combining it with any other "mood-drugs"? have you experienced any sedation, dizziness, dry mouth, or any of the other side effects which sometimes go along with antagonism of certain serotonin receptors? what drove you to try this drug -- did you investigate it on your own, or was your doctor "hip" to it already? is it expensive? hope i'm not prying too much, but i'm curious about this one.....
i'd also welcome any comments from other board-visitors who might have some familiarity or experience with ondansetron.
thanks much,
Stan
Posted by bobbyy on August 6, 2002, at 6:07:50
In reply to Re: Tremendous strides with ondansetron » ryan_s, posted by Stan on August 6, 2002, at 5:58:21
egads..I just looked up zofran at http://www.rxusa.com a cheaper online drug site
it is expensive..also looked it up on a canadian website..can't put the url down cuz I am an affiliate..it is much cheaper but still expensive
Bobby
Posted by Ritch on August 6, 2002, at 9:47:37
In reply to Tremendous strides with ondansetron , posted by ryan_s on August 5, 2002, at 21:37:01
> First of all thank all of you for your support over the last four years of my life. These last four years have been extremely difficult. I have been on over twenty different medications without any relief. However, with patience, my hunt for a medication that makes me feel normal and happy has finally arrived. Ondansetron a 5ht antagonist has made a huge difference in my life. The fog has started to lift and this med is allowing me to get back on track with my life. I know that so many of you feel trapped in your current situation. Please Pleas Please, from what I have learned, trust yourself and if a medication does not work, switch medications and do not keep on taking a med b/c your pdoc insists that it will help your in the future. Believe me your will know when a med is making a difference in your life. Also, do not take this the wrong way; I am not fully cured from my anxious situation, but a for the first time in years I feel that I am taking tremendous strides with ondansetron. If any of you have questions please post a reply, and I will get back to you as soon as possible.
>
> Best Regards,
> Ryan
>
> Get busy livin or get busy die--Shawshank Redemtion
>Ryan,
How much and how often do you take it? How much is it costing you (I know it is expensive out the yin-yang). I asked a question about it some time back. I was interested in how adding it to an SSRI would reverse the GI upset that accompanies SSRI use (reflux, diarrhea, nausea, etc.). Can you be more specific in how it affects you, and what types of meds you have taken previously and for what diagnosis?
thanks,
Mitch
Posted by ryan_s on August 6, 2002, at 18:52:20
In reply to Re: Tremendous strides with ondansetron » ryan_s, posted by Stan on August 6, 2002, at 5:58:21
Thanks for everyones support; I truely appreciate it. As for your questions stan, I will be more than happy to answer them for you.
After trying prozac, paxil, serzone, buspar, neurontin, depakote, celexa, lithium, adderall, klonopin, cytomel, synthroid, zyprexa, geodon, seroquel, tegrotal, effexor, remeron, and others that I have probably forgotten, I knew that there was something wrong with my brain that none of the above medications addressed. To tell you the truth it was very frustrating telling the pdoc that an SSRI, antipsychotic, anticonvulsant, or an amphetamine like adderall, were not getting to the heart of my problem and that same pdoc forcing different SSRI in my face tell me, "2/3's of patients that do not do well with one antidepressant will have a profound affect with another". Hogwash, I do not mean to be a cynic, but deep down inside I knew that depression was not the problem and not one pdoc agreed. Once I began to understand what was wrong with me, genetically predisposed alcoholism or early onset alcoholism, the puzzle began to fit into place. I researched as much as possible online and before my initial treatment with ondansetron, I tried acamprosate (a drug pending FDA trials for the treatment of alcoholism and has also been available in Europe for years) and it made me feel somewhat normal. A sense of normalcy in which no other medication listed in the opening sentence gave me before. I knew that I was onto something. After a month on acamprosate, the side effects were a little unbearable, so I wanted another option. This is where Ondansetron comes into this little autobiography. I ordered this med from overseas and yes it is extremely expensive. However if you buy the pills in packs of ten it is only 100 dollars, and you can take each one of the 4mg tablets and split them up as small as possible. It is very easy to split them since they are dissolvable on the tongue. Anyways to get to the heart of this story, I take .25mg twice daily and the only side effect is a little headache and that is it. Good luck with your quest for happiness.
Ryan
Posted by Ritch on August 7, 2002, at 0:56:03
In reply to Re: Tremendous strides with ondansetron, posted by ryan_s on August 6, 2002, at 18:52:20
> Thanks for everyones support; I truely appreciate it. As for your questions stan, I will be more than happy to answer them for you.
>
> After trying prozac, paxil, serzone, buspar, neurontin, depakote, celexa, lithium, adderall, klonopin, cytomel, synthroid, zyprexa, geodon, seroquel, tegrotal, effexor, remeron, and others that I have probably forgotten, I knew that there was something wrong with my brain that none of the above medications addressed. To tell you the truth it was very frustrating telling the pdoc that an SSRI, antipsychotic, anticonvulsant, or an amphetamine like adderall, were not getting to the heart of my problem and that same pdoc forcing different SSRI in my face tell me, "2/3's of patients that do not do well with one antidepressant will have a profound affect with another". Hogwash, I do not mean to be a cynic, but deep down inside I knew that depression was not the problem and not one pdoc agreed. Once I began to understand what was wrong with me, genetically predisposed alcoholism or early onset alcoholism, the puzzle began to fit into place. I researched as much as possible online and before my initial treatment with ondansetron, I tried acamprosate (a drug pending FDA trials for the treatment of alcoholism and has also been available in Europe for years) and it made me feel somewhat normal. A sense of normalcy in which no other medication listed in the opening sentence gave me before. I knew that I was onto something. After a month on acamprosate, the side effects were a little unbearable, so I wanted another option. This is where Ondansetron comes into this little autobiography. I ordered this med from overseas and yes it is extremely expensive. However if you buy the pills in packs of ten it is only 100 dollars, and you can take each one of the 4mg tablets and split them up as small as possible. It is very easy to split them since they are dissolvable on the tongue. Anyways to get to the heart of this story, I take .25mg twice daily and the only side effect is a little headache and that is it. Good luck with your quest for happiness.
>
> RyanRyan,
Thanks for the added info. Acamprosate is also an experimental treatment for bipolar disorder from what I understand. I do remember seeing a news story on TV about an Odansentron trial a while back. Perhaps the manufacturer can substantially cut prices if there are other potential "off-label" uses that could increase the volume and economy of scale besides just chemotherapy and general anesthetic induced vomiting and nausea?
Mitch
Posted by Shawn. T. on August 7, 2002, at 1:53:40
In reply to Tremendous strides with ondansetron , posted by ryan_s on August 5, 2002, at 21:37:01
Other selective 5-HT3 antagonists are granisetron, tropisetron, and hydrodolasetron. I find tropisetron to be the most interesting one of the bunch (2 to 5mg hint hint). You would probably be able to give the people curious about substance p antagonists a bit of knowledge (5-HT3 antagonists may be better in my opinion, but I can't say for sure). I'd like to hear from someone that has combined one of these drugs with Wellbutrin; I am wondering about how that might work out. Note that I'm primarily interested in these drugs for their pain relieving effects (some people say antidepressants are actually analgesics; I would agree).
http://nootropics.com/tropisetron/index.html
http://www4.infotrieve.com/search/databases/detailsNew.asp?artID=28908356
http://www4.infotrieve.com/search/databases/detailsNew.asp?artID=24286515
http://www4.infotrieve.com/search/databases/detailsNew.asp?artID=29152513
http://www4.infotrieve.com/search/databases/detailsNew.asp?artID=28908361
http://www4.infotrieve.com/search/databases/detailsNew.asp?artID=11338441
http://www4.infotrieve.com/search/databases/detailsNew.asp?artID=23342224
http://www4.infotrieve.com/search/databases/detailsNew.asp?artID=16309414
http://www4.infotrieve.com/search/databases/detailsNew.asp?artID=10633193
"The absolute reduction in pain-score was -13.5% for 5 mg tropisetron, -13.0% for 10 mg tropisetron, and -6.3% for placebo (p<0.05). The effects of 15 mg tropisetron were similar to placebo, thus suggesting a bell-shaped dose-response curve."
I'd like to figure this out. 5-HT3 receptors are confusing, however, so I'm not sure it will be an easy puzzle to put together. I am super curious about how that information might apply to Remeron; I am constantly telling people that they're taking too much. I really believe that 5-HT3 antagonists are terrific drugs. I disagree with the kitchen sink statement about Remeron; I find that it is a well thought out drug. What's not well thought out is the dosage recommendations. 7.5mg/day works well for me, and I was even considering lowering the dosage just to see what happens. I burned one of my fingers on a hot oven coil and felt a glimpse of slight pain for about a second. I can bite hard into my arm (for science, not mutilation), leaving a mark, and feel no pain at all. Stubbing my toe isn't nearly as bad as it used to be, etc etc. I'll go deeply into detail on why 5-HT2 and 5-HT3 antagonists relieve pain if anyone wants me to...
Shawn
Posted by Stan on August 7, 2002, at 7:44:30
In reply to Re: Tremendous strides with ondansetron , posted by Shawn. T. on August 7, 2002, at 1:53:40
<<<<<Shawn T. wrote the stuff in brackets>>>>>
<<<<<<Other selective 5-HT3 antagonists are granisetron, tropisetron, and hydrodolasetron. I find tropisetron to be the most interesting one of the bunch (2 to 5mg hint hint). You would probably be able to give the people curious about substance p antagonists a bit of knowledge (5-HT3 antagonists may be better in my opinion, but I can't say for sure). I'd like to hear from someone that has combined one of these drugs with Wellbutrin; I am wondering about how that might work out. Note that I'm primarily interested in these drugs for their pain relieving effects (some people say antidepressants are actually analgesics; I would agree).>>>>>
hi shawn - i haven't tried any of the 5-HT3 antagonists alone or in combination but i'm certainly going to research those links you posted to see if one might be appropriate for experimentaion without costing a fortune like ondanestron. i recall you mentioned that blocking this receptor may inhibit the release of substance P which in turn may result in a reduction in psychic pain as well as physical pain. for some reason i seem to remember hearing some second-hand reports that merck's "substance P" drug trials weren't going very well and perhaps their investigational drug wasn't proving very effective at alleviating depression & anxiety.....but that info could be flawed.
<<<<I disagree with the kitchen sink statement about Remeron; I find that it is a well thought out drug.>>>>>
i was the one that made that statement, but i didn't mean it in a derogatory sense -- in fact it may be the next antidepressant that i try. i think antagonism of 5-HT2A, 5-HT2B, 5-HT2C, and 5HT3 (all of which remeron accomplishes) is capable of producing positive improvements in depressives whose symptoms include anxiety, insomnia, agitation, restlessness, etc. i'm taking serzone, which only antagonizes 5-HT2A, and i'm still highly anxious and wondering if blocking those additional sub-receptor groups with remeron would be more beneficial for me.
however, as far as remeron's effects at adregenic and histamine sites go, i'm not so sure that that the drug scores high marks for minimizing side effects with its various manipulations in those places. it is an alpha-2 antagonist, which is good in the sense that this allows more serotonin to be released (and "directed" towards the 5HT1A receptor) but perhaps not so good from the standpoint of releasing too much NE and perhaps being over-stimulative and actually having an anxiogenic effect for some sensitive patients who are bothered by over-activation. it seems that a VERY potent antihistamine effect (blocking H-1) was thrown in to counterbalance this excess NE release.....and there's the rub. no drug is perfect, of course, but it seems to me that this is where this drug falls down.....it's common for antihistamines to produce sedation and weight gain, and many people become more depressed when they are tired much of the time and if they're already above their ideal weight (very common for americans), additional gains can be equally depressing. histamine blockers can be somewhat anxiolytic and promote sleep, but it appears that remeron's antihistamine effects are just too potent for the average individual. higher doses (45-60 mg) are supposed to activate the NE-releasing effect to such a degree that the antihistamine consequences become less noticable and sedation less pronounced.....but i wonder why the alpha-2 and H-1 antagonism wasn't left out altogether (hence my "kitchen-sink" comment about affecting multiple receptors). but since i've never taken it and because i assume that it's very difficult to "design" these newer drugs to an optimal degree, then i guess we just have to give remeron the benefit of the doubt. i look forward to trying it this fall sometime.
<<<<< What's not well thought out is the dosage recommendations. 7.5mg/day works well for me, and I was even considering lowering the dosage just to see what happens. I burned one of my fingers on a hot oven coil and felt a glimpse of slight pain for about a second. I can bite hard into my arm (for science, not mutilation), leaving a mark, and feel no pain at all. Stubbing my toe isn't nearly as bad as it used to be, etc etc. I'll go deeply into detail on why 5-HT2 and 5-HT3 antagonists relieve pain if anyone wants me to...
Shawn>>>>>i'd be very interested in reading your comments pursuant to that topic, shawn, if you get a chance to post them. also, here's a link to an article that covers certain aspects of remeron which may be of interest to you -- if you scroll down aways you'll see that the author suggests that at low doses, remeron's potent antihistamine properties essentially override its other effects, which he claims kick-in only after doses considered therapeutic for depression are administered (15 mg and higher). by the way, what do you think of serzone? if you haven't tried it, perhaps you'll have comments on a purely theoretical basis. here's that link:
Column - Imipramine, Mirtazapine, and Nefazodone: Multiple Targets:
http://www.preskorn.com/columns/0003.htmlStan
Posted by michael on August 7, 2002, at 16:24:29
In reply to Re: Tremendous strides with ondansetron » Shawn. T., posted by Stan on August 7, 2002, at 7:44:30
Fwiw - I haven't looked lately, but a couple of years ago I got ondansetron via the internet from on-line pharmacies in India... very affordably, even w/$40 shipping charge. Might be worth looking into.
Posted by Shawn. T. on August 8, 2002, at 22:42:03
In reply to Re: Tremendous strides with ondansetron » Shawn. T., posted by Stan on August 7, 2002, at 7:44:30
> "hi shawn - i haven't tried any of the 5-HT3 antagonists alone or in combination but i'm certainly going to research those links you posted to see if one might be appropriate for experimentaion without costing a fortune like ondanestron. i recall you mentioned that blocking this receptor may inhibit the release of substance P which in turn may result in a reduction in psychic pain as well as physical pain. for some reason i seem to remember hearing some second-hand reports that merck's "substance P" drug trials weren't going very well and perhaps their investigational drug wasn't proving very effective at alleviating depression & anxiety.....but that info could be flawed."
I believe that they should look into using that drug for pain relief instead of the treatment of depression. Substance P acts at neurokinin-1 (NK-1) receptors. There are two other NK receptors, and NK-2 antagonism may turn out to be more effective than NK-1 antagonism (a drug or combination of drugs acting at both of these receptors would be very effective at relieving inflammation). Neurokinin A acts at NK-2 receptors, and neurokinin B acts at NK-3 receptors. I'm fairly positive that your information wasn't flawed.
>
> <<<<I disagree with
the kitchen sink statement about Remeron; I find that it is a well thought out drug.>>>>>
>
> i was the one that made that statement, but i didn't mean it in a derogatory sense -- in fact it may be the next antidepressant that i try. i think antagonism of 5-HT2A, 5-HT2B, 5-HT2C, and 5HT3 (all of which remeron accomplishes) is capable of producing positive improvements in depressives whose symptoms include anxiety, insomnia, agitation, restlessness, etc. i'm taking serzone, which only antagonizes 5-HT2A, and i'm still highly anxious and wondering if blocking those additional sub-receptor groups with remeron would be more beneficial for me.
>Serzone increases activation of 5-HT2c & 5-HT3 receptors via its serotonin reuptake inhibition property. That could cause anxiety.
"however, as far as remeron's effects at adregenic and histamine sites go, i'm not so sure that that the drug scores high marks for minimizing side effects with its various manipulations in those places. it is an alpha-2 antagonist, which is good in the sense that this allows more serotonin to be released (and "directed" towards the 5HT1A receptor) but perhaps not so good from the standpoint of releasing too much NE and perhaps being over-stimulative and actually having an anxiogenic effect for some sensitive patients who are bothered by over-activation."
You're exactly right; alpha-2 antagonism is not a desirable property to have in an antidepressant drug. Alpha-2 receptors can decrease inflammatory cytokine levels and noradrenaline levels, which are definitely desirable properties to have in an antidepressant (NA reuptake inhibitors increase alpha-2 activation, which interestingly can cause anxiolytic effects). High noradrenaline levels can cause alpha-1 NA receptor activation; that results in increased CRF (corticotropin release factor) release. This is offset, however, by the inhibitory effects of beta adrenoceptors on CRF release (it probably be unwise to combine a beta blocker with Remeron). High NA levels are generally undesirable; that is why I am not crazy about high doses of Remeron.
"it seems that a VERY potent antihistamine effect (blocking H-1) was thrown in to counterbalance this excess NE release.....and there's the rub."
I would guess that they would have left the H1 effects out if they could have. I think that 7.5mg is better than 15mg because the H1 effects aren't quite as severe (people generally aren't as drowsy while taking the smaller dose). I would like to know how strongly the smaller dose affects 5-HT2a/c receptors.
"no drug is perfect, of course, but it seems to me that this is where this drug falls down.....it's common for antihistamines to produce sedation and weight gain, and many people become more depressed when they are tired much of the time and if they're already above their ideal weight (very common for americans), additional gains can be equally depressing. histamine blockers can be somewhat anxiolytic and promote sleep, but it appears that remeron's antihistamine effects are just too potent for the average individual. higher doses (45-60 mg) are supposed to activate the NE-releasing effect to such a degree that the antihistamine consequences become less noticable and sedation less pronounced.....but i wonder why the alpha-2 and H-1 antagonism wasn't left out altogether (hence my "kitchen-sink" comment about affecting multiple receptors). but since i've never taken it and because i assume that it's very difficult to "design" these newer drugs to an optimal degree, then i guess we just have to give remeron the benefit of the doubt. i look forward to trying it this fall sometime."
I sort of consider Remeron to be the handwashing sink (just a smaller sink) of antidepressant drugs; it is certainly not perfect, just better than most. The higher dose/ lower side effect theory is interesting, but in the end, not exactly true. I like the idea of lowering those dose below 15mg to decrease histamine relate side effects rather than increasing it. I'm going to discuss with my psychiatrist how the lower dose has worked in other patients; he may have suggested the lower dose because I was already taking Wellbutrin, however.
>
>
> "i'd be very interested in reading your comments pursuant to that topic, shawn, if you get a chance to post them."I'm still researching the topic; there isn't exactly a wealth of data out there, but just enough for me to get by.
"also, here's a link to an article that covers certain aspects of remeron which may be of interest to you -- if you scroll down aways you'll see that the author suggests that at low doses, remeron's potent antihistamine properties essentially override its other effects, which he claims kick-in only after doses considered therapeutic for depression are administered (15 mg and higher). by the way, what do you think of serzone? if you haven't tried it, perhaps you'll have comments on a purely theoretical basis. here's that link:
>
>
> Column - Imipramine, Mirtazapine, and Nefazodone: Multiple Targets:
> http://www.preskorn.com/columns/0003.html
>
> Stan
>
>
I'd read that a while ago; I sort of skimmed over it then, however. Dr. Preskorn has a good article on why in vitro data is usually not a good predictor of in vivo pharmacology. I usually dismiss most of the in vitro studies that I see, unless the specific situation seemed to make such an approach valid.
Shawn
This is the end of the thread.
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