H. Vibald. Stephen F. Austin State University.

Why is it soooo much harder if you only have 20 pounds to lose than if you have 100? If you have purchase genuine cytotec line treatment modalities, for instance buy cheap cytotec online treatment 1st 2nd degree burns, two people who are 5 foot 7 inches tall and one is 150 pounds and the other is 250 pounds then it takes more calories to keep the 250 pound person at that weight. Therefore they can burn more calories in a day than the more slender person can. River: Whether or not there is proof, why would anyone want to create health problems in addition to their weight problem. Dr Krentzman: The FDA asked our help in finding cases so they could get some idea if the diet drugs are somehow involved with heart valve illness. This has not yet been proven, only partly suggested. Should this cause tens of thousands of obese people to die by avoiding the diet drugs WHICH WORK? I guess the choice is the health problem I understand vs. Bob M: Can you please explain when it is appropriate to consider taking diet drugs like Fen-Phen and Redux? Dr Krentzman: Anyone who has a BMI of 30 or more will benefit. Those with less weight (you can see a BMI chart on my website) can benefit if you are a BMI of 27 or more and have heart disease, diabetes or hypertension. Koop, former Surgeon General of the United States believes that Diabetics could benefit down to a BMI of 20 I will not help anyone lose weight below 20 because that is where lifespan begins to shorten. Bob M: What is the difference between Fen Phen and Redux and what is each indicated for? Dr Krentzman: Phen/Fen is made up of two separate drugs, Phentermine and Fenfluramine. Redux is made of one drug which is the active weight controlling half of Fenfluramine (Pondimin). The only side effect I experienced was a horrible headache that lasted 4 days. Lori H: I was on fen - phen for a few months and gained 15 pounds. Dr Krentzman: Phen/Fen is made up of two separate drugs, Phentermine and Fenfluramine. Redux is made of one drug which is the active weight controlling half of Fenfluramine (Pondimin). In other words, fenfluramine and redux are the same. No one has ever given me any proof that my belief, loudly stated on my website, is wrong. Less than 1% have diarrhea or constipation and even less have mental confusion or short term memory problems. All these side effects go away when the level of medicines is reduced or stopped. Dr Krentzman: For the person who wondered why they could gain 15 pounds of Phen-Fen, The medication combination works on 60% of humans, and not on 40%. 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.

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I expect that the longer it has gone on discount cytotec 200 mcg online medicine 1800s, the longer it may take to heal buy 200 mcg cytotec with mastercard medicine zoloft. Another factor is how willing you are to gain weight if need be to get well. Is there any way to change something so long standing? Young: I understand why you feel that way and medical school is stressful, but it is never too late. The sooner you seek help, the sooner you can get better. You really can find other ways to cope and feel good about yourself. Some say the eating behavior can feel like a best friend, but what a destructive one. Sometimes an outside party can help, or even a book or an article. The bottom line though, is to do it for you, no matter what other people believe. I have never been anywhere close to recovery, but for a while I was doing better (though my nutritionist questions even that). You need to admit to those you work with, that it feels like a relapse. Try to trust their recommendations on what will help you manage stress differently. Some suggestions are relaxation techniques like breathing and yoga. And remember, progress is often up and down like this. Young, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. We have a large eating disorders community here at HealthyPlace. You will always find people in the eating disorders community, interacting with various sites. Joe Kort, MSW will talk to us about gay, lesbian, bisexual, transgender, and questioning (GLBTQ) individuals, and their family members. He will also talk about coming out, sexual orientation, GLBT relationships, sexuality and sexual behavior, and more. Our topic tonight is "Coming Out and other GLBT Issues". Our guest tonight, Joe Kort, works primarily with gay, lesbian, bisexual, transgender, and questioning individuals (GLBTQ) and their family members. Kort is a certified Imago Relationships Therapist and is certified in the area of sexual addiction and compulsivity. Besides doing therapy, he leads retreats for single or partnered gay and lesbian individuals to help them explore their own sexual identity and develop positive relationships. I think, for most people, the hardest thing in life is to confide in others what we consider to be a "deep darkThough being gay, lesbian, bi, or transexual (GLBT) is not as "surprising" as it was 10-15 years ago, is it still a "deep dark secret" for many? Joe Kort: I think it depends on the area in which you live and I can tell you that here in Michigan, it sure is for MANY Gays and Lesbians. David: I read the story on your website, but for the audience, can you recount your feelings about coming out to your family? My mother sent me to a therapist because I was becoming a loner. I was an outcast in my school being called faggot and sissy and spotted for being Gay, before I even knew what it was. In therapy, the therapist asked me what kind of girls I liked, and I lied at first, but then told him I really liked boys. He was of the psychoanalytic approach, and pathologized my homosexuality, but asked lots of questions and totally desensitized me about talking about being gay. He and I would argue about the fact that I could change. He saw my adolescence as a "second chance" to become "normal". He taught me that I was gay because I had a smothering domineering mother (which I did), and a distant, absent, uninvolved father ( which I did also). So when I came out to them at age 18 in 1982, I blamed them for making me this way. I got this from his website:"I tried to tell my mother originally at the age of 15, in 1978, during the Chanukah season. I started crying, telling her I had something awful to tell her. She lovingly touched my shoulder and told me that everything would be fine, and she gave me some Chanukah money. Now, as an adult looking back, was it "that difficult"? But I think it would have been a LOT easier if the therapists had been more supportive. But I caution them to understand that when they come out of the closet, the family goes in the closet. They should give their family and significant others time. I do coach for Gays and Lesbians to be out and authentic with their loved ones. David: It may be easier for adults to come out, but what about teenagers. In their minds, everything is at risk, including being rejected by their family. Joe Kort: Yes that is a LOT harder for them given their position in the family..... I would encourage that they be aware of PFLAG (Parents, Friends and Family of Lesbians and Gays) and possibly, if they can, go to a GLBT community center to talk to other teens about how it went for them. I still would encourage them to be out and open about who they are, and educate their parents about the importance of honesty and authenticity. I know it is not this easy but I think the alternative of keeping it in, is much more damaging. I came out to my wife after 22 years and to my parents one year after that. What is the best way to deal with their denial of my orientation? Joe Kort: My belief is for you to keep talking about it, letting them know how your life is going, if you are dating, what being Gay means to you, etc.

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For me buy genuine cytotec online medicine 1800s, I have finally gained most of the pertinent memories about my abuse purchase cytotec 200mcg treatment junctional tachycardia. But I am DID and so have great difficulty with connecting feelings to factual memories. Is there hope for someone like me to ever be "normal? Sheila Fox Sherwin: People can dissociate facts, feelings, physical pain. Sheila Fox Sherwin: Part of the work is learning how to express rage in a way that that will be healing. It also must be contained so there is no harm to self, others or property. David: We had a great conference on rage and controlling anger. Dissociation has a range from mild everyday dissociation to the extreme which was called MPD and is now called DID. I am so open it is like the shut off part of me comes out to let her know they know everything that is going on but have little control. I am wondering why I should want to integrate with the pain - the physical part of my system? I would suggest you continue to explore this in treatment. David: We have two questions on therapeutic relationships:funnyduck: What is the difference between an alliance with a therapist and ethical boundaries? Sheila Fox Sherwin: An alliance with a therapist includes ethical boundaries -- re: safety, time, dates, length of treatment, confidentiality and honesty. An ethical therapist will not violate you in any way. AbbySky: How do you know when you have an unhealthy relationship with your therapist? Sheila Fox Sherwin: One thing you can do is discuss it with your therapist. You can discuss your concerns with other caring people. You can get a second opinion from another therapist. Are there any good inpatient progrsms that offer more than short term/crisis help? The inpatient programs that offer good treatment for DID are fewer and fewer. David: Thank you, Sheila, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. We have a very large and active community here at HealthyPlace. You will always find people interacting with various sites. People with Dissociative Identity Disorder often describe an array of symptoms that can resemble those of other mental health disorders as well as many physical disorders. Some symptoms are an indication that another disorder is indeed present, but some symptoms may reflect the intrusions of past experiences into the present. For example, sadness may indicate coexisting depression, or it may be that one of the personalities is reliving emotions associated with past misfortunes. Dissociative Identity Disorder is chronic and potentially disabling or fatal, although many with the disorder function very well and lead creative and productive lives. People with this disorder are prone to injuring themselves. Some personalities appear to know and interact with one another in an elaborate inner world. Other personalities may or may not be aware of personality B, and personality B may or may not be aware of them. Because the personalities often interact with each other, people with DID report hearing inner conversations and the voices of other personalities commenting on their behavior or addressing them. They experience distortion of time, with time lapses and amnesia. They often have concern with issues of control, both self-control and the control of others. In addition, people with Dissociative Identity Disorder tend to develop severe headaches or other bodily pain and may experience sexual dysfunction. Different clusters of symptoms occur at different times. People with Dissociative Identity Disorder may not be able to recall things they have done or account for changes in their behavior (amnesia). Often they refer to themselves as "we," "he," or "she. The Diagnostic and Statistical Manual of Mental Disorders (DSM IV)Initially, most people with Dissociative Identity Disorder are unaware they have the condition. Children with Dissociative Identity Disorder (DID) have a great variety of symptoms, including depressive tendencies, anxiety, conduct problems, episodes of amnesia, difficulty paying attention in school, and hallucinations. Often these children are misdiagnosed as having schizophrenia. By the time the child reaches adolescence, it is less difficult for a mental health professional to recognize the symptoms and make a diagnosis of Dissociative Identity Disorder. At the time that a person with DID first seeks professional help, he or she is usually not aware of the condition. A very common complaint in people with DID is episodes of amnesia, or time loss. These individuals may be unable to remember events in all or part of a proceeding time period. Often people with Dissociative Identity Disorder are depressed or even suicidal, and self-mutilation is common in this group. Approximately one-third of patients complain of auditory or visual hallucinations. It is common for these patients to complain that they hear voices within their head.

Minipress (prazosin HCl) is a trademark of Pfizer Inc generic cytotec 100mcg on-line medicine 8 capital rocka. Uroxatral (alfuzosin HCl) is a trademark of Sanofi-SynthelaboHTTP/1 cytotec 100 mcg discount medications bladder infections. Rosenbaum, MD Sexual dysfunction is common among individuals with major depressive disorder. For instance, a study by Kennedy and colleagues[1] revealed that of 134 patients with major depression surveyed, 40% of men and 50% of women reported decreased sexual interest ; 40% to 50% of the sample also reported reduced levels of arousal. Sexual dysfunction is also a common side effect of antidepressant treatment, particularly pharmacotherapy with serotonin reuptake inhibitors (SRIs). Treatment-emergent SRI-induced sexual dysfunction ranges from approximately 30% to 70% of patients treated for depression. Antidepressant-induced sexual dysfunction becomes an important issue in the context of treatment effectiveness, as antidepressant medications are helpful only insofar as patients take them. Intolerable side effects may be one reason that patients are noncompliant with antidepressant treatment. Given the important clinical implications of premature discontinuation -- for example, higher rates of relapse and recurrence -- increasing attention is currently being devoted to the management of antidepressant-induced sexual dysfunction and other unwanted side effects of pharmacotherapy for depression. The issue of sexual functioning in the context of depression was discussed by a number of clinical researchers at the 156th annual meeting of the American Psychiatric Association in San Francisco, California. Topics included a comparison of the rates of treatment-emergent sexual dysfunction across various SRI antidepressants as well as strategies for managing antidepressant-induced sexual dysfunction, such as adding as-needed sildenafil to SRI pharmacotherapy for remitted depressed patients. The sexual response cycle consists of 4 phases: desire, arousal, orgasm, and resolution, and, as explained by Anita Clayton, MD,Professor and Vice Chairman, Department of Psychiatric Medicine, University of Virginia, Charlottesville, the phases of the sexual response cycle are affected by reproductive hormones and neurotransmitters. Clayton, estrogen, testosterone, and progesterone promote sexual desire; dopamine promotes desire and arousal, and norepinephrine promotes arousal. Prolactin inhibits arousal, and oxytocin promotes orgasm. Serotonin, in contrast to most of these other molecules, appears to have a negative impact on the desire and arousal phases of the sexual response cycle, and this seems to occur through its inhibition of dopamine and norepinephrine. Serotonin also appears to exert peripheral effects on sexual functioning by decreasing sensation and by inhibiting nitric oxide. The serotonergic system, therefore, may contribute to various sexual problems across the sexual response cycle. Clayton recommended that clinicians conduct a thorough assessment with patients when attempting to ascertain the etiology of sexual dysfunction. Factors to consider include primary sexual disorders, such as hypoactive sexual desire disorder, as well as secondary causes, such as psychiatric disorders (eg, depression) and endocrine disorders (eg, diabetes mellitus, which may cause neurologic and/or vascular complications). Physicians should also inquire about situational and psychosocial stressors (eg, relationship conflict and job changes), as well as the use of substances known to exert a negative impact upon sexual functioning, such as psychotropic medication and drugs of abuse, such as alcohol. Antidepressant-induced sexual dysfunction is common but underreported. There are a number of patient risk factors for sexual dysfunction. These include age (being 50 years old or older), having less than a college education, not being employed full-time, tobacco use (6-20 times per day), a prior history of antidepressant-induced sexual dysfunction, a history of little or no sexual enjoyment, and considering sexual functioning as "not" or only "somewhat" important.. Gender, race, and duration of treatment, in contrast, do not appear to predict sexual dysfunction. Clinicians may employ several strategies to manage antidepressant-induced sexual dysfunction. One is waiting for tolerance to develop, although, according to Dr. Clayton, this is typically not successful, as only a small portion of patients report improvement in sexual functioning over time during SSRI pharmacotherapy. Another option is to reduce the current dose, but this may result in subtherapeutic doses of medication. Drug holidays may provide relief from SSRI-induced sexual dysfunction,but, cautioned Dr. Clayton, may result in SSRI discontinuation symptoms after 1 to 2 days or encourage medication noncompliance. The use of sildenafil (Viagra), bupropion (Wellbutrin), yohimbine, or amantadine may be helpful as antidotes, but, as yet, these agents are not indicated specifically for this use. Switching to antidepressants with little risk of inducing sexual dysfunction -- for example, bupropion, mirtazapine, and nefazodone (no longer on market) -- may be a successful strategy for some patients,although there is the risk that depressive symptoms may not respond as well to the second agent as they did to the first. A study comparing the incidence of treatment-emergent sexual dysfunction among depressed patients treated with duloxetine (Cymbalta), a serotonin norepinephrine reuptake inhibitor (SNRI) currently under US Food and Drug Administration (FDA) review for the treatment of depression (ed. Researchers pooled data from 4 eight-week, randomized, double-blind clinical trials designed to evaluate the efficacy of duloxetine vs paroxetine for depression during the acute phase of treatment. Pooling data from the 4 studies yielded the following treatment conditions: 20-60 mg of duloxetine twice per day (n = 736), 20 mg of paroxetine once daily (n = 359), and placebo (n = 371). Two of the studies included 26-week extension phases in which acute treatment responders received duloxetine (40 or 60 mg twice per day; n = 297), paroxetine (20 mg/day; n = 140), or placebo (n = 129). Sexual functioning was assessed using ASEX, a 5-item questionnaire that taps sex drive, arousal, and ability to achieve orgasm. The authors reported the following findings: (1) Significantly higher rates of sexual dysfunction were observed with both duloxetine and paroxetine compared with placebo, but the incidence of acute-phase treatment-emergent sexual dysfunction was significantly lower for patients treated with duloxetine than those treated with paroxetine. Sexual functioning, as measured by the CSFQ, was compared between depressed patients receiving mirtazapine fast dissolving tablets and those treated with sertraline. At the beginning of treatment for depression, 171 patients received mirtazapine (mean daily dose of 38. Findings indicated that by the second week of treatment, patients treated with mirtazapine showed a significantly greater decrease in depressive symptoms, as measured by the Hamilton Depression Scale (HAM-D), compared with those treated with sertraline. Data regarding sexual functioning were available for a subset of the patients receiving mirtazapine (n = 140) and sertraline (n = 140) during the depression efficacy trials. By the end of 8 weeks of treatment, patients treated with mirtazapine appeared, on average, to show normal sexual functioning, whereas patients treated with sertraline, on average, were below the CSFQ cutoff for normal sexual functioning. This pattern of findings was observed for both male and female patients. Other findings included the observation that males treated with higher doses of mirtazapine (more than 30 mg/day) showed significantly greater improvements from baseline on overall sexual functioning by the fourth, sixth, and eighth week of treatment compared with males treated with higher doses of sertraline (more than 100 mg/day). In an 8-week, randomized, double-blind, placebo-controlled trial, gepirone-ER 20-80 mg/day was administered to outpatients diagnosed with major depressive disorder. Sexual functioning was assessed using the Derogatis Interview for Sexual Functioning Self-Report (DISF-SR), a 25-item questionnaire that assesses cognition/fantasy, arousal, behavior, orgasm, and drive. Patients receiving gepirone-ER (n = 101) demonstrated a significantly greater mean change from baseline on the HAMD-17 compared with those receiving placebo (n = 103) at weeks 3 and 8, suggesting that gepirone is an efficacious antidepressant. Sexual functioning total scores were then evaluated in a subgroup of patients who had completed the DISF-SR at baseline and at end point.

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