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This disturbance or disruption may even lead to heart attack or stroke cheap 120 mg silvitra visa erectile dysfunction qof. The potential for ginseng to quiet down the blood vessels may prove to be protective against heart and other forms of cardiovascular disease trusted silvitra 120 mg erectile dysfunction age 36. Although not proven, ginseng may also raise HDL (the good cholesterol), while reducing total cholesterol levels. Finally, there is some controversy about whether, under certain circumstances, ginseng may help improve blood pressure. Ginseng is generally considered to be a substance to avoid if you have hypertension because it can raise blood pressure. In a couple of studies, however, of red Korean (Asian) ginseng, high doses of this herb actually lowered blood pressure. Some feel that the usual doses of ginseng may increase blood pressure while high doses may have the opposite effect of decreasing blood pressure. Much more information is needed in this area before a conclusion can be drawn. And, if you have high blood pressure or heart disease, it is not safe to try ginseng on your own, without specific instructions from a knowledgeable clinician. Because of its ability to help resist or reduce stress, some herbal specialists may consider ginseng as part of the herbal treatment for depression. Although American ginseng has been better researched for this purpose, both types of Panax ginsengs have been shown to lower blood sugar levels in those with type 2 (adult onset) diabetes. Ginseng is widely believed to be capable of enhancing sexual performance. However, studies in people to investigate this are limited. In animal studies, Panax species of ginseng have increased sperm production, sexual activity, and sexual performance. A study of 46 men has also shown an increase in sperm count as well as motility. Ginseng is believed to enhance the immune system, which could, in theory, help the body fight off infection and disease. In one study, in fact, giving people ginseng before getting the flu-vaccine did boost their immune response to the vaccine compared to those who received a placebo. Two well-designed studies evaluating red Korean (Asian) ginseng suggest that this herb may relieve some of the symptoms of menopause, improving mood (particularly feelings of depression) and sense of well-being. Mental Performance and Mood Enhancement Individuals who use ginseng often report that they feel more alert. Preliminary studies do suggest that this feeling has scientific merit. Early research shows that ginseng may improve performance on such things as mental arithmetic, concentration, memory, and other measures. More research in this area, although not easy to do, would be helpful. On the other hand, for those who report that ginseng elevates their mood, the science thus far does not support that this herb changes your mood if you are otherwise healthy. There have been a number of studies in people looking at the effects of ginseng on athletic performance. Results have not been consistent, with some studies showing increased strength and endurance, others showing improved agility or reaction time, and still others showing no effect at all. Nevertheless, athletes often take ginseng to increase both endurance and strength. In patients with severe chronic respiratory disease (such as emphysema or chronic bronchitis), daily treatment with ginseng improved respiratory function, as evidenced by increased endurance in walking. Ginseng has long been valued for its ability to help the body deal with stress. A study of 501 men and women living in Mexico City found significant improvements in quality of life measures (energy, sleep, sex life, personal satisfaction, well-being) in those taking ginseng. The ginseng plant has leaves that grow in a circle around a straight stem. Yellowish-green umbrella-shaped flowers grow in the center and produce red berries. Wrinkles around the neck of the root tell how old the plant is. This is important because ginseng is not ready for use until it has grown for four to six years. Ginseng products are made from the ginseng root, and the long, thin offshoots, called root hairs. In addition to ginsenosides, Asian ginseng also contains glycans (panaxans), polysaccharide fraction DPG-3-2, peptides, maltol, B vitamins, flavonoids, and volatile oil. White ginseng (dried, peeled) or red ginseng (unpeeled root, steamed before drying) is available in water, water-and-alcohol, or alcohol liquid extracts, and in powders or capsules. It is important when buying ginseng to read the label carefully and make sure that you are purchasing the type of ginseng that you want. If you are looking for Asian or American ginseng, look for a Panax species, not Siberian ginseng (Eleutherococcus senticosus) which, although there is some overlap, has different actions and side effects overall. This herb is not recommended for use in children because of its stimulant properties. Fresh root: 1 to 2 grams daily for up to three monthsDried root: 1/2 to 2 grams dailyTincture (1:5): 1 to 2 teaspoonsLiquid extract (1:1): l to m teaspoonsStandardized extract (4% total ginsenosides): 100 milligrams twice daily. In healthy individuals who wish to increase physical or mental performance, to prevent illness, or to improve resistance to stress, ginseng should be taken in one of the above dosages in cycles. For example, take every day for 2 to 3 weeks, then stop for 2 weeks. For help recovering from an illness, the elderly should take 500 mg twice daily for three months. Alternatively, they may take the same dosage (500 mg twice daily) for a month, followed by a two-month break. The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a practitioner knowledgeable in the field of botanical medicine. Both American and Asian ginsengs are stimulants and may cause nervousness or sleeplessness, particularly if taken at high doses.

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We never were really alone until the day before we left discount silvitra express erectile dysfunction urban dictionary. And he was changing and everyone was out and I was downstairs best silvitra 120 mg erectile dysfunction treatment bay area. He then led me up a hill (we were in the countryside and I had no idea where we were going. I was pregnant from the rape in the woods and we had this fake relationship. His wife even knew and she was going to leave so I could move in with him. He ended up calling and did the only respectable thing he probably did the whole time we knew each other. I just needed help, not to be stripped of more dignity. I told them I tried to kill myself over school work and grades and pressure. He did in a way, simply because I probably would have succeeded one of those times I tried... I got into therapy at a rape counseling place and saw this therapist to work on my anger management. I then went to my college pre-orientation where I met my fiance. We immediately hit it off and even talked all night the first night we met. We started dating a week later and he went to that great course I mentioned that weekend. I was having a rough time of it because it was the anniversary of my rape. My boyfriend proposed to me two weeks ago exactly today. I guess that explains feeling so bad all of a sudden. He started to watch me shower, constantly pushing me down, telling me how dirty I was. Then he started raping me anally for years until it progressed to vaginal rape. The last time it happened, I had to be hospitalized. When I was 13, I was dating this heroin addict named Mike. He was moving away, so I was planning on giving him sex. His friend John was over and Mike raped me and then John did the same. When I was 15, I stupidly took a ride from a stranger and got raped. A few weeks ago, I took a ride from a friend and he asked to use my phone. This happened not even a week after I got out of a residential treatment center for two years where I was being treated for self-mutilation, drug and alcohol abuse, and anorexia/bulimia. Although I still have nightmares and flashbacks, those are normal. I had just moved from Puerto Rico to Miami to start my freshman year at college. I was 17 and it was two weeks into the semester when some friends invited me to a dorm party. I started drinking as soon as I got there and I met this guy that was a junior there. We talked throughout the night and he kept bringing me drinks. After awhile, I invited him to my dorm room which was a couple of doors away. When we got there we started kissing and he started taking off my clothes and I let him. I tried to push him away but he grabbed my hands and pushed them against the bed. He called me and I always felt uncomfortable talking to him. After awhile he stopped calling me and when he saw me on campus he would ignore me. I told my best friend of many years a couple of days ago. These women, and occasionally men, experience a myriad of psychological and emotional issues long after any physical injuries have healed. While victims should always seek individual therapy from a mental health professional, many find that talking to other rape survivors in a safe, group setting very cathartic. But many remain so imprisoned by fear, guilt, anger, and a loss of social wellbeing, that they have difficulty finding the courage to take the first step. Perhaps well-meaning family members have told the victim never to speak about it, claiming it will help her forget it ever happened. This dangerous advice can result in devastating mental health consequences for those who survive rape. By taking this first step, your experience can become a badge of courage instead of a living Hell. Your story can act as a tool that helps other victims ??? rape survivors who feel alone, frightened, angry, and depressed ??? see that they can heal and reclaim their lives from the specter of sexual assault. Talk to a therapist or counselor about publicly sharing your rape story. Faces of Survivors: Voices Reclaimed ??? A photo essay of rape survivors that celebrates the healing process and strength of survivors. Take Back the Night ??? A safe place for victims of sexual violence to take a stand and break the silence. Speaking out about a rape experience can empower victims by slowly breaking down the psychological hold it has on their lives. Rape survivors can transform their traumatic experiences into tools for helping others break the silence and gain freedom. Law enforcement and others usually refer to women raping women as "lesbian rape" even though one or both parties involved might not consider their sexual orientation as lesbian. Women raped by other females report perpetrators forcing digit (finger) masturbation, digital penetration, and stimulation of clitoris and vulva using the tongue or inserting foreign devices, such as vibrators or phallic-like objects, into the vagina or anus.

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Priapism - One case of priapism was reported in the premarketing database purchase silvitra 120mg line erectile dysfunction operations. While the relationship of the event to ziprasidone use has not been established 120mg silvitra impotence causes and treatment, other drugs with alpha-adrenergic blocking effects have been reported to induce priapism, and it is possible that ziprasidone may share this capacity. Appropriate care is advised when prescribing ziprasidone for patients who will be experiencing conditions which may contribute to an elevation in core body temperature, e. Suicide - The possibility of a suicide attempt is inherent in psychotic illness or bipolar disorder, and close supervision of high-risk patients should accompany drug therapy. Prescriptions for ziprasidone should be written for the smallest quantity of capsules consistent with good patient management in order to reduce the risk of overdose. Use in Patients with Concomitant Illness - Clinical experience with ziprasidone in patients with certain concomitant systemic illnesses (see Renal Impairment and Hepatic Impairment under CLINICAL PHARMACOLOGY, Special Populations) is limited. Ziprasidone has not been evaluated or used to any appreciable extent in patients with a recent history of myocardial infarction or unstable heart disease. Patients with these diagnoses were excluded from premarketing clinical studies. Because of the risk of QTc prolongation and orthostatic hypotension with ziprasidone, caution should be observed in cardiac patients (see QTc Prolongation under WARNINGS and Orthostatic Hypotension under PRECAUTIONS ). Information for Patients Please refer to the patient package insert. To assure safe and effective use of GEODON, the information and instructions provided in the patient information should be discussed with patients. Patients being considered for ziprasidone treatment that are at risk of significant electrolyte disturbances should have baseline serum potassium and magnesium measurements. Low serum potassium and magnesium should be repleted before proceeding with treatment. Patients who are started on diuretics during ziprasidone therapy need periodic monitoring of serum potassium and magnesium. Ziprasidone should be discontinued in patients who are found to have persistent QTc measurements >500 msec (see WARNINGS ). Drug-drug interactions can be pharmacodynamic (combined pharmacologic effects) or pharmacokinetic (alteration of plasma levels). The risks of using ziprasidone in combination with other drugs have been evaluated as described below. All interactions studies have been conducted with oral ziprasidone. Based upon the pharmacodynamic and pharmacokinetic profile of ziprasidone, possible interactions could be anticipated:(1) Ziprasidone should not be used with any drug that prolongs the QT interval (see CONTRAINDICATIONS ). The Effect of Other Drugs on Ziprasidone Carbamazepine - Carbamazepine is an inducer of CYP3A4; administration of 200 mg BID for 21 days resulted in a decrease of approximately 35% in the AUC of ziprasidone. This effect may be greater when higher doses of carbamazepine are administered. Ketoconazole - Ketoconazole, a potent inhibitor of CYP3A4, at a dose of 400 mg QD for 5 days, increased the AUC and Cmax of ziprasidone by about 35-40%. Other inhibitors of CYP3A4 would be expected to have similar effects. Cimetidine - Cimetidine at a dose of 800 mg QD for 2 days did not affect ziprasidone pharmacokinetics. Antacid - The coadministration of 30 mL of Maalox^ with ziprasidone did not affect the pharmacokinetics of ziprasidone. In addition, population pharmacokinetic analysis of schizophrenic patients enrolled in controlled clinical trials has not revealed evidence of any clinically significant pharmacokinetic interactions with benztropine, propranolol, or lorazepam. In vitro studies revealed little potential for ziprasidone to interfere with the metabolism of drugs cleared primarily by CYP1A2, CYP2C9, CYP2C19, CYP2D6, and CYP3A4, and little potential for drug interactions with ziprasidone due to displacement (see CLINICAL PHARMACOLOGY, Pharmacokinetics). Lithium - Ziprasidone at a dose of 40 mg BID administered concomitantly with lithium at a dose of 450 mg BID for 7 days did not affect the steady-state level or renal clearance of lithium. Oral Contraceptives - Ziprasidone at a dose of 20 mg BID did not affect the pharmacokinetics of concomitantly administered oral contraceptives, ethinyl estradiol (0. Dextromethorphan - Consistent with in vitro results, a study in normal healthy volunteers showed that ziprasidone did not alter the metabolism of dextromethorphan, a CYP2D6 model substrate, to its major metabolite, dextrorphan. There was no statistically significant change in the urinary dextromethorphan/dextrorphan ratio. Carcinogenesis, Mutagenesis, Impairment of FertilityCarcinogenesis - Lifetime carcinogenicity studies were conducted with ziprasidone in Long Evans rats and CD-1 mice. Ziprasidone was administered for 24 months in the diet at doses of 2, 6, or 12 mg/kg/day to rats, and 50, 100, or 200 mg/kg/day to mice (0. In the rat study, there was no evidence of an increased incidence of tumors compared to controls. In male mice, there was no increase in incidence of tumors relative to controls. In female mice, there were dose-related increases in the incidences of pituitary gland adenoma and carcinoma, and mammary gland adenocarcinoma at all doses tested (50 to 200 mg/kg/day or 1 to 5 times the MRHD on a mg/m2 basis). Proliferative changes in the pituitary and mammary glands of rodents have been observed following chronic administration of other antipsychotic agents and are considered to be prolactin-mediated. Increases in serum prolactin were observed in a 1-month dietary study in female, but not male, mice at 100 and 200 mg/kg/day (or 2. Ziprasidone had no effect on serum prolactin in rats in a 5-week dietary study at the doses that were used in the carcinogenicity study. The relevance for human risk of the findings of prolactin-mediated endocrine tumors in rodents is unknown (see Hyperprolactinemia under PRECAUTIONS, General). Mutagenesis - Ziprasidone was tested in the Ames bacterial mutation assay, the in vitro mammalian cell gene mutation mouse lymphoma assay, the in vitro chromosomal aberration assay in human lymphocytes, and the in vivo chromosomal aberration assay in mouse bone marrow. There was a reproducible mutagenic response in the Ames assay in one strain of S. Positive results were obtained in both the in vitro mammalian cell gene mutation assay and the in vitro chromosomal aberration assay in human lymphocytes. Impairment of Fertility - Ziprasidone was shown to increase time to copulation in Sprague-Dawley rats in two fertility and early embryonic development studies at doses of 10 to 160 mg/kg/day (0. Fertility rate was reduced at 160 mg/kg/day (8 times the MRHD on a mg/m2 basis). There was no effect on fertility at 40 mg/kg/day (2 times the MRHD on a mg/m2 basis). The effect on fertility appeared to be in the female since fertility was not impaired when males given 160 mg/kg/day (8 times the MRHD on a mg/m2 basis) were mated with untreated females. In a 6-month study in male rats given 200 mg/kg/day (10 times the MRHD on a mg/m2 basis) there were no treatment-related findings observed in the testes. Pregnancy - Pregnancy Category C - In animal studies ziprasidone demonstrated developmental toxicity, including possible teratogenic effects at doses similar to human therapeutic doses. When ziprasidone was administered to pregnant rabbits during the period of organogenesis, an increased incidence of fetal structural abnormalities (ventricular septal defects and other cardiovascular malformations and kidney alterations) was observed at a dose of 30 mg/kg/day (3 times the MRHD of 200 mg/day on a mg/m2 basis). There was no evidence to suggest that these developmental effects were secondary to maternal toxicity. The developmental no-effect dose was 10 mg/kg/day (equivalent to the MRHD on a mg/m2 basis).

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My experiments with diet have been limited to just myself and my issues with pain and arthritis generic silvitra 120 mg amex erectile dysfunction remedies natural, etc cheap 120 mg silvitra with amex erectile dysfunction doctor pune. Lesia: Just a week ago, we found that our son is possibly ADHD (Attention Deficit Hyperactivity Disorder) and the doctor has told us that he would like to put him on Ritalin 5mg twice a day. My husband and I have only heard bad things about this drug. Please tell me that we have another road to take, other than medicating him. Brandi Valentine: Please remember this is just my opinion and that I am not a medical professional. My experience and opinion is this: even though my son was displaying what I now know to be ADD, ADHD symptoms at 3 years old, if I was given a diagnosis at that age, and was told to medicate him, I would ask myself these questions:What drove me to seek a diagnosis? Do I instinctively know that there is something wrong based on behavior and other issues? We know now that children who have been on Ritalin are not candidates for the military. If you have used Ritalin, it is much harder if not impossible to get a pilots license. Plus, the choice to medicate often comes with a large burden of guilt. On one hand, you have professionals who are eager to see you "medicate first, ask questions later". Then, you have your own doubts as to whether or not you have done the right thing, about the long-term effects, etc. I feel that if you try other alternatives first, and choose medication last, then, without guilt or doubt, you can say to yourself that you chose the best route for your child. Brandi Valentine: May I ask what drove you to seek a medical diagnosis? The school has been good, and they have been working with us very closely. Brandi Valentine: You had the medical evaluation, have you had the academic evaluation? They now know that many gifted and talented children are misdiagnosed as add/adhd due to the fact that going unchallenged leaves them bored and exhibiting symptoms similar to ADHD children. Perhaps an Individualized Educational Plan (IEP) would give him more individualized help. Help like that, might give him the ability to do what is being asked of him, without the aid of medication. David: Brandi, since you introduced the subject of "parental guilt"-- earlier you said you felt very guilty when you found out your children had ADHD. Your feelings and how they have changed over the years, if at all? I was told this by school professionals, medical doctors, family members, etc. The ADHD diagnosis lifted some of that guilt, by telling me that I was not responsible for what was happening to my son, but then, new guilt issues stepped in. And then too, the fact that I consented to have him committed to a psychiatric facility for 2 weeks. A lot of times, I am able to keep the guilt behind me, not let it affect me. And each decision I made, at the time, was the best possible one to make. I simply try my best not to put myself with people who do not understand or support my decisions. Unfortunately, some of these people are family members, but I do my best to either avoid the issue with them or avoid them. We, as parents, can only do what we think is best at the time. We are not experts in every field and so sometimes the choices may not be the best ones. I also want to thank everyone in the audience for coming tonight. Brandi Valentine: Thank you for having me and thanks everyone for coming. David: Good night everyone and thank you again for being here tonight. Richfield is a child psychologist the creator of The Parent Coaching Cards. These cards help to develop frustration tolerance and other self control skills in ADD/ADHD children, as well as helping children learn to analyze situations, adapt to them, and restrain themselves rather than acting on impulse. Our topic tonight is "Coaching, For Parents of ADD/ADHD Children. If you want to know what "coaching" is all about before we get into the conference, please click on this link. Our guest tonight is psychologist and developer of The Parent Coaching Cards, Dr. Richfield is a child psychologist, parent/teacher trainer, and has been working in the mental health field since 1980. He is based in Pennsylvania and specializes in the treatment of disruptive behavior disorders and sees families with children diagnosed as having ADD/ADHD, behaviors that are difficult for both child and parent to manage. Parent coaching is a prescriptive type of parenting involving tools and goals to help children develop social and emotional skills. David: What kind of tools and goals are we talking about? Richfield: The tools range from Parent Coaching Cards to other concrete strategies developed by parents and children in a partnership. David: So when you say the word "coaching" are you really referring to "tutoring" in the sense of teaching your child how to deal with various situations that may arise? Richfield: Many skills such as frustration tolerance and other self control skills can be coached. Parents can access the lessons right on the spot or prepare their kids for future challenges David: For instance, what kinds of situations or behaviors is coaching good for? They can use the Coaching Card "Quit The Clowning" to prepare a kid for an event. And at what age can you begin coaching your ADD child? Richfield: Classroom environments, family gatherings, and recess are all coachable places. The Cards target ages 7 - 12 but are used with younger and older kids. Coaching can begin very early - in the preschool years. David: And specifically, how is coaching effective in working with ADD-ADHD children?

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