By E. Grok. Tufts University. 2019.
David: How many years have you suffered with mania and depression? I remember being very depressed for long periods of time when I was a child cheap 25 mg clomid overnight delivery minstrel show. Mary Ellen Copeland: I thought I could control it myself discount clomid american express pregnancy labor. But now I know a lot of ways to help myself feel better, so the moods no longer overwhelm me and my life. I still have symptoms, but they are much milder and of shorter duration. I used to spend months in the hospital, but now I have either a bad day, or several days, or sometimes just a bad afternoon. I want to mention here that Mary Ellen is not a medical doctor, but she is a therapist, and now is involved primarily in educating others about mental health. The information she has to share with us tonight is based on interviews she did with others and her own experiences. Please tell us, Mary Ellen, who you interviewed and what they were suffering with? Mary Ellen Copeland: I have, in the last twelve years interviewed thousands of people from all over the country, who experience psychiatric symptoms or mental health problems. David: And what have you found out in terms of self-help methods that worked? Mary Ellen Copeland: I have found many things that are helpful to people. I have found so many things, that now I have ten books based on my findings. One of the first things I learned for myself, was that I, myself, had to do things that I enjoy. I had forgotten how to play and how to have a good time. So I began sewing, playing the piano, painting pictures, getting together with friends, and it made a huge difference in how I felt. I learned about the effects of diet, light and exercise on my moods and how to use them as ways to get my moods back under control. Mary Ellen Copeland: I have found that junk food (food that is highly processed or loaded with sugar or fat) makes me feel much worse. If my diet focuses on healthy foods, like fresh vegetables, fruit, whole grain foods, some chicken and fish, I do much better. I have found that there are certain foods that make me feel worse including foods that I think should be OK. Working with a good nutritionist and educating myself through self help books and internet options. My diet is much different now than it was just a few years ago. David: We will continue on with more of these self-help methods. But we have a lot of audience questions, Mary Ellen. Mary Ellen Copeland: Medications are never the whole answer. Are you spending time with people who treat you well? Take a look at your lifestyle, and make changes where you need to. Mary Ellen Copeland: I suggest you learn a lot more about this, by checking out websites and books that deal with healthy diet. You may notice that your son feels worse when he eats certain foods. That will give you good clues about what is really going on. Furthermore, what part is going to yield to your type of therapy? Do I have to be in two ports to find out where my ship is going to arrive and when? Mary Ellen Copeland: I think you should do everything you can to take good care of yourself. Then, if you still have symptoms that are hard for you to manage, you can use medications, if you choose to. It is important to remember that medications are just one tool to use to maintain mood stability. You will find many other things that are helpful to you as well. David: One of the other tools you mentioned is light. Mary Ellen Copeland: Many people notice that they get more and more depressed when the days get shorter in the fall or when there is a series of cloudy days. They may also notice it when they spend a lot of time indoors. Getting outdoors, even on cloudy days, can help you feel better. Mary Ellen Copeland: I am saying that there are choices to be made. I think it is very important not to expect medications to take care of problems in your life that need to be addressed in other ways, such as: taking good care of yourself and spending time with nice people. Many people find that when they have become very good at taking care of themselves, they need less medications, or no longer need them. But it takes time to learn the skills needed, to take really good care of yourself. It is important not to stop your medications but, first, to work on your wellness. And I found the side-effects of many of the medications, like extreme weight gain, lethargy, and lack of sex drive, to be intolerable. Mary Ellen Copeland: I have been in therapy with a wonderful woman therapist for many years. We have also worked together on issues related to trauma when I was a child. I think these traumatic events were a key factor in my mood instability. Current research is supporting the link between traumatic experiences and psychiatric symptoms. David: I noticed that several of your books are geared towards women.
Table 2: Efficacy Results in Double-Blind order clomid in united states online menstruation smell, Placebo-Controlled purchase clomid 25mg otc women's health big book of yoga amazon, Add-On TrialsProtocol Efficacy ResultsPartial Onset Seizures Studies in AdultsPrimary Generalized Tonic-ClonicLennox-Gastaut SyndromeImprvmnt. The results of 2 multicenter, randomized, double-blind, placebo-controlled, parallel-group clinical trials established the effectiveness of TOPAMAX^ in the prophylactic treatment of migraine headache. The design of both trials (one study was conducted in the U. Patients with a history of cluster headaches or basilar, ophthalmoplegic, hemiplegic, or transformed migraine headaches were excluded from the trials. Patients were required to have completed up to a 2 week washout of any prior migraine preventive medications before starting the baseline phase. Patients who experienced 3 to 12 migraine headaches over the 4-weeks in the baseline phase were equally randomized to either TOPAMAX^ 50 mg/day, 100 mg/day, 200 mg/day, or placebo and treated for a total of 26 weeks (8-week titration period and 18-week maintenance period). Treatment was initiated at 25 mg/day for one week, and then the daily dosage was increased by 25-mg increments each week until reaching the assigned target dose or maximum tolerated dose (administered twice daily). Effectiveness of treatment was assessed by the reduction in migraine headache frequency, as measured by the change in 4-week migraine rate from the baseline phase to double-blind treatment period in each TOPAMAX^ treatment group compared to placebo in the intent to treat (ITT) population. In the first study a total of 469 patients (416 females, 53 males), ranging in age from 13 to 70 years, were randomized and provided efficacy data. Two hundred sixty five patients completed the entire 26-week double-blind phase. The mean migraine headache frequency rate at baseline was approximately 5. The change in the mean 4-week migraine headache frequency from baseline to the double-blind phase was -1. The differences between the TOPAMAX^ 100 and 200 mg/day groups versus placebo were statistically significant (p<0. In the second study a total of 468 patients (406 females, 62 males), ranging in age from 12 to 65 years, were randomized and provided efficacy data. Two hundred fifty five patients completed the entire 26-week double-blind phase. The mean migraine headache frequency rate at baseline was approximately 5. The change in the mean 4-week migraine headache period frequency from baseline to the double-blind phase was -1. The differences between the TOPAMAX^ 100 and 200 mg/day groups versus placebo were statistically significant (p=0. In both studies, there were no apparent differences in treatment effect within age, or gender, subgroups. Because most patients were Caucasian, there were insufficient numbers of patients from different races to make a meaningful comparison of race. TOPAMAX^ (topiramate) Tablets and TOPAMAX^ (topiramate capsules) Sprinkle Capsules are indicated as initial monotherapy in patients 10 years of age and older with partial onset or primary generalized tonic-clonic seizures. Effectiveness was demonstrated in a controlled trial in patients with epilepsy who had no more than 2 seizures in the 3 months prior to enrollment. Safety and effectiveness in patients who were converted to monotherapy from a previous regimen of other anticonvulsant drugs have not been established in controlled trials. TOPAMAX^ (topiramate) Tablets and TOPAMAX^ (topiramate capsules) Sprinkle Capsules are indicated as adjunctive therapy for adults and pediatric patients ages 2 - 16 years with partial onset seizures, or primary generalized tonic-clonic seizures, and in patients 2 years of age and older with seizures associated with Lennox-Gastaut syndrome. TOPAMAX^ (topiramate) Tablets and TOPAMAX^ (topiramate capsules) Sprinkle Capsules are indicated for adults for the prophylaxis of migraine headache. The usefulness of TOPAMAX^ in the acute treatment of migraine headache has not been studied. TOPAMAX^ is contraindicated in patients with a history of hypersensitivity to any component of this product. Hyperchloremic, non-anion gap, metabolic acidosis (i. This metabolic acidosis is caused by renal bicarbonate loss due to the inhibitory effect of topiramate on carbonic anhydrase. Such electrolyte imbalance has been observed with the use of topiramate in placebo-controlled clinical trials and in the post-marketing period. Generally, topiramate-induced metabolic acidosis occurs early in treatment although cases can occur at any time during treatment. Bicarbonate decrements are usually mild-moderate (average decrease of 4 mEq/L at daily doses of 400 mg in adults and at approximately 6 mg/kg/day in pediatric patients); rarely, patients can experience severe decrements to values below 10 mEq/L. Conditions or therapies that predispose to acidosis (such as renal disease, severe respiratory disorders, status epilepticus, diarrhea, surgery, ketogenic diet, or drugs) may be additive to the bicarbonate lowering effects of topiramate. In adults, the incidence of persistent treatment-emergent decreases in serum bicarbonate (levels of <20 mEq/L at two consecutive visits or at the final visit) in controlled clinical trials for adjunctive treatment of epilepsy was 32% for 400 mg/day, and 1% for placebo. Metabolic acidosis has been observed at doses as low as 50 mg/day. The incidence of persistent treatment-emergent decreases in serum bicarbonate in adults in the epilepsy controlled clinical trial for monotherapy was 15% for 50 mg/day and 25% for 400 mg/day. The incidence of a markedly abnormally low serum bicarbonate (i. Serum bicarbonate levels have not been systematically evaluated at daily doses greater than 400 mg/day. In pediatric patients (<16 years of age), the incidence of persistent treatment-emergent decreases in serum bicarbonate in placebo-controlled trials for adjunctive treatment of Lennox-Gastaut syndrome or refractory partial onset seizures was 67% for TOPAMAX (at approximately 6 mg/kg/day), and 10% for placebo. The incidence of a markedly abnormally low serum bicarbonate (i. Cases of moderately severe metabolic acidosis have been reported in patients as young as 5 months old, especially at daily doses above 5 mg/kg/day. In pediatric patients (10 years up to 16 years of age), the incidence of persistent treatment-emergent decreases in serum bicarbonate in the epilepsy controlled clinical trial for monotherapy was 7% for 50 mg/day and 20% for 400 mg/day. The incidence of a markedly abnormally low serum bicarbonate (i. The incidence of persistent treatment-emergent decreases in serum bicarbonate in placebo-controlled trials for adults for prophylaxis of migraine was 44% for 200 mg/day, 39% for 100 mg/day, 23% for 50 mg/day, and 7% for placebo. The incidence of a markedly abnormally low serum bicarbonate (i. Some manifestations of acute or chronic metabolic acidosis may include hyperventilation, nonspecific symptoms such as fatigue and anorexia, or more severe sequelae including cardiac arrhythmias or stupor. Chronic, untreated metabolic acidosis may increase the risk for nephrolithiasis or nephrocalcinosis, and may also result in osteomalacia (referred to as rickets in pediatric patients) and/or osteoporosis with an increased risk for fractures. Chronic metabolic acidosis in pediatric patients may also 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. Measurement of baseline and periodic serum bicarbonate during topiramate treatment is recommended. If metabolic acidosis develops and persists, consideration should be given to reducing the dose or discontinuing topiramate (using dose tapering).
In the time between initial infection and AIDS cheap clomid 50 mg with amex breast cancer zippered checkbook covers, the infected person may feel relatively normal clomid 25 mg free shipping women's health clinic vero beach, despite the constant attack by HIV. People living with HIV have to understand, however, that despite feeling well on the outside, significant damage can be occurring on the inside. But February 14, which is also National Condom Day, should also serve as reminder of the importance of protecting yourself and your partner from sexually transmitted disease (STD). According to the American Social Health Organization, there are an estimated 15. As a result, people- especially those in committed relationships - tend to underestimate their risk of transmitting or acquiring an STD and are often lax about condom use. By developing a sense of "negotiated safety," couples often come to the unfounded conclusion that they are not putting each other at risk for an STD. And still others use condoms incorrectly, sometimes making sex less enjoyable and the condom less effective. Below, Richard Crosby, PhD, of the College of Public Health at the University of Kentucky in Lexington, discusses common barriers to condom use and why couples need to make decisions about condom use together. Are more people using condoms today than they were 10 years ago? There have been some increases and some general trends towards stability, with very little evidence of decline. We have some evidence that condom use among adolescents increased substantially in the 1990s and is now relatively stable. But among young gay men evidence suggests the possibility of decreases in condom use. These are men who have always known AIDS, and who, in a sense, may have accepted AIDS as a normal part of gay life. The factors that influence use for adolescents are going to be quite different than those that influence use for adults. Among adolescents, factors like peer norms are important. For example, adolescents who have friends who use condoms are more likely to use condoms themselves. In adults, a lot of factors have been studied, and probably one of the most commonly reported findings is adults in steady relationships are far less likely to use condoms than those who are having sex within non-steady relationships. Why are committed couples less likely to use condoms? Some couples will eventually get to a point where there is some mutual testing for HIV or STDs. Although the evidence is not definitive, their thinking may be: "If we were going to have a problem as a result of having unprotected sex, that problem would have occurred by now. We have evidence showing that some of that negotiated safety is something that partners discuss and the decision is a mutually agreed-upon decision by the couple. In other cases, though, the decision may be unilateral. It may be a decision that is made by a female or a male partner. In many cases, the evidence suggests that male partners make this decision more often than female partners. This form of unilateral decision-making is clearly problematic if the male partner is unconcerned about transmitting HIV, STDs or causing a pregnancy. Lack of pleasure and irritation caused by condoms are very common. But because people often have very littleTrue enough, erectile dysfunction or ED (formerly called impotence) is three times more common among men with diabetes. And women with diabetes are twice as likely as those without the disease toOften, such difficulties are temporary and easily solved. In this Diabetes Forecast special section, we bring you up to date on the latest research and most promising treatment options. And we explore how psychological and emotional health can directly affect sexual functioning and enjoyment for both men and women. Finally, we offer help with what may be the most difficult, and the most essential, step in solving sexual problems: talking openly and honestly with your partner. Our 10 tips for talking about sex can help you and your partner face sexual problems together and make a great start toward reclaiming your sex life in a positive and loving way. Have the symptoms zapped your passion or stymied your in-bed performance? Is your significant other afraid of making love--or seemingly put off by it? Answer "yes" to any of these questions and you may be a good candidate for sex therapy. Heis director of Psychological Services at the Bernard W. Gimbel MS Comprehensive Care Center at Holy Name Hospital in Teaneck, New Jersey, and has worked with people who have MS for over 25 years. Whomever you tap should provide you with a non-threatening environment where you and your partner learn to initiate intimate conversation and activity. Once the door opens, however, a therapist usually helps partners reduce their vulnerability. They learn to use words and phrases that are respectful and not accusatory. You may learn, for instance, how to maneuver your spastic legs into a comfortable position during sex. Or you may establish a new framework to counter the sensations altered by MS damage in the central nervous system. Foley teaches a technique called body mapping to help partners find new sensual points that make orgasm possible once again. One of his clients marshaled new pathways so well that she and her husband not only enjoyed sex again, they conceived a baby. While this particular couple took months to reconnect, therapy need not last forever. Another couple needed just one session to learn how to incorporate self-catheterization into foreplay. But each symptom can potentially interrupt enjoyment, so it may be appropriate to pay return visits. Obviously, progress comes more easily if both individuals are committed. However you play the song, you need to believe that MS can coexist with a loving relationship of hearts, flowers...
If this cancer is found early buy discount clomid 100 mg menopause 9gag, most of the time the testicle can be removed successfully buy clomid now women's health center of santa cruz. Finding the cancer early is the key to the best outcome. Your doctor should advise you to check your balls on a regular basis-once a month or so. You will quickly learn how your testicles feel and will be able to discover a new lump or bump on them. If you do feel a lump, see your physician immediately to have it checked out. If you notice pain in or around the testicles, have it checked out also. For example, a lump in the scrotum may not be a tumor of the testicle, but a collection of veins called a varicocele. At any rate, expect that a physical examination will include an examination of your testicles. The doctor needs to examine them by touching to be sure they and you are healthy! In fact, if your doctor does not do this during an examination, ask him or her why this very important part of your body is being ignored! Acquaintance rape, which is also referred to as " date rape " and "hidden rape," has been increasingly recognized as a real and relatively common problem within society. Much of the attention that has been focused on this issue has emerged as part of the growing willingness to acknowledge and address issues associated with domestic violence and the rights of women in general in the past three decades. The scholarly research done by psychologist Mary Koss and her colleagues is widely recognized as the primary impetus for raising awareness to a new level. By debunking the belief that unwanted sexual advances and intercourse were not rape if they occurred with an acquaintance or while on a date, Koss compelled women to reexamine their own experiences. Many women were thus able to reframe what had happened to them as acquaintance rape and became better able to legitimize their perceptions that they were indeed victims of a crime. For current purposes, the term acquaintance rape will be defined as being subjected to unwanted sexual intercourse, oral sex, anal sex, or other sexual contact through the use of force or threat of force. Unsuccessful attempts are also subsumed within the term "rape. The electronic media have developed an infatuation with trial coverage in recent years. Among the trials which have received the most coverage have been those involving acquaintance rape. The Mike Tyson/Desiree Washington and William Kennedy Smith/Patricia Bowman trials garnered wide scale television coverage and delivered the issue of acquaintance rape into living rooms across America. Another recent trial which received national attention involved a group of teenaged boys in New Jersey who sodomized and sexually assaulted a mildly retarded 17-year old female classmate. While the circumstances in this instance differed from the Tyson and Smith cases, the legal definition of consent was again the central issue of the trial. Although the Senate Judiciary Committee hearings on the Supreme Court nomination of Judge Clarence Thomas were obviously not a rape trial, the focal point of sexual harassment during the hearings expanded national consciousness regarding the demarcations of sexual transgression. The sexual assault which took place at the Tailhook Association of Navy Pilots annual convention in 1991 was well documented. At the time of this writing, events involving sexual harassment, sexual coercion, and acquaintance rape of female Army recruits at the Aberdeen Proving Grounds and other military training facilities are being investigated. As these well publicized events indicate, an increased awareness of sexual coercion and acquaintance rape has been accompanied by important legal decisions and changes in legal definitions of rape. Until recently, clear physical resistance was a requirement for a rape conviction in California. The definition of "consent" has been expanded to mean "positive cooperation in act or attitude pursuant to an exercise of free will. A person must act freely and voluntarily and have knowledge of the nature of the act or transaction involved. Most states also have provisions which prohibit the use of drugs and/or alcohol to incapacitate a victim, rendering the victim unable to deny consent. Acquaintance rape remains a controversial topic because of lack of agreement upon the definition of consent. In an attempt to clarify this definition, in 1994, Antioch College in Ohio adopted what has become an infamous policy delineating consensual sexual behavior. The primary reason this policy has stirred such an uproar is that the definition of consent is based on continuous verbal communication during intimacy. The rules also state that "If you have had a particular level of sexual intimacy before with someone, you must still ask each and every time. This attempt to remove ambiguity from the interpretation of consent was hailed by some as the closest thing yet to an ideal of " communicative sexuality. Most criticism centered on reducing the spontaneity of sexual intimacy to what seemed like an artificial contractual agreement.. Feminists have traditionally devoted much attention to issues such as pornography, sexual harassment, sexual coercion, and acquaintance rape. The sociological dynamics which influence the politics of sexual equality tend to be complicated. There is no single position taken by feminists on any of the aforementioned issues; there are differing and often conflicting opinions. Views on pornography, for example, are divided between two opposing camps. Libertarian feminists, on one hand, distinguish between erotica (with themes of healthy consensual sexuality) and pornography (material that combines the "graphic sexually explicit" with depictions which are "actively subordinating, treating unequally, as less than human, on the basis of sex. Socalled "protectionist" feminists tend not to make such a distinction and view virtually all sexually-oriented material as exploitative and pornographic. Views on acquaintance rape also appear quite capable of creating opposing camps. Despite the violent nature of acquaintance rape, the belief that many victims are actually willing, consenting participants is held by both men and women alike. Prominent authors have espoused this idea in editorial pages, Sunday Magazine sections, and popular journal articles. Some of these authors are women (a few identify themselves as feminists) who appear to justify their ideas by drawing conclusions based on their own personal experiences and anecdotal evidence, not wide-scale, systematic research. They may announce that they too have probably been raped while on a date to illustrate their own inevitable entanglement in the manipulation and exploitation which are part of interpersonal relations. In 1993, The Morning After: Sex, Fear, and Feminism on Campus by Katie Roiphe was published. Roiphe alleged that acquaintance rape was largely a myth created by feminists and challenged the results of the Koss study.