By U. Rune. Central State University.

All these side effects go away when the level of medicines is reduced or stopped order aurogra 100 mg fast delivery. Dr Krentzman: For the person who wondered why they could gain 15 pounds of Phen-Fen generic aurogra 100mg otc, The medication combination works on 60% of humans buy aurogra 100 mg fast delivery, and not on 40% aurogra 100mg otc. Since all other ways fall in the 2% success rate, the diet drugs are the best odds you can get. About 15 more medicines are in the research pipeline. IF you stop taking the medicines, there is a 98% chance that you will regain all the weight you lost over the next 5 years (or sooner). There was an article by a panel of obesity experts, called together by the National Institutes of Health to review the literature. They concluded that if you stop the medicines EVER you will regain ALL the weight you lost. They said that using the medicines for less than 12 months had no value and that there was only one small study for over 12 months so they could not recommend using the diet drugs for longer. My study is 26 months along with 800 patients and no unusual problems. Another doctor here in Los Angeles says he has treated 20,000 patients in his 18 clinics without any strange problems. PEDSI: What good do these diet drugs do if you have to stay on them to prevent the weight coming back? Dr Krentzman: What good does insulin do for a diabetic if they have to stay on it for life to prevent dying from diabetes? What good are eyedrops which prevent glaucoma from causing blindness? This is like asking an asthmatic to stop wheezing without taking their medicines. In all cases, including obesity, nothing is cured, only controlled. The diet drugs, if used a lot, could reduce that 300,000 deaths per year caused by obesity. Dr Krentzman: No deaths have been reported associated with phentermine. Dr Krentzman: There are no other ways that work over the long term. Any time you reduce the total calories you take in, you will lose weight. The pills do this for 60% of the people who try them. Today I saw a 5 foot one inch lady who has lost from 150 lbs to 117. She went down to a size 3 and is now in maintenance. For those who are severely overweight, 40 BMI or greater, surgery has a 73% success rate. It is really worthwhile talking to someone who has done 100 or more of these operations. Liz: I am interested in drugs other than phen/fen and Redux. What other drugs are there out there and how effective are they when compared to Fen-Phen and Redux? Dr Krentzman: There are a few drugs in the same classification as phentermine which are approved for use and do work. It, and the others, are no more effective than phentermine, just different enough so that I can get around strange reactions and allergies. Fenfluramin and Redux and one other rarely used medication are in another classification with fewer alternatives. There are about 6 other classes of drugs which increase the serotonin in the brain. They are not more effective and are considered less effective. Bob M: Many people, as you mentioned before, who diet, complain that keeping the pounds off is very tough. What is the correlation between taking the drugs and the need to exercise? Dr Krentzman: There is very little use in moderate exercise. Since I am the only person who is trying the medicines without diet or exercise, and it works, this is an unstudied field. Moderate exercise can lower weight 5 or 10 pounds with diet. Tina: Do your patients change their diet and exercise habits in addition to taking the drugs? Do they continue these changes after their weight loss? Dr Krentzman: My patients sometimes change these habits. I ask all my patients to NOT DIET for the first 8 weeks. In this way I can tell if the medicines are working. I tell my patients that exercise is good and very healthy and will help them to live longer. Bob M: What about diet products like Herbal-life and herbs, etc. There have been articles recently tying obesity to depression. Dr Krentzman: I have not seen any studies which show that the obese get more depressed than the thin. One big study by Stunkard gave psychological tests to 300 people before surgery and 600 random people (thin and fat). A year later they retested them and found both groups had the same amount of problems. The surgical group had lost an average of 60 pounds. Divorce, jobs, hospital admissions, illness, mental testing, all were the same. River: Overweight people seem more unhappy, if only because we have such an image-conscious culture.

Evidence of maternal toxicity (decreased body weight gain 100mg aurogra, clinical signs safe aurogra 100mg, and/or mortality) was seen at 35 mg/kg and above cheap 100mg aurogra. When female rats were treated during the latter part of gestation and throughout lactation (0 buy 100 mg aurogra. Maternal toxicity (decreased body weight gain, clinical signs) was evident at 100 mg/kg or greater. In a rat embryo/fetal development study with a postnatal component (0. There are no studies using TOPAMAX^ in pregnant women. TOPAMAX^ should be used during pregnancy only if the potential benefit outweighs the potential risk to the fetus. In post-marketing experience, cases of hypospadias have been reported in male infants exposed in utero to topiramate, with or without other anticonvulsants; however, a causal relationship with topiramate has not been established. In studies of rats where dams were allowed to deliver pups naturally, no drug-related effects on gestation length or parturition were observed at dosage levels up to 200 mg/kg/day. The effect of TOPAMAX^ on labor and delivery in humans is unknown. Topiramate is excreted in the milk of lactating rats. The excretion of topiramate in human milk has not been evaluated in controlled studies. Limited observations in patients suggest an extensive secretion of topiramate into breast milk. Since many drugs are excreted in human milk, and because the potential for serious adverse reactions in nursing infants to TOPAMAX^ is unknown, the potential benefit to the mother should be weighed against the potential risk to the infant when considering recommendations regarding nursing. Safety and effectiveness in patients below the age of 2 years have not been established for the adjunctive therapy treatment of partial onset seizures, primary generalized tonic-clonic seizures, or seizures associated with Lennox-Gastaut syndrome. Safety and effectiveness in patients below the age of 10 years have not been established for the monotherapy treatment of epilepsy. Chronic untreated metabolic acidosis in pediatric patients may cause osteomalacia/rickets and may reduce growth rates. A reduction in growth rate may eventually decrease the maximal height achieved. The effect of topiramate on growth and bone-related sequelae has not been systematically investigated (see WARNINGS ). Safety and effectiveness in pediatric patients have not been established for the prophylaxis treatment of migraine headache. No age related difference in effectiveness or adverse effects were evident. However, clinical studies of topiramate did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently than younger subjects. Dosage adjustment may be necessary for elderly with impaired renal function (creatinine clearance rate S70 mL/min/1. Evaluation of effectiveness and safety in clinical trials has shown no race or gender related effects. The data described in the following section were obtained using TOPAMAX (topiramate) Tablets. The adverse events in the controlled trial that occurred most commonly in adults in the 400 mg/day group and at a rate higher than the 50 mg/day group were: paresthesia, weight decrease, somnolence, anorexia, dizziness, and difficulty with memory NOS [see Table 4]. The adverse events in the controlled trial that occurred most commonly in children (10 years up to 16 years of age) in the 400 mg/day group and at a rate higher than the 50 mg/day group were: weight decrease, upper respiratory tract infection, paresthesia, anorexia, diarrhea, and mood problems [see Table 5]. Approximately 21% of the 159 adult patients in the 400 mg/day group who received topiramate as monotherapy in the controlled clinical trial discontinued therapy due to adverse events. Adverse events associated with discontinuing therapy ( c2%) included depression, insomnia, difficulty with memory (NOS), somnolence, paresthesia, psychomotor slowing, dizziness, and nausea. Approximately 12% of the 57 pediatric patients in the 400 mg/day group who received topiramate as monotherapy in the controlled clinical trial discontinued therapy due to adverse events. Adverse events associated with discontinuing therapy ( c5%) included difficulty with concentration/attention. The prescriber should be aware that these data cannot be used to predict the frequency of adverse events in the course of usual medical practice where patient characteristics and other factors may differ from those prevailing during the clinical study. Similarly, the cited frequencies cannot be directly compared with data obtained from other clinical investigations involving different treatments, uses, or investigators. Inspection of these frequencies, however, does provide the prescribing physician with a basis to estimate the relative contribution of drug and non-drug factors to the adverse event incidences in the population studied. Table 4: Incidence of Treatment-Emergent Adverse Events in the Monotherapy Epilepsy Trial in AdultsWhere Rate Was at Least 2% in the 400 mg/day Topiramate Group and Greater Than the Rate in the 50 mg/day Topiramate GroupCentral & Peripheral Nervous System DisordersGastro-Intestinal System DisordersGastroesophageal RefluxLiver and Biliary System DisordersMetabolic and Nutritional DisordersDifficulty with Memory NOSDifficulty with Concentration/AttentionResistance Mechanism DisordersValues represent the percentage of patients reporting a given adverse event. Patients may have reported more than one adverse event during the study and can be included in more than one adverse event category. Table 5: Incidence of Treatment-Emergent Adverse Events in the Monotherapy Epilepsy Trial in Children Ages 10 up to 16 YearsWhere Rate Was at Least 5% in the 400 mg/day Topiramate Group and Greater Than the Rate in the 50 mg/day Topiramate GroupThe most commonly observed adverse events associated with the use of topiramate at dosages of 200 to 400 mg/day in controlled trials in adults with partial onset seizures, primary generalized tonic-clonic seizures, or Lennox-Gastaut syndrome, that were seen at greater frequency in topiramate-treated patients and did not appear to be dose-related were: somnolence, dizziness, ataxia, speech disorders and related speech problems, psychomotor slowing, abnormal vision, difficulty with memory, paresthesia and diplopia [see Table 6]. The most common dose-related adverse events at dosages of 200 to 1,000 mg/day were: fatigue, nervousness, difficulty with concentration or attention, confusion, depression, anorexia, language problems, anxiety, mood problems, and weight decrease [see Table 8]. Adverse events associated with the use of topiramate at dosages of 5 to 9 mg/kg/day in controlled trials in pediatric patients with partial onset seizures, primary generalized tonic-clonic seizures, or Lennox-Gastaut syndrome, that were seen at greater frequency in topiramate-treated patients were: fatigue, somnolence, anorexia, nervousness, difficulty with concentration/attention, difficulty with memory, aggressive reaction, and weight decrease [see Table 9]. In controlled clinical trials in adults, 11% of patients receiving topiramate 200 to 400 mg/day as adjunctive therapy discontinued due to adverse events. This rate appeared to increase at dosages above 400 mg/day. Adverse events associated with discontinuing therapy included somnolence, dizziness, anxiety, difficulty with concentration or attention, fatigue, and paresthesia and increased at dosages above 400 mg/day. None of the pediatric patients who received topiramate adjunctive therapy at 5 to 9 mg/kg/day in controlled clinical trials discontinued due to adverse events. Approximately 28% of the 1,757 adults with epilepsy who received topiramate at dosages of 200 to 1,600 mg/day in clinical studies discontinued treatment because of adverse events; an individual patient could have reported more than one adverse event. Approximately 11% of the 310 pediatric patients who received topiramate at dosages up to 30 mg/kg/day discontinued due to adverse events. Adverse events associated with discontinuing therapy included aggravated convulsions (2. Incidence in Epilepsy Controlled Clinical Trials Adjunctive Therapy- Partial Onset Seizures, Primary Generalized Tonic-Clonic Seizures, and Lennox-Gastaut Syndrome Table 6 lists treatment-emergent adverse events that occurred in at least 1% of adults treated with 200 to 400 mg/day topiramate in controlled trials that were numerically more common at this dose than in the patients treated with placebo. In general, most patients who experienced adverse events during the first eight weeks of these trials no longer experienced them by their last visit. Table 9 lists treatment-emergent adverse events that occurred in at least 1% of pediatric patients treated with 5 to 9 mg/kg topiramate in controlled trials that were numerically more common than in patients treated with placebo.

Patients should be cautioned about performing activities requiring mental alertness buy discount aurogra 100mg online, such as operating hazardous machinery or operating a motor vehicle buy aurogra 100mg amex, until they are reasonably certain that SAPHRIS therapy does not affect them adversely [see Warnings and Precautions (5 order 100 mg aurogra visa. Patients and caregivers should be counseled that a potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with administration of antipsychotic drugs cheap aurogra 100 mg visa. Signs and symptoms of NMS include hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia) [see Warnings and Precautions (5. Patients should be advised of the risk of orthostatic hypotension (symptoms include feeling dizzy or lightheaded upon standing) especially early in treatment, and also at times of re-initiating treatment or increases in dose [see Warnings and Precautions (5. Patients should be advised to notify their physician if they become pregnant or intend to become pregnant during therapy with SAPHRIS. Patients should be advised not to breast feed if they are taking SAPHRIS [see Use in Special Populations (8. Patients should be advised to inform their physicians if they are taking, or plan to take, any prescription or over-the-counter medications since there is a potential for interactions. Patients should be advised to avoid alcohol while taking SAPHRIS [see Drug Interactions (7)]. Patients should be advised regarding appropriate care in avoiding overheating and dehydration [see Warnings and Precautions (5. Distributed by Schering Corporation, a subsidiary of Schering-Plough Corporation,Y 2009, Schering Corporation. The term "addiction" describes a compulsive act which causes harm to the person and those around them and over which the person no longer has control. An example of this is a person who constantly drinks to excess in spite of the fact that it is hurting his family and career. An addict may even deny there is a problem and state they are, "just having fun. When asking "what is addiction," we can turn to The American Society of Addiction Medicine which uses the following addiction definition: "Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry... This is reflected in the individual pursuing reward and/or relief by substance use and other behaviors. Addiction is considered a mental illness and can be treated similarly to other mental illnesses with therapy, medication and lifestyle changes. There is no definition of addiction in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), but substance abuse is defined for drugs like nicotine, heroin, marijuana, alcohol and others. Substance abuse is defined as any of the following over a 12-month period: Dysfunction in work, school or home because of substance abuseRepeated use of substance in dangerous situationsSubstance-related legal problemsPersonal problems as a result of substance useThis definition of abuse can be applied to behaviors as well as substances. Drug abuse or abuse of a behavior describes use that harms the self or others. More than just abusive use of the drug or behavior, the definition of addiction is characterized by psychological changes and changes to behaviors in daily life such as:Inability to stop; relapseLoss of control over addictionContinuing addiction in spite of negative consequencesWhile some doctors now believe behavioral addictions can include a wide range of behaviors such as playing video games or exercising compulsively, there are several behaviors that have specifically been identified in the DSM-IV-TR. These behavior disorders are called impulse control disorders; however, their diagnosis tends to mirror an addiction definition. Impulse control disorders include kleptomania (compulsion to steal), pyromania (compulsion to set fires), gambling and others. Most drug abusers think they can stop taking drugs without the help of formal drug abuse treatment, but unfortunately, without treatment for drug abuse, many of them fail. Formal treatment for drug abuse is important if a drug abuser is to succeed in recovery. Treatments for drug abuse include:Medical drug abuse treatmentDrug abuse rehabilitation programsDrug abuse counseling or support groupsMedical Drug Abuse TreatmentDrug abuse treatment often starts with a visit to a doctor who can assess the specific needs of the patient. A doctor can refer someone to a hospital, a drug abuse rehabilitation program or counseling services. A doctor may also prescribe medication as part of drug abuse treatment. This medication may be used to ease withdrawal symptoms or prevent relapse. Common drug abuse treatment medications include: Benzodiazepines - tranquilizers that can ease withdrawal from drugs like alcoholMethadone - used to control cravings and prevent relapse from heroinNicotine patches - used to replace the addictive chemical in cigarettes, and is gradually taperedMedical drug abuse treatment will also screen for other mental disorders, as substance abuse frequently co-occurs with a mental illness. If a mental illness is diagnosed, part of drug abuse treatment will include treating the mental illness. Drug abuse rehabilitation programs can be run through medical facilities like a hospital or in separate facilities (read: substance abuse treatment facilities ). Drug abuse rehabilitation programs can be particularly helpful for those with severe or long-term substance abuse issues. Programs for drug abuse rehabilitation can be inpatient with around-the-clock care, or outpatient, where the drug abuser attends only during the day. Programs for drug abuse rehabilitation are designed to provide all the services a drug abuser might need to succeed in quitting drugs. This typically includes:Behavioral treatment - counseling in an individual or group settingAn aftercare program for when the drug abuser leaves rehabilitationWhile medical drug abuse treatment can help with physical withdrawal symptoms and sometimes cravings, staying clean means also changing thoughts and behaviors around drug use. Drug abuse counseling aims to address these psychological and behavioral issues. Drug abuse counseling may be:Medical and provided by a psychiatristPart of a drug abuse rehabilitation programProvided by private practitioners such as addiction therapistsDrug abuse treatment also commonly includes peer support groups both during and after treatment. These groups allow drug abusers to support each other in staying clean and sober. Alcoholics Anonymous and Narcotics Anonymous are 12-step groups believing in physical, psychological and spiritual healing in drug abuse recovery. SMART Recovery is secular and another commonly used drug abuse support group. In many cases, this is too late to prevent the damage addiction can do to the addict and those around them. Knowing what addiction symptoms to look for can help identify a problem early and provide the best chance at successful drug recovery. Drug addiction describes a state where the user is no longer in control of their drug use. The primary drug addiction symptoms reflect the definition of drug addiction itself. The basic symptoms of drug addiction include:An inability to stop taking the drug, in spite of multiple attemptsNegative consequences to the drug user and those around them caused by drug useThe drug user continues to take greater amounts of the drugWithdrawal symptoms when not using the drugSigns of drug addiction vary depending on the type of drug being abused. Some drugs or methods of drug use can provide obvious signs of drug addiction. One of the obvious signs of drug addiction in this case is the presence of injection equipment like a syringe, burned spoon and lighter. Other times, it is harder to spot the signs of drug addiction. Signs of drug addiction have to be considered with addiction symptoms and other information to indicate whether drug addiction is an issue.

What do you mean that it is a philosophical approach? Sonja: How is Multiple Personality Disorder philosophical rather than a reality? All of us are composed of many combinations of emotions and we tend to take on a different character when expressing a particular emotion discount aurogra 100 mg without prescription. The truth is that everyone who has ever been born has a multiple personality discount aurogra 100 mg otc. Human beings are the most complicated creatures imaginable 100 mg aurogra. She 100mg aurogra fast delivery, or you, may have thousands alters, and I may have 1500. Ewart, is that "6-month therapy deadline" is really a flashpoint for questions and criticism. Ewart: Lisa, do not quit unless you have something better. Ewart: The fact that you are functioning demonstrates great strength of character, but for every action there is a reaction, and it is not necessary to continue to drag the baggage. Ewart: smssafe, the feeling unsafe, comes from the feeling of deserving punishment, probe why you feel you deserve to be punished. Ewart, given that predators inherently know how to select their victims, is there a way for sexual abuse victims to identify the predator before she/he is taken advantage of again? Second, they will have either a strong or a very weak personality, one extreme or the other, and they will become possessive very early in the relationship. David: Would you say that once you identify someone as a predator, run as fast as you can? Bascha: I find that I am open to abuse mostly from myself. I also got kidnapped, tortured, beaten and raped twice as an adult by perpetrators I did not know. LauraM: I was told once by some friends, and then understood it was true, that I tend to be impolite to people who are nice to me and tend to be extremely nice to people who treat me badly. DeafDeb: There have been times that I felt I was a magnet for abuse. Ewart: The nature of the predator has an uncanny ability to spot wounded prey and they always pursue them. Like a hawk will never change into a dove, a predator will never change into a gentleman. David: So it seems from some of these comments that Dr. Ewart has really struck a chord here; that sexual abuse really breaks down the personality, leaving the victim open for further sexual abuse. The wounded draws more predators, and the person allows more predators because she believes she deserves no better. Ewart, if the further abuse has to be sexual abuse, or can it be emotional abuse or physical abuse too? David: Here are some more audience responses to my question:If you have been abused; have you discovered that your personality has left you open for further emotional abuse, physical abuse, or sexual abuse? The frustration with that though, is that you are constantly telling yourself that you would never let anyone ever do anything abusive to you it always seems to happen. MsJune: Yes, where one neighbor left off, about the age of 13, another one picked-up. Then I jumped into a relationship with a man I knew for hours, moved in with him, and found that he was extremely abusive. Under the circumstances, you could not have done otherwise. Remember that there is no normal way to respond to craziness. We B 100: I feel like I could still be controlled by my father (my abuser) mainly because he is so manipulative. Again, the greater the abuse, the greater the loyalty. Always remember that possession is the opposite of love, and that love always fosters freedom. Are most predators men, or are there women predators too? Little girls are abused more often than little boys but not by much. When boys are abused, they tend not to become abusive, but to be very sensitive to abuse and careful not to abuse others. Let me add that some predators might be predators, no matter how they are raised. And they do know that they are a predator and they choose to remain that way. No form of therapy has proven to be successful in changing them. Is it possible to actually become dependant on abuse? Many times I feel that I have developed a whole web around it hard to break, because in some ways it gives a lot of support to many things in my life. It makes me take off responsibility over many things on my life. Can that be a reason for the constant "victimization"? LauraM: I mainly meant using abuse as some kind of "crutch". I am a victim, so most things that happen to me or that I do, are not my fault. I am breaking that, but still sometimes think this way. Ewart: That is the "my fault" mentality that is common in abuse. It sounds like you are trying to overcome the my fault mentality, but not in a constructive way. Jazzmo07: Is it worse, or the same, if one was sexually abused by both parents?

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