Controlling heartburn/reflux without a PPI?

[ILiveInFlipFlops]

Can this be done? I have very persistent reflux, and given the new research, I managed to get off Prilosec without too much rebound trouble 5-6 weeks ago. However, the reflux has increased along with my weight, so I'm sure that's a major culprit, and while I'm motivated, I have a good amount of weight to lose. Now I pretty much have painful reflux after eating or drinking anything, and this morning I woke up with a horrible lump in my throat from the acid. 

 

Obviously I need to manage this much better than I currently am, but I'm worried about taking Prilosec now. I can't take Tums because for whatever reason, one Tums is enough to...er, stop up the works (IYKWIM) for days, literally. I've been drinking baking soda water, but that seems to be having the same effect, oddly, and there's only so much of that I can stomach. 

 

I've been doing some Googling on alternatives to PPIs, but I'm mostly coming up with natural "remedies," none of which have ever worked for me (I swear I tried them all before giving up and taking the Prilosec). 

 

Do other medications or treatments for heartburn exist that can be used long-term while I work on losing the weight? I also can't lose weight too quickly because of my history of making gall stones (gall bladder was removed a few years ago). 

 

Ugh! Such a pain in my rear (and throat). I'd love to hear any suggestions anyone has. Thanks!

[J-rap]

Sleeping on my back or my left side (never the right) makes all the difference for me, at least at night, when I'm most prone to getting it).  I heard a reason for it once, but can't remember it.  It truly, though, makes a huge difference for me.

 

 

[gardenmom5]

eat a liver friendly diet - and I avoid all forms of sugar.

 

eta: low thyroid can also *trigger* the chain reaction that starts reflux.  (free t3, free t4 and reverse t3 should be at *optimal* levels.  western medicine treats  to  TSH - which is an utterly worthless number, and if the TSH is 4, they dont' care if you are still symptomatic.  optimum TSH is actually *below* 1 1/2.)

 

 

eta: since engaging in a liver friendly diet - I have only very rarely had heartburn (and then just used tums.)  almost every single time was because I had sugar.  I used to be on a rx

Edited June 13, 2016 by gardenmom5

[SparklyUnicorn]

I haven't figured anything out.  I take Prevacid.  I take a break from it now and then, but no I can't manage without it long term.

 

I bought a wedge pillow.  That helps a lot at night.

 

You could try something like Zantac. 

[SparklyUnicorn]

not sure if Zantac is a PPI...I do think it's different, but not sure.

 

 

[VeteranMom]

I had terrible reflux and was on nexium for years.  I do believe that the PPIs are poison.  I was able to stop my medication.  It took quite a bit of trial and error to find something that would stop my symptoms.  I take a daily probiotic.  The thing that has most helped, though, is drinking a glass filled with half apple juice, half water, and a couple tablespoons of Bragg's Apple Cider Vinegar.  It can be taken a multiple times throughout the day.  I usually only drink it at bedtime now.  Make sure to drink it was a straw and brush your teeth immediately after you are finished.  Do you have any foods that seem to cause worsening of your symptoms?  A big issue for me is wheat.  If you can figure out foods that bother you, try to cut back or eliminate them.  I really like to read Dr. Axe's advice.  I think I have leaky gut and try to work on fixing that.  I had my gallbladder out, too, and things really went downhill for me after that.  

[Bambam]

I'd love to know too. 

 

I've tried a wedge pillow. Uncomfortable and seemed to make no difference.

 

I've tried the digestive enzymes when a YL consultant friend recommended (not the YL brand though, I'm not willing to pay their inflated prices). Didn't seem to make a difference.

 

It does help slightly if I avoid certain trigger foods (anything with caffeine, strawberries, lemons, orange, tomato-based sauces, probably chocolate but I'm ignoring that - just cutting back!). But even if I'm good for weeks, I still have acid reflux. So discouraging. It is just worse if I indulge in any of those triggers.

 

I'm currently on Dexilant because it was pretty bad. I try to take it every three days vs. daily though. I don't like it, but it is terrible without it.

[SparklyUnicorn]

I have tried some of the natural remedies.  It didn't do anything.  The vinegar was the worst one of all.  Really it's like you have reflux, here is some battery acid...

 

And there is no rhyme or reason or triggers for me. I had it when thin...heavier...and everything in between.  Didn't matter.  It started when I was pregnant and never went away.

 

 

 

 

[Carol in Cal.]

What is wrong with Prilosec??

 

(I take it occasionally, as needed)

 

I have gotten pretty good results with strong ginger tea.  I cut 5-6 'coins' of peeled, fresh ginger root, drop them in a mug, pour boiling water over this, and let steep until lukewarm, about every 2-4 hours during the day.  Prilosec stops acid production, so the reflux still happens but it's not acidic, but ginger seems to actually heal my stomach so that the reflux stops.  

[City Mouse]

Losing weight and changing my eating habits fixed my acid reflux. Usually, it will go away within 2-3 days on a lower carb/lower calorie diet.

 

When I do have issues, I take Pepcid Complete or the generic version.

[ILiveInFlipFlops]

eat a liver friendly diet - and I avoid all forms of sugar.

 

eta: low thyroid can also *trigger* the chain reaction that starts reflux.  (free t3, free t4 and reverse t3 should be at *optimal* levels.  western medicine treats  to  TSH - which is an utterly worthless number, and if the TSH is 4, they dont' care if you are still symptomatic.  optimum TSH is actually *below* 1 1/2.)

 

I really like my current GP, but she is useless in this area. I asked her to run thyroid tests, but she only ordered the standard tests and accepted the normal range the lab gives. I need to find a doctor that will take this seriously. I'm just not sure how to go about doing that!

 

I haven't figured anything out.  I take Prevacid.  I take a break from it now and then, but no I can't manage without it long term.

 

I bought a wedge pillow.  That helps a lot at night.

 

You could try something like Zantac. 

 

Ah, thanks! That gave me a place to start looking. Zantac is not a PPI, it's a H2 blocker, and what I just read said it's good for nighttime. That might be a good solution for the moment.

 

I had terrible reflux and was on nexium for years.  I do believe that the PPIs are poison.  I was able to stop my medication.  It took quite a bit of trial and error to find something that would stop my symptoms.  I take a daily probiotic.  The thing that has most helped, though, is drinking a glass filled with half apple juice, half water, and a couple tablespoons of Bragg's Apple Cider Vinegar.  It can be taken a multiple times throughout the day.  I usually only drink it at bedtime now.  Make sure to drink it was a straw and brush your teeth immediately after you are finished.  Do you have any foods that seem to cause worsening of your symptoms?  A big issue for me is wheat.  If you can figure out foods that bother you, try to cut back or eliminate them.  I really like to read Dr. Axe's advice.  I think I have leaky gut and try to work on fixing that.  I had my gallbladder out, too, and things really went downhill for me after that.  

 

 

The ACV was absolutely horrible for me, unfortunately. Besides making my heartburn worse, it made my nose stuffy constantly and gave me terrible post-nasal drip. I tried for weeks and finally gave it up. Within days, I was back to normal. I seriously tried just about every natural alternative I could find, but no luck. 

 

Gluten is definitely one of the triggers, as are caffeine (sob!) and chocolate. But these days it's really everything I eat. I just ate two little plain eggs for breakfast, and my heartburn kicked in about 10 minutes later. I'm supposed to be drinking a lot of water, and even a glass makes my heartburn kick in (it floats the acid). Very frustrating.

[EmilyGF]

I think some people can and some people can't. My FIL, one of the healthiest living people I know (runs or walks daily, no sugar, no caffeine ever, cut out all sorts of foods to control his heartburn, etc) was never able to get it under control. He only was willing to take heartburn pills when his doctor told him he'd be at risk of cancer if he didn't get the heartburn under control.

 

Emily

[ktgrok]

I've pretty much given up. I can go a day or two without prilosec, but then it comes back. Not sure if it is rebound acid or what but it isn't tolerable. 

[SparklyUnicorn]

I've pretty much given up. I can go a day or two without prilosec, but then it comes back. Not sure if it is rebound acid or what but it isn't tolerable. 

 

I would die without Prevacid.  Seriously seriously so damn painful without it.

 

My son has acid reflux too.  I don't know what to make of that.  He is young and not overweight.  He had it since being a baby (when i started with it).  He doesn't take the PPIs though.  He manages with Zantac.

[ktgrok]

I would die without Prevacid.  Seriously seriously so damn painful without it.

 

My son has acid reflux too.  I don't know what to make of that.  He is young and not overweight.  He had it since being a baby (when i started with it).  He doesn't take the PPIs though.  He manages with Zantac.

 

yup. When I was pregnant with my 2nd I would aspirate acid into my lungs while sleeping and wake up coughing and sputtering. Nothing is worth that. 

 

I've had heartburn since I was a teen, and wasn't overweight. It came and went, then stuck around after the last pregnancy. I would wake up crying with my first pregnancy, just in tears over the pain. That pregnancy I took only tums, at the insistence of my care providers. The next one same, only tums, and was aspirating acid. I did discover baking soda and water with that one, which worked way better than tums. third, I said screw it and took zantac or pepcid or something...whichever had the safest rating. I still had heartburn, but didn't think I was going to die and never ended up in tears. 

 

If I get pregnant this time, I'm staying on prilosec. I've done the research, and I'm comfortable with my choice. I just will not go through that again. And I seem to maintain my iron count okay on prilosec. Otherwise I'd be taking tums all day long and the calcium blocked my iron intake and I was horribly anemic. I just can't do it again. 

[SparklyUnicorn]

yup. When I was pregnant with my 2nd I would aspirate acid into my lungs while sleeping and wake up coughing and sputtering. Nothing is worth that. 

 

I've had heartburn since I was a teen, and wasn't overweight. It came and went, then stuck around after the last pregnancy. I would wake up crying with my first pregnancy, just in tears over the pain. That pregnancy I took only tums, at the insistence of my care providers. The next one same, only tums, and was aspirating acid. I did discover baking soda and water with that one, which worked way better than tums. third, I said screw it and took zantac or pepcid or something...whichever had the safest rating. I still had heartburn, but didn't think I was going to die and never ended up in tears. 

 

If I get pregnant this time, I'm staying on prilosec. I've done the research, and I'm comfortable with my choice. I just will not go through that again. And I seem to maintain my iron count okay on prilosec. Otherwise I'd be taking tums all day long and the calcium blocked my iron intake and I was horribly anemic. I just can't do it again. 

 

Hey same here.  First pregnancy they said I could only take stuff like Tums.  No Zantac no nothing.  That doesn't cut it!  Second pregnancy they said I could take Zantac.  That made it bearable.

 

Oddly if I take too many Tums it gives me diarrhea.

[jjeepa]

I've pretty much given up. I can go a day or two without prilosec, but then it comes back. Not sure if it is rebound acid or what but it isn't tolerable. 

 

This is me!  After reading about the recent research finds, that honestly scared me, I tried to cut back to taking Prilosec every other day.  The rebound reflux was horrible.  Searing, sharp, acute pain.  No thank you.  It's a quality of life issue for me now.  I hate being on them.  I don't think they are safe, but nothing else has worked.  I eat a very restricted diet anyway because of the reflux and hypoglycemia...there's no other triggers to cut out and I still have the reflux.  

[ktgrok]

This is me!  After reading about the recent research finds, that honestly scared me, I tried to cut back to taking Prilosec every other day.  The rebound reflux was horrible.  Searing, sharp, acute pain.  No thank you.  It's a quality of life issue for me now.  I hate being on them.  I don't think they are safe, but nothing else has worked.  I eat a very restricted diet anyway because of the reflux and hypoglycemia...there's no other triggers to cut out and I still have the reflux.  

 

Exactly.

 

I did find that cutting out carbonation helped a lot. I drank a lot of sparkling water. And sugar. And of course the normal triggers, but at some point when even water is a trigger you need meds. 

[marbel]

You have to work with a doctor to help you assess the various risks.    I've been off and on PPIs for years - 18 at least, I think. I see a kidney specialist because of stones (not related to PPIs).  My kidneys look great, he says.  He didn't even blink when he reviewed my medications list and I had omeprazole listed.  He's not a hack doctor, but a very highly respected specialist. 

 

One thing I saw - and could not find again, so no cite, sorry - was that studies relating PPIs and kidney failure did not control for NSAID use among the study subjects.  NSAIDs are another potential cause of kidney disease, apparently. 

 

So, I realize that is just anecdotal (about me) and vague (about the article I can't find again).  But, sometimes it's about mitigating and not eliminating risks.  Using some made-up numbers:  If PPI use doubles a 1% risk of one health problem, but cuts by 25% a 10% risk of a different one, I would probably be willing to take that risk.  

 

Anyway, the only times I've been able to get off PPIs is when I lost weight.  I carry all my weight in my stomach, and it has a huge effect on that.  Unfortunately it is a terrible struggle to keep the weight down.

Edited June 13, 2016 by marbel

[hornblower]

You could try tweaking diet a bit more 

[Laurie4b]

What worked for me: 

 

Elevated head of bed (dh put blocks under feet of bed at the head, so no wedge pillow)

Sips of cold water as needed

Small meals

Chewing gum (saliva apparently counteracts stomach acids, so with chewing gum, you get constant saliva)

 

PPIs have their own issues. H2 drugs can cause or aggravate cognitive decline once you're older. I try to avoid all drugs like that.

[HRAAB]

I have severe GERD.  I was on Nexium for years until the side effects got to be too much.  These are some ideas that have helped me, to some extent.  Of course, I have to remember and employ some serious self discipline.

 

Sit very straight when eating.

Chew very slowly (count to 20)

Do not bend over after eating for at least an hour

Take a walk after eating.  Not fast walking, slow and leisurely

Avoid foods that trigger my reflux (obviously).  I have a list of acidic and alkaline foods, with the ones that cause me the most distress highlighted, on my refrigerator as a reminder

Don't combine proteins with starches.  No meat and potatoes for me.

When eating an acidic food, pair it with an alkaline one.  For instance, eggs with spinach and avacado

Take a zantac when I know I'm going to be eating outside my normal routine

 

I've had three esophageal endoscopies with dilation to open up strictures caused by the GERD.  Every time I get the same advice.  Take Nexium daily and come back when you have trouble swallowing.  Or surgery for my hiatal hernia.  Gee, thanks.

 

I've been off PPIs for almost a year now.  If I religiously follow the above list, it is much better.  Not totally alleviated, but better.  But life being what it is, I don't always.  At least the side effects from the Nexium are gone.

 

Oh, I lost 10 lbs., mostly from my middle, and I do believe that has helped.  Now if I could lose another 20.

 

 

[HRAAB]

One more thing.  I used to drink a lot of water with every meal because I thought it alleviated the feeling of reflux.  I've found out that if I don't drink much liquid with my meals, it is actually better.  I think it is due to not filling up my stomach with liquid and creating more pressure.

[Lady Florida.]

You have to work with a doctor to help you assess the various risks.    I've been off and on PPIs for years - 18 at least, I think. I see a kidney specialist because of stones (not related to PPIs).  My kidneys look great, he says.  He didn't even blink when he reviewed my medications list and I had omeprazole listed.  He's not a hack doctor, but a very highly respected specialist. 

 

One thing I saw - and could not find again, so no cite, sorry - was that studies relating PPIs and kidney failure did not control for NSAID use among the study subjects.  NSAIDs are another potential cause of kidney disease, apparently. 

 

So, I realize that is just anecdotal (about me) and vague (about the article I can't find again).  But, sometimes it's about mitigating and not eliminating risks.  Using some made-up numbers:  If PPI use doubles a 1% risk of one health problem, but cuts by 25% a 10% risk of a different one, I would probably be willing to take that risk.  

 

 

 

My gastro doc put me on prescription strength Nexium about a month before the study linking it to kidney problems became news, and before that I had been on OTC versions on and off for years. Naturally I was concerned when the study came out.

 

Some things do help, like keeping my weight down, eating the right diet for my condition, and not eating large meals or eating too close to bedtime. (I tried raising the head of the bed but that did nothing). Still, in the end, the medicine helps the most. 

 

The doctor also told me to lay off the NSAIDs, which I was taking for my chronic back pain. I didn't realize the study hadn't taken NSAID use into consideration but that would definitely make a difference.

 

My story too is anecdotal but I just wanted to commiserate. It's important not to take any drug, including OTC, without keeping your doctor informed. PPIs are OTC so people tend to self-medicate, which is certainly not a good idea for long term conditions.

 

OP, I suggest you try some of the suggestions made here. Many are recommended even for those of us who regularly take PPIs. However, don't be terrified of medication. Talk to your doctor. Make sure he looks carefully at your individual risk factors and then determine if short or long term medication along with other lifestyle and diet changes are right for you. I sound like a commercial, but it's true. 

[marbel]

<snip>

 

My story too is anecdotal but I just wanted to commiserate. It's important not to take any drug, including OTC, without keeping your doctor informed. PPIs are OTC so people tend to self-medicate, which is certainly not a good idea for long term conditions.

 

<snip>

 

Every time my kids and I see a doctor of any kind, I take a list of every medication (prescription and OTC), vitamin, herbal supplement etc. that the subject of the appointment takes on a regular basis.  (I don't mention, say, ibuprofen for the occasional mild headache or cramps.)  When my kids used medicated acne creams, I included those, because antibiotic creams count.   

 

No doctor has ever said "no thanks, don't need to see this."  Even if the doctor has nothing to do with the problem, they see it. (Allergist may or may not need to know about GI drugs, but she's going to.) 

Edited June 13, 2016 by marbel

[mathnerd]

eat a liver friendly diet - and I avoid all forms of sugar.

 

 

Sorry for the hijack - stress is a trigger for my heartburn - so, what is a liver friendly diet? What should I avoid eating to prevent heartburn and reflux?

[hornblower]

Sorry for the hijack - stress is a trigger for my heartburn - so, what is a liver friendly diet? What should I avoid eating to prevent heartburn and reflux?

 

I posted a link above you could check out. 

 

Foods to avoid if you want to be nice to your liver: alcohol, fats esp fried foods, saturated fats, processed foods. 

 

Liver friendly would be low fat, high in vegetables, high in  fiber. 

[gardenmom5]

I really like my current GP, but she is useless in this area. I asked her to run thyroid tests, but she only ordered the standard tests and accepted the normal range the lab gives. I need to find a doctor that will take this seriously. I'm just not sure how to go about doing that!

 

 

 

 

.

Stop the thyoid madness -sttm.com - has info on how to order your own labs, how to find a doc, and what to look for Edited June 13, 2016 by gardenmom5

[clemota]

There's been some recent research on melatonin and reflux/heartburn.  A quick google search brought up the following article http://www.medscape.com/viewarticle/717460_5

 

Something in a slightly more friendly format:  http://www.drweil.com/drw/u/QAA400827/Melatonin-for-Acid-Reflux.html

 

It seems that it's not a cure-all, but there is some research backing it up.  Maybe ask your doctor?

 

[abcmommy]

I started WW in February and have not needed acid reflux meds since beginning it.  I was startled to feel so much better so quickly.  I was taking prilosec or similar daily and also usually adding in zantac.  It was BAD

[MerryAtHope]

My heartburn etc... went away after I started on the No-S diet. I wasn't even expecting that as a side-effect, but I guess my system was just really over-taxed with the way I was eating previously. I like that No-S is so do-able and sustainable too. 

[ktgrok]

wanted to add that I eat low carb, small meals and even when on liquids only after weight loss surgery still needed the prilosec. I HAVE gone down from nexium to prilosec, so that is something (nexium is basically twice as strong). 

 

 

[SparklyUnicorn]

wanted to add that I eat low carb, small meals and even when on liquids only after weight loss surgery still needed the prilosec. I HAVE gone down from nexium to prilosec, so that is something (nexium is basically twice as strong). 

 

I've tried everything but voodoo.  Water gives me reflux.  There is really no telling when I'll get it. 

 

I've been lower carb for years.  I eat plenty of fiber.  I don't tend towards overly processed anything. 

 

I honestly think some of this diet advice is ridiculous.  When I was pregnant, when it started, I went days without eating nearly anything and sipping water.  Still had it. 

 

One thing I do know is that my uterus never went back down.  My "theory" is that it's pushing up and that's not helping.  Of course trying to get a doctor to actually listen is another story.

[Carol in Cal.]

I've tried everything but voodoo.  Water gives me reflux.  There is really no telling when I'll get it. 

 

 

This is when the ginger really helps me a lot.  YMMV.

[SparklyUnicorn]

This is when the ginger really helps me a lot.  YMMV.

 

Oh I tried that too.  I've tried all sorts of remedies people swear by.

 

I have not tried Melatonin, but I won't.  Why bother?  Sounds like something that guy just wants to sell for one thing.  I'm done wasting money on it.

[ktgrok]

I've tried everything but voodoo.  Water gives me reflux.  There is really no telling when I'll get it. 

 

I've been lower carb for years.  I eat plenty of fiber.  I don't tend towards overly processed anything. 

 

I honestly think some of this diet advice is ridiculous.  When I was pregnant, when it started, I went days without eating nearly anything and sipping water.  Still had it. 

 

One thing I do know is that my uterus never went back down.  My "theory" is that it's pushing up and that's not helping.  Of course trying to get a doctor to actually listen is another story.

 

huh..my uterus is out of place as well, it's adhered to my uterine wall in fact. Up high, out of my pelvis, where I can feel it. Never connected the two things, but it certainly could play a role. 

[ktgrok]

This is when the ginger really helps me a lot.  YMMV.

 

Oh wow...no. Ginger is one of my biggest reflux triggers! It loosens the LES valve, letting more stuff wash back up. Ginger snaps, ginger ale, anything with ginger. 

[SparklyUnicorn]

huh..my uterus is out of place as well, it's adhered to my uterine wall in fact. Up high, out of my pelvis, where I can feel it. Never connected the two things, but it certainly could play a role. 

 

Oh now that is interesting.

[Tap]

What is wrong with Prilosec??

 

(I take it occasionally, as needed)

 

I have gotten pretty good results with strong ginger tea.  I cut 5-6 'coins' of peeled, fresh ginger root, drop them in a mug, pour boiling water over this, and let steep until lukewarm, about every 2-4 hours during the day.  Prilosec stops acid production, so the reflux still happens but it's not acidic, but ginger seems to actually heal my stomach so that the reflux stops.  

Occasional use is fine.  The problem is some people take it once or twice every single day.  They have linked long term, daily use to some health issues. Also your body adjusts to them,  so that if you skip one, you get heartburn.  Some people become reliant on them, don't change their diet/or lifestyle, and steadily start increasing their dose.

[Tap]

Have you tried taking an antacid like Ranitidine/Zantac?

 

I don't use it, but dh does and it works great for him.

 

I get heartburn if I drink citrus drinks before I lay down in bed. I don't get it if I am sitting up, buy laying down is not good.   Margaritas (lime +alcohol) are horrible for me after dinner time, even if it is going to be hours before bed..  I use Gaviscon Extra Strength tablets, but I can use it as a preventive, since I know it is going to happen.  It doesn't prevent the acid like a PPI (Prilosec,Nexium, Prevacid), but it reduces the acid once it is there.

Edited June 14, 2016 by Tap

[The Governess]

When mine has been so bad that I get that lump-in-throat feeling, one thing that has really helped is drinking hot mugs of chicken broth. At times it was the only thing I could eat or drink that wouldn't make things worse.

[BrittanyM]

Sauerkraut works wonders for me. You have to get the kind that hasn't been heated, like Bubbies brand, or Trader Joe's has one too. If I know I'm going to eat something that will cause heartburn I eat a couple tablespoons of sauerkraut a half hour before the meal and don't have a problem. If I start to feel acid building up I drink some of the juice in the jar or eat a few bites and it almost always helps. I've also been using some enzymes and that has helped as well but not as reliably.

 

 

Sent from my iPhone using Tapatalk

[sheryl]

Thank you for this thread. 

 

I had an endoscopy after my birthday in March. 

 

I had one nearly 30 years ago as well.

 

This most recent test resulted in a good report and I'm thankful!  He said that my esophagus was 13, I think, and they like it to be 16 or so.  They stretched it and put me on Prilosec temporarily - 3 to 4 months.  Finishing in 2 weeks will put me on the med for 3 months.  Now after reading this thread, I may stop earlier than planned.

He also said allergies can trigger symptoms.   I had allergies for now and was on shots and meds.  I'm now allergy free and not on shots/meds.

 

However, I do need to lose weight!
 

[SparklyUnicorn]

Sauerkraut works wonders for me. You have to get the kind that hasn't been heated, like Bubbies brand, or Trader Joe's has one too. If I know I'm going to eat something that will cause heartburn I eat a couple tablespoons of sauerkraut a half hour before the meal and don't have a problem. If I start to feel acid building up I drink some of the juice in the jar or eat a few bites and it almost always helps. I've also been using some enzymes and that has helped as well but not as reliably.

 

 

Sent from my iPhone using Tapatalk

 

I eat lots of sauerkraut.  We even make our own.

 

Does.not.work....