Ulcers
A peptic ulcer is a sore in the lining of your stomach or your duodenum, the first part of your small intestine. A burning stomach pain is the most common symptom. The pain:
- Starts between meals or during the night
- Briefly stops if you eat or take antacids
- Lasts for minutes to hours
- Comes and goes for several days or weeks
Peptic ulcers happen when the acids that help you digest food damage the walls of the stomach or duodenum. The most common cause is infection with a bacterium called Helicobacter pylori. Another cause is the long-term use of nonsteroidal anti-inflammatory medicines (NSAIDs) such as aspirin and ibuprofen. Stress and spicy foods do not cause ulcers, but can make them worse.
To see if you have an H. pylori infection, your doctor will test your blood, breath, or stool. Your doctor also may look inside your stomach and duodenum by doing an endoscopy or x-ray.
Peptic ulcers will get worse if not treated. Treatment may include medicines to reduce stomach acids or antibiotics to kill H. pylori. Antacids and milk can't heal peptic ulcers. Not smoking and avoiding alcohol can help. You may need surgery if your ulcers don't heal.
NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Ulcers FDA Approved Drugs
DUEXIS [FamotidineC8H15N7O2S3 : IbuprofenC13H18O2]
RX
- 26.6mg : 800mg (oral tablet)
Horizon PharmaApr 23, 2011
- Relief of signs and symptoms of rheumatoid arthritis and osteoarthritis and to decrease risk of developing upper gastrointestinal ulcers in patients who are taking ibuprofen for those indications.
VIMOVO [Esomeprazole Magnesium2C17H18N3O3SMg3H2O : NaproxenC14H14O3]
RX
- eq 20mg base : 375mg (oral tablet, delayed release)
eq 20mg base : 500mg (oral tablet, delayed release)
Horizon Pharma UsaApr 30, 2010
- Relief of signs and symptoms of arthritis and risk-reduction of nsaid-associated gastric ulcer.
- Risk-reduction of nsaid gastric ulcer in patients requiring chronic nsaid treatment.
- Risk-reduction of nsaid-associated gastric ulcer in patients requiring nsaid treatment.
- Risk-reduction of nsaid-associated gastric ulcer.
- Risk-reduction of nsaid-associated gastric ulcers in patients also taking low dose aspirin.
YOSPRALA [AspirinC9H8O4 : OmeprazoleC17H19N3O3S]
RX
- 325mg : 40mg (oral tablet, delayed release)
81mg : 40mg (oral tablet, delayed release)
Aralez PharmsSep 14, 2016
- Treatment or secondary prevention of cardiovascular disease, cardiovascular events, or cerebrovascular events and risk-reduction of aspirin-associated gastric ulcers.
WARNING: Consult a licensed physician in the appropriate field for medical treatment and drug prescription. Do not self medicate.
WARNING: All medicines, drugs, plants, chemicals or medicial precedures below are for historical reference only. Many of these treatments are now known to be harmful and possibly fatal. Do not consume any plant, chemical, drug or otherwise without first consulting a licensed physician that practices medine in the appropriate field.
Felter's Materia Medica on Ulcers
ABIES (Tsuga canadensis)TSCA
The bark and prepared resinous exudate of Tsuga canadensis, Carriére (Abies canadensis, Michaux; Pinus canadensis, Linné). (Nat. Ord.... / ...rhoea and a good local application of this type for aphthous and other oral ulcerations, gangrenous ulcers, prolapsus ani and prolapsus uteri. The specific medicine on cotton. may be applied to the ce... / ...be used where there is excessive secretion of mucus and the cough is largely precipitated by a feeble and relaxed state of the uvula and fauces. 1
The bark and prepared resinous exudate of Tsuga canadensis, Carriére (Abies canadensis, Michaux; Pinus canadensis, Linné). (Nat. Ord.... / ...rhoea and a good local application of this type for aphthous and other oral ulcerations, gangrenous ulcers, prolapsus ani and prolapsus uteri. The specific medicine on cotton. may be applied to the ce... / ...be used where there is excessive secretion of mucus and the cough is largely precipitated by a feeble and relaxed state of the uvula and fauces. 1
BALSAMUM PERUVIANUM
...enile and other forms of pruritus, especially pruritus vulvae, and in chilblains. As a stimulant to ulcers of low vitality and pus-oozing granulations following operations, and similar conditions in b......f gauze to allow of free drainage. This method is one of the best forms of treatment for old tibial ulcers, due to varicosis, but the patient must be compelled to rest the leg in a horizontal position...1
...enile and other forms of pruritus, especially pruritus vulvae, and in chilblains. As a stimulant to ulcers of low vitality and pus-oozing granulations following operations, and similar conditions in b......f gauze to allow of free drainage. This method is one of the best forms of treatment for old tibial ulcers, due to varicosis, but the patient must be compelled to rest the leg in a horizontal position...1
BAPTISIA
...) are effective as washes and dressings for indolent and fetid as well as for irritable and painful ulcers, inflammations with full or swollen and dusky tissues, and tendency to destruction, aphthous ......pearance, with expressionless countenance, like one who has been long exposed to cold. There may be ulcers of an indolent character, with bluish or purplish edges. The excretions are fetid-those of th...1
...) are effective as washes and dressings for indolent and fetid as well as for irritable and painful ulcers, inflammations with full or swollen and dusky tissues, and tendency to destruction, aphthous ......pearance, with expressionless countenance, like one who has been long exposed to cold. There may be ulcers of an indolent character, with bluish or purplish edges. The excretions are fetid-those of th...1
CALAMUSACCA4
...he removal of epitheliomata with asserted benefit, and as an application to gangrenous and indolent ulcers, with capillary impairment, it is said to have stimulated replacement by healthy tissues. A w......somotor stimulant it has been advised internally to reinforce its local action, particularly in old ulcers, varicose veins, capillary engorgement of tissues, and chronic suppurative and catarrhal cond...1
...he removal of epitheliomata with asserted benefit, and as an application to gangrenous and indolent ulcers, with capillary impairment, it is said to have stimulated replacement by healthy tissues. A w......somotor stimulant it has been advised internally to reinforce its local action, particularly in old ulcers, varicose veins, capillary engorgement of tissues, and chronic suppurative and catarrhal cond...1
CALENDULA
...he removal of epitheliomata with asserted benefit, and as an application to gangrenous and indolent ulcers, with capillary impairment, it is said to have stimulated replacement by healthy tissues. A w......somotor stimulant it has been advised internally to reinforce its local action, particularly in old ulcers, varicose veins, capillary engorgement of tissues, and chronic suppurative and catarrhal cond...1
...he removal of epitheliomata with asserted benefit, and as an application to gangrenous and indolent ulcers, with capillary impairment, it is said to have stimulated replacement by healthy tissues. A w......somotor stimulant it has been advised internally to reinforce its local action, particularly in old ulcers, varicose veins, capillary engorgement of tissues, and chronic suppurative and catarrhal cond...1
CAMPHORA
A stearopten (having the nature of a ketone) derived from Cinnamomum Camphora. (Linné), Nees et Ebermeier (Nat. Ord. Lauraceae). China and... / ...urticaria, and zoster. Many snuffs contain powdered camphor, and it is useful to stimulate sluggish ulcers. Sprinkled upon the face it is used to control itching and to prevent pitting in small-pox. T... / ...due to gaseous distention of the stomach, or to nervous irritability. In occipital headache, from mental strain, or overstudy, small doses of 1
A stearopten (having the nature of a ketone) derived from Cinnamomum Camphora. (Linné), Nees et Ebermeier (Nat. Ord. Lauraceae). China and... / ...urticaria, and zoster. Many snuffs contain powdered camphor, and it is useful to stimulate sluggish ulcers. Sprinkled upon the face it is used to control itching and to prevent pitting in small-pox. T... / ...due to gaseous distention of the stomach, or to nervous irritability. In occipital headache, from mental strain, or overstudy, small doses of 1
CARBO LIGNI
Charcoal prepared by burning soft wood. It must be kept in tightly-closed vessels. Common Names: Charcoal, Wood Charcoal; Synonym: Carbo... / ...bsorbent, deodorant and disinfectant, but not antiseptic. It is used very largely to deodorize foul ulcers, carcinomata, and gangrene, possessing the advantage of being an odorless deodorant. It is fr... / ...the belly-wall tumid and doughy, the tongue expressionless and pale with little coating and lenticular spots, or the coating may lift in patches.1
Charcoal prepared by burning soft wood. It must be kept in tightly-closed vessels. Common Names: Charcoal, Wood Charcoal; Synonym: Carbo... / ...bsorbent, deodorant and disinfectant, but not antiseptic. It is used very largely to deodorize foul ulcers, carcinomata, and gangrene, possessing the advantage of being an odorless deodorant. It is fr... / ...the belly-wall tumid and doughy, the tongue expressionless and pale with little coating and lenticular spots, or the coating may lift in patches.1
CINCHONACINCH
I. Cinchona.-The dried bark of Cinchona Ledgeriana, Moens; Cinchona Calisaya, Weddell, and hybrids of these with other species of Cinchona... / ...iseptic and astringent. A poultice of the bark has been successfully used upon fetid and gangrenous ulcers, and where such an application has been thought necessary upon suppurating and sloughing felo... / ...chronic suppuration; and to arrest profuse and debilitating night sweats in one suffering from general debility with poor recuperative powers.1
I. Cinchona.-The dried bark of Cinchona Ledgeriana, Moens; Cinchona Calisaya, Weddell, and hybrids of these with other species of Cinchona... / ...iseptic and astringent. A poultice of the bark has been successfully used upon fetid and gangrenous ulcers, and where such an application has been thought necessary upon suppurating and sloughing felo... / ...chronic suppuration; and to arrest profuse and debilitating night sweats in one suffering from general debility with poor recuperative powers.1
CONIUM
The full grown fruit, gathered green, of Conium maculatum, Linné (Nat. Ord. Umbelliferae). Europe and Asia; naturalized in the United... / ...Locally applied extract of conium, or the powdered drug, relieves the pain of cancerous growths and ulcers. Locke advised, Rx. English Extract of Conium, 2 drachms; Petrolatum, 6 ounces. Mix. Apply lo... / ...be applied and be given to relieve pain even when a cure is not possible. It relieves the pain of swollen mammae during the menstrual periods a1
The full grown fruit, gathered green, of Conium maculatum, Linné (Nat. Ord. Umbelliferae). Europe and Asia; naturalized in the United... / ...Locally applied extract of conium, or the powdered drug, relieves the pain of cancerous growths and ulcers. Locke advised, Rx. English Extract of Conium, 2 drachms; Petrolatum, 6 ounces. Mix. Apply lo... / ...be applied and be given to relieve pain even when a cure is not possible. It relieves the pain of swollen mammae during the menstrual periods a1
COPAIBACOOF2
An oleoresin derived from species of Copaiba growing in South America. Dose, 5 to 30 drops. Description.A viscid, pale-yellow or brownish-yellow... / .... Therapy.External. Copaiba is sometimes applied to frost-bites and chilblains, sore nipples, old ulcers, and anal fissures, and to fistulous tracts to soften hardened edges and surfaces; also in sl...1
An oleoresin derived from species of Copaiba growing in South America. Dose, 5 to 30 drops. Description.A viscid, pale-yellow or brownish-yellow... / .... Therapy.External. Copaiba is sometimes applied to frost-bites and chilblains, sore nipples, old ulcers, and anal fissures, and to fistulous tracts to soften hardened edges and surfaces; also in sl...1
COPTIS
The rhizome and rootlets of Coptis trifolia, Salisbury. (Nat. Ord. Berberidaceae.) A plant of dark, cold swamps and sphagnous woods, found in... / ... given internally. The infusion or the tincture may be used, with or without hydrastis, in aphthous ulcers of the mouth. Internal. Coptis is a pure bitter and one that ought to be more generally used....1
The rhizome and rootlets of Coptis trifolia, Salisbury. (Nat. Ord. Berberidaceae.) A plant of dark, cold swamps and sphagnous woods, found in... / ... given internally. The infusion or the tincture may be used, with or without hydrastis, in aphthous ulcers of the mouth. Internal. Coptis is a pure bitter and one that ought to be more generally used....1
ECHINACEA
...tive power is poor, and the discharges saneous and unhealthy. It is especially valuable in sluggish ulcers, bed sores, stinking tibial ulcers, and ulcers of the nasal mucosa, due either to ozaena or t......nes. We have found it especially useful in dermatitis venenata after denudation of the cuticle when ulcers form and the neighboring glands swell. Echinacea has a greater record for success than any si...1
...tive power is poor, and the discharges saneous and unhealthy. It is especially valuable in sluggish ulcers, bed sores, stinking tibial ulcers, and ulcers of the nasal mucosa, due either to ozaena or t......nes. We have found it especially useful in dermatitis venenata after denudation of the cuticle when ulcers form and the neighboring glands swell. Echinacea has a greater record for success than any si...1
EUCALYPTUSEUAN12
The leaves of Eucalyptus Globulus, Labillardiere. Collected from the older parts of the tree. (Nat. Ord. Myrtaceae.) A native tree of Australia;... / ...nge. All preparations of eucalyptus may be used from full strength to any desired dilution upon old ulcers, wounds, gonorrhoeal discharges, ozoena, septicemia, and gangrene; all with free but fetid di... / ...Used according to indications as given above, eucalyptus is a very satisfactory and pleasant medicine. It is best given in syrup or glycerin.1
The leaves of Eucalyptus Globulus, Labillardiere. Collected from the older parts of the tree. (Nat. Ord. Myrtaceae.) A native tree of Australia;... / ...nge. All preparations of eucalyptus may be used from full strength to any desired dilution upon old ulcers, wounds, gonorrhoeal discharges, ozoena, septicemia, and gangrene; all with free but fetid di... / ...Used according to indications as given above, eucalyptus is a very satisfactory and pleasant medicine. It is best given in syrup or glycerin.1
FICUS
The fleshy receptacle of Ficus Carica, Linné bearing fruit on its inner surface. (Nat. Ord. Moraceae.) Persia and Asia Minor; cultivated in all... / ... Billroth, employed a poultice of dried figs and milk to overcome the stench of cancerous and fetid ulcers. Internal. Nutritive, demulcent, and aperient. Figs are frequently resorted to by individuals... / ...raisins, prunes, and senna leaves. This is wrapped in tinfoil, and sliced off and eaten according to the requirements of the individual.1
The fleshy receptacle of Ficus Carica, Linné bearing fruit on its inner surface. (Nat. Ord. Moraceae.) Persia and Asia Minor; cultivated in all... / ... Billroth, employed a poultice of dried figs and milk to overcome the stench of cancerous and fetid ulcers. Internal. Nutritive, demulcent, and aperient. Figs are frequently resorted to by individuals... / ...raisins, prunes, and senna leaves. This is wrapped in tinfoil, and sliced off and eaten according to the requirements of the individual.1
GRINDELIA
...rawness; harsh, dry cough; dyspnea with cyanosed countenance. Locally, rhus poisoning; old indolent ulcers. Grindelia squarrosa: malarial cachexia with splenic congestion. Action.The grindelias have...... valuable in chronic skin diseases with feeble circulation and tendency to ulceration. For indolent ulcers a lotion of the specific medicine (2 fluidrachms to Water, 16 fluidounces) may be applied fre......to Water, 16 fluidounces) may be applied freely upon compresses. It stimulates growth and heals the ulcers. Grindelia similarly applied is one of the best of applications in rhus dermatitis. Applied t...1
...rawness; harsh, dry cough; dyspnea with cyanosed countenance. Locally, rhus poisoning; old indolent ulcers. Grindelia squarrosa: malarial cachexia with splenic congestion. Action.The grindelias have...... valuable in chronic skin diseases with feeble circulation and tendency to ulceration. For indolent ulcers a lotion of the specific medicine (2 fluidrachms to Water, 16 fluidounces) may be applied fre......to Water, 16 fluidounces) may be applied freely upon compresses. It stimulates growth and heals the ulcers. Grindelia similarly applied is one of the best of applications in rhus dermatitis. Applied t...1
WARNING: All medicines, drugs, plants, chemicals or medicial precedures below are for historical reference only. Many of these treatments are now known to be harmful and possibly fatal. Do not consume any plant, chemical, drug or otherwise without first consulting a licensed physician that practices medine in the appropriate field.
Physician's Materia Medica on Ulcers
ACID BORIC (Boracic Acid)
Antiseptic, yet non-irritant and not poisonous. Used largely in powder or glycerite as antiseptic dressing for wounds and ulcers; solutions are employed as collyria and for local use in nasal catarrh, ozena, cystitis, gonorrhea and various cutaneous diseases. Internal ly it is prescribed to render the urine acid in cystitis and as a remedy in fermentative dyspepsia. Dose, 0.3 to 1.0 Grm. (5 to 15 grs.).2
Antiseptic, yet non-irritant and not poisonous. Used largely in powder or glycerite as antiseptic dressing for wounds and ulcers; solutions are employed as collyria and for local use in nasal catarrh, ozena, cystitis, gonorrhea and various cutaneous diseases. Internal ly it is prescribed to render the urine acid in cystitis and as a remedy in fermentative dyspepsia. Dose, 0.3 to 1.0 Grm. (5 to 15 grs.).2
ACID GALLIC
Astringent but not locally hemostatic, Prescribed in diarrheas, in atonic albuminuria, in hematuria, colliquative sweats, diabetes insipidus (combined with opium) and in internal hemorrhages. Ap plied locally in ointments in hemorrhoids and for unhealthy ulcers. Dose, 0.2 to 1.0 Grm. (3 to 15 grs.)2
Astringent but not locally hemostatic, Prescribed in diarrheas, in atonic albuminuria, in hematuria, colliquative sweats, diabetes insipidus (combined with opium) and in internal hemorrhages. Ap plied locally in ointments in hemorrhoids and for unhealthy ulcers. Dose, 0.2 to 1.0 Grm. (3 to 15 grs.)2
ACID LACTIC
Classed as tonic and astringent. Used in some forms of gas tric and intestinal indigestion and for relief of diarrhea in children. Locally acts as a cauterant, and formerly much used in treatment of chancres, chancroids, phagedenic ulcers and gangrene. Dose of the official diluted acid (10%), 0.6 to 1.6 c. c. (10 to 25 M).2
Classed as tonic and astringent. Used in some forms of gas tric and intestinal indigestion and for relief of diarrhea in children. Locally acts as a cauterant, and formerly much used in treatment of chancres, chancroids, phagedenic ulcers and gangrene. Dose of the official diluted acid (10%), 0.6 to 1.6 c. c. (10 to 25 M).2
AGRIMONYAGRIM
The herb of AGRIMONIA EUPATORI,-3, Lin. Astringent. Used in passive hemorrhages, bowel troubles, leucorrhea; the infusion as an astringent wash for ulcers or gargle for sore throat.2
The herb of AGRIMONIA EUPATORI,-3, Lin. Astringent. Used in passive hemorrhages, bowel troubles, leucorrhea; the infusion as an astringent wash for ulcers or gargle for sore throat.2
BENZOIN
Balsamic resin from STYRAX BENZOIN, Dryander. Stimulant and expectorant, antiseptic, vulnerary. Used in chronic bronchitis and in catarrhal affections of the bowels. Externally applied for its healing effect on wounds, ulcers, etc.2
Balsamic resin from STYRAX BENZOIN, Dryander. Stimulant and expectorant, antiseptic, vulnerary. Used in chronic bronchitis and in catarrhal affections of the bowels. Externally applied for its healing effect on wounds, ulcers, etc.2
BLACK WALNUTJUNI
The leaves, also the bark of JUGLANS NIGRA, Lin. Bitter tonic. astringent, alterative, deobstruent. An infusion of the leaves is ap plied locally to indolent ulcers.2*Slight
The leaves, also the bark of JUGLANS NIGRA, Lin. Bitter tonic. astringent, alterative, deobstruent. An infusion of the leaves is ap plied locally to indolent ulcers.2*Slight
CAROBA
The leaves of JACARANDA PROCERA, Spreng. Diuretic, diaphore tic, alterative, anti-syphilitic; infusion applied locally to syphilitic ulcers.2
The leaves of JACARANDA PROCERA, Spreng. Diuretic, diaphore tic, alterative, anti-syphilitic; infusion applied locally to syphilitic ulcers.2
CHARCOAL
Antiseptic, deodorant, absorbent. Prescribed in dyspepsia at tended with flatulence and gastralgia. Applied in poultices to foul and gangrenous ulcers. Dose, 0.6 to 4 Grm. (10 to 60 grs.).2
Antiseptic, deodorant, absorbent. Prescribed in dyspepsia at tended with flatulence and gastralgia. Applied in poultices to foul and gangrenous ulcers. Dose, 0.6 to 4 Grm. (10 to 60 grs.).2
CHLORETON E (Acetone-chloroform)
Hypnotic, saiative, anesthetic, antiseptic, antiemetic; resembles chloral in its action, but is less depressing to heart and respiration; useful for relief of neuralgic pain and gastralgia; in insomnia, and as a local application to burns, scalds, carious teeth, painful ulcers, etc. Dose, 0.4 to 1.3 Grm. (6 to 20 grs.).2
Hypnotic, saiative, anesthetic, antiseptic, antiemetic; resembles chloral in its action, but is less depressing to heart and respiration; useful for relief of neuralgic pain and gastralgia; in insomnia, and as a local application to burns, scalds, carious teeth, painful ulcers, etc. Dose, 0.4 to 1.3 Grm. (6 to 20 grs.).2
EUCALYPTUSEUAN12
The leaves of EUCALYPTUS GLOBULUS, Labili. Stimulant tonic, antiseptic, antiperiodic, stomachic. Valuable in treatment of chronic catarrhal affections of the genito-urinary tract and of the air passages. Locally applied as a disinfectant and vulnerary in treat ing foul ulcers, etc. The oflicial volatile oil is the chief active consti tuent, and of this Euealyptol is the valuable portion. Both are used. especially in spray or by inhalation, in subacute and chronic bronchitis; also internally in d2
The leaves of EUCALYPTUS GLOBULUS, Labili. Stimulant tonic, antiseptic, antiperiodic, stomachic. Valuable in treatment of chronic catarrhal affections of the genito-urinary tract and of the air passages. Locally applied as a disinfectant and vulnerary in treat ing foul ulcers, etc. The oflicial volatile oil is the chief active consti tuent, and of this Euealyptol is the valuable portion. Both are used. especially in spray or by inhalation, in subacute and chronic bronchitis; also internally in d2
WARNING: All medicines, drugs, plants, chemicals or medicial precedures below are for historical reference only. Many of these treatments are now known to be harmful and possibly fatal. Do not consume any plant, chemical, drug or otherwise without first consulting a licensed physician that practices medine in the appropriate field.
Physician's Therapeutics Memoranda on Ulcers
BED SORES
When threatened, harden skin by frequent use of astringent lotions, lead water, tannin dissolved in dilute alcohol, 2 grs. to fl. oz.; whiskey and salt (2 drachms to pint); Antiseptine diluted with wa ter or whiskey. When ulcers have formal, protect with soap plaster and use antiseptics. especially Iodosyl ointment. Sustain patient’s strength with nourishing and predigested food. Iron in form of the tincture is generally of service.2
When threatened, harden skin by frequent use of astringent lotions, lead water, tannin dissolved in dilute alcohol, 2 grs. to fl. oz.; whiskey and salt (2 drachms to pint); Antiseptine diluted with wa ter or whiskey. When ulcers have formal, protect with soap plaster and use antiseptics. especially Iodosyl ointment. Sustain patient’s strength with nourishing and predigested food. Iron in form of the tincture is generally of service.2
CORNEAL ULCERS
For local application Iodosyl surpasses all other remedies; atro pine if there is a tendency to iritis. Tonic and roborant treatment is generally indicated.2
For local application Iodosyl surpasses all other remedies; atro pine if there is a tendency to iritis. Tonic and roborant treatment is generally indicated.2
ULCERS
The treatment must depend on the conditions. In general the applications that are of most benefit are at once stimulating and antiseptic. That most generally useful is Iodosyl. As a cleansing agent, hydrogen peroxide is generally best, although more powerful applications (caustics) have their use, particularly strong carbolic acid followed by alcohol to limit its destructive action.2
The treatment must depend on the conditions. In general the applications that are of most benefit are at once stimulating and antiseptic. That most generally useful is Iodosyl. As a cleansing agent, hydrogen peroxide is generally best, although more powerful applications (caustics) have their use, particularly strong carbolic acid followed by alcohol to limit its destructive action.2
References
1) Felter, Harvey Wickes, 1922, The Eclectic Materia Medica, Pharmacology and Therapeutics, Cincinnati, Ohio.
2) Nelson, Baker & Co., 1904, Physician's Handy Book of Materia Medica and Therapeustics, Detroit, Michigan.
2) Nelson, Baker & Co., 1904, Physician's Handy Book of Materia Medica and Therapeustics, Detroit, Michigan.