Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth symptoms migraine cheap topamax 100mg on line. The impact of alcohol consumption and cholecystectomy on small intestinal bacterial overgrowth medicine 123 order 200mg topamax overnight delivery. The prevalence of overgrowth by aerobic bacteria in the small intestine by small bowel culture: relationship with irritable bowel syndrome medicine wheel colors buy 100mg topamax amex. Dysmotility and proton pump inhibitor use are independent risk factors for small intestinal bacterial and/ or fungal overgrowth symptoms 5 days past ovulation cheap 200mg topamax with amex. A systematic review o f diagnostic tests for small intestinal bacterial overgrowth treatment narcolepsy cheap topamax 100mg without prescription. Bacterial populations contaminating the upper gut in patients with small intestinal bacterial overgrowth syndrome symptoms 37 weeks pregnant cheap 200mg topamax with mastercard. The prevalence o f overgrowth by aerobic bacteria in the small intestine by small bowel culture: relationship with irritable bowel syndrome symptoms right after conception buy topamax 200mg visa. Microbial pathways in colonic sulfur metabolism and links with health and disease 7 medications that can cause incontinence buy topamax 100 mg on line. Correlation between body mass index and gut concentrations of Lactobacillus reuteri, Bifidobacterium animalis, Methanobrevibacter smithii and Escherichia coli. Increased risk of irritable bowel syndrome after bacterial gastroenteritis: cohort study. Post-infectious irritable bowel syndrome: mechanistic insights into chronic disturbances following enteric infection. Incidence of post-infectious irritable bowel syndrome and functional intestinal disorders following a water-borne viral gastroenteritis outbreak. Development of functional gastrointestinal disorders after Giardia lamblia infection. Role of cytolethal distending toxin in altered stool form and bowel phenotypes in a rat model of postinfectious irritable bowel syndrome. Sung J et al Effect of repeated Campylobacter jejuni infection on gut flora and mucosal defense in a rat model o f post infectious functional and microbial bowel changes. Autoimm unity links vinculin to the pathophysiology of functional bowel changes following Campylobacter jejuni infection in a rat model. Relationships among the lactulose breath test, intestinal gas volume, and gastrointestinal symptoms in patients with irritable bowel syndrome. Abdominal pain in Irritable Bowel Syndrome: a review of putative psychological, neural and neuro-immune mechanisms. Methane on breath testing is associated with constipation: a systematic review and meta-analysis. Methane, a gas produced by enteric bacteria, slows intestinal transit and augments small intestinal contractile activity. Methane production during lactulose breath test is associated with gastrointestinal disease presentation. Glycoprotein degradation in the blind loop syndrome: identification of glycosidases in jejunal contents. Nutritional protocol for the treatment of intestinal permeability defects and related conditions. Evaluation of small intestine bacterial overgrowth in patients with functional dyspepsia through H2 breath test. Small intestinal bacterial overgrowth: roles of antibiotics, prebiotics, and probiotics. Manipulation of dietary short chain carbohydrates alters the pattern o f gas production and genesis of symptoms in irritable bowel syndrome. Clinical predictors of small intestinal bacterial overgrowth by duodenal aspirate culture. A 14-day elemental diet is highly effective in normalizing the lactulose breath test. The treatment of small intestinal bacterial overgrowth with enteric-coated peppermint oil: a case report. Herbal therapy is equivalent to rifaxim in for the treatment of small intestinal bacterial overgrowth. Lombardo L, Increased Incidence of Small Intestinal Bacterial Overgrowth During Proton Pump Inhibitor Therapy. Rifaximin therapy for patients with irritable bowel syndrome without constipation. Rifaximin treatment for small intestinal bacterial overgrowth in children with irritable bowel syndrome. Experimental and clinical pharmacology of rifaximin, a gastrointestinal selective antibiotic. Effects of rifaximin on bacterial virulence mechanisms at supraand sub-inhibitory concentrations. A combination of rifaximin and neomycin is most effective in treating irritable bowel syndrome patients with methane on lactulose breath test. Furnari M, Clinical trial: the combination of rifaximin with partially hydrolysed guar gum is more effective 86. Die funktionelle Dyspepsie bei Kindern - eine retrospektive Studie mit einem Phytopharmakon. Low-dose nocturnal tegaserod or erythromycin delays symptom recurrence after treatment of irritable bowel syndrome based on presumed bacterial overgrowth. Probiotic yogurt in the elderly with intestinal bacterial overgrowth: endotoxaemia and innate immune functions. Yogic versus conventional treatment in diarrhea-predominant irritable bowel syndrome: a randomized control study. He engages in patient care four days per week and is a professor of gastroenterology. Sandberg-Lewis often treats patients whose health conditions have defied diagnosis despite exhaustive medical testing. Restoring ideal digestive function and normalizing the gut microflora have earned the center a reputation for success in helping many who previously suffered digestive diseases without hope of cure. Improvement in patient survival or disease related symptoms has not been established. Continued approval for these indications may be contingent upon verification of clinical benefit in confirmatory trials. Advise women of potential risk to a fetus and to avoid pregnancy while taking Zydelig. Interrupt and then reduce or discontinue Zydelig as recommended [see Dosage and Administration (2. Interrupt or discontinue Zydelig as recommended [see Dosage and Administration (2. Accelerated approval was granted for this indication based on Overall Response Rate [see Clinical Studies (14. An improvement in patient survival or disease related symptoms has not been established. Continued approval for this indication may be contingent upon verification of clinical benefit in confirmatory trials. The optimal and safe dosing regimen for patients who receive treatment longer than several months is unknown. For other severe or life-threatening toxicities related to Zydelig, withhold drug until toxicity is resolved. If resuming Zydelig after interruption for other severe or lifethreatening toxicities, reduce the dose to 100 mg twice daily. Recurrence of other severe or life-threatening Zydelig-related toxicity upon rechallenge should result in permanent discontinuation of Zydelig. Platelets <25 Gi/L Thrombocytopenia Platelets 50 to <75 Gi/L Platelets 25 to <50 Gi/L Maintain Zydelig dose. These findings were generally observed within the first 12 weeks of treatment and were reversible with dose interruption. Median time to resolution ranged between 1 week and 1 month across trials, following interruption of Zydelig therapy and in some instances, use of corticosteroids [see Dosage and Administration (2. If pneumonitis is suspected, interrupt Zydelig until the etiology of the pulmonary symptoms has been determined. Patients with pneumonitis thought to be caused by Zydelig have been treated with discontinuation of Zydelig and administration of corticosteroids. Advise patients to promptly report any new or worsening abdominal pain, chills, fever, nausea, or vomiting. Discontinue Zydelig permanently in patients who experience intestinal perforation. Other severe or life-threatening (Grade 3) cutaneous reactions, including dermatitis exfoliative, rash, rash erythematous, rash generalized, rash macular, rash maculo-papular, rash papular, rash pruritic, exfoliative rash, and skin disorder, have been reported in Zydelig-treated patients. Monitor patients for the development of severe cutaneous reactions and discontinue Zydelig. In patients who develop serious allergic reactions, discontinue Zydelig permanently and institute appropriate supportive measures. Monitor blood counts at least every two weeks for the first 3 months of therapy, and at least weekly in patients while neutrophil counts are less than 1. Idelalisib is teratogenic in rats, at systemic exposures 12 times those reported in patients at the recommended dose of 150 mg twice daily. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to a fetus [see Use in Specific Populations (8. Serious adverse reactions were reported in 54 (49%) subjects treated with Zydelig + rituximab. The most frequent (2%) serious adverse reactions reported for subjects treated with Zydelig were pneumonia (17%), pyrexia (9%), sepsis (8%), febrile neutropenia (5%) and diarrhea (5%). Adverse reactions that led to discontinuation of Zydelig occurred in 11 (10%) subjects. The most common adverse reactions that led to treatment discontinuations were hepatotoxicity and diarrhea/colitis. Thirty-nine subjects (35%) had dose interruptions and sixteen subjects (15%) had dose reductions due to adverse reactions or laboratory abnormalities. The most common reasons for dose reductions were elevated transaminases, diarrhea or colitis, and rash. Table 2 and Table 3 summarize common adverse reactions and laboratory abnormalities reported for Zydelig + rituximab and placebo + rituximab arms. R: rituximab Any Grade 66 (60) 22 (20) 27 (25) 41 (37) 10 (9) 20 (18) 55 (51) 13 (12) 10 (9) 29 (27) 4 (4) 5 (5) 38 (35) 27 (25) 29 (26) 62 (56) 59 (54) 12 (11) 22 (20) 9 (8) 6 (5) 2 (2) 3 (3) 8 (7) 0 2 (2) 11 (10) 15 (14) 15 (14) 37 (34) 50 (46) 5 (5) 16 (15) 1 (1) 0 3 (3) 0 2 (2) 0 7 (6) Summary of Clinical Trials in Indolent Non-Hodgkin Lymphoma the safety data reflect exposure to Zydelig in 146 adults with indolent non-Hodgkin lymphoma treated with Zydelig 150 mg twice daily in clinical trials. The most frequent serious adverse reactions that occurred were pneumonia (15%), diarrhea (11%), and pyrexia (9%). Adverse reactions resulted in interruption or discontinuation for 78 (53%) subjects. The most common reasons for interruption or discontinuations were diarrhea (11%), pneumonia (11%), and elevated transaminases (10%). Table 4 provides the adverse reactions occurring in at least 10% of subjects receiving Zydelig monotherapy, and Table 5 provides the treatment-emergent laboratory abnormalities. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to a fetus. Animal Data In an embryo-fetal development study, pregnant rats were administered oral doses of idelalisib during the period of organogenesis at 25, 75, and 150 mg/kg/day. Embryofetal toxicities were observed at the mid- and high-doses that also resulted in maternal toxicity, based on reductions in maternal body weight gain. Adverse findings at idelalisib doses 75 mg/kg/day included decreased fetal weights, external malformations (short tail), and skeletal variations (delayed ossification and/or unossification of the skull, vertebrae, and sternebrae). Additional findings were observed at 150 mg/kg/day dose of idelalisib and included urogenital blood loss, complete resorption, increased postimplantation loss, and malformations (vertebral agenesis with anury, hydrocephaly, and microphthalmia/anophthalmia). Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from Zydelig, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. In patients 65 years of age or older with indolent non-Hodgkin lymphoma in comparison to younger patients, older patients had a higher incidence of discontinuation due to an adverse reaction (28% vs 20%), higher incidence of serious adverse reactions (64% vs 37%), and higher incidence of death (11% vs 5%). Advise females of reproductive potential to avoid becoming pregnant while taking Zydelig. If contraceptive methods are being considered, use effective contraception while taking Zydelig and for at least one month after taking the last dose of Zydelig. Advise patients to contact their healthcare provider if they become pregnant, or if pregnancy is suspected, while taking Zydelig [see Use in Specific Populations (8. Patients with baseline hepatic impairment should be monitored for signs of Zydelig toxicity [see Warnings and Precautions (5)]. Follow dose modifications for adverse reactions [see Dosage and Administration (2. The chemical name for idelalisib is 5-fluoro-3-phenyl-2-[(1S)-1-(9H-purin-6 ylamino)propyl]quinazolin-4(3H)-one. Each tablet contains either 100 mg or 150 mg of idelalisib with the following inactive ingredients: microcrystalline cellulose, hydroxypropyl cellulose, croscarmellose sodium, sodium starch glycolate, magnesium stearate and a tablet coating. Idelalisib induced apoptosis and inhibited proliferation in cell lines derived from malignant B-cells and in primary tumor cells. Treatment of lymphoma cells with idelalisib resulted in inhibition of chemotaxis and adhesion, and reduced cell viability. Idelalisib exposure increased in a less than dose-proportional manner over a dose range of 50 mg to 350 mg twice daily in the fasted state. Distribution Idelalisib is greater than 84% bound to human plasma proteins with no concentration dependence. Following a single dose of 150 mg of [14C] idelalisib, 78% and 14% of the radioactivity was excreted in feces and urine, respectively. Specific Populations Age, Gender, Race, and Weight Population pharmacokinetic analyses indicated that age, gender, race, and weight had no effect on idelalisib exposure. Pediatric Patients the pharmacokinetics of idelalisib has not been studied in pediatric patients. Patients with baseline hepatic impairment should be monitored for signs of Zydelig toxicity [see Boxed Warning and Warnings and Precautions (5. Idelalisib did not induce mutations in the bacterial mutagenesis (Ames) assay and was not clastogenic in the in vitro chromosome aberration assay using human peripheral blood lymphocytes. Idelalisib was genotoxic in males in the in vivo rat micronucleus study at a high dose of 2000 mg/kg. In a fertility study, treated male rats (25, 50, or 100 mg/kg/day of idelalisib) were mated with untreated females. Decreased epididymidal and testicular weights were observed at all dose levels and reduced sperm concentration at the mid- and high doses; however, there were no adverse effects on fertility parameters. In a separate fertility study, treated female rats (25, 50, or 100 mg/kg/day of idelalisib) were mated with untreated males. There were no adverse effects on fertility parameters; however, there was a decrease in the number of live embryos at the high dose. Cardiac inflammation was mainly seen in a 28-day study in rats, the other findings were observed in the 13-week and/or 6-month studies. Subjects were randomized 1:1 to receive 8 doses of rituximab (first dose at 375 mg/m2, subsequent doses at 500 mg/m2 every 2 weeks for 4 infusions and every 4 weeks for an additional 4 infusions) in combination with either an oral placebo twice daily or with Zydelig 150 mg taken twice daily until disease progression or unacceptable toxicity. In Study 1, the median age was 71 (range 47, 92) with 78% over 65, 66% were male, and 90% were Caucasian. The most common (>15%) prior regimens were: bendamustine + rituximab (98 subjects, 45%), fludarabine + cyclophosphamide + rituximab (75 subjects, 34%), single-agent rituximab (67 subjects, 31%), fludarabine + rituximab (37 subjects, 17%), and chlorambucil (36 subjects, 16%). The trial was stopped for efficacy following the first pre-specified interim analysis. The median age was 62 years (range 33 to 84), 54% were male, and 90% were Caucasian. At baseline, 33% of patients had extranodal involvement and 26% had bone marrow involvement. Patients received 150 mg of Zydelig orally twice daily until evidence of disease progression or unacceptable toxicity. Tumor response was assessed according to the revised International Working Group response criteria for malignant lymphoma. The median age was 65 years (range 50 to 87), 73% were male, and 81% were Caucasian. Subjects received 150 mg of Zydelig orally twice daily until evidence of disease progression or unacceptable toxicity. Advise patients to report symptoms of liver dysfunction including jaundice, bruising, abdominal pain, or bleeding. Advise patients to notify their healthcare provider immediately if they develop a fever or any signs of infection [see Warnings and Precautions (5. If contraceptive methods are being considered, advise to use adequate contraception during therapy and for at least one month after completing therapy. Also advise patients not to breastfeed while taking Zydelig [see Warnings and Precautions (5. Advise patients that if a dose of Zydelig is missed by less than 6 hours, to take the missed dose right away and take the next dose as usual. If a dose of Zydelig is missed by more than 6 hours, advise patients to wait and take the next dose at the usual time. This Medication Guide does not take the place of talking with your doctor about your medical condition or treatment. Zydelig can cause serious side effects that can lead to death, including: Liver problems. Your doctor will do blood tests before and during your treatment with Zydelig to check for liver problems. Tell your doctor right away if you get any of the following symptoms of liver problems: yellowing of your skin or the white part of your eyes (jaundice) dark or brown (tea colored) urine pain in the upper right side of your stomach area (abdomen) bleeding or bruising more easily than normal Severe diarrhea. Tell your doctor right away if the number of bowel movements you have in a day increases by six or more. Your doctor may do tests to check your lungs if you have breathing problems during treatment with Zydelig.
Other commonly recalled behaviors included simulating intercourse and teasing that involved using sex words symptoms mold exposure generic 100mg topamax, lifting skirts medicine 0025-7974 buy 200 mg topamax with visa, or peeking in toilet stalls (Larsson & Svedin medicine daughter lyrics topamax 100 mg discount, 2002a) symptoms jet lag discount topamax 200 mg mastercard. In another retrospective study medications emt can administer topamax 100mg without a prescription, 85 percent of the 128 American female undergraduates surveyed recalled engaging in a childhood sexual game and that the average age of occurrence of the sexual play was 7 treatment toenail fungus purchase topamax 200mg on line. This finding is notable in that it suggests a pattern of increasing masturbatory behavior as children move from childhood toward adolescence medicine 751 m generic 100mg topamax with mastercard. Ramsey also found that preadolescent boys experienced erections in response to both erotic and nonerotic stimuli medicine urinary tract infection 100mg topamax, with the nonerotic responses generally tapering off after age 12. Additionally, Kinsey, Pomeroy, and Martin (1948) reported that 2025 percent of boys had attempted intercourse with a female by age 12. Less information was available then, as it is now, regarding preadolescent female sexuality, possibly due to cultural constraints that discourage girls more than boys from exploring sexuality-a situation that also makes gathering selfreports from girls a more difficult task (Martinson, 1997). These numbers are supported by another recent Swedish study, in which 6 and 7 percent of boys and girls, respectively, recalled masturbating to orgasm between ages 6 and 10, but nearly 43 percent of boys and more than 20 percent of girls reported such behavior between the ages of 11 and 12 (Larsson & Svedin, 2002a). Taken together with the reports from earlier decades of research, it is safe to say that although the estimates of incidence of masturbation vary by study, culture, and era in which the data were collected, all studies indicate a gradual increase in the behavior throughout preadolescence (McAnulty & Burnette, 2004). Thus far, we have described self-stimulatory sexual behaviors in preadolescence, but it should be noted that this period of development is also a time during which partnered sexual encounters become more common. In one retrospective study of more than 1, 000 American undergraduates, 42 percent of the sample reported having experienced a sexual encounter with another child prior to age 13, with the majority of those experiences involving heterosexual hugging and kissing (Haugaard & Tilly, 1988). In a Swedish study with a similar research design, Larsson and Svedin (2002a) found that 82 percent of those surveyed reported having had a mutual sexual experience before age 13, with hugging, kissing, talking about sex, and viewing pornographic pictures together being the most common behaviors. It is more difficult to estimate the frequency of experiences involving sexual intercourse during the preadolescent phase. In the Haugaard and Tilly study, 10 percent of the undergraduates surveyed reported having had sexual intercourse before age 13. Although some theorists have raised the possibility that such differential knowledge may influence behavior rates as well as what is viewed as normal in a given context, cross-cultural comparisons of sexual behavior have been the focus of little empirical research. Overall, the preschool-age children from Sweden evidenced higher rates of sexual behavior than those from the United States. Among boys, significant differences were identified for fourteen of the twentyfive behaviors assessed, with Swedish boys exhibiting higher levels for thirteen of the measured behaviors. The differences were somewhat less pronounced among girls; that is, reliable differences were detected on ten behaviors, with Swedish girls displaying higher rates in nine cases. The researchers also noted that a similar unpublished study comparing Dutch and American preschoolers yielded findings consistent with their own, with higher frequencies of sexual behavior reported in the Dutch sample (Larsson et al. Given that Dutch society is among the most open and liberal about sexuality, reported differences in sexual behavior between Dutch and American children may be viewed as providing further support for the notion that larger cultural attitudes about sexuality may influence the behaviors observed. Nevertheless, the literature base is still quite limited in this area, both in number of studies and cultures involved, with the available research largely focusing on Western cultures. Such findings, particularly when considered in conjunction with the research indicating that a wide range of behaviors occur in normative samples of children (Friedrich et al. Thus it is critical, as Larsson and Svedin (2002b) emphasize, for professionals working with children and responding to questions about, and reports of, child sexual behavior(s) to be thorough in their information gathering and thoughtful in their interpretation, examining the context in which the sexual behavior occurs, identifying antecedents of the behavior, and noting distress that may be present. Toward the end of expanding further this important line of study, we offer the following suggestions for future directions for research in this area: First, greater attention needs to be given to the methodologies used to collect data on this important topic. As it stands, much of the information that exists on the topic of normative childhood sexuality has been pieced together from small studies or case reports. Further, we would encourage the design of prospective, longitudinal studies in order to better understand the pathways that individual children follow toward sexual maturity. Consistent with the early stages of research in any area, the literature on normative sexual development has relied on cross-sectional studies designed to gather initial data on the incidence and prevalence of particular behaviors and experiences. Longitudinal designs also allow for drawing conclusions preview odd pages, download full ebook: book999. Sexual knowledge and emotional reaction as indicators of sexual abuse in young children: Theory and research challenges. Posttraumatic stress in sexually abused, physically abused, and nonabused children. Socializing influences and the value of sex: the experience of adolescent school girls in rural Masaka, Uganda. We examine how adolescence, and adolescent sexuality in particular, has been depicted as problematic. We then review contemporary theories of adolescence that focus on social, cognitive, and neurological changes. These more general discussions of adolescence then set the stage for an exploration of current understandings of adolescent sexuality. Within this we explore the types of experiences, social settings, and consequences of adolescent sexual behavior. We end with a discussion of education programs and their conflicting goals of controlling adolescent sexuality, while at the same time supposedly helping adolescents become adults with healthy sexual lives. This span of a decade or more encompasses a period of rapid physical development, the onset of puberty and consequent maturation to full reproductive capacity, substantial social and cognitive developments, and the attainment of the rights and responsibilities of adulthood. Although adolescence marks the transition from childhood to adulthood, with 1 preview odd pages, download full ebook: book999. Adolescents are often depicted as being unduly influenced by peers-of being conformists. Whereas choices about clothing, hairstyle, and music might be more in line with the choices of peers rather than of parents, most major decisions reflect parental values. In fact, according to Harris (1995), they are likely to choose peers who come from families like their own, and who share similar values to those of their own parents. One of the shortfalls of developmental science is that childhood is extensively studied and then compared to assumed behavior in adulthood. Adolescent conformity to peers is compared to conformity in earlier childhood, with the verdict that adolescents are great conformists. It is hard to argue that individuals with only minor responsibilities and very little to lose would conform more to expectations than an older group who have major expectations and responsibilities placed on them by colleagues, employers, and family members. Perhaps adolescents have been viewed as high in conformity, in part, because they have not always conformed to the expectations for adult behavior, which is rarely seen as conformist. In other words, putting on a suit is no less conforming than putting on the right brand of jeans. Adolescents are given permission to drive, to spend time away from adults, and to make some decisions independent from the adults in their lives. Their decisions might not be guided by the same knowledge or concerns, and they might have fewer social and cognitive skills to deal with awkward situations. Adolescents are more influenced by the perceived benefits of risk-taking behavior than by the perceived risks (Leigh & Stacy, 1993; Parsons, Halkitis, Bimbi, & Borkowski, 2000). This is partly because the benefits are more direct and immediate than are the negative consequences. It means, however, that the adult focus on negative outcomes might not be the best way to motivate and influence adolescents. More importantly, high risk-taking behavior is not necessarily characteristic of the majority of adolescents, even though it is more likely to occur in adolescence than in childhood. Adolescents in Western societies are confronted with a number of conflicting messages. Sexual images and themes are prevalent in television, movies, music videos and lyrics, and magazines. Sexualized appearances, even for younger children, are promoted through the available clothing choices. On the other hand, especially in North America, adolescents are often told that they preview odd pages, download full ebook: book999. Career directions become critical as an adolescent selects a major at university, and then reappear as an issue years later when the individual seeks employment. One other main objection to the identity theory as a key element during adolescence is that research has found that identity moratorium and achievement are often not attained until after the end of the adolescent period (see Kroger, 2003, for a review). Cognitive Explanations A number of significant cognitive developments occur during adolescence. Relative to their younger counterparts, adolescents are more able to reason abstractly; consider future, potential outcomes; and reflect on themselves and their own behavior. Reasons for these cognitive advances during adolescence generally focus on one or more of the following: changes in thought as a child enters formal operations (promoted by Piaget, 1952, 1972), changes in information processing (see Siegler, 1998), and advances in metacognition (see Kuhn, 1999). They start to understand more subtle forms of humor and behavior, and can reflect on their thoughts and behaviors to a much greater degree. Whereas adolescents are developing the ability to reason and think in the abstract, most of them lack the general knowledge and experience to apply these abilities faultlessly (Byrnes, 2003). Hence, they might show superb reasoning within a familiar domain, but fail when the area is beyond their knowledge base. Because adolescents more readily engage in reflective thought, they are able to use metacognitive strategies to a greater extent than younger children can. Adolescents show greater ability to monitor their performance, to think about their goals and progress toward them, and to make necessary adaptations. During adolescence, there is an increased awareness of how oneself and others view the world. Adolescents demonstrate the ability to reflect on their own thoughts and how those thoughts came to be. Similarly, they begin to accept more readily that truths might be relative rather than absolute. These developments are orchestrated by an elegant cascade of various chemicals produced within the developing child. By the end of primary school, many girls will be noticeably in the grips of pubertal change, with the boys soon to follow. Puberty lasts somewhere between two and six years, with a one- to two-year gap in progression on average between girls and boys. Thus, puberty often begins before what is conventionally referred to as adolescence and ends well before adolescence is over. This growth spurt occurs earlier in girls than in boys, and the rate of increase for girls is less than that for boys. For example, the greatest rate of growth for girls is at around 12 years, where they gain approximately 9 cm during the year. Boys, however, reach their highest growth rate at around 14 years, when they gain 10 cm. They begin later, and thus grow for an additional two years on average, and they grow at a greater rate. These two factors account for much of the final height difference between women and men. Secondary sex features show noticeable changes soon after the increased growth begins. Pubic hair forms, breast buds develop in girls, testicles enlarge in boys, and boys also experience changes to the larynx, which lead to the initial cracking and then lowering of the male voice. Approximately two and a half years after initial breast development, menstruation begins in girls. Spermarche, or first ejaculation, occurs approximately two years after initial testicular enlargement begins in boys. Other changes include increased muscle growth in boys, redistribution of fat in girls and boys, and increases in bone mineral content in both (see Rogol, Roemmich, & Clark, 2002). Pubertal timing is believed to be related to the onset of depressive symptoms in girls (Angold & Worthman, 1993). Antisocial behavior has been linked with puberty, but this might be due to the increased association with older, deviant peers that is likely with early-maturing adolescents (see Susman & Rogol, 2004). Greater moodiness is associated with puberty, but causal links between adolescent moodiness and hormone levels are not particularly strong (Buchanan, Eccles, & Becker, 1992). Greater moodiness might also be influenced by the greater occurrence of negative life events during adolescence (Larson & Ham, 1993). Timing of puberty is believed to be important, and the effects of timing are different for girls than for boys. Girls who reach puberty earlier than their peers might feel uncomfortable with their changed bodies, particularly the preview odd pages, download full ebook: book999. Inconsistencies do not occur randomly, but they occur to different degrees according to gender, age, family variables, and ethnicity. Illustrating this reluctance to disclose, another study comparing adult retrospective report with prior adolescent report found no inconsistency for age at first reported coitus, but a significant inconsistency for age at first masturbation (Halpern, Udry, Suchindran, & Campbell, 2000). The authors stated that masturbation, even more so than other behaviors, is a sensitive topic. Adolescents may be reluctant to disclose sensitive information even if they are assured that their reporting is confidential. Furthermore, research suggests that individuals least comfortable with questions about sexuality or with the least amount of sexual experience may decline to participate completely, potentially biasing accounts to a greater degree (Strassberg & Lowe, 1995). Another factor related to inconsistent reporting includes the language used to ask about sexual behavior. Reluctance by researchers to use explicit or colloquial language may result in varying interpretations by participants. For example, ``having sex' may be interpreted in various ways, from coitus, oral sex, the presence of orgasm, through to a variety of individual interpretations (Sanders & Reinisch, 1999; Savin-Williams & Diamond, 2004). Capturing homosexuality may be particularly difficult because attraction, behavior, and labeling can be distinct categories that are often discordant (Diamond, 2000; Friedman et al. Frequently, researchers conceptualize sex as entailing vaginal/penile penetration. Even if this is clearly communicated to participants, failure to ask about a broader range of behaviors leaves large omissions in our understanding of adolescent sexual experience and the meaning attributed to experiences. It is worth noting that some researchers have begun asking about a wider variety of behaviors and defining what they mean by ``to have sex. Crucially, researchers must extend their investigations beyond behavior, to attend to the meanings attributed to those behaviors and the social and emotional facets that are an integral part of sexual experience. Sweden has a relatively sexually permissive culture and arguably less of a sexual double standard. Interestingly, overall reported rates of masturbation were higher, and the gap in masturbation experience between males and females was smaller; 99 percent of males reported ever having masturbated, compared to 91 percent of women, although men continued to report a reasonably higher frequency. It is likely that a number of factors contribute to the low rates of masturbation reported by U. Precoital Behaviors the majority of studies devoted to adolescent sexuality present sex as a dichotomous variable (Whitaker, Miller, & Clark, 2000). Unfortunately, few studies explore these broader behaviors and feelings or the meanings adolescents attribute to them. As a result, it is possible to give descriptive accounts of some precoital behaviors but difficult to provide any substantive analysis of the relationship between them, their developmental course, how they are interpreted, or how behaviors and cognitions relate to later coitus. Precoital sexual expression, as with coitus, becomes more common with increasing age. A nationally representative study revealed that 12 percent of virgins and 18 percent of all participants aged 1214 years had been in a relationship in the last eighteen months that had included ``touching under clothes, ' while 6 percent of virgins and 13 percent of all students reported genital touching within at least one romantic relationship (Bruckner & Bearman, 2003). For older students, another nationally representative study of males found that approximately 40 percent of 15-year-olds and 60 percent of 16-year-olds had precoital sexual experience, such as masturbating or engaging in oral sex (Gates & Sonenstein, 2000). In another study, 35 percent of students in ninth through twelfth grade had engaged in noncoital heterosexual activity in the prior year; specifically, masturbation of a partner (29 percent) and by a partner (31 percent), fellatio with ejaculation (9 percent), and cunnilingus (10 percent). Homosexual masturbation and oral sex were less commonly reported (around 12 percent) for different behaviors (Schuster, Bell, & Kanouse, 1996). Retrospective reports by college students of their experiences prior to coitus revealed that most had engaged in kissing and fondling of breasts and genitals, 70 percent of males had performed cunnilingus, and 57 percent of females had performed fellatio at least once; moderate to high preview odd pages, download full ebook: book999. Males were more likely to report having had sex than were females up until twelfth grade, and prevalence increased as students moved through high school. Of those who had sex in the past three months, in relation to their most recent sexual encounter, 25. For example, 90 percent of adolescent boys stated that teenagers should be given a ``strong' abstinence message from society (unpublished data cited by the National Campaign to Prevent Teen Pregnancy, 2003a). In their sample of predominately (80 percent) African American girls, 14 years was the mean age of first intercourse. The authors reported that 78 percent of the girls said they were ``too young' whereas 22 percent said their age had been ``just right. Some studies have found that condoms were more likely to be used in a romantic relationship than in a casual relationship; however, other studies have found the opposite pattern. This discrepancy can be resolved by considering that in longer-term relationships, condoms may be disregarded for other forms of contraception. Individual factors are also associated with condom use, as those who use condoms consistently in one relationship are more likely to do so within other relationships. Characteristics of the individual that decrease the likelihood of condom use included Hispanic ethnicity, low academic achievement, and religiosity. The characteristics that increase the likelihood of condom use included having two biological parents, parents with higher educational attainment, and holding positive attitudes toward contraception. More consistent contraceptive use is associated with hormonal contraceptive methods than with condoms. The proportion increased with age so that by age 18, 76 percent of adolescents reported having experienced a romantic relationship, and 8 percent reported a ``liked' relationship (Carver, Joyner, & Udry, 2003). In another study, with adolescents 14 and younger, 42 percent reported ever having dated. Of those, the majority (40 percent) had only dated 13 times (Terry-Humen & Manlove, 2003). Nonromantic Relationships Not all sexual involvement occurs within a romantic relationship. Despite sexual involvement having different ramifications according to age-group, there is often no breakdown of ages or data collected from adolescents aged 15 and older. Despite increased risk, the proportion of sexually active individuals aged 14 or younger is not declining like that of those in the older age-group, but is instead increasing.
Kessler symptoms 2016 flu buy 100 mg topamax visa, Institute for Social Research medications blood thinners quality topamax 200 mg, University of Michigan crohns medications 6mp discount topamax 200 mg without a prescription, Ann Arbor symptoms ms generic 200 mg topamax with amex, Michigan 48106-1248 treatment alternatives buy 200mg topamax. Therefore treatment 3rd degree hemorrhoids generic topamax 200 mg on line, there is reason to suspect that daily stressors have similarly varied effects symptoms 6 months pregnant buy topamax 100 mg fast delivery. For this reason it is difficult to establish that they lead to the onset of mood disturbance medicine 2015 buy discount topamax 100 mg line. Often all that can be shown in conventional nonexperimental research is that enduring everyday stress is associated with enduring poor mental health. Clearly, such associations do not rule out the possibility of reverse causation or spuriousness due to third variables. Moreover, there is reason to believe that the measures of minor stress used in many studies are systematically biased because they are based on retrospective reports that can be affected by preexisting emotional impairment (Dohrenwend, Dohrenwend, Dodson, & Shrout, 1984). A significant breakthrough in the study of minor stress has been the use of daily diaries. These are self-report instruments that are completed each day over a period of several weeks and are designed to record day-to-day variation in stressful events and emotional functioning. These instruments help resolve the retrospective recall problem by allowing respondents to report minor stressors near the time they occur. They also help solve the problem of causal imputation by capturing information about the dynamics of roles and relationships that, in conventional, cross-sectional designs, appear static. As is discussed later, combining different stressors within the same role domain masks important variations in stressor effects. As in other areas of research that have been opened up by methodological innovation, more initial progress has been made in establishing field procedures (Stone & Neale, 1982; Verbrugge, 1980, 1984) and measurement instruments (Stone & Neale, 1982, 1984) than in documenting important empirical associations. This article attempts to move in a more substantive direction by using the diary method to provide basic data on the emotional effects of daily stress. Research Q u e s t i o n s this study is based on daily reports of stress obtained over a 6-week period from husbands and wives in a large sample of married couples. In this article, we focused on the individual, rather than the couple, as the unit of analysis. A basic aim of the study was to obtain information on the emotional effects of the various kinds of daily stressors that people most commonly experience. Almost all previous research has either ignored this issue or provided only aggregate information on the effects of stress. A related research question stems from the fact that daily stressors can cluster in time; for example, spouses may argue on successive days. This suggests that research on daily stress processes should attend to multiday episodes of stress and to their changing effects on well-being as episodes become prolonged. The conventional line of thinking is that the persistence of a stressor over several days increases its emotional impact (Brown & Harris, 1978; Silver & Wortman, 1980). An alternative possibility is that people habituate to the impact of events over time (Marks, 1977). The longitudinal design of this study permits us to test these alternative possibilities in a rigorous manner. Yet there is good reason to think that the meanings and effects of particular daily stressors can be modified by the occurrence of other stressors. The notion of role overload, for example, suggests a situation where multiple events within a given role domain. Similarly, the notion of role conflict suggests that an emergent stress is created when overloads occur in two different role domains at the same time. We tested for these interactive effects by examining the cooccurrence of a range of daily stressors. In summary, this study used a daily diary methodology to obtain information on daily stress from husbands and wives in a representative sample of married couples in a major metropolitan area. We investigated whether these stressors have different effects on mood as stress episodes be- 809 come prolonged, and we investigated the interactive effects of various combinations of daily stressors. Method Design and Sample Respondents were men and women in 166 married couples, all of whom had previouslyparticipated in a communitysurvey of stress and coping. The original sample consisted of 778 intact couples from the Detroit metropolitan area. Of these, we attempted to recontact and recruit 489 couples by telephone to participate in the current study 1 year after the earlier interview (the remaining 289 couples were not called because they had been approached in an earlier study). We were successfulin tracing and recruiting only 166 couples in which both spousesagreed to participate. A response rate this low makes it difficult to think of the sample as superior in any substantial way to the volunteer samples that have been used in many previous daily diary studies. Respondentswere asked to complete a short daily diary questionnaire on each of 42 consecutive days (6 weeks). Each week they received by mail a diary booklet containing diary forms for each of 7 days. Respondents were not paid for their participation, although a $5 gift was sent along with the first diary booklet. Of the respondents who agreed to participate in the diary phase of the study, 74% completed the full set of 42 diary days, and 89% completed 28 days or more. Data were obtained on 12, 054diary days in all and on 11, 578 diary days in which both the husband and wife in a couple reported. Because participants mailed their completed diaries to us weekly rather than daily, we cannot be sure that they actually filled them out on a daily basis. We sought, however, to offset any pressures people might feel to be dishonest about the timing of their reports. We assumed that some people would occasionally forget to fill out their diaries, and we allowedpeople to fillthem out late. Eighty percent of the time, people reported filling out the diaries on the appropriate day. Thus, it appears that 95% of reports were completed within I day of the target day. Although these reports may not be entirely reliable, our procedure probably lessened pressures to lie about timing. The low response rate (34%) makes it especially important to compare the diary sample to the larger community sample. Bolger, DeLongis, Kessler, and Wethington (1989a) made such a comparison on a range of background variables obtained in the baseline survey, including age, education, hours worked, number of children, family income, and frequency of marital conflicts. No systematic differences were observed between the groups except in frequency of conflicts. This comparison suggests that the low response rate did not lead to bias in prevalence estimates for daily stressors other than marital conflicts;estimates of marital conflict, however, are biased downward. Because our model specifies that stress and mood affect one another within the same time period, the data do not allow us to test the causal relationship between the variables. We assume, however, that the bulk of the relationship between stress and mood is due to a causal effect of stress on mood. Control variables were included in the model to adjust for time-varying correlates of stress and mood. These included day of the week (six dummy [0, 1] variables) and the linear and quadratic forms of a variable defining the number of days that had elapsed since the respondent first began filling out the diary. Day of the week was controlled because prior research has documented systematic day-of-the-week variation in mood. We also know that some events are more likely to occur on particular days of the week. Finally, we controlled for length of time in the study in order to capture any common tendency of respondents to change how they filled out the diaries in response to novelty, fatigue, or boredom. Previous work has found that diary respondents report fewer stressors and health problems over time (DeLongis, Folkman, & Lazarus, 1988). We allowed for nonlinear change in such effects by including both linear and quadratic forms of this variable. This list, shown in the Appendix, is based on earlier pilot testing of stressor items in a sample of 64 married couples (see Kessler, DeLongis, Haskett, & Tal, 1988). In the earlier study, we also used an open response format to identify common daily events in this population. We included only those daily stressors-identified by either open- or closed-format methods-that occurred on at least 5% of person-days in the earlier study and were associated with distressed daily mood in a pooled within-person regression analysis (see Equation 1 in the following section). For the purposes of analysis, checklist responses were aggregated into 10 summary event categories. First, we grouped stressors on a rational basis; for instance, we included the items spouse sick and child sick in a more highly aggregated measure of family demands. Our second criterion was that the stressors had to have similar effects on mood in order to be combined. Thus, stressors were grouped together only if they were conceptually similar and had similar effects (magnitude and direction) on mood. We determined comparability of effects in a preliminary regression analysis using all 21 checklist items simultaneously. The regression model we used was identical to that presented in the following section. The final 10 event categories were as follows: (a) overload at home; (b) overload at work; (c) family demands; (d) other demands. The diary also included an inventory of 18 mood items from the Affects Balance Scale (Derogatis, 1975) designed to measure anxiety. Responses to all items were combined and rescaled to create a summary measure of distressed mood, which ranged from 0 (all items endorsed not at all) to 1 (all items endorsed a lot). This model is different from a conventional regression equation or time series equation in that it is based on a multilevel data array of i people, each assessed at t time points. This means that both withinperson and between-persons variation play a role in the unrestricted data structure (Mason, Wong, & Entwisle, 1984). We wanted to focus our analysis, however, on within-person variation and to purge the data of the effects of individual difference variables that create between-persons variation. We accomplished this by subtracting the within-person mean on the dependent variable (Mr. Preliminary analyses of some slightly less aggregated groups-relatives (other than spouse or children), coworkers, friends, and others-failed to document any meaningful variation in effects. Also, it was rare to find a respondent who reported the occurrence of arguments with three or more people on the same day, so multiple arguments were coded as a single variable indicating arguments with two or more persons. Powerful analysis of the relationship between more than two arguments on a day and mood was not possible, but the data suggest that the emotional effects of exactly two versus more than two arguments do not differ. Our measure of distress contains components that load highly on negative affect (anxiety and hostility) and that load moderately on (low) positive affect (depression). Specifically, the effects of stressors on mood will be unbiased estimates of the population values. We found that 19% o f the within-person variance in m o o d is associated with daily stress among men, F(10, 5210) = 122. In contrast, the controls (the six day-of-week d u m m y variables, day o f study, and the square o f the day o f study) explained 1% o f the variance for women, F(8, 5359) = 6. Results o f this sort are more compelling than results based on crosssectional data (between-persons analyses) or unrestricted analyses o f pooled diary data (analyses combining both within-person and between-persons variance), because the confounding influences of individual difference variables are taken out of consideration. Almost all previous analyses o f daily stressor effects have used aggregate stress measures. We went beyond this preliminary kind o f analysis to study the relative influences o f different kinds o f stressors. As is shown in Table 1, our analysis documented the existence o f considerable variation in daily stressor effects. In particular, interpersonal conflicts are m u c h m o r e upsetting than other dally stressors. A m o n g men and women alike, not only do conflicts have the largest effects on mood, but these effects are, in almost all cases, more than twice as large as those o f other daily events. A striking illustration o f the importance o f interpersonal conflicts can be seen by examining their contribution to explained variance in mood. As noted earlier, the set o f 10 stressors explained 19% and 20% o f the variance in m o o d for men and women, respectively. However, controlling for the 6 other stressors, the 4 interpersonal conflict measures alone uniquely explained 16% o f the m o o d variance for men, F(4, 5210) = 254. These results clearly show that interpersonal conflicts are overwhelmingly the most i m p o r t a n t kind o f daily stress influencing psychological distress among the stress categories considered in this analysis) Gender differences. Inspection o f the data in Table 1 shows that in 7 o f 10 comparisons the effects o f stress on m o o d are stronger among women than men. In addition, our methodology may be biased against detecting certain kinds of negative events, such as the nonoccurrence of an expected positive event. Also, these analyses do not take account of the effects of less frequent, major negative events. Such events were very rare in the sample of days we analyzed-only 58 out of 12, 054 (. In preliminary analyses, we included a dummy (0, 1) variable in our regression models for such events in order to take account of their unique effects on mood. In addition, home overloads are associated with significantly better m o o d for women, 7 whereas they are associated with worse m o o d among men. Length of Stressful Episode Nearly half the stressful events reported in the diaries represented second or later days in a series of events of the same type. As we noted earlier, prior theory suggests that the emotional effects of these stressors might vary depending on when they occurred within episodes. Hence, our estimates of gender differences will not be biased, but they will be slightly inefficient. We have ignored this loss of power because statistical power is not a problem in a data set of over 10, 000 observations. We reestimated the model for each of these groups and found no significant difference between them in the relationship between overloads at home and negative mood, F(I, 5347) =. For example, even if the object of a stressor changed across days of an episode (subject of an argument, specific tasks involved in an overload), one stress may have led to another. We were able to determine, however, that the stress episodes in our data occurred more frequently than would be expected by chance. The number of days involved in muitiday series was consistently higher in the actual data than in the simulated data for all Speed of Recovery From Stressful Event Previous research suggests that, for the average person, the effects o f daily stressors do not persist beyond the day they occur. In our analysis, we c o m p a r e d distress scores on two types o f stress-free days: (a) those immediately following a stressful event and (b) all other stress-free days. To do this, we added nine (0, 1) d u m m y variables (we c o m b i n e d arguments with single and multiple others) to the regressions s u m m a r i z e d in Table 2. Each d u m m y variable was coded 1 on the first stress-free day following a stressor series and 0 otherwise. With this parameterization, the coefficient for each o f these d u m m y variables represents the mean difference in distress between a stress-free day immediately following a given stressor series and other stress-free days. In seven out o f nine comparisons for m e n and in eight out of nine comparisons for women, m o o d was better on stress-free days following a stressor than on other stress-free days. However, we performed a global test o f the distress difference between the two types of stress-free days by testing the significance o f all nine d u m m y variables as a group. Thus, there is a rebound effect associated with the termination o f a stressful experience. This model is an augmentation of the basic 10-stressor model presented in Equation 1. Instead of using a single d u m m y variable to capture the effect of a given stressor, we used three d u m m y variables to differentiate first-day, second-day, and third-or-later-day stressors (adding the three variables together would result in the original stressor variable). The predictive power of this augmented model was significantly better than the basic m o d e l - F(20, 5181) = 3. Predictive power is improved because the effects of daily stressors change after the first day of episodes; no substantial change occurs between second and later days of episodes, however. Consequently, we present results based on a model distinguishing the effects of first-day from later-day stressors by using a d u m m y variable for the first day of an episode of each stressor and a d u m m y variable for second or later days of an episode of each stressor. Results in Table 2 show that first- and later-day stressor effects for conflicts and nonconflict stressors exhibit different patterns. For nonconflict stressors, first-day stressor effects are larger than those that occur later in episodes in five of six comparisons among both men and women (the other-demands category is the only exception). In contrast, for conflict stressors, first-day stressor effects are smaller than those that occur later in episodes in four out of the four comparisons for men and three out of the four comparisons for women. We compared the proportionate temporal change in the effects of interpersonal conflicts and other daily stressors using tests of the difference between coefficients from the same regression model (see Cohen & Cohen, 1983, Appendix A2. Specifically, for men and women separately, we carried out four multivariate tests. Each test summarized six comparisons: an argument effect versus each of the six nonconflict effects. In summary, mood is typically worse on later days of a conflict stressor series, whereas it is typically better on later days ofa nonconflict stressor series. Only l of the l0 comparisons was significant: There is a striking gender difference in reactions to conflicts with children, F(l, 10559) = 12. Women are in significantly better mood after the first day of an episode, whereas men are in worse mood. Certain combinations of these events could be exstressors for both men and women (from 6% to 25% higher for women, and from 8% to 19% higher for men). Also, series lasting 3 days or longer were 12% to 62% more prevalent for men, and 1% to 73% more prevalent for women. Therefore, we are confident that the stresses involved in a substantial number of the multiday series are related.
An all-liquid diet of pre-digested nutrients medicine xanax generic 100mg topamax with mastercard, called an elemental or polymeric diet treatment hypercalcemia quality 100 mg topamax, has been shown to reduce inflammation in the intestine medications qd generic topamax 200mg visa. It is usually given overnight through a tube that runs through the nose to the stomach medicine upset stomach generic 100 mg topamax free shipping. It can improve symptoms and reduce inflammation medicine ads order topamax 200mg without a prescription, but it is very hard for most people to do harrison internal medicine buy topamax 100mg on-line. The intestinal bacteria in the gut can react to these foods and cause abdominal pain symptoms 7 days after iui order 200mg topamax with amex, gas symptoms yeast infection women purchase topamax 200mg amex, bloating, diarrhea and/or constipation. It is a two-part diet consisting of elimination and challenge (reintroduction) phases. The Registered Dietitian will guide you to eat nutritious and tasty meals that suit your palate and agree with your gut. Caffeine speeds up intestinal motility (the movement of food through the digestive tract) and can cause diarrhea even among people with healthy intestines. A food diary can also show if your diet is providing the nutrients your body needs. If not, the dietitian can suggest ways to change your diet so that you get what you need. That may mean increasing the amount of food you eat, changing what you eat, or adding vitamins or minerals to your diet. Meat, fish, poultry, and dairy products are sources of protein; bread, cereal, starches, fruits, and vegetables are sources of carbohydrate; butter and oils are sources of fat. Some people, especially those of Asian or African backgrounds, cannot tolerate lactose as they get older. However, they can often handle small amounts of dairy in their diet, and by taking lactase tablets with dairy foods they can often tolerate even more. This inflammation Original: September 30, 2009 Revised: February 22, 2017 Page 85 Inflammatory Bowel Disease Program Patient Information Guide can damage the lining of the intestine, and cause lactose intolerance for 1 to 3 months. Your body needs dairy products because they provide calcium and vitamin D, as well as protein. Unless you have been told you have lactose intolerance, there is no reason to avoid milk and dairy products. When this happens, a low-fiber or low-residue diet may help to ease abdominal pain and other symptoms. This diet reduces the amount of food that cannot be digested (solid residue) in the stool. Foods to avoid include seeds, raw fruits, and vegetables; especially apple peels and stringy roughage, like celery. These fibers are not digested and can tangle into a net and block or slow down the passage of other food through the part of the intestine with the stricture. It is likely that these changes in your diet will only be needed for a short time until the inflammation that caused the narrowing goes away. If the disease is in the ileum (the last part of the small intestine) or if the ileum has been removed, it may be hard to absorb vitamin B12. Blood levels of vitamin B12 should be checked before you start to take a B12 pill. If you take these medicines, you also need to take a 1 mg folate tablet every day. Vitamin D is needed to absorb the calcium from the diet, so it helps keep bones strong. It is caused by blood loss during inflammation, and by reduced iron absorption as a result of inflammation. Taking iron by mouth often turns the stool black, which can be confused with intestinal bleeding. Original: September 30, 2009 Revised: February 22, 2017 Page 86 Inflammatory Bowel Disease Program Patient Information Guide Other possible problems include low levels of potassium and magnesium. Low potassium levels may be caused by diarrhea or vomiting or as a result of prednisone treatment. A lack of magnesium can be caused by chronic diarrhea, a large amount of inflammation in the small intestine, or after a large amount of the intestine is removed. This is most common when people avoid dairy products because they are lactose intolerant or because they think they are lactose intolerant. It can also happen to people who have enough calcium in their diets but do not absorb it as they should because of intestinal inflammation or because a large amount of the small intestine has been removed. Long-term use of prednisone and other steroids, for example, slows the process of new bone formation and quickens the breakdown of old bone. People with bone loss should avoid steroids as much as possible to improve bone health. These people need to aim for at least 1, 500 mg of calcium daily, either in food or in a pill taken three times during the day. During a period of active inflammation, any food can make pain, bloating, cramping, and diarrhea worse. You also need to drink plenty of fluids with salt and water so that you absorb and retain fluid. If your urine is very yellow or you are not making much urine, you are likely dehydrated. If it does not get better, call your doctor or nurse or go to the nearest emergency room. Although it may be hard to keep up your normal (about 2000 calories) intake when you are feeling poorly, eating at least some food (about 1000 calories) will help maintain the cells in the lining of your gut and also help heal ulcers. After a flare, slowly restart your normal diet (not a triple cheeseburger on the first good day). In the long term, be sure to eat a balanced diet with a wide variety of healthy foods to maintain your health. An elemental diet is made up of liquids with all of the nutrients you need, including amino acids, fats, sugars, vitamins, and minerals. This diet can be taken by mouth in the form of products you can buy over the counter (for example, Ensure). The goal is to allow the gut to rest and heal before it has to deal with whole foods again. What to Eat When in a Flare this handout provides suggestions for what to eat when you are experiencing active inflammation and increased symptoms related to your Inflammatory Bowel Disease. Once your intestines have healed and symptoms have calmed down, you may slowly reintroduce foods and ultimately resume your normal diet. The following chart includes suggested foods (foods that may be easier to tolerate during a flare) and foods to limit/avoid (foods that may exacerbate symptoms), taking into account the general tips provided above. Limit/Avoid Recommended Dairy Milk, yogurt, ice cream, soft cheese (cottage and ricotta cheese), soy milk, rice/coconut milk Lactose free milk (such as Lactaid), almond milk, lactose free yogurt, kefir, lactose free ice cream, lactose free cottage cheese, and any hard/aged cheeses *Lactaid milk or equivalent is preferred over rice/coconut milk as it is higher in protein and calories. Original: September 30, 2009 Revised: February 22, 2017 Page 88 Inflammatory Bowel Disease Program Patient Information Guide Wheat products (bread, pasta, crackers, cookies, bagels, some cereals), high fiber grains: brown rice, oatmeal, quinoa, corn/popcorn White rice, gluten-free rice pasta and breads, rice crackers (without onion/garlic seasoning), rice chex or corn chex cereal, plain Cheerios, sweet or white potato without skin, corn tortillas, corn flakes, rice cakes, cream of rice hot cereal Recommended *Cook all vegetables to decrease fiber and avoid thick skins/peels. Grains/starches Limit/Avoid Raw vegetables including salads; onion, garlic, artichokes, asparagus, cauliflower, sugar snap peas, mushrooms, celery Vegetables Carrots, green beans, zucchini, broccoli, peppers, spinach, eggplant, tomato, green peas, olives *Limit to Ѕ-1 cup serving per meal/snack. If needed, cook the fruit to decrease fiber or try blending in a smoothie with lactose free yogurt. Fruit Apples, pears, grapefruit, peaches, cherries, nectarines, apricots, plums/prunes, dates, persimmon, watermelon, blackberries, mango, dried fruit Proteins *Try to include protein at each meal Fried meats, sausage, bacon, fatty cuts of beef, raw nuts, beans Seasonings Spicy food, onion, garlic (powder and fresh), honey, agave, high fructose corn syrup Soda and drinks with high Banana, blueberries, strawberries, cantaloupe, grapes, papaya, honey dew melon, pineapple, clementine, orange, kiwi, lemon/lime Lean meats (chicken breast, turkey, lean beef such as ground sirloin/tenderloin, fish, shellfish, pork tenderloinsuch as shredded slowcooker pork), peanut/almond butter, eggs, tofu, tempeh, and lactose-free dairy products, whey protein isolate powder (99% lactose free), rice protein powder Salt, pepper, lemon, soy sauce, fresh or dried herbs as tolerated Water, decaf coffee/tea, Page 89 Original: September 30, 2009 Revised: February 22, 2017 Inflammatory Bowel Disease Program Patient Information Guide Beverages fructose corn syrup (including Gatorade, lemonade made Powerade), regular caffeinated with real sugar (8oz limit per coffee/tea, apple juice meal/snack), orange/cranberry/grape juice as tolerated (1/2 cup limit per meal/snack), lactose free milk, Ensure (Original, Plus, Clear), homemade smoothie sugar-free gum and candy, large portions of concentrated sweets/desserts Sample Menu Day 1: Breakfast: Rice chex with lactose free 2% milk Snack: 2 scrambled eggs Lunch: Roasted turkey sandwich with cheese and mustard on gluten-free bread. That said, experts have a lot to learn about natural, herbal, and alternative therapies. Most of the products are said to have "some benefits" for digestion or keeping your bowel movements regular. The people who work in these stores are sometimes paid extra when they sell supplements. They will often guide people to products that pay the highest rates, to add to their own pay. In contrast, your doctor does not receive money from drug companies for medicines you are prescribed. Others may interact with your other medicines and increase your risk for severe side effects. Some supplements work because they have ingredients that are not listed on the label, such as steroids. Some of these have had poisons or toxins (for example, mercury or lead) but it was not known until people became ill or died. Also, the suppliers can change the formula without any warning or regulation, which may lead to new side effects. It is important to know that some of these companies take advantage of people who want to get better. Please tell your doctor if you are taking supplements and which ones you are taking. They interfere with their action or increase the likelihood that you will have side effects. In addition, probiotics have been shown to be harmful in rare cases for people who are very sick. One well-done study of probiotics used in people with severe acute pancreatitis was stopped early because those taking probiotics were dying at a much higher rate than those taking the placebo. The lesson here is to be very careful with probiotics especially during active intestinal disease. It seems likely that live bacteria could cross intestinal ulcers through the wall of the intestine and get into the bloodstream, which could lead to serious infections. People who are also taking immunosuppressive medicines at the same time are at increased risk. This is because immunosuppressive medicines can make it harder for your body to fight infections. At this time, trying probiotics on your own may not be wise, especially if you are taking immunosuppressive medicines or if you have active disease. Fish oil, which is high in omega-3 fatty acids, may be of some benefit at high doses for heart disease. It may be cheaper and safer to eat cold-water fish that are high in omega-3 (for example, salmon, mackerel, herring) 2 to 3 times a week than to pay for fish oil capsules. One small clinical study with 44 people who have ulcerative colitis showed that aloe vera gel (100 mL) taken twice a day for 4 weeks had a modest benefit. The form of aloe vera gel used in the study is not the same as what is usually sold in stores. Aloe vera juice, which is often seen, has a laxative effect and is therefore a problem for people who have diarrhea. Side effects of aloe vera include bloating, foot pain, sore throat, ankle swelling, acne, and eczema. A study done at the University of Michigan showed that patients with ulcerative colitis who cleaned out their colons for a colonoscopy were more likely to have a minor flare of symptoms in the following 2 weeks. These flares were more common for those who needed steroids to control their symptoms. There is no proof of benefit and when the colon is inflamed, colon cleansing may be mildly harmful. The best source is the National Center for Complementary and Alternative Medicine, which is funded by the National Institutes of Health. Taking care of your mental well-being is equally as important as taking care of your physical well-being. Behavioral health services are provided by a licensed clinical psychologist who has a unique understanding of the psychosocial issues specific to gastrointestinal disorders. Megan Riehl uses the most up-to-date, scientifically based treatments to assist you with managing your condition and improving your quality of life. She provides a safe, comfortable therapy environment (within the Taubman Center) where treatment is designed to help you feel better both mentally and physically. Treatments are designed for people who do not necessarily have a mental health problem, rather for people who want to better manage their physical condition. You may be a good candidate for our services if you find that life stressors make your symptoms worse, you are excessively worried about the impact of your symptoms, you have trouble understanding your condition or treatment plan, your medicine is not working, you have trouble relaxing, you are experiencing anxiety or depression because of your symptoms or you feel as though you do not have an adequate support system. Psychological interventions that address stress and, in some cases, intestinal symptoms directly, can be beneficial for your gastrointestinal health and emotional well-being. Your first visit will be an initial comprehensive consultation, which is designed for Dr. Riehl to learn about what brings you in for treatment and for you to ask any questions you may have. You will complete a New Patient Health Questionnaire to bring to your consultation. Original: September 30, 2009 Revised: February 22, 2017 Page 94 Inflammatory Bowel Disease Program Patient Information Guide What is Cognitive Behavioral Therapy? By changing your unhelpful thinking patterns, your feelings and actions will also change. You will be asked to work on new skills that you learn in session during the time in between your appointments ("homework") and bring what you experienced on your own to your appointments to review and build upon. You may choose to stay in treatment longer to address other therapeutic treatment goals. Hypnotherapy was one of the first psychological therapies to be used in medical populations. It has been associated with positive outcomes in several chronic diseases such as cancer, fibromyalgia, chronic pain and others. Research has shown that gut-directed hypnotherapy is linked to improved function and health in the gastrointestinal tract. It has demonstrated efficacy in several gastrointestinal disorders, with treatment gains maintained for many years. Megan Riehl, is a licensed clinical health psychologist who specializes in the treatment of gastrointestinal problems and anxiety related-disorders. Working from a collaborative perspective, she believes that a strong therapeutic relationship will aid in facilitating change and improvements in quality of life. Her approach relies on principles of cognitive-behavioral therapy, to design unique and flexible treatment plans tailored to the individual she is working with. She is a clinical instructor on faculty in the Department of Internal Medicine at the University of Michigan. Primary Care Physician Referring Physician My Address My Phone Numbers Cell: Emergency Contact Names 1. The Friends and Family Form allows you to give permission for us to speak to your family members or friends about your care. You can print the Friends and Family Form from the internet and bring it to your next visit. Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Refills needed? Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Do I need a driver for this appointment? Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Original: September 30, 2009 Revised: February 22, 2017 Page 97 Inflammatory Bowel Disease Program Patient Information Guide My Medicines Strength Medicine (example, milligrams or mg) Number taken at a Frequency (example, time 3 times per (example, 2 tablets) day) Start Date End Date Why stopped? Original: September 30, 2009 Revised: February 22, 2017 Page 98 Inflammatory Bowel Disease Program Patient Information Guide Planning for My Next Visit Questions and Concerns Answers and Comments Original: September 30, 2009 Revised: February 22, 2017 Page 99 Inflammatory Bowel Disease Program Patient Information Guide Bathroom (Bowel Movements) Tracker Date Time Consistency (hard/soft/liquid) Time from urge to go Blood present? Inflammation Scarring or Blockage Adhesions Other What segment(s) of intestine was removed? Not connected ileostomy colostomy Connected J pouch connected to Not connected ileostomy colostomy Connected J pouch connected to Not connected ileostomy colostomy Connected J pouch connected to Not connected ileostomy colostomy Connected J pouch connected to Inflammation Scarring or Blockage Adhesions Other Inflammation Scarring or Blockage Adhesions Other Inflammation Scarring or Blockage Adhesions Other Original: September 30, 2009 Revised: February 22, 2017 Page 103 Inflammatory Bowel Disease Program Patient Information Guide Monitoring My Laboratory Tests (for patients taking azathioprine or methotrexate) If you are not able to get your lab tests done on time, call your nurse (phone no. Date tests due Time Date labs completed Appointment location Please call your nurse (phone no. Please choose one lab for all of your blood tests, based on where you live and your health insurance. It is common to have lab tests done every 2 weeks for the first month, then monthly for 2 months as we figure out the best dose for you. Once you are taking a steady dose of the medicine and your blood tests are normal, you will have lab tests on a set schedule every 3 months. Preventing Infections with Vaccines Vaccines are used to reduce our risk for infections. Some vaccines are made with a live virus and others are made with an inactivated form of the virus. People taking thiopurine medicines (like azathioprine [Imuran] and mercaptopurine [Purinethol]) are at a high risk for infections with viruses that stay in the body for a long time and become active again. For example, the virus that causes chickenpox can return much later in life as shingles. There is also an increased risk for bacterial infections of the skin and soft tissues. Original: September 30, 2009 Revised: February 22, 2017 Page 105 Inflammatory Bowel Disease Program Patient Information Guide Vaccines the pneumonia vaccine (Pneumovax) can protect people against 23 of the most aggressive types of pneumonia with just one shot. This vaccine is advised for all adults age 65 and older and also for anyone who is taking immunosuppressive medicines (including prednisone). The flu vaccine can prevent the flu or shorten the time the flu lasts and ease its symptoms. Anyone who takes immunosuppressive medicines should get the shot and avoid the nasal spray. The shot is made of inactivated virus and the nasal spray is made of the live virus. It often comes in a form that combines both hepatitis A and hepatitis B vaccines in a single shot (although it is still three [3] shots total).
Cheap 100mg topamax otc. Signs and Symptoms of Multiple Sclerosis in Women - Health and life.
