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DRUG THERAPIES FOR HEALTHY BONES: RALOXIFENE (EVISTA)

The newest pharmaceutical option for protecting bone density is raloxifene (brand name Evista). Raloxifene is a selective estrogen receptor modulator (SERM), which, simply stated, means it has a chemical structure similar to estrogen and attaches itself to molecules in the body where estrogen would otherwise attach. It prevents bone loss by reducing breakdown of bone much the way estrogen replacement therapy does. Postmenopausal women can expect about a 3 percent increase in bone density in the first year of taking raloxifene and 1 to 2 percent per year after that. This brings a 40 to 50 percent reduction of risk of fracture in the spine. Less than 60 percent of women will see increases in bone density with raloxifene, a markedly lower response rate than with the options described earlier, including estrogen. Raloxifene is sometimes given with a progesterone, which might improve your chances of benefiting, as well as the magnitude of your results, though there is no hard evidence of that yet.
Since raloxifene blocks estrogen, it is the best choice for postmenopausal women who can’t take estrogen, especially those fearing an increase in breast cancer risk. It is not an option for men. Although it isn’t quite as effective as other prescription options in protecting bone at the hip, and is only about half as effective in the spine, it doesn’t increase the risk of uterine cancer (as estrogen does) and may actually protect against breast cancer. (Raloxifene is very similar to tamoxifen, which has gotten a lot of press as preventing breast cancer.) It doesn’t cause breast soreness or uterine bleeding, as estrogen can.
If you can take estrogen but are hesitant to, and are wondering if this is a better alternative, note that raloxifene does not offer some of the benefits that estrogen does. Raloxifene’s effect on the heart is still unclear. Though it appears to lower cholesterol levels, it is unknown as yet whether that translates into protection against heart disease and heart attacks equivalent to estrogen’s. Raloxifene does not relieve menopausal symptoms, and can even cause or increase hot flashes. No studies have yet been completed on raloxifene’s effect on colon cancer or Alzheimer’s disease, but estrogen is known to offer protection against both. Finally, raloxifene has one of the same potential side effects as estrogen: dangerous blood clots.
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HOW TO FACE GIVING UP THE FOOD: JESUS SUFFERED

Another way that I have been able to endure the pain of change is to know that even Jesus did not escape the suffering, and He was God’s favorite, so to speak. Hebrews 5:7-10 refers to the suffering that Jesus bore. “During the days of Jesus’ life on earth, he offered up prayers and petitions with loud cries and tears to the one who could save him from death, and he was heard because of his reverent submission. Although he was a son, he learned obedience from what he suffered and, once made perfect, he became the source of eternal salvation for all who obey him and was designated by God to be high priest . . ..” So, even Jesus suffered. Isaiah expressed it very well:
Yet it was the Lord’s will to crush him and cause him to suffer and though the Lord makes his life a guilt offering, he will see his offspring and prolong his days, and the will of the Lord will prosper in his hand. After the suffering of his soul, he will see the light of life and be satisfied. (Isaiah 53:10,11a)
The words of Isaiah came true. After the suffering, He saw the light of life and was satisfied. Obviously, acknowledging Jesus’ willingness to suffer helps us swallow this bitter pill.
So, not only do we endure the sufferings sent by God—we offer ourselves to suffering as God calls for it because it says to the world, “I believe and trust that this is a good God with great ability to run the world.” When we endure and allow this outward suffering, others will witness the inside of us being very much alive, beautiful, and valuable. Happiness is something made on the inside of you.
Jesus suffered and voluntarily gave His life because the Father asked this of Him.
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ADJUVANT ANALGESICS: ORAL LOCAL ANAESTHETICS, ANTIBIOTICS AND KETAMEVE

Indication. Neuropathic pain refractory to other therapy.
Action-Probably by neuronal membrane stabilisation.
Drugs-Mexiletine is the preferred drug; flecainide was associated with an increased risk of sudden death in post-myocardial infarction patients. Mexiletine is commenced at a dose of 150 mg/d and increased by the same amount each few days up to a maximum of 750 mg/d. The medication should be taken with food. The side effects include nausea, sedation and tremor. Mexiletine must be given with particular care to patients with ischaemic heart disease or cardiac arrhythmias.
Ketamine-Ketamine, a dissociative anaesthetic used for short surgical procedures, can relieve unresponsive neuropathic pain. It acts as a NMDA receptor antagonist. It is given in subanaesthetic doses by subcutaneous infusion: 0.1-0.5 mg/kg/h and titrated against effect.
Antibiotics-The pain of cellulitis, mucositis and fungating tumours is often compounded by secondary infection. The use of appropriate antibiotic or antifungal agents can improve pain control.
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VITAMIN A IN PREGNANCY: SUPPLEMENTS

In Australia the recommended dietary intake (RDI) of vitamin A as retinol equivalents (RE) needed to maintain normal body functions in a healthy individual is:
Babies – birth to 6 months             300 mcg = l,000 IU
Babies – 6 months to 1 year           450 mcg = l,498 IU
1 year to 5 years                       300 mcg = l,000 IU
6 years to 8 years                      400 mcg = l,332 IU
12 years to 15 years                    725 mcg = 2,420 IU
15 years and over                       750 mcg = 2,500 IU
Vitamin A is vital for the healthy development of the unborn child. During pregnancy the RDI is 2,500 IU of vitamin A which must be obtained from the diet or by supplementation each day. When breastfeeding, the RDI increases to 4,000 IU daily.
There is evidence that the excessive intake of vitamin A in pregnancy may lead to birth defects. Some medical researchers state that pregnant woman should avoid vitamin A (retinol) in amounts over 25,000 IU daily.
It is very important if expecting a child not to eat large quantities of liver and meat offal as these contain very high levels of vitamin A. If taking a vitamin A supplement then always follow the directions. Research has shown that some women, especially those women born in the United Kingdom, may be consuming levels as high as 283,050 IU per day. These high intakes could lead to birth defects; therefore organ offal meats as part of the diet should be avoided.
Under medical supervision, doses of up to 50,000 IU of vitamin A (retinol) are used for severe deficiency in children over 8 years of age and adults. Vitamin A has also been used therapeutically in doses of up 300,000 IU daily for five months with minimum side effects for the treatment of acne vulgaris. However, these amounts of vitamin A should not be consumed during pregnancy.
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YOUTH NUTRIENTS: MAKING THE FOOD CONNECTION

These antioxidants—vitamin C, vitamin E, beta-carotene and calcium— are locked deep and safe inside certain foods. And when we eat these foods, we release the antioxidants.
Eating Antioxidant-Deprived Foods
So, if you bite into a big juicy hamburger, for example, you are going to do two things. You are going to create a whole bunch of free radicals simply through the process of chewing and digestion. And you are going to create even more free radicals because when the stuff you swallowed turns into molecules, those molecules get attacked by free radicals. Any that lose an electron turn into free radicals themselves. Not so good.
Eating Antioxidant-Rich Foods
Now look what happens when you bite into a big juicy slice of cantaloupe. You are also going to do two things. You are going to create free radicals simply through the process of chewing and digestion. But you are also going to release antioxidants that destroy any free radicals that may have been created as you chewed, and are going to go on and defuse and destroy all kinds of other free radicals already there—even some of the ones from that burger. Yes!
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SKIN DISORDERS IN ADULTS: CONTACT ALLERGIC DERMATITIS

This type of dermatitis is caused by a true allergy to a particular substance and is detected by patch testing. Various substances are applied to the skin, left on for forty-eight hours, and then checked for reactions. Given that we are exposed to so many different chemicals, contact allergic dermatitis is surprisingly rare. The most common causes are as follows:
Cosmetics
Cosmetics contain at least ten substances which can produce allergic reactions. The most common of these is perfume, but preservatives, which are used in all cosmetics (even so-called ‘natural’ cosmetics), are also frequently to blame. The most commonly used preservatives include Dowicill (Quanternium 15), Germall (Imidazoyl urea), Kathon (methylchloro-isothiozalone) and parabens. All cosmetics manufacturers are now required to list the ingredients of their products on the labels so that people can tell which cosmetics they are able to use. With the increased interest in ‘natural’ cosmetics many plant extracts are now being included in cosmetics. Plant extracts such as aloe vera, however, can also cause allergic reactions.
Perfumes
Perfumes contain many chemicals, often numbering thirty or more. These are present not only in actual perfumes, but in most cosmetics and even some medicinal creams. Perfumes are used to mask the chemical smell of cosmetics, thus making them more attractive to consumers. Perfume allergy can produce dermatitis on the eyelids, neck and face. Some cosmetic ranges, such as Almay, Clinique and Innoxa, are not perfumed, and so may be safely used. If you are allergic to perfume it should not be applied directly onto the skin but can be applied to clothing instead.
Hair dyes
Hairdressers are particularly prone to contact allergic dermatitis from hair dye, as are those who have their hair dyed. Hair dye rarely causes dermatitis of the scalp itself, but rather around the scalp margin and on the eyelids. If contact dermatitis develops to a particular hair dye, another colouring agent should be used. Contact allergic dermatitis can also be caused by perming solutions.
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EXTERNAL FEMALE ANATOMY

The external genitalia, known collectively as the vulva, are comprised of the mons pubis, labia majora, labia minora, clitoris, urethral opening, vaginal opening, and the perineum.
The mons pubis (or mons veneris, “mount of love”) is a rounded, fatty pad of tissue, which becomes covered with pubic hair at puberty. It lies on top of the pubic bone and is the most visible part of the genitals when a woman is standing up.
The labia majora are the fleshy outer lips (in Latin labia means lips). The outer surface of these lips is covered with pubic hair; the inner surface is composed of mucous membrane. Inside the labia majora, and lying parallel to them, are the labia minora, or inner lips, which vary widely among women in appearance and color, with the color often varying from pink to brown along their surface. Normal configurations of labia minora include those that remain tucked in under the outer lips and those that protrude and hang down lower than the outer lips. This latter variety has occasionally been a cause of consternation for women with such lips whose only basis for comparison was stylized medical or marriage manual drawings or former Playboy type models with airbrushed vulvas showing no protruding inner lips.
The labia minora join at the top and divide into two folds which surround the clitoris. The upper fold forms the clitoral hood, and the lower constitutes the frenulum of the clitoris. At their base, the labia minora form the fourchette.
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EFFECTIVE COMMUNICATION WITH YOUR DOCTOR DURING CANCER TREATMENT

The diagnosis of cancer and its treatment creates enormous physical, emotional and spiritual vulnerability in the patient and her loved ones. None of us can predict how we will react to this extreme episode in life. Much of it will depend on your personality, stage in life, and strength of existing relationships with your partner and loved ones, and prior experience with the health system. For many, it will be your first stay in hospital. Therefore most women, and their carers, have no prior experience with the way to manage cancer, from diagnosis through treatment, to life after treatment. Most undoubtedly will have a view, often negative and fearful, that is developed from a range of sources including the media, but mostly from stories of others that have experienced cancer. Therefore your relationship with the cancer specialist and the treatment team is vital to maintaining some quality in your life, and progressing through your treatment with a level of confidence.
As good communication is essential to both the doctor and yourself in making sure your needs are fully met, it is important that you quickly develop some sort of rapport. How can this be established?
If the doctor is someone known from reputation or a recommendation, you immediately have prior knowledge of the doctor’s style and ability. This immediately instills a level of trust. For most, however, the doctor will be someone who is completely unknown to you, and rapport has to be developed from the first appointment. It is important that a sense of mutual trust be established. ‘Can you talk openly with your doctor?’ Without trust your recovery may be slowed by fear, uncertainty and confusion. Trust does not necessarily mean ‘like’. In the first visits when you are numbed by the diagnosis, you may not develop the instant rapport you had hoped. However, if you have trust in the specialist skills of the doctor, and he or she has a sound reputation, rapport most often quickly develops.
You may be like the ‘very assertive patient, who generally takes an ‘intellectual’ approach to her illness, who will question, make demands and have a great need to be in control of all decisions and management of her treatment. She may often take longer in the appointment and is usually able to clearly articulate all aspects of her treatment, using medical jargon, to doctor, friends and family. She will often seek current medical literature from global sources and be involved in specialist ‘chat rooms’. These women are often using complementary therapies as a daily routine, are high Internet users for sources of information and are aware of current cancer therapies. Building close rapport with the health team is usually not a priority as she sees herself as highly independent and in control.
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SPINAL CORD INJURY: PHYSICAL CHANGES AND LIMITATIONS

At this stage in your recovery, awareness of physical changes and limitations is a primary concern. You may not be able to walk to the bathroom, tie your shoes, or eat your food without assistance from another person. Like Jim, you may not be able to walk at all. If your cervical spine is damaged, your arms and hands may be weak or paralyzed. You may not be able to turn over in bed, feed yourself, or hug your child.
For many people with spinal cord injury, being unable to walk is the most frustrating part of their disability. Persons with paraplegia can sometimes learn to walk with crutches and metal braces, but this is not for everyone. “Brace-walking” may require weeks and weeks of intensive physical therapy, because it is quite different from “normal” walking. It requires a whole gamut of new physical skills, and it can be slow and extremely strenuous. Even with sophisticated braces, lightweight crutches, and extensive physical therapy, some individuals with paraplegia find that walking with crutches and braces is simply too difficult, too strenuous, and too slow for use in the real world.
Individuals with injury at a very high level of the spinal cord may need to use a mechanical ventilator (respirator), because the muscles that control breathing are partially paralyzed. Some need special help to cough or clear fluids from the throat and chest. Some people have difficulty communicating because the ventilator and tracheostomy tube interfere with speech, and paralysis of the arms prevents them from writing. Weeks of speech therapy and specialized tubing and air valves may be needed to learn to talk again.
Depending on the type of spinal cord damage, you may have mild or profound changes in sensation. If you are quadriplegic, you may be unable to regulate your body temperature, perhaps experiencing fluctuations from hot to cold (even developing a fever in hot weather) and having to rely more on air conditioners, heaters, blankets, and so forth. You may experience bowel or bladder incontinence, inability to empty your bowel or bladder spontaneously, or a combination of these, requiring bladder catheterization or a bowel program to maintain healthy elimination. And your sexual function and sensation may be affected. Men may have changes in their ability to have an erection, experience sexual pleasure, or ejaculate. Women’s menstrual cycles may be temporarily interrupted, although menses and fertility generally return after some months, and they may have changes in genital sensation and the ability to lubricate or have an orgasm.
Rehabilitation is the period in which you confront and come to understand the full range of your limitations, disabilities, and complications. This is one of the most physically difficult tasks a person can undertake. It is also emotionally disruptive, intellectually demanding, and a challenge to your personality, social skills, and spiritual beliefs. One of the keys to success is being able to cope with a variety of emotional responses while simultaneously focusing your energy on physical recovery.
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THE EMOTIONAL EATER-WHAT KIND OF PEOPLE ARE THEY?

Eaters are sensual people—far more so than noneaters. After all, eating can only be described as a highly sensual experience. While we may not acknowledge this trait of ours, this life energy tends to frighten us. This sensuality is so intense and often so awesome that we often eat not only to satisfy our need but also to mask it, both from ourselves and from others.
Eaters are high-energy people, creative people, striving people. We eat out of frustration, because our power and energy are so scattered and unfocused. If we haven’t found our creative avenue, we turn to food. Or we eat to ease off a high, typically after an achievement—after our creativity is spent—to fill the void that comes with accomplishment, the empty space of “what’s next?”
Eaters are wanters. And we want what we want when we want it, and we want it all right now. “More, more, more. . . . Give me more.” Too much is never enough. If something is good, more is better. The closest star is never good enough. We’ve got to have the star farthest away. We’re never satisfied. For most of us, if we don’t have what we want right now, we think the world will explode. Eaters are not patient people.
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