Category Archives: Treatments

Doppler Test for PMA? Sounds Good!

Doppler Test for PMA

Back in November of 2019, my neurologist ordered a Doppler Test of my legs to try to discover why my legs and feet were consistently cold, even in the middle of summer, when the rest of my body is sweltering in the heat. He opined that this was NOT a normal result of PMA or ALS! A quick perusal of PLM would have soon disavowed him of this conclusion.  However, I decided that I would go ahead with the test anyway. Perhaps there would be some indications of how to overcome the problem as a result.

What is a Doppler Test

A Doppler test uses ultrasonography (ultrasound) to measure blood pressure and flow rates in veins and arteries in various parts of the body to highlight circulation problems. It is invaluable, for instance, in indicating the presence and position of blood clots. It is also used as a diagnostic tool when Raynaud’s Syndrome is suspected. Raynaud’s is a rare affliction where parts of the body (usually the extremities, fingers and toes) become susceptible to even mild amounts of cold and can lead to loss of them in a fashion similar to frostbite.

Why a Doppler Test for PMA?

If we could have a dollar for every time that a supposedly knowledgeable medical professional states categorically: “That is NOT part of ALS/MND/PMA!”, we would have enough for research to conquer this disease! I have heard it too many times. A quick search on PatientsLikeMe revealed that there are almost 300 pALS who have reported it as a symptom. It seems likely that the problem occurs when muscle activity declines to the point where the lack of movement no longer aids in moving the blood back to the heart leading to pooling, edema and discoloration. In many, if not most situations, the problem can be alleviated by raising the affected limb(s) above the level of one’s heart so as to ameliorate the blood flow. Where this is not possible,  compression socks and applying compression and/or heat can improve the situation. I went into this test not expecting much in the way of helpful results!

Hospital Visits Amidst Covid 19

I do not like hospital visits at the best of times, and these are definitely NOT the best of times. The entrance to the Civic Hospital in Ottawa more closely resembled a MASH unit than a regular hospital.  Obtaining ingress was like entering Fort Knox and after answering the requisite Covid questions, I was informed that my carer (my wife) could NOT accompany me inside. I explained, in vain, that I would need her assistance in dressing and undressing, in particular aiding with my compression socks. We called up to the Imaging department and were told that there would be someone there to assist me (they lied!)

The Test Left Me Cold!

With much trepidation, I made my way up to the appropriate department where there were several patients waiting but no sign of a desk clerk or indeed any medical staff. Eventually, someone appeared, took my details and ask me to take a seat (I was in a wheelchair). After another extended wait, a technician called my name and showed me into the examination room. He offered no help to get me undressed and into the hospital gown nor to transfer to the examination gurney! I am lucky that I still have upper body function but even so, struggled to get this done. I won’t describe in detail the first part of the test except to say that he started with jelly on my belly and then moved on to several locations on my legs. This first phase took about 15 minutes.

The young man conducting the test was obviously not used to testing patients with limited function because he kept asking me to reposition my legs. I told him that if he needed them moved, he would have to do it himself.

The technician then explained that he would be doing a test involving placing my feet into freezing water to cool them and then warming them with hot towels to measure the difference in pressure and flow and also recording the ‘recovery time’.  He was clearly apprehensive about how I might manage to get my feet into the basin with the ice. Fortunately, by dangling my useless appendages over the edge of the bed, he was able to lower the bed until my feet descended into the icy liquid. Then followed an awkward couple of minutes where he stared into my face obviously expecting a reaction he did not get. He kept asking me: “Are you doing OK?” I could not figure out why! He seemed frustrated when he finally raised the bed and put sensors on both my big toes. He seemed not to be getting the readings he expected. He then warmed my feet with heated towels and replaced the sensors on my toes.

Looking flummoxed, he said he needed to repeat the test and said that this time I should tell him when I started to feel discomfort. The problem was that I never did. I could have sat there all day with my feet in the ice water. For some reason, I seem to have lost a lot of sensation in my feet and toes. After I explained this, he didn’t allow me to leave my feet in as long the second time. He ended the session by saying: “That was challenging!” He then departed and left me alone to struggle with dressing.

A Sound Conclusion

As previously stated, I don’t really expect anything concrete to come from this test. I shall just have to suck it up and continue with my own remedies.

P.S.  The fastest response time EVER: Just 24 hours after the test, the neurologist’s assistant called to say that everything on the test came back ‘normal’ 🧐


Power Wheelchairs for PMA

Power Wheelchairs for PMA

Let me start out by stating that since PMA like its other variants of Motor Neuron Disease can have diverse symptoms, progressions and outcomes, choosing power wheelchairs for PMA sufferers can be quite challenging. It is, however, very important to choose the right one since its owner is likely, at some point, to be spending a great deal of time in one!

Types of Power Wheelchair

There is a dizzying array of types and sizes of power wheelchairs (PWC). There are also many different features and add-ons that can add a great deal of function and utility to your device and make you more mobile, active, and above all, comfortable. Although I will be approaching the subject from my own perspective as a PMA sufferer with mostly lower limb involvement, there will be much information relevant to pALS (person with ALS) in general. In a single post, we cannot hope to cover the entire gamut of power wheelchairs for PMA. We will however try to cover the most salient features and options most likely. Before choosing the optimum power wheelchair for your particular situation, you will need to consider all of the following


It is unfortunate but there really is no ‘one size fits all’ solution when looking for the best PWC for your own situation. We will list the most obvious and relevant features and options. The first and perhaps most important factor in your selection should be deciding where you will spend most of your time.:

  • Indoor – If you will be spending a lot of time indoors, size and weight will be important considerations. Also types of flooring,  size of corridors and door frames need to be taken into account. If you have to make a lot of modifications to accommodate your wheelchair, it obviously adds to the cost.  
  • Outdoor – This covers a lot of ground (sic). Think about whether you will mostly stick to sidewalks and pavement and do not expect to have to navigate high curbs and uneven surfaces. If you will be ‘off-roading’ even a moderate amount, many of your choices will not be suited for this. Most power wheelchairs, for example, will not be able to climb obstacles higher than 3 inches and will perform poorly in rain, snow, on grass or gravel or climbing anything more than moderate inclines.

Drive Type – Battery type – Speed

These are three important considerations that are not often discussed with the Occupational Therapists or Mobility device suppliers but they are important factors that you should consider:

  • Drive Type – There are two main options here:
    • Rear-wheel drive where the power is sent to the rear wheels. Usually, the rear wheels are large and the front ones smaller. Since power is on the rear wheels, you can often mount higher curbs by backing up them. Although there may be anti-tip wheels at the rear, only four wheels are in constant contact with the ground.
    • Mid-wheel Drive usually means having small wheels or casters front and rear and larger drive wheels towards the centre. This usually means a much smaller turning circle and a smoother ride. This is offset by the inability to mount high curbs because the drive wheels are easily lifted off the ground by those front and rear.
    • Hybrid/Four-Wheel Drive – Although they are neither cheap nor wide-spread, it is possible to find this type of drive system where either all four wheels can be powered simultaneously or where the front wheels will be supplied power to assist in mounting higher curbs than possible with the other two types.
  • Battery Type Although there may be others, there  are usually two main types of batteries available for power assistive devices:
    • Lead Acid The most common and less expensive option for all but travel chairs. They can be either wet or dry (gel). Most manufacturers only use the latter type since they require no maintenance and cannot spill. Many airlines and common carriers will not transport the wet type.
    • Lithium-Ion These are both lighter and more compact but they do not generally last as long and are much more expensive. They are only typically used in travel chairs. Although generally approved for airline travel, the battery must usually be removed and carried with the passenger and is limited in the allowed capacity. Many power wheelchair suppliers offer an ‘airline-approved’ lithium battery as an option.
  • Speed If you intend to use your wheelchair mostly indoors, the maximum speed will not likely be a major concern. Outdoors is another matter entirely. The typical top speed of most power wheelchairs is 3.5 -4 mph (5 – 6.5 kph). Some, however, are rated for up to 10 mph (15kph) or more. This will only make a difference if you are planning to travel longer distances.  To travel 5 miles at 4 mph would take 1 hour 15 minutes. At 10 mph, it would only take 30 minutes, a significant improvement.

Wheels & Tyres

Do not underestimate the difference that the size and type of wheel can make to the overall wheelchair experience. Wheel size will make a huge difference in the ride comfort and climbing ability of your wheelchair. The bigger, the better!  As a general rule, the size of the front wheel will determine the size of curb or other obstacle that you can climb. The usual range of size for the drive wheels is between 8 and 14 inches. The forward and rear wheels are usually between 6 and 8 inches. As a general rule, you will be able to climb half the diameter of the front wheel.  There are 3 widely available types of tyre: Solid rubber or composite, foam-filled and pneumatic (air-filled). Solid rubber is the hardest and pneumatic the softest with foam-filled somewhere in between.

Size & Weight

Once again, these are qualities often overlooked by Occupational Therapists and equipment suppliers. And yet, they are critical to your use and enjoyment of your device. As mentioned above, the length and turning circle of your chair will determine how well you can navigate your home without colliding with walls, furniture cupboards, etc. If you have ramps for entry into your home or you wish to transport the chair, both the overall size and weight will be important factors.


There are simply too many to list in this article but the major functions that may be material to your present and future needs are:  Seat recline, seat tilt, leg elevation,  seat elevation, sit-to-stand. Of course, each additional feature adds to the cost but you should be aware that it is usually cheaper to have them included than to add them later. In addition, many insurances, health providers, etc. will not fund additions but may cover the initial cost if added when new. Remember that most will only cover a new chair every 5 years or so, so you must predict your future needs as well as your current ones.


Once again, these may not be covered by your funding source and can often be negotiated for a reduced price or even thrown in free at the time of purchase. They include, amongst others, cup holder, phone holder, cane holder, front, rear or side pockets, or baskets, travel covers, oxygen tank holders and much, much more. The one add-on that I consider indispensable is the swing-away controller which allow the chair much closer to tables and counters.


It will not surprise you to learn that prices are all over the map. The wheelchair specified for me by the O.T. and mobility supplier had a list price of $38,000+ CAD. The one that I subsequently purchased was $4.600 CAD and had most of the features and functions that I believed that I needed. In the case of the former, the provincial health insurance and our private insurance agreed to cover approximately $18,000 leaving us $20,000 out of pocket. It definitely pays to shop around though. I picked up a brand new travel power-wheelchair for just $1,300 when the exact same model normally retails for around $3,000 

Where to Get help

All of this may seem, at first, to be completely overwhelming (not to mention) expensive if this is your first try at finding the right power wheelchairs for PMA. If the cost is a major issue, try the ALS loan closet. In addition, Kijiji and Craigslist have many available.  Just be aware that some can be adjusted to meet your needs and some cannot. It will not help to get it cheaper if it does not do the job. By all means, consult an Occupational Therapist but always be aware that they may not have much experience with or knowledge of ALS or your particular variant of it and may steer you in the wrong direction.

Air Compression Leg Massager with Heat

Air Compression Leg Massager with Heat

I only discovered these air compression leg massager units very recently. Poor blood circulation resulting in swelling and cold feet and legs has been one of the worse symptoms of PMA for me. In the past couple of years, I have tried just about everything from heated socks, heated insoles, hot water bottles, electric blanket, lambswool slippers, etc. Of all the things I have tried, this air compression therapy device has been, without a doubt the most successful.

Quinear Leg Massager with heat

What causes Swelling (edema) and Cold Feet?

Most of us learn about muscles in biology at school. However, most of us never learn how muscle activity helps to move blood around our bodies. Even my own neurologist was apparently unaware of the severity of these problems for many Motor Neuron Disease sufferers. In fact, he ordered a Doppler (Ultrasound) test of my legs to check for abnormalities other than PMA that might account for it. Lately, I have seen numerous posts from pALS and cALS regarding swelling and lack of temperature control.  On further research, I have learned that blood circulation is a major factor in controlling body temperature. Again, most of us are aware that the heart is the major organ that pumps blood. However, in the extremities, there is often not enough blood pressure to recirculate the blood. Normal muscle movement activity then serves to supplement the heart’s efforts. When this fails, blood pools in the feet and lower legs resulting in swelling, discoloration and lack of heat control.

How Does Air Compression Help?

Most of us have had some type of massage at some point in our lives. Indeed, it was prescribed for me by both my GP and my neurologist. However, getting to the RMT office (especially in winter), dressing, undressing, getting on and off the massage table all counterbalanced the positive effects of the treatments themselves. After 4 sessions, I gave up.

Just 20 minutes of sitting with my legs in the air compression leg massager is enough to leave me with benefits for the balance of the day.


Where Can I find one?

Although I had never heard of these devices before, it turns out that they are widely available. They are available with differing sizes, functions and can come with or without the heat function. Prices in Canada range from $90 – $300. The ones I purchased were $159 CAD and have three massage cycles, three levels of compression and two levels of optional heat.

Quinear-Leg-MassagerAs you have probably surmised by now. I am a great fan of this product. I only wish that I had found it earlier. Of course, your own mileage may vary but my own problems of swelling or cold feet are now largely a thing of the past. 

Swimming with PMA

Swimming with PMA

Many things, including swimming with PMA, have to be done differently when one has Motor Neuron Disease. I consider myself extremely fortunate that we have the financial wherewithal to afford the equipment that makes otherwise herculean or impossible tasks doable for those of us with physical limitations. Last year, we had a pool lift installed at a cost of around $7,500. Because we had trouble finding workmen to do the actual install, it was not up and running until late in the season and I was still able to use the handrail to enter the pool. As a result, I only used the lift a couple of times and the weather and water were both warm.

The Pool Lift

If you have PMA, PLS, ALS, or any other MND and own a pool, or are thinking about getting one this might give you some ideas of the pros and cons. Quite apart from the expense, you have to consider how well you are able to get in and out of the lift. Since I still have good upper body strength and function, this is less on an issue for me than it might be for others. However, I still have to position my power wheelchair just right to make the transition to the lift chair.

We purchased the Aqua Creek Admiral model 

swimming with pma

It was supplied and installed by a local Mobility Specialist but we needed the concrete pool deck to be prepared by drilling holes, setting anchor bolts and leveling the base plate. This was the difficult part since it was a relatively small job and few local handymen were willing to tackle it. Luckily, the company who was doing some other landscape work (making the back yard more accessible for my wheelchair), agreed to do it. The unit is pretty heavy (160lbs+) and, in our case at least, has to be removed before winterising the pool, since the winter safety cover cannot be installed with it in place.

Taking the Plunge

This year, we were able to get the pool opened up relatively early and eagerly awaited the time when we could take a dip without freezing our (insert your own word here) off. Yesterday was that day. The sun was shining and the water temperature was at 21/70 degrees. I know that to many of you this might seem on the cool side but prior to PMA, I would dive in at 18/65 degrees, so I thought that this would not be a problem!

As you can see, I was in for a somewhat rude awakening!  In the past, I would have considered the temperature just fine, since I would simply dive in and the shock would last only a couple of seconds. This time was different, being slowly lowered with no control and not able to jump off the seat until it was completely submerged was like a version of the Chinese Water Torture. Once in the water and swimming, everything was fine. Even though I have almost no function in my legs, swimming is both cooling, relaxing and a chance to exercise my legs gently. In spite of the video above, I do highly recommend it.

You can find my solution to other daily challenges here!

Cannabis & PMA

Medical Marijuana: Finding the trees in the forest!

Even before my MND/PMA diagnosis, I started to talk to medical professionals who were treating me for a then-unspecified neuro-muscular disorder about the possibility that Cannabis could be beneficial for my condition. The first thing that I discovered was that although Medical Marijuana was about to be legalised here in Canada, most of those that I spoke to were unwilling to engage in a meaningful conversation of the pros and cons and how it might help or hinder my condition (since diagnosed as PMA – Primary Muscular Atrophy, a form of ALS). I soon realised that ‘if it’s to be, it’s up to me!’ Accordingly, I started doing research into the world of medical cannabis.

There is a vast array of information available on the benefits, pitfalls and even dangers of medical marijuana but most of it refers to the category as a whole and does not do a good job of highlighting the fact that sourcing cannabis is a bit like buying a motor vehicle. First, you have to decide on car, van, SUV, truck, motorcycle or electric scooter. They will all get you from point a to point b, but speed, ease of use, cost and durability are all factors affecting your choice. Similar differences exist in styles, types, potencies and cost of various strains and formats of consumer cannabis.

Possible benefits FOR PMA/MND Sufferers:

What follows here is a purely personal summary of what I have found during my research on Cannabis & PMA. I would encourage you to do your own inquiries as to whether there might be some benefit for your own particular case. Bear in mind that these benefits may be specific to a particular blend or ratio of active ingredients.

  1.  Relief of muscular pain, stiffness and/or cramps.
  2.  Lessening of anxiety and depression.
  3.  Aid in relaxation and sleeping.
  4.  Possible neuroprotective properties.
  5.  Anti-oxidant

Types or Forms of Cannabis:

  1. Flower or leaf
    This is probably the most popular and possibly the least expensive way to purchase marijuana. The drawback here is that the active ingredients need to be activated with heat. This means that you either have to smoke it, bake it or use some other high-temperature method to release or activate those ingredients. One significant advantage to this method is that the desired effects will manifest much more quickly as the active ingredients are introduced directly into the bloodstream via the lungs. Dosing will be somewhat harder to judge with this method and it is hardly unobtrusive since all strains of cannabis give off a distinct aroma. Although the manufacturer will list the amount of each active ingredient, there is no way of knowing how much is activated and actually absorbed into your system. Also, there is some concern that long-term smoking of weed can be harmful to one’s lungs, similar to the effect of sustained tobacco smoke.
  2. Oils or sprays
    Made to be orally ingested, cannabis oils make precise dosing easy and provided you have no problems swallowing the liquid and can stomach the taste, this will be the preferred choice of many users. It is easy to transport, leaves no noticeable aroma and can be taken at any time, anywhere. It can take up to 90 minutes to fully enter the bloodstream but this can be quickened by holding the oil under your tongue for as long as possible before swallowing. As a general rule, you can be sure that 100% of the active ingredients will eventually be made available to your system.
  3. Capsules
    In my personal experience, this is an expensive way of using marijuana. Dosing, although precise, is more difficult to modify. Due to cost, they tend to be fairly potent but since they are in a gelcap form, you cannot divide one and take only a portion. Additionally, this is the slowest acting of the 3 normal formats, since the gelcap has to be dissolved in your stomach before its ingredients are released. Generally, only those who cannot smoke or swallow the oils for any reason will opt for the gels.
  4. Edible products
    We have all heard of ‘special’ brownies baked with marijuana. There is now a dizzying array of products available laced with marijuana. They are not usually geared to the medical marijuana market though and, as one might expect, both higher price and lower potency are likely with this option.

Active Ingredients in Marijuana:

There are too many potential active ingredients in the various strains of cannabis plants for us to give an extensive overview here, so I will limit myself to the three main ones.
THC – This is the psychoactive component of marijuana that gives the user the perhaps familiar and often sought after high. It is the main ingredient for pain relief and for improving sleeplessness but has the disadvantage of being mind-altering and therefore would have many of the same drawbacks as alcohol consumption and can indeed be addictive. In general, the Indica strains tend to be high in THC.
CBD – Unlike THC, CBD has no mind-altering properties and is also non-addictive. It is an anti-inflammatory and it that capacity can have analgesic effects similar to Ibuprofen. CBD is also the principal ingredient in marijuana that offers potential neuroprotective properties with long-term use. In addition to its stand-alone properties, when combined with THC, it can lessen some of the potential side-effects of the latter, in particular, the possible psychosis that THC can cause. In general, the Sativa strains tend to be high in CBD.
Terpenes – These are a large class of organic compounds found in various combinations in all cannabis plants. They are what give each strain its individual aroma or taste. They are generally considered to be safe and are seen to provide ancillary or complementary benefits to the two main active ingredients above. In many manufactured cannabis products the terpenes are removed to remove tastes and odours that some find unpleasant. Most medical marijuana manufacturers will list the terpenes (if) present in their various offerings.

Although there is currently a lot more research being done on determining the benefits and side-effects of the various ingredients that make up the different strains of the cannabis plant, much of the literature to be found abounds with anecdotal evidence rather than empirical research.

Determining the active strength of different offerings:

Most manufacturers of medical marijuana will list statistics of THC/CBD concentrations without giving any indication of what this means. Since I personally use Oils, I will discuss those here, though similar calculations can be done with the alternate formats. I personally use 2 differing formulations of cannabis oil. One for daytime and one for nighttime.
Daytime Formula: 20MG CBD/ML, <1MG THC/ML
Nighttime Formula: 15MG CBD/ML, 10MG THC/ML
Clear as mud, right? Well, it is actually quite easy to figure out what this means. In the daytime formula, the active ingredients are 95+% CBD and <5% THC. This low level of THC will make this formulation legal in many jurisdictions where THC is a banned substance. It will have little or no psychoactive effect. In the nighttime formula, the ingredients are 60% CBD and 40% THC. Although there is some potential for psychoactive effects, these will be tempered by the higher level of CBD.
You will find that you can obtain products that range from virtually 100% down to 0% of both CBD and THC. You may need to experiment to get the correct blend(s) suitable for your individual needs. However, there is one final factor that we need to look at.


Now we get into one of the more difficult and nebulous areas of medical marijuana consumption. How to determine the correct dosage for your personal situation. My first piece of advice is to start out slowly and gradually increase dosages until you reach the desired level of results. Be aware that not all formulations are equally strong and you may well wish to opt for the most potent combination and choose a lower dosage since this tends to be the most cost-effective route.
As an example, my preferred supplier offers 40 ml with 5mg CBD/ML, 5mg THC/ML. That means at a dose of 1ML, I will be taking 5mg THC and 5mg CBD. My usual blend offers 15mg CBD/ML and 10mg THC/ML. Therefore, the same 1ml dose will give me 15mg CBD and 10mg THC. I would have to take 2 -3 times the dose of the former blend to equal the potency of the latter.


Prices are really all over the map and it can be quite hard to determine which is the best value for money. Again, I will restrict my comments here to oils but the same type of calculation can be done for any format to determine how much bang you are actually getting for your buck. To make life simple, we will assume that both THC and CBD have equivalent cost/value per MG. Most oils come in either 20/30/40ml bottles. To determine the equivalent cost per active ingredient we have to multiply concentration by volume. In the two examples above, the bottles are each 40ml and cost $50 and $90 respectively. On the surface, the lower cost would appear to be the better value for the same quantity of oil. However, when we do the math, we find that all is not as it appears. In the first case, we have 5mg+5mg of active ingredient per ml. Therefore in the whole bottle, we have 400mg of active ingredients. If the bottle costs $50, then we are paying 12.5 cents per mg. In the second bottle, we have 10mg + 15mg, so 40ml gives us 1,000mg of active ingredient. The bottle costs $90, so we are now paying only 9 cents per mg. The more expensive bottle reduces our overall cost by 25% or more.


Treatments For PMA

Treatments for PMA

This is where you will find valuable information on the various treatments for PMA, prescription drugs, supplements and assistive devices that we have used over the time since initial diagnosis of MND (Motor Neuron Disease) in October of 2017.

Although the emphasis will be on the benefits and drawbacks will relate specifically to PMA (Progressive Muscular Atrophy), much of it will be of interest to pALS or patients with other related neurological diseases, specifically ALS, PLS, MMA and others.

The best source for further information on the treatments for PMA can be found at Patients Like Me

Rilutek – Riluzole Evaluation

Rilutek - Riluzole

Although I had been offered Riluzole/Rilutek at an earlier date, I was not convinced to start taking it since I had no definitive diagnosis of ALS. In addition, although this medication is purported to add an additional 3 months life expectancy to some pALS, many report no benefit and significant side effects, particularly elevated liver enzymes. The latter is something that has been an ongoing issue for me for many years.

However, since being diagnosed with PMA a few days ago, I decided that I would start taking it and closely monitor my liver stats.

You evaluated Riluzole

Feb 26, 2018
  • Started: Feb 22, 2018
  • Dosage: 50 mg Twice daily
  • Effectiveness: Can’t tell (for progressive muscular atrophy)
  • Side effects: None
  • Adherence:  Always
  • Burden: A little hard to take
  • Cost< $25 monthly
  • Advice & Tips: Best to set a timer since it is supposed to be 1 hour before or two hours after a meal.

See more treatments


Rabeprazole – a Proton Pump Inhibitor for Acid Reflux

Rabeprazole,  also known as Pariet, is a PPI (Proton Pump Inhibitor) that is designed to reduce stomach acid production. It is generally considered relatively safe with few side-effects for the majority of patients. You can get a full review of the risk-benefit spectrum of Rabeprazole – Pariet  here

You evaluated Rabeprazole

Feb 28 2018
  • StartedNov 26, 2017
  • Dosage20 mg Daily
  • Effectiveness Major (for acid reflux)
  • Side effects None
  • Adherence Sometimes
  • Burden Not at all hard to take
  • Cost< $25 monthly
  • Advice & Tips: I have been on this for a few years now and only needed to take it for a couple of days for it to work. Now with all the supplements I take, acid reflux is more of a problem and I am taking this regularly. When I stop for more than a couple of days the problem resurfaces.

You can check out other treatments for PMA