Time to Grow a Spine

[kneedragger]

it's occurred to me that i may not actually have any therapists. they may just be voices in my head. i still like the PhD better than the MD. which is weird since it was the PhD's idea for me to start taking drugs in the first place. i've been miserable ever sinceÂ…certainly more miserable than i was before i met herÂ…i thinkÂ…it's hard to remember. anyway, the PhD likes to blame the MD and she encourages me to do the same. which is also weird since she was the one who recommended the MD. the voices don't play by their own rules.

but i did what she said. i called up the MD and said these drugs suck; they're fucking useless. i asked her if there was anything else to try or should we just resort to my original suggestion; medicinal marijuana. she ignored my suggestion...again. she's very even keel despite my tone being thick with accusation. is that further evidence that she's not real? i didn't call her a quack, but that's what that voice inside my head was screaming. i guess the outside me still has better manners.

but then she turned into a pusher. at least that's what i've been telling myself. maybe she was a pill pusher all along, maybe not, but i can't go back to her now. she acknowledged that everything she'd recommended wasn't working, so her solution was to try an anti-psychotic. i smiled politely and then punched her as hard as i could on her left tit. i'm pretty sure i only did it in my imagination, but if i really need anti-psychotics, i guess i can't be sure. i told her to cancel my future appointments and then i left.

i got back to my office and starting doing searches on withdrawal symptoms for wellbutrin and lexapro. i have three voicemails on my cell phone from little miss MD warning me not to stop taking the drugs. the stupid bitch is worried about the side effects of withdrawel - like there's anything SHE could teach ME about side effects. holy shit, i might get irritable? i might have nausea and diarrhea? anxiety? dizziness? loss of balance and coordination? does anybody else find it fucked up that the side effects of not taking the drugs are the same as the side effects of taking them? fuck these people and they're fucking drugs. bring on the fucking side effects!

[Notdeadyet]

Day 200

Thought I'd update the community on my experiences with therapyu and anti-depressants. Some of you have expressed interest in learning from my experiences, so I hope this is helpful. Here is the history of my prescriptions over the last 60 days:

August 8th - 10mg Lexapro
August 17th - 10mg Lexapro and 100mg Wellbutrin Sr
September 7th - 10mg Lexapro and 200mg Wellbutrin Sr
September 21st - 10mg Lexapro and 300mg Wellbutrin XL

These changes are all related to my feedback and what I've experienced as side effects. The Lexapro made me very drowsy and the sexual side-effects are frustrating. The Wellbutrin was meant to counter some of this. It did make me feel more awake, but I still have the suppressed libido. We stepped up the Wellbutrin because it seemed to be having more positive impact. But Wellbutrin is a stimulant and my doctor is hesitant to prescribe significant increases all at once. That's why I've had to take it in stages. Some people experience significant anxiety and feel like their heart is pounding out of their chest when they take Wellbutrin. I've experienced some of the anxiety, but not the accelerated heart rate.

Unfortunately, I felt the best when I was on the 200mg of Wellbutrin Sr. For some reason, going to XL seemed to not work as well, even though the dosage is increased. It's supposedly the same stuff, just in an extended release format, so you can take one tab in the morning and not have to take multiple tabs during the day. I was very disappointed when I actually felt worse after making this change.

Overall, this process has been extremely frustrating. The lack of positive results while seeing two separate therapists is a little tough to handle. I've also had a lot of uncomfortable side effects that the literature says only occur in very few patients. So far I've had anxiety, diarrhea, flatulence, decreased libido, difficulty ejaculating, drowsiness and weird cravings for carbohydrates. The anxiety feels like a restlessness and tension that triggers cravings for me. I've been pigging out to fight the cravings. I'm up about 12lbs and all my pants are tight. Tight waste bands are tough when you already have GI discomfort. I've taken to pulling up close to my desk and undoing my belt and top button. I've come close to ditching this whole process several times. The only thing keeping me hanging on is the fact that I have so much invested. A finance guy would tell you that's faulty logic, but it is what it is.

Wellbutrin is supposed to generally improve your mood. It acts on dopamine, same as nicotine. Lexapro is supposed to give you this feeling of separation from what's causing the depression. You can still see it and deal with it, but you're not as emotionally attached. I guess I started to feel some of the benefits of improved mood from Wellbutrin, but I haven't felt anything close to the way Lexapro is supposed to make you feel. If anyone's had different experiences, I'd love to hear about it.

Unfortunately, while all this has been going on, my wife has been spending weeks out in Detroit caring for her terminally ill mother. We've been flying back and forth on the weekends, but the weeks are lonely. Being home alone is also a powerful trigger for me. I've averaged a pint of Ben  Jerry's a night fighting these cravings and I haven't worked out in three and a half weeks.

Spending time on the KTC website has been a huge help to me during this time. I read constantly and still post roll call in the June 2011 and July 2010 quit groups. This morning, I logged on to post roll in June 11, and everyone was congratulating me on 200. Wasn't really expecting that - it felt pretty damn good. Just the boost I needed to stay quit another day. Thanks to everyone for keeping me honest. I'd have been crawling back to the nic bitch a long time ago if it weren't for this community.

-KD out

Thanks KD. This is exactly the kind of stuff that takes big nuts to share and really helps a lot of people. You are one bad-ass quitter.

-NDY

[kneedragger]

Day 200

Thought I'd update the community on my experiences with therapyu and anti-depressants. Some of you have expressed interest in learning from my experiences, so I hope this is helpful. Here is the history of my prescriptions over the last 60 days:

August 8th - 10mg Lexapro
August 17th - 10mg Lexapro and 100mg Wellbutrin Sr
September 7th - 10mg Lexapro and 200mg Wellbutrin Sr
September 21st - 10mg Lexapro and 300mg Wellbutrin XL

These changes are all related to my feedback and what I've experienced as side effects. The Lexapro made me very drowsy and the sexual side-effects are frustrating. The Wellbutrin was meant to counter some of this. It did make me feel more awake, but I still have the suppressed libido. We stepped up the Wellbutrin because it seemed to be having more positive impact. But Wellbutrin is a stimulant and my doctor is hesitant to prescribe significant increases all at once. That's why I've had to take it in stages. Some people experience significant anxiety and feel like their heart is pounding out of their chest when they take Wellbutrin. I've experienced some of the anxiety, but not the accelerated heart rate.

Unfortunately, I felt the best when I was on the 200mg of Wellbutrin Sr. For some reason, going to XL seemed to not work as well, even though the dosage is increased. It's supposedly the same stuff, just in an extended release format, so you can take one tab in the morning and not have to take multiple tabs during the day. I was very disappointed when I actually felt worse after making this change.

Overall, this process has been extremely frustrating. The lack of positive results while seeing two separate therapists is a little tough to handle. I've also had a lot of uncomfortable side effects that the literature says only occur in very few patients. So far I've had anxiety, diarrhea, flatulence, decreased libido, difficulty ejaculating, drowsiness and weird cravings for carbohydrates. The anxiety feels like a restlessness and tension that triggers cravings for me. I've been pigging out to fight the cravings. I'm up about 12lbs and all my pants are tight. Tight waste bands are tough when you already have GI discomfort. I've taken to pulling up close to my desk and undoing my belt and top button. I've come close to ditching this whole process several times. The only thing keeping me hanging on is the fact that I have so much invested. A finance guy would tell you that's faulty logic, but it is what it is.

Wellbutrin is supposed to generally improve your mood. It acts on dopamine, same as nicotine. Lexapro is supposed to give you this feeling of separation from what's causing the depression. You can still see it and deal with it, but you're not as emotionally attached. I guess I started to feel some of the benefits of improved mood from Wellbutrin, but I haven't felt anything close to the way Lexapro is supposed to make you feel. If anyone's had different experiences, I'd love to hear about it.

Unfortunately, while all this has been going on, my wife has been spending weeks out in Detroit caring for her terminally ill mother. We've been flying back and forth on the weekends, but the weeks are lonely. Being home alone is also a powerful trigger for me. I've averaged a pint of Ben  Jerry's a night fighting these cravings and I haven't worked out in three and a half weeks.

Spending time on the KTC website has been a huge help to me during this time. I read constantly and still post roll call in the June 2011 and July 2010 quit groups. This morning, I logged on to post roll in June 11, and everyone was congratulating me on 200. Wasn't really expecting that - it felt pretty damn good. Just the boost I needed to stay quit another day. Thanks to everyone for keeping me honest. I'd have been crawling back to the nic bitch a long time ago if it weren't for this community.

-KD out

[kneedragger]

Day - 183

I'm taking a break from bitching about my problems today to share something a bit more important. My wife's mother was diagnosed with Non-Hodgkin's Lymphoma about 11 years ago. She went through several rounds of treatment, including chemo and an autologous (using her own stem cells) stem cell transplant in 2006. Eventually, all of these treatments and exposure to radiation led to MDS, which is a bone marrow condition that can lead to Leukemia. Remarkably, the treatment for this is more radiation and an allogenic (using donor stem cells) transplant. Unfortunately, allo transplants are grueling and very scary, with mortality rates that are quite a bit worse than those for auto transplants. With an iron will, she agreed to the procedure and showed remarkable strength and determination as she fought towards recovery.

Unfortunately, all has not gone as planned. I explain the rest of the story in a letter I sent to my family last week. The last thing I'll add is that my mother-in-law is a beautiful and inspiring woman. It is clear that cancer is a ruthless and non-discriminating killer. The letter is copied below:

Hi All,

I thought you all should know what's happening with [my wife's] mother, Leah. As you may know, Leah was diagnosed with MDS last year. This is essentially a bone marrow deficiency caused by exposure to radiation. If MDS progresses, it can lead to Leukemia. Leah went through a very difficult stem cell transplant to treat the MDS and appeared to be making a remarkable recovery until about 7 months after the transplant. Her blood counts suddenly dropped and we learned that the transplant hadn't worked. She started seeing an Oncologist at [Hospital Name] and started a treatment regimen that consisted of treatments once a day for seven days, every four weeks. It was taxing, but she was starting to enjoy some improvement in her quality of life and had even done some travelling. Unfortunately, in late July, her doctor told her that the treatment wasn't working and her blood counts were dropping again. They switched to another drug and she's been trying that since mid-August.

Last week, she was having problems with sores in her mouth and bleeding gums and she was experiencing extreme fatigue. Her doctor recommended she go to the ER. After a series of tests she was diagnosed with pneumonia and she's been held in the hospital while they attempt to get her fevers under control.

Unfortunately, while this was going on, Leah got news from her oncologist that the second drug is also not working. The only course of action left to her is a very extreme course of very strong chemo. This has been an option that Leah has been avoiding since she learned that her last stem cell transplant didn't work. It's possible that she would not survive the treatment. It's also clear that if she did the treatment and didn't survive it, her remaining days would be extremely unpleasant. It is our belief that Leah will likely opt for supportive care with transfusions and attempt to enjoy the time she has left with her friends and family. The doctor expects her time left will be weeks to months.

Remarkably, Leah remains positive. [My wife] left to be with her Thursday morning. [My son] and I will fly out to see her this weekend. Not sure if you've had the chance to see Leah's blog, but I've copied the link below. Her's is a truly inspiring story of strength and determination that has touched the lives of many.

[link deleted]

Chris

[dchogs]

Jesus, KD, your quit just gave my quit a boost.

While I love my quit and how sexy it is, your quit is the fucking bomb. I'm proud that your quit and my quit are on the same website, Internet, and planet, but I suspect your quit just might be from a different planet that had some crazy evolutional event that caused all of the quit to be fucking awesome. And, of course, they send the most awesome of the awesome to explore and seed other planets.

Keep up the good quit, brother. Keep your wife involved. Thank her. You are a better man without nicotine, and I'm proud of you.

[LLCope]

I am glad you are moving forward and staying Quit! Good for you to do what you need to do to stay quit and improve your quality of life. You have good support from your wife and doctors.

Keep us updated--you are a great asset to this site.

[kneedragger]

Day - 157

I've had two appointments in the last two days, one each with the two therapists I'm seeing, first the MD, then the Phd. But before I get to that, I'm feeling the need to get something off my chest:

I'd like to just give a deeply satisfying and heartfelt fuck you to the world for this mountain of shit. Serve up your best, worldÂ…I got three words for youÂ…IÂ’M STILL QUIT!

Now that I've got that out of my system, my first appt was yesterday with shrink #2; the M.D. She felt my side-effects were excessive, so she wanted to change my prescriptions. But she also told me she was going to be on vacation for the next two weeks, so I was immediately worried about being stuck with a decision that wasn't working. I decided to prioritize the side-effects that I was trying to solve for. The biggest issue for me was that I was experiencing strong cravings. I think the cravings are associated with the side effect of heightened anxiety that's very unsettling. At the same time, I've had feelings that most on this site would refer to as the fuck its. It's this feeling that I'm putting up with all this shit, I have two fucking therapists, I'm taking all these drugs, wouldn't it be easier to just say fuck it and dive into a tin.

Anyway, the cravings are strong and I'm back to avoiding streets with bodegas and tobacco shops. For this reason, I decided getting help with the cravings is more important than fixing my broken tool or my explosive diarrhea. Since I could only change one thing, I stuck with the Lexapro and added Wellbutrin. Wellbutrin works on Dopamine, so it has a side effect of lessoning cravings for those addicted to nicotine. So now I'm on both of them, and eventually, I'll probably have to swap Lexapro for Prozac. But hopefully, I can do that after little miss M.D. comes back from holiday. I also found it interesting that I was having all these side effects with the lowest possible dose of Lexapro. I was only taking 10mg, and my therapist was hoping she could up it to closer to 20mg. I can't imagine the craps I'd be taking under that regiment.

My other therapist meeting was this morning. She's more empathetic and less clinical which is nice. I went with my wife. I think she appreciates my willingness to let her in on everything that's going on and be a part of the decisions about treatment. But my therapist thinks I lean on her when she's there and don't work as hard on the session as I would if it was one on one. There may be something to that. So my wife is going to come periodically going forward but not all the time.

So what's the big summary? First depression sucks, and I definitely feel depressed. The toughest thing is that it's just barely thereÂ…below the surfaceÂ…subtle but corrosive and quite debilitating. If you think you might be suffering from low to moderate depression, definitely talk to someone. Left untreated, it usually gets worse.

Second, these drugs take commitment and patience; two attributes that are in short supply when you're depressed. Having a partner to remind you that you have to see it through can help. I'm glad my wife is there with me, because my case of the fuck its might get the better of me otherwise.

Lastly, it might take a bit more experimenting to find the right mix of medication for me. And it will likely be another 3-4 wks before I start feeling any benefit. I'll be sure to keep you guys posted. Thanks to everyone that's expressed support. I hope to god someone finds all this personal shit helpful.

-KD

[kneedragger]

155 Days - Update on the drugs - sorry this is a bit stream of consciousness, but thought some might appreciate the update. Here's what's transpired since our last round of posts.

My wife and I decided that I should try the anti-depressants and discussed it with my therapist. Unfortunately, my therapist is a Phd, not an MD, so she had to refer me to someone else to get an actual prescription. This involved trying to summarize everything I'd uncovered with my prior therapist in a single 90 minute session with a new lady who I didn't know, trust or even particularly like. It put me in a pretty sour mood, and kinda made my head hurt. I had several "ah, just fuck it" kind of moments, where it just didn't seem worth the trouble to get this stranger to understand me. But eventually I got through it, choked down her egregious bill and left with a prescription for Lexapro, with a chaser of Ativan thrown in for good measure.

Lexapro works as an SSRI drug, which is the mechanism of action. Without getting too detailed about what that means, for most people, it takes four to six weeks to build up in the body before it starts having an impact on depression. Some people claim they feel something immediately. My personal belief is that this a combination of placebo effect and perhaps the relief that comes from having something that gives you hope. Regardless, I haven't had any immediate improvement in my depression symptoms in the week I've been taking the drug. But I have had side effects.

For one, I'm absolutely exhausted. My sleep patterns have been upset at night, so this is contributing to it, but it feels like more than just tired from a bad night's sleep. Last Sat I slept for two hours in the afternoon, still went to bed at 9pm and didn't wake up until 9am the next morning. Then I was still exhausted all day. This wasn't a common side effect that the doctor discussed with me, so I'm planning to ask her about it in my next appointment on Wed.

Side effects that I was expecting included nausea and anxiety. I haven't experienced nausea, but I have had other forms of digestion discomfort. So far, Lexapro has turned my asshole into a bazooka. Supposedly, these symptoms only last for three or four days, so we'll see if they subside.

I've also definitely felt the anxiety. Unfortunately, for me it's actually given my some pretty strong craves. It's just kind of this antsy tension in the small of my back, combined with feeling scatter-brained and struggling to concentrate on things. Not sure why, but it's had me thinking of dip a lot more than usual. I've already binged on pizza twice this week, which I haven't done since the first few weeks of my quit. Ativan is numbing, but it doesnÂ’t seem to quite target it for me. Plus it's addictive, so I'm scared of it. I've only tried one, and I'm thinking I'll probably throw the rest of them away. The new shrink lady said she could prescribe a combination of Lexapro and Wellbutrin if anxiety becomes a problem. Since Wellbutrin works on dopamine receptors, it's often helpful in fighting cravings. It actually lists anxiety as a common side effect as well though, so I'm a bit confused about that. Again, I plan to discuss this more with my therapist.

Finally, libido. I was warned of this one, but if I'm being honest, I think it's pretty cruel. It's like the Pharma companies kicking you when you're down. You never realize what you've got until it's gone. I'm not even talking about sexÂ…just the option to rub one out in the shower if I feel like it. That's every man's god given right. And just to be clear, I still have the urge to do that, and I can still get it upÂ…I just can't finish. I guess I thought I was in pretty good shape, but I'm lacking in wrist endurance and I have no skin left on the bishopÂ… It wouldn't be so bad if I couldn't do it and didn't want to. But wanting to and not being able to just sucks.

Anyway, I have nothing to report on efficacy yet. Hopefully, my next post will have more good news. As I mentioned, there's a number of issues I needs to investigate further with my therapist. I'll update you if something interesting comes out of those conversations.

Proud to be quit with you. Keep fightin' the good fight, gentleman.

-KD out

[Scowick65]

Good stuff. Maybe after you make your choice and some time passes you might assess your choice. I am curious and would like to learn a bit.

[Remshot]

If you go the meds way, remember that it takes time for them to become effective, and if you go off of them, you cannot quit cold turkey. You must be weened from them.

[Parputt]

There is no shame in admitting you need help and definitely no shame in taking medication it will help.

[kneedragger]

Day - 129 - You can't buy support like this...

I guess I can't really claim to be worried about being a pussy, because I'm going to admit publicly right now that I got choked up a bit just now when I checked the site. I continue to be mystified by what makes complete strangers put so much sincere effort into helping me. All I can say is thanks. You guys are really helping me think this through and you've made several points I hadn't considered. The fact that it's all so free of judgment just makes it all the more amazing to me.

Alright, so enough with the gushing. Russ, to answer your question, I never really thought of depression as playing a role in my prior failures. I remember a distinct uneasiness prior to caving, but always thought of it more as anxiety. It was like a weird tension, and I convinced myself I could find relief from it with nicotine. I'm probably not explaining it well, but one thing I can say definitively is that I didn't do anything about it. I think that's part of how I planned to cave the last time - by not doing everything I could to get the help I needed. I instead used it as an excuse to run back to my addiction. So the most important thing for me this time around is not make that mistake again. To get the help I need and do everything I can to protect my quit.

I think what I'm taking away from all this is that I need to do two things.

1). The first is show this thread to my wife. I've committed to making her my partner in this, and I think this thread will help her understand what I'm dealing with and how others have, rightly or wrongly, dealt with similar issues. Assuming that goes wellÂ…

2). Â…the second thing is for my wife and I to meet with my therapist to discuss a plan for the judicious use of medication, hopefully in a non-"forever" sort of way.

Please feel free to pontificate if you disagree with my conclusions or believe there to be glaring omissions.

Thanks to everyone who responded, both in this thread and in PMs. A few personal notes, Scowick, never apologize again for posting on this thread. I've definitely learned to value your input. And, Teamgreen, it's good to hear from you. You were a huge part of my quit when I was in the July 2010 group and now you're helping me stay quit this time around. Amazing. Thanks, brother.

Thanks to you all.

-KD

[rustaf]

This is why I love this site.

I think what it ultimately comes down to is what your comfort level is with meds after listening to your therapist, a med provider (preferably a psychiatrist or a mental health nurse practitioner), your spouse, yourself, and a bunch of people on the internet that have some experience going through the same kind of shit. It can be done without meds for sure. I have seen a lot of people suffer needlessly when they could have gotten help through psych meds, especially men.

I guess I would suggest to try them out. If you aren't satisfied with the results then you haven't lost anything by trying.

You said earlier that you felt as though you were cheating on your quit by trying to gain relief from the depression. Did the depression play a role in your relapse before?

[Scowick65]

This is why I love this site.

[per034]

Day - 127

Havin' a bit of a tough run.  It occurred to me not too long ago that the rage and mood swings usually associated with the early quit had not subsided as much as I would have expected.  I still get pretty frustrated and I can be thrown into a mood swing with little provocation.  I also feel like that voice in my head that says wildly inappropriate things at high volumes is coming closer and closer to breaking through the surface. 

Anyway, I guess I thought I was handling it, but recently my therapist took notice.  In a recent session she recommended anti-depressants.  It was a pretty big blow to my feeling of accomplishment, but she seems to feel like my mood swings are extreme and effecting my ability to function productively.  And of course she thinks it could be taking its toll on my wife.

She assures me that the goal is not to lobotomize me, but it's hard not to feel like I'm just trading one crutch for another.  If this is my new reality, then maybe I just need to learn to live with it.  Regardless, it's been very difficult not to be depressed about possibly needing anti-depressants.  That's obviously counter-productive, but that's been my world for the last week or so.  If anyone's got any advice on this one, I'm all ears.

I had a funk in the 120s. I have not had many since and I am on day 222.

Would you feel the same about anti-depressants if they were insulin for diabetes? You may have a chemical imbalance in your head that needs some adjusting to function in a better way. If that new crutch can save your marriage, your job, the life you have, isn't that worth one pill in the morning or night? Strength is asking for help, not ignoring the problem.

I'm glad you responded, Russ. Partly because I love your avatar, but mostly because I wanted you're opinion. I get the whole chemical imbalance argument, it's just unfortunate that having an imbalance feels a lot like being a whiney bitch.

Regardless of whether or not I'm chemically imbalanced, I'm struggling to find a rationale for anti-depressants that makes sense to me. I think the logic proposed by my therapist is that I'm attempting to adapt, both psychologically and physiologically, to life without nicotine and this imbalance is a temporary side effect of that.

If that's the case, and it's really temporary, then the pills only serve to help me through this rough patch as my body attempts to adjust. This explanation is somewhat appealing as it suggests only a temporary need for medication. But part of me feels that if this is part of the suffering I have coming to me to free myself from nicotine, then I should bare that burden and fight for my freedom on my own. Maybe that's immature, or it's my inner Braveheart speaking, I don't know, but I can't help feeling like I'm cheating on my quit.

The other possibility is that she's wrong, and this is just who I am. Maybe this aspect of me has been muted over the last 25 years by an addiction to nicotine, but if this is my new reality, then I should learn to cope on my own.

What am I missing, Russ?

Adding my 2cents again. Sorry. This conversation is good for me as well because my symptom was/is depression as well.

Here is the ledger

Day 127 vs #of Days you dipped

For me:

Day 222 clean vs 7,300 days of dipping. Probably 2,000 cans dipped.

We have to allow some time for our bodies and mind to adjust.

I get you're point, Scowick, but would this realization help you make a decision as to whether or not you should use anti-depressants?

I would not use anti-depressants because I have a strong bias against drugs of any sort. I am sure this is a hard call on your part. Scowick has a strong bias against drugs but used nicotine for 20 years? 'Crazy'

This is a good conversation here. Kneedragger, I think your mindset is exactly where my mindset would be. I am very much of the "suck it up and be a man" variety. Or at least I was. Then someone very close to me had problems with depression. My attitude was "suck it up and be a man." That was the advice I gave and it didn't work. It spiraled into a deeper depression and bordered on suicidal. I am now a proponent on anti-depressants. I used to think that "depression" was just a new term for being a pussy. I don't think that way anymore. This is real - and there are tools to help you deal with it. Just like KTC is a tool to help you deal with your nicotine addiction, anti-depressants are a tool to help you deal with your depression.

We all quit this nicotine because it was going to kill us. Don't think for a minute that depression can't kill you.

Talk to your therapist about a program. Weaning on and weaning off and how long you should do that for. See if perhaps a 6 month regimen will get you through the haze and you won't need the anti-depressants anymore. Don't think of this as forever. Tell your therapist your worried about "forever" and that you need a concrete plan that shows you the light at the end of the tunnel.

I was of the same mind as you, so I completely understand where you're coming from. Depression isn't "being a pussy." It's real. Get the help that's available.