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I have heard mixed opinions about using restraining orders order line tadacip erectile dysfunction treatment in lahore. Women seem to think it just incites the stalker to bother you even more order tadacip 20 mg free shipping impotence beta blockers. But my stalker is different than others cheap tadacip 20 mg line erectile dysfunction drugs in pakistan, I think purchase tadacip 20mg otc erectile dysfunction specialist doctor, because he comes over to my home and enters my home to do damage. Again, the opinions and even the data on restraining orders are mixed. He gets a big kick in the fact that he can come into my house without breaking any windows or doors. David: A few more audience comments on what has been said so far:DawnA: In our California county, we have mandatory 52 week Batterers Treatment Counseling for domestic violence offenders. The treatment provider runs a Stalker group within the program. The stalker continued to "stalk" from jail with letters. TexGal: I helped a lady who was being stalked, even drew a sketch of her stalker, she saw him, she was bi-polar and it caused serious problems with her health. Orion: In terms of punishment: California is the most progressive state for stalking victims. They have many excellent programs like ESP in Los Angeles. In other states, stalkers can get up to 20 years for felony stalking, but the usual punishment is 3-5 years. After they finish with you, do they go onto the next person? One study found that in the case of erotomanic stalkers, 17% stalked previous victims. There is also evidence that in that kind of stalking, having had more than one victim increases the propensity for violence. And I want to thank everyone in the audience for coming and participating. Thomas Schear, is a Certified Alcohol and Drug Counselor with about 20 years experience in the field. The discussion centered around alcoholism and drug addiction and dual diagnosis, along with self-medicating. Our topic tonight is "Addictions and Dual Diagnosis" and our guest is Dr. Thomas Schear is a licensed marriage and family therapist and a Certified Alcohol and Drug Counselor. He has over 15 years of experience working with clients who deal with substance abuse problems and dual diagnosis. Just so everyone is clear on the term dual diagnosis, it means someone who has a mental illness, psychiatric disorder and an addiction. Tonight, we will be talking about addictions issues AND also dual diagnosis. There are a lot of reasons why it is so hard to kick an addiction habit. Part of the reason is that it becomes part of a lifestyle that begins to set the person up to behave in certain ways and expect certain outcomes. For some, reality is too hard to handle in some ways. It seems that the addict is someone who feels pain more readily than the rest of us. David: So, would you say that some people are "more susceptible" to developing an addiction habit than others? To some extent, addictive behaviors are a lifestyle choice. For most of us, using alcohol is no big deal, but for the person who may be more susceptible, their first drink is a sensation and clearly the solution to their problems. David: At this time, I want to give our audience the link to the Addictions Community. Here, you will find lots of information related to the issues we are talking about tonight. Also, you can sign up for the mail list at the top of the page so you can keep up with events like this. Shear, when it comes to treatment for addictions, when is it time to say "I need help"? Schear: Frequently, the user has to experience the consequences of their usage and resultant behaviors before they decide it is time to get help. Generally, family, friends and others, enable the user by paying fines, making excuses, tolerating the intolerable behavior. These people need to withdraw their enabling behaviors, so the user begins to experience the pain associated with their use. The pain of recovery is seen as less than the pain of continuing the addictive behaviors. How does one figure out which treatment for addictions to choose? And, in your experience, what works best in initially treating an addiction habit? Schear: In recent years, Client Placement Criteria have been established by ASAM to better determine what level of care is appropriate for the addictive client. Everyone is measured on several continuums having to do with withdrawal symptoms: how much of a support system does the person have, if they also have medical problems, psychological problems that need additional support, etc. Depending on how "healthy" a person is, will determine where they ought to go for treatment. The person who has no withdrawal symptoms, who has the support of clean and sober family and friends, has a job, no psychiatric or medical problems and maybe a couple of drunk driving charges, may be appropriate for an outpatient setting. However, the person with no support system, who has experienced withdrawal symptoms in the past, has medical and maybe psychiatric problems, will need more intensive and long-term care. The level, or intensity of care, really depends on a lot of these factors. It appears that the introduction of managed care and funding issues seems to drive some of this, but it does better utilize the resources too. Schear:squeaker: I have been sober for nine months now. My doctor says I am not an alcoholic, it is solely due to my bipolar disorder. Schear: The concern I have when someone has a psychiatric diagnosis and drinks is that the combination of medication with alcohol can negate the effects of the medication. The result, then, is that a bipolar condition is not being properly treated because the client is also using alcohol. It is less of a question of whether you are alcoholic or not, than it is a question of properly treating the psychiatric condition. By the same token, if a person wants to drink so badly that they will interfere with their treatment for a bipolar condition, maybe the alcohol use is a problem. The main concern should be properly treating the psychiatric condition. GiddyUpGirl: I was wondering if you know anything about SSI (Social Security Insurance), and if one could be terminated if they were found to be a substance abuser. I really need treatment and I am close to signing myself into a psych ward for depression and need to know if I should tell them about my addiction? Yes, you must tell the people at the psychiatric ward about your addiction. They cannot properly diagnose or treat the psychiatric problem, if they do not know about that. Your use of substances is likely contributing significantly to the depression, and the depression may lead you back to substance use. Chesslovr: I have been clean and sober for 18 years but have been given Valium by my doctor for medical problems. Schear: Valium is a drug and all drugs have their effects. Is the valium a temporary solution or a more or less permanent thing? Keep clear with your doctor and yourself what the Valium is for. David: Earlier, I mentioned the term "dual diagnosis," having a mental illness and an addiction? Of the addiction population, how many people, would you guess, fall into that category (percentage-wise)? One question that always comes up with this topic is "which came first? If psychiatric symptoms persist, there is apparently a co-existing problem that needs treatment. Much more frequently though, for the vast majority of addicts, once they stop using, much of the psychiatric problems go away. They may still feel guilty, angry, depressed, but much of that may be the result of the things they did while using, rather than a psychiatric condition. A period of being clean and sober and a thorough assessment, are essential to sort this all out. Or are there body indicators to tell if drugs have been used?

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It helps to have someone else who can hold onto hope for you and help you through those points 20 mg tadacip with amex erectile dysfunction pills for heart patients. There are referral services to help people find sliding scale or low fee therapy buy tadacip 20mg low cost fda approved erectile dysfunction drugs. You need to research your area effective tadacip 20 mg impotent rage, do an internet search purchase tadacip online now erectile dysfunction injections youtube, or ask someone to help you find resources if you are too overwhelmed. Then there are free support groups and twelve step groups like Overeaters Anonymous. Some anorexics and bulimics find OA meetings helpful and think about restricting, bingeing and purging as their "addiction. You can contact me through my sites by email and I can share the resources I know about. I was wondering if there was an average time it takes for someone to get over this disease? I expect that the longer it has gone on, the longer it may take to heal. 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. I believe it is our (GLBT) responsibility to keep the discussion going about our lives, just as the rest of the family talks about their lives. The more you talk, the more desensitized they will become. I am 54 and I knew that I was different, but I did not know what I was. I never did feel like my mother or father had anything to do with the way that I felt. I knew that I had different feelings, but never thought of telling anyone In high school. I was very careful, dated very little, but I knew that I did not want to be called a faggot. She says she wants me happy, but yet is afraid of her peers reaction. Sexual abuse really complicates the coming out process. The individual was traumatized by the abuse, and had to keep a secret and pretend nothing happened, or is wrong and fear that telling will get them in trouble.

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While there was no change in the placebo group 20 mg tadacip with mastercard impotence beta blockers, there was a 35 cheap tadacip master card impotence of organic origin 60784. Over the same period of time purchase generic tadacip from india erectile dysfunction over 80, he reported purchase 20 mg tadacip overnight delivery do erectile dysfunction pills work, the trace element content in fruits and vegetables appears to have fallen significantly. According to the Centers for Disease Control, 79 percent of high school students eat less than five fruits or vegetables a day, and it is estimated that the ratio of omega-6 to omega-3 intake has increased six-fold since Paleolithic times. The RDA was never meant to be regarded as optimal, more than one speaker reminded those at the same symposium. Instead, it is the minimum considered to prevent diseases such as scurvy or beriberi. According to a review article by Fairfield and Fletcher published in the June 19, 2002 JAMA, "most people do not consume an optimal amountof all vitamins by diet alone. The study population (female undergrads) were all well-nourished with no mood disorders. In another study, those on 100 mcg of the trace mineral selenium - twice the RDA - reported less depression, anxiety, and tiredness following five weeks than the control group. Finally, a 1995 study on young healthy adults found that 10 times the recommended doses of nine vitamins after 12 months resulted in improved performance on a range of cognitive functions in the females but not the males. Benton related that the brain is arguably the most nutritionally sensitive organ in the body, playing a key role in controlling bodily functions. With millions of chemical processes taking place, he went on to say, if each of these is only a few percent below par, it is easy to imagine some sort of cumulative effect resulting in less than optimal functioning. Added Bonnie Kaplan, PhD of the University of Calgary: "We know that dietary minerals and vitamins are necessary in virtually every metabolic action that occurs in the mammalian brain. The only raw materials for their syntheses are nutrients, namely, amino acids, vitamins, minerals, etc. If the brain receives improper amounts of these nutrient building blocks, we can expect serious problems with our neurotransmitters. Pyrroles bind with B6 and then with zinc, thus depleting these nutrients. According to Dr Walsh, these individuals cannot efficiently create serotonin since B6 is an important factor in the last step of its synthesis. An outcome study of 200 depressed patients treated at the Pfeiffer Center found 60 percent reported major improvement and 25 percent minor improvement. Treatment complements medications, but as the patient begins improving meds may be lowered or gradually dropped. Nutrient deficiencies include: Vitamin B2, Vitamin B6 (which can be low in those taking birth control or estrogen), and Vitamin B9 (folic acid). According to the article, 31 to 35 percent of depressed patients have folic acid deficiencies. Other deficiencies affecting depression include Vitamin B12, Vitamin C (to a lesser extent), magnesium, SAM-e, tryptophan, and omega-3. A 2003 Finnish study of 115 depressed outpatients being treated with antidepressants found that those who responded fully to treatment had higher levels of vitamin B12 in their blood at the beginning of treatment and six months later. The comparison was between patients with normal B12 levels and higher than normal ones rather than between deficient and normal. Another theory is that vitamin B12 deficiency leads to the accumulation of the amino acid homocysteine, which has been linked to depression. A 1999 study found that both higher levels of B12 (compared to patients with deficient levels) and folate (vitamin B9 found in leafy green vegetables)corresponded with a better outcome. A 1997 Harvard study supports earlier findings that show: 1) a link can be made between folate deficiency and depressive symptoms, and 2) that low folate levels can interfere with the antidepressant activity of the SSRIs. A 2002 Oxford review of three studies involving 247 patients found that folate when added to other treatment reduced Hamilton Depression scores by 2. A recent Duke University study found 600 mcg of chromium picolinate resulted in a reduction of symptoms associated with atypical depression, including a tendency to overeat. Chromium may act on insulin, which controls blood sugar (researchers have linked depression and diabetes). According to Mattson and Shea of the NIH in a 2002 study: "Dietary folate is required for normal development of the nervous system, playing important roles regulating neurogenesis and programmed cell death. The brain, being the most metabolically active organ in the body, is especially susceptible to free radical damage. The RDA for vitamin E is 22 international units (IU) and 75 to 90 mg for vitamin C, but supplements may contain up to 1,000 IU of vitamin E and more than 1,000 mg of vitamin C. Taking either of the vitamins alone or taking multivitamins provided no protection. A 2003 USDA Human Nutrition Research Center on Aging/Welch Foods study of rats nearing the end of their expected life spans found that feeding them Concord grape juice "appeared to reduce or reverse the loss of sensitivity of muscarinic receptors, thus enhancing cognitive and some motor skills. Concord grape juice has the highest antioxidants of any fruits, vegetables, or juices. Phenylalanine, a precursor, to tyrosine, is also an option. Tryptophan, the precursor to serotonin, was removed from the US market in 1989 after a manufacturer produced a highly toxic contaminate, but is still available by prescription. Less is more, with lower doses (one to three gm) more effective than higher doses. Taking the amino acid with carbohydrates helps in its absorption. The intermediary between tryptophan and serotonin, 5HTP, is available without prescription. Julia Ross refers to GABA as "our natural valium," and recommends it to her clients for calming down. However, as this neurotransmitter does not easily cross the blood-brain barrier, you may wind up instead with very expensive urine. Psychology Today reports that Andrew Stoll MD, the Harvard psychiatrist who put omega-3 on the map with his 1999 pilot study, is exploring the amino acid taurine for treating bipolar disorder. In making the case for nutritional supplements, she notes:Average calcium consumption in the US and Canada is two thirds of the RDA level of 800 mg. Fifty-nine percent of our calories come from nutrient-poor sources such as soft drinks, white bread, and snack foods. The average American achieves only half the recommended levels of folic acid. Nine of 10 diets contain only marginal amounts of vitamins A, C, B1, B2, B6, chromium, iron, copper, and zinc. Only one person in five consumes adequate levels of vitamin B6. Seventy-two percent of adult Americans fall short of the RDA recommendation for magnesium. The Journal of Clinical Nutrition reported less than 10 percent of those surveyed ate a balanced diet. Up to 80 percent of exercising women have iron-deficient blood. In 1969 the Nobel scientist Linus Pauling coined the term "orthomolecular" to describe the use of naturally occurring substances, particularly nutrients, in maintaining health and treating disease. According to Dr Pauling: "Orthomolecular psychiatry is the achievement and preservation of mental health by varying the concentrations in the human body of substances that are normally present, such as the vitamins. I assumed it would take 40 years, since in medicine it typically takes two generations before new ideas are accepted. In fact, there is an institutional bias against studying more than one ingredient at a time, which dooms proposals for large-scale randomized control trials for multi-vitamins and minerals to death by red tape. To turn the critical spotlight around, the evidence for the three meds combinations most of us find ourselves on is totally lacking, with no studies whatsoever, which would make any polypharmacy claims by the psychiatric profession equally deplorable (not that we would ever think of using such a term). Thirty years later, the profession is still a long way from embracing nutritional supplements, but it has probably advanced from employing excessive rhetoric to attack its practitioners. Speaking of fantastic claims:In 2000, this writer happened to come across an item in a Canadian newspaper about an Alberta Company, Synergy of Canada Ltd, that was test marketing a mix of 36 supplements, called EMPower, based on a formula to calm aggressive hogs. David came up with a variation on his formula he used for calming down hogs, and Anthony administered the supplement to his kids. As he describes it:"Joseph was treated with lithium. When he would take the lithium he complained of severe side effects... Within two weeks, his mood and emotional control improved drastically. He has maintained total wellness, and essentially no symptoms of bipolar since that time. Within four days she was forced to eliminate Haldol and Rivotril [Klonopin] because of the drastically increasing side effects. Ativan was no longer required as the mania became more manageable in the absence of hallucinations. After one week on the program, she returned home to her husband. After one month, she began the reduction and elimination of the Epival [Depakote] (used as a mood stabilizer). March 28, 1996 marks the last day that Autumn took medication for bipolar affective disorder. In her final visit with her psychiatrist, he indicated that there was never an expectation for remission, given her diagnosis and severe and unrelenting cycles. In December 2001, however, Synergy received a significant boost to its credibility with a pilot study and accompanying commentary published in the Journal of Clinical Psychiatry.

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I want to be here with this partner purchase cheap tadacip on-line impotence word meaning, enjoying one another order tadacip pills in toronto smoking and erectile dysfunction statistics. Shiple: So many ideas flooded my mind to answer your question buy tadacip 20 mg without prescription erectile dysfunction treatment comparison. Actually order generic tadacip on-line erectile dysfunction drugs that cause, that is such a personal experience, that it is hard to create an answer that would fit for each person. Giving each partner focus for being pleasured and satisfied. Including the elements that each partner finds GREAT! Shiple: Do not be distracted by the simplicity of this, consider it seriously. If so, ask her what she thinks it would take for her to feel sexier about herself and listen carefully to what she tells you. Ask for clarification if anything is unclear about what she thinks would make her feel sexier. Then create a plan together, if she is willing, to begin to address whatever she has said. Compliment her on each step, or any beginning step she is able to make. Recognize that this is probably very, very difficult for her. After all, she has spent all of these years, however old she is, not feeling all that sexy. Ask her what she needs to help her feel more comfortable with this. David: Why would someone see a sex therapist and when is it time to consider that you need to see a sex therapist? Shiple: There are many reasons that clients see sex therapists. Some of these include sexual dissatisfaction, sexual dysfunction (the inability to attain an erection and/or have an orgasm if the person wants to), disagreements in frequency of sexual interaction, painful intercourse when all physical and medical reasons for this have been eliminated. That would be when you and your partner are dissatisfied with some aspect of what is going on between you two in your sexual relationship. Oftentimes, we find that the real issues may not be sexual. They may be in some other areas of communication, or, more often still, LACK of communication. Then, together with the therapist, you both create a strategy for solving the difficulties. What if a fear of sex has removed all desire for it, except for occasional pornography and masturbation? You would be surprised at how often a fear of sex, or some aspect of the sexual encounter, is EXACTLY what prevents someone from having satisfying sexual interaction. I would suggest that you find a good, sensitive sex therapist in your area and outline for him/her what you have said above. The first step in dealing with this, would possibly be, to go back to that event and discover the dynamics that created the outcomes you experienced. Then, awareness of the thoughts that you have used over time, that have kept these dynamics active and present, would be in order. I would expect that, in clearing up what was going on in the past, you would be in the position to create new sexual directions in the present. David: Would you say that you, generally, have to feel good about yourself to have satisfying sex? That, and knowing what you find to be satisfying and pleasing, so you CAN relate this to your partner. Shiple: There have been several research studies to quantify this. There is a false belief in vogue that the only satisfying sex is having orgasms together. This is not only not necessary, but it happens rather infrequently. It can be a problem to limit the ways that you are willing to "accept" or allow yourself pleasure. This can also limit the pleasure that you have nett: Is it okay to have anal sex, and does it have any lasting ill effects? Shiple: In terms of human sexual practice, anal sex is OK. In terms of some religious proscriptions, there are differing opinions. The problem with anal sex can be tearing the lining of the anus. Because you will be using your anus for other purposes later on (when you defecate, this carries bacteria). If the lining of the anus is torn, you can get the infection in your body. So, you would want to use plenty of lubrication and if your partner is very large, get him to enter you before he is fully erect. If that is not possible, you might want to forego the experience. I am on Paxil and it has changed my sexual experience. Is this common and do you know of any meds that do not have this effect? Shiple: Oh, Jullian, you are entering touchy territory. Yes, many medications affect your sexual interaction. One difficulty in answering the "any meds that do not" question, is that people experience different results from different medications. As a general rule, I would refer you back to your doctor. She or he better knows your history and can make recommendations. One word of encouragement: do not give up your quest. Keep working to find a medication that does not adversely affect your sexual interest and/or pleasure until you find one. David: How do you broach your sexual "desires" with your partner. For instance, for some the idea of asking for anal sex might be difficult to bring up? Choose a time that you are relaxed and your partner is relaxed. By this, I mean to say something like, "I have something that is important for me to ask you, but I am embarrassed (if you are) or nervous (if you are) about it. If she/he does not respond appropriately to this, it probably is not time yet to go on to something more sensitive like stating that you would really enjoy to experience having anal sex with her/him. If what you are doing is satisfying to you, and to your partner, it may not be necessary to change it. First, you would want to take plenty of time to get to know your partner and not rush the physical, sexual interaction. Then, in that time, you would begin to experience other emotional responses with your partner. See if her expression of her desires, and how she feels, can spark some emotional response in you. You would want to find an excellent and skilled cognitively-oriented sex therapist, because what you are dealing with, is how concepts and ideas affect your behavior. Then really dedicate yourself to WORK with this therapist. Other issues, which would be a part of this, would be accepting and loving yourself as good and beautiful! Shiple: Absolutely, and it is not just a male-female thing. So, at a time of extreme stress, this element alone can make sex desirable for some people. For other people, as you so well point out, it is just the opposite. The stressful event takes center-stage in your mind, with all lights focusing on it. In a relationship, the difficulty with these differential ways of responding, is how you resolve the twopoles. Or does it become an argument as another way of diverting the stress-filled energy? David: In terms of a relationship, where you have been with your partner for some time, is part of the "deal", whether you are a man or woman, to have sex when your partner wants it -- even though at occasional times you may not want to have sex at that moment? Or maybe a better phrasing of the question is, is that part of having a good relationship? What I mean by that is, I think there have to be three modes of interacting:we both want to have sex and we doone of us wants to have sex and the other of us has no serious problem/objection with that. I would add that I think (c) needs to be used sparingly. But, by not having a (c), it sets up the circumstance in which one partner might feel forced, or create resentment.