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Just a few comments on the gammaCore device. As was mentioned by someone earlier in the thread, I think the first inclination on the device should be of the positives it brings. The cost is more a product of our broken and complicated medical system than of it's current cost. The Vagus nerve has long been discussed as it's potential involvement in cluster headaches. So it was a logical choice in research. The company did spend millions on this research and it has an important role to play in the overall need for more research into clusters and helping find another piece of the puzzle. Even research that eliminates possible routes to successful treatments and an eventual cure help paint the picture and help us all zero in on discovery. So, the most important part of this particular story, to me, is the basic research and someone, anyone, investing money into searching for something that helps us as a community that has for so long been completely ignored. The eventual effectiveness of this or any treatment is secondary. Of course we all would hope that this research finds is help but some things will be more of a help than others. Its most important that they keep searching, keep researching. The FDA approved this device because they understood that even of only 30% of the people using it were helped, that's 30% of an entire community that needs help. That's 30% of a community that can find a new option that helps that they didn't have before. I'm extremely happy for those 30%. It should also be important for the rest of us in that there are people looking for things that can help us. That alone should give hope to 100% of the community. Clusterbusters has been trying to help the community since 2002. In many cases its been helping people one at a time. That take s a lot of time and dedication from a lot of people. We appreciate anything that helps just one of us. This is a very close knit community and we know that helping just one person, helps the entire community. When individuals or companies or even government agencies try to take advantage of the community and anyone in the community, we have and will take a stand and try to protect each of us. We have been following this research for many years and we have heard many reports of people getting better results the longer they use this device. Yes we've also heard many stories where it was not helpful at all. Its a similar story for so many of the treatments we choose or have available. We will stay on this and follow up on its success and failures. With the cost being the biggest hurdle for people to try it, we will continue to fight to get insurance companies to cover its cost. As everyone knows, Clusterbusters has always offered help and advice regarding things that people can't get a prescription for from their doctor. We also know that a large portion of our community relies upon staying within the rules and only using prescription medications and treatments. We fight just as hard for all of them and try to move the entire medical community forward to find help for all of us. People should be able to choose whatever treatment works best for them and they should be able to afford that treatment. As simple as that sounds, there are many barriers that we need to tear down. Peace out~ Hope everyone has a great 2019 Bob

I have been amazed by the Ketamine. So many doctors seem to be so scared of it, and the more experience and research I do with it makes me not understand why. Truthfully, I blame Nancy Reagan and her damn drug war, but I tend to blame her for a lot of things. Ketamine can be psychologically addictive, but it is not physically addictive. I have taken ketamine at times daily for two weeks straight. When I stopped I was very surprised to find that the only withdrawal (if you can even call it that) was that I was little cranky for a day or two. Nothing a bong hit or two couldn't help. Another thing that is a amazing is it's short duration of action. Most times the amount I take does not inebriate me much and I can go about my day just fine--when I have had heavy hitters and I go for a higher dose it can be pretty intoxicating but it really only lasts about an hour. You don't get stupid like alcohol or opiates either--you are very aware of the intoxication and you don't want to do stupid things like drive a car or french kiss your cousin. I will say this though, a heavy dose is just weird. I have done a lot of drugs and the only thing I could compare it to is a really strange nitrous oxide trip. As a "dissociative" it can "distance" you from things, I don't know how else to put it. Even when it does not work completely for me and I switch to the big guns like Imitrex, it still seems like a lifesaver. Sometimes it can take 20 min for a shot of trex to work for me--and anybody with clusters knows that 20 minutes is just to long. The Ketamine distances me and tones down the pain, making it a hell of a lot easier to wait it out. So many Doctors are willing to prescribe narcotics that you build tolerance to rapidly for pain, cause physical addiction, constipate the hell out of you, lead to depression and withdrawal...the list of negative effects of the opiates is ridiculous (and yes, I still use them from time to time) For regular, non cluster pain, the combination of Ketamine and opiates seems to be a much better choice than just regular opiates--mostly because the pain relief is more complete and you can take less of the physically addictive opiates. When I was having some really painful teeth work done I was going for the hydrocodone and Cannabis mnixture (another great thing that can lower your needed intake of Opiates) and it worked all right but I was still in a good bit of pain. This seemed like it was eventually causing a cluster which I would take my Ketamine for--and the tooth pain would just disappear. I don't think the Ketamine alone would do it at the low doses I was using, but it seemed like the combo kicked ass. Here is a link to "Postoperative Ketamine Can Reduce Morphine Consumption and Nausea" http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2605142/ One study on Intraoperative ketamine showed that "We have demonstrated that intraoperative preventative ketamine reduces opiate consumption in the acute postoperative period by 37% in opiate-dependent patients with chronic pain who are undergoing painful back surgery. In addition, it seems to reduce pain intensity postoperatively in the PACU and at 6 weeks and to reduce consumption of morphine at the first postoperative visit. The findings of this study add considerably to the body of literature pertaining to the efficacy of ketamine in preventative NMDA receptor antagonism." http://ether.stanford.edu/Ortho/Intraoperative%20Ketamine%20Reduces%20Perioperative%20Opiate.pdf To me, it sounds like if a Cluster patient has tried just about everything and ends up on Opiates, it would be a damn good idea to mix ketamine in there too. Another thing about the Nitrous oxide--it is in the same class as Ketamine (NMDA receptor antagonists) so it's not that strange for them to have similarities. A big thing to be aware of though is that for me they seem to work synergistically. When I went to the dentist with a cluster I took a good 10 sprays then sat down and had them put the nitrous mask on--within a few minutes it was complete interdimensisional travel. Many of the specifics are a little fuzzy, but I could see all the dimensions of the verse (as I call it, because the Uni-verse would imply a singular space instead of the infinite unbounding cosmos that I was experiencing) splayed out like a deck of cards being shuffled. I could see into all the dimensions and I could see that my own dimension, the one where I was having a crown done in a dentist office was going downhill fast. I knew that if I didn't intervene, everything everywhere was going to dissolve into nothingness. Then I retreated to being a very small, shy child in the corner of a very dark room. Part of me was urging this child to DO SOMETHING! SAVE THE VERSE" and the little child would reply, "but I'm scared...I don't know if I can" Eventually convinced that every cosmos everywhere was about to be completely annihilated I slowly put the effort into raising my hand. It was like the air was complete thick tar, it might have been the most effort I ever put into anything. As it slowly got into the air I felt more and more exuberance---"I'm SAVING THE WORLD!" About this time was when the dental hygenist looked in and found me sitting calmly with my hand in the air. She came in and asked me if I was ok--to which I gave no reply and stared at the wall as if I had no idea she was there. They promptly stopped the nitrous and I came back to earth, aware of the unbelievable beauty and strength of the world, the verse and myself. I was not aware until a few minutes later that I was in a dentist chair with a couple of worried hygenists looking in at me. Then I started laughing hilariously and asking them "what the hell just happened" To which they replied "I have no idea" The rest of the appointment was kinda rough on me and the dentist, mostly because no one had any idea that I had saved everything everywhere (You're welcome folks, just another day's work ) and no one had any idea why I kept erupting into maniacal laughter. So the lesson is--be real careful with the nitrous ketamine combo--unless of course, you're into that kinda thing. It was pretty cool. -Ricardo BTW--thanks Doc, for all your input. Your presence on here could make a big difference for the folks that want to try this and are meeting resistance with their doctors.