text:
Can Kratom Get You High?
Can Kratom Get You High? Effects, Signs & Symptoms, Detox & Addiction Treatment
Home » Blog » Addiction » Can Kratom Get You High?
What Is Kratom?
"Kratom" commonly refers to an herbal substance that can produce opioid- and stimulant-like effects. Kratom and kratom-based products are currently legal and accessible in many areas, though U.S. and international agencies continue to review emerging evidence to inform kratom policy.
While there are no uses for kratom approved by the U.S. Food and Drug Administration, people report using kratom to manage drug withdrawal symptoms and cravings (especially related to opioid abuse), pain, fatigue, and mental health problems. [1]
Can kratom get you high? Yes. In the short term, the opioid effects can relieve pain and make people feel relaxed and happy. However, opioids can also have harmful effects, including:
Common stimulants effects are:
A person feels more awake
Confident or energetic
"Kratom" refers to both Mitragyna speciosa, a tree native to Southeast Asia, and to products derived from its leaves that are marketed as herbal supplements. Kratom leaves contain many chemical compounds (known as bioactive alkaloids) that can affect the body.
Is Kratom Harmful?
Can kratom get you high? according to Healthline, [2] the potentially harmful effects of kratom on individuals are:
Regular use may cause addiction, lack of appetite, and insomnia
Even low doses can cause severe side effects like hallucinations and lack of appetite
Kratom can cause potentially deadly interactions with other drugs, or even medicines
Can kratom get you high? While withdrawal and substance use disorder symptoms related to kratom use have not been extensively studied, some people who use kratom report experiencing them.
How Fast Can You Get Addicted To Kratom?
Can kratom get you high? yes, and some experts are concerned about kratom's addictive potential because the main kratom compounds, mitragynine, and 7-hydroxymitragynine, partially activate the same receptors (specific molecular structures on the surface of nerve cells) in the brain on which drugs with known addictive properties act. However, researchers have observed that the way kratom compounds activate these receptors may reduce the potential for addiction relative to opioids. Further, studies in animal models indicate the addictive potential of mitragynine and 7-hydroxymitragynine may differ from one another. Further research is needed to better understand how fast can you get addicted to kratom and how various compounds related to kratom interact to influence the risk of withdrawal and addiction. [3]
What Are The Effects Of Kratom?
Researchers are still learning how kratom and kratom compounds affect the body, as well as how short- and long-term kratom use may impact health. While the evidence is quickly evolving, early studies have revealed important information about how the drug works.
Effects may vary widely. Like all drugs, kratom's effects may depend on the amount taken, potency (concentration and strength), formulation of the product, the way it is ingested, other drugs in a person's system, a person's underlying medical conditions, and a person's previous experience with the substance, among other factors. Importantly, kratom products vary, so effects are difficult to predict. Some kratom products have been found to contain contaminants that produce effects not associated with kratom or kratom compounds alone.
Kratom produces opioid- and stimulant-like effects. People who use kratom report both stimulant-like effects (increased energy, alertness, and rapid heart rate) and effects that are similar to opioids and sedatives (relaxation, pain relief, and confusion). Can kratom get you high? while many people who use kratom report that smaller doses of kratom produce stimulant-like effects and larger doses produce opioid- or sedative-like effects, studies have not yet established that these effects depend on the amount or method of kratom consumed.
Mitragynine, 7-hydroxymitragynine, and other kratom compounds drive these effects. The effect of kratom products can vary depending on the concentration and combination of specific kratom compounds within the product. While kratom leaves contain many chemical compounds that may influence the human body, the most well-studied is mitragynine. When ingested, mitragynine breaks down into another chemical called 7-hydroxymitragynine, which also influences the body and is an important subject of research.
Adverse effects range from mild to severe. Some people who use kratom have reported mild side effects, such as nausea, constipation, dizziness, and drowsiness. In case of reports, clinicians report seeing patients with a wide range of rare but serious adverse effects associated with kratom exposure—including mental and neurological symptoms (confusion, tremors, and seizures), heart and lung problems (high blood pressure and slow breathing), gastrointestinal problems (nausea and vomiting) and liver problems. A very small number of deaths have been linked to kratom products, and nearly all cases involved other drugs or contaminants.
Drug interactions may influence effects. Studies suggest many people who use kratom also use other drugs and have conditions for which medications are often prescribed. Case reports suggest using kratom in combination with other drugs (sometimes called polysubstance use) may produce severe adverse effects, such as liver problems or even death.
Long-term health effects are not well understood. Because kratom research is relatively new compared to more widely used drugs, there is little evidence to determine how kratom use may affect someone over time. Case reports do show regular, long-term, kratom use in large amounts may be associated with serious liver problems. These cases appear to occur unpredictably in a small minority of people who use kratom, and it is unclear what role other substances and underlying health conditions may play. Researchers are also still learning how often and to what extent people who use kratom experience withdrawal or substance use disorder symptoms related to kratom use.
Research on the potential therapeutic effects of kratom is ongoing. Can kratom get you high? yes, and many researchers have not proven kratom to be safe or effective for any medical purpose, though kratom has been used in traditional medicine. Many people who use kratom products report doing so to self-treat pain, anxiety, depression, fatigue, and drug cravings and withdrawal symptoms (especially related to opioid use). [4]
Kratom Addiction Signs
Can kratom get you high? Yes, but to be diagnosed with a substance use disorder, a person must meet specific diagnostic criteria for continued, compulsive substance use despite negative consequences. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)—a reference text published by the American Psychiatric Association that health professionals use to diagnose substance use disorders and other psychiatric disorders—does not include a specific diagnosis related to kratom use. However, some researchers studying kratom have modified criteria to study kratom use patterns and symptoms that resemble other substance use disorders.
Can kratom get you high? Yes. The U.S. Drug Enforcement Administration (DEA) has listed kratom as a "drug of concern," though kratom and kratom compounds are not listed on the U.S. schedule of controlled substances.
DSM-5 Diagnostic Criteria For Substance Use Disorders
Can kratom get you high? yes, and know that substance use disorders are defined as a pattern of use that results in marked distress and/or impairment, with two or more of the following symptoms over the course of a 12-month period:
Using the substance in larger amounts or over a longer period of time than intended
Unsuccessful attempts or persistent desire to reduce the use
Too much time spent on obtaining, using, and/or recovering from the effects of the substance
A strong craving for the substance
Significant interference with roles at work, school, or home
Continued use despite recurrent social or interpersonal consequences
Reducing or giving up important social, occupational, or recreational activities because of the substance use
Substance use in situations in which it may be physically hazardous
Substance use despite recurrent or persistent physical or psychological consequences
Tolerance of the substance
Withdrawal from the substance [5]
Kraton Detox
Inpatient drug rehab center programs usually begin with detoxification (detox) in a medically supervised detox program, such as Kratom detox. These provide professional support and medical monitoring while the client flushes harmful toxins from their body gained during substance abuse. Detox is the initial, physical part of treatment. Once this stage is complete, clients most often move to the next level of care.
Inpatient rehab center programs require clients to live onsite at the facility for the duration of treatment. Depending on the facility, the participant will be issued a bed in either a private or shared room for their stay. Each day, clients are required to attend counseling, therapy, classes, and different types of treatments every day for the majority of the day.
Programs, services, and treatments vary. We Level Up rehab center offers inpatient substance abuse treatment. Offering co-occurring treatments. We treat the entirety of addiction and behavioral health disorders including their secondary corresponding illnesses to improve long-term recovery outcomes. Get a free health assessment and find out what treatment options are most suitable for you. Call to learn more about how long is kratom in your system.
Kratom Addiction Treatment Near Me
Can kratom get you high? Yes, but worry no more. For those with substance use disorder or who know an individual suffering from substance use disorder, consider treatment. Because this is an evolving situation. Clearing kratom from the body and overcoming withdrawal symptoms is the goal of detox, which is the first step of treatment for addiction.
We Level Up has a comprehensive team prescribing medications that can alleviate your withdrawal pains while monitoring your health 24 hours during the detox. We prioritize your safety and comfort because this is a fragile and challenging time for you.
Can kratom get you high? If you are someone who may be concerned about kratom addiction. Contact We Level Up for more details.
Once detox is complete, a new doorway in treatment opens up, which is referred to as a residential level of care. The residential care program slowly and effectively introduces the individual into an atmosphere of therapeutic growth, marked by master's level therapists, clinicians, group counselors, psychiatrists, and a community of like-minded individuals with the same aim: to attain sobriety and live a great life.
Some of the many modalities applied and practiced within our residential treatment facility are:
DBT Therapy
12-Step Groups
How We Can Help? Searched for "Can kratom get you high?" or are you seeking a national inpatient rehab destination?
We Level Up treatment tailors the program to the individual and the individual to the program of recovery. We begin by assessing our client's history of mental health, drugs, and alcohol-related past.
The needs of each patient are specific and personalized because we aim to provide comprehensive support for mental health, addiction, and dual diagnosis treatment. The supportive environment is designed accordingly to give patients 24-hour care for sobriety. Most importantly, we hope to have our clients live comfortably within the facility during this crucial and fragile time.
We Level Up prioritizes removing temptations for relapse and applying an air of recovery into every component of the treatment timeline. We Level Up finds that when clients are living in a supportive community, especially during their early recovery process, they can truly focus on what matters most: their recovery.
If you or a loved one is struggling with kratom addiction, reach out to We Level Up because we may be able to help you explore treatment options. For any questions such as "Can kratom get you high?", contact WLU today.
[1,3,4] Kratom – National Institute on Drug Abuse
[2] Kratom: Is It Safe? – https://www.healthline.com/health/food-nutrition/is-kratom-safe
[5] Adapted from American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). Washington, DC: American Psychiatric Publishing; 2013.
1 Can Kratom Get You High?
1.1 Can Kratom Get You High? Effects, Signs & Symptoms, Detox & Addiction Treatment
1.2 What Is Kratom?
1.2.1 Is Kratom Harmful?
1.2.2 How Fast Can You Get Addicted To Kratom?
1.3 What Are The Effects Of Kratom?
1.4 Kratom Addiction Signs
1.4.0.1 DSM-5 Diagnostic Criteria For Substance Use Disorders
1.5 Kraton Detox
1.6 Kratom Addiction Treatment Near Me
1.6.0.1 How We Can Help? Searched for "Can kratom get you high?" or are you seeking a national inpatient rehab destination?
Tags:Can Kratom Get You HighHow Fast Can You Get Addicted To KratomKratom AddictionKratom Addiction SignsKratom Addiction Treatment Near Me
previousWhat Does Meth Feel Like?
nextPTSI VS PTSD
Kratom and Blood Pressure
Kratom and Blood Pressure, Blood Pressure Medications, Alcohol Interactions & Rehab Treatment
How Long Is Kratom In Your System?
How Long Is Kratom In Your System? Uses, Drug Tests, Detox & Substance Abuse Treatment
What Does Kratom Look Like?
What Does Kratom Look Like? How is it Taken, Abuse, Dangers & Addiction Treatment


text:
Comedy TV on DVD
Comedy TV on DVD──────────All CategoriesGaming Board Games & Card Games DVD & Blu-ray Collectables & Hobbies Music & Books Technology Toys & Games Sports & Outdoors Clothing Home & Garden
Home / TV on DVD / Comedy TV on DVD / Karl Pilkington An Idiot Abroad Series 1 DVD
Karl Pilkington An Idiot Abroad Series 1 DVD
NewCondition DVDB1603
in Comedy TV on DVD
Please note this is a region 2 DVD and will require a region 2 (Europe) or region Free DVD Player in order to play.
The bald-headed buffoon with a head like an orange, attempts to broaden his beautiful Manc mind by traversing the globe in search of the new seven wonders of the world, experiencing some of the many delights that foreign cultures have to offer, from extreme naked yoga to scorpions on a stick!
Ricky Gervais and Stephen Merchant are outraged that Karl has written off the Seven Wonders claiming they're all "a bit s**t" having never seen any of them with his own eyes. They've thrown down the gauntlet to send him around the globe to force him out of his comfort zone. Stephen wants the experience to broaden Karl's mind and change his outlook on the world. Ricky wants Karl to hate every minute of it for his own amusement.
Despatched on what many would term a journey of a lifetime, the 'little Englander' will be putting his misgivings to one side as Karl finds out for himself what the fuss is about. He will travel to the Great Wall of China, Christ the Redeemer in Brazil, Petra in Jordan, Machu Picchu in Peru, Chichen Itza in Mexico, the Taj Mahal in India and the Great Pyramids of Egypt. Meanwhile Gervais and Merchant will be keeping a watchful eye from London, monitoring every step of Pilkington's journey.
Actors Karl Pilkington, Ricky Gervais & Stephen Merchant
Certificate 15 years and over
"Fantastic and easy to use - 10/10!"
— Paul Lester
Want to know when Karl Pilkington An Idiot Abroad Series 1 DVD - ozgameshop.com drops below a certain price? Enter your email address and price below and we'll let you know when it drops below that price!

redpajama_set_name: RedPajamaCommonCrawl


Dental decay and periodontal disease are the most common diseases in the oral cavity, but there are other diseases that can affect the mouth and surrounding structures. Some of these conditions are painful or they may result in gingival (gum) bleeding or halitosis (bad breath), which may prompt the patient to seek treatment. Other conditions, however, may give no symptoms until late in their course. It is very important to have regular dental examinations to check on the health of both the teeth and soft tissues of the mouth, as early diagnosis of a problem results in better chances of treatment.
A sub speciality within oral medicine is Oral and maxillofacial radiology, which uses enhanced imaging techniques for diagnostic purposes. They help in detecting the extent of tooth decay, to assess the damage to the alveolar bone, locating tumors, diagnosing temporomandibular joint (TMJ) disorders, infectious diseases of the jaw, and most importantly in traumatic injuries.


text:
NewsVaccines
Now Vaccine-pushing Scientists Want to Turn Your Groceries into mRNA Vaccines
September 27, 2021 2988 views0
(by Lance Johnson | Global Research) – The global agenda to inoculate every man, woman and child is coming straight to your dinner plate. A team of scientists from the University of California, Riverside are researching ways to turn your GROCERIES into mRNA vaccines. In order to combat "vaccine hesitancy" in the population, these scientists want to distribute coronavirus spike proteins throughout the food supply. This experiment could give rise to a new paradigm of vaccination that gives Big Pharma total control over the food supply, as they venture to genetically alter food to inundate the population with more blood clotting spike proteins.
Is this the reason why GMO/vaccine investor Bill Gates is buying up farmland across the United States? Will all current vaccines and hundreds of future vaccine experiments be carried out through the food supply?
Genetic modification of the food supply could soon be used to vaccinate the population
The future of bio-warfare and human experimentation will likely be carried out through the food supply, and advertised as safe. By altering the cytoplasm of edible plants, scientists hope to introduce foreign spike protein toxins into your food. These vaccine-pimping scientists are already experimenting on lettuce and spinach plants, to develop a new species of greens that can vaccinate people more often and in a less invasive manner. These new designer greens can be grown at home, too. The scientists are working on a way to quantify the correct dosage of spike protein per plant while demonstrating that the plant can replicate enough mRNA to out-perform the current vaccine supply.
"Ideally, a single plant would produce enough mRNA to vaccinate a single person," Juan Pablo Giraldo, lead researcher and associate professor in UCR's Department of Botany and Plant Sciences. "We are testing this approach with spinach and lettuce and have long-term goals of people growing it in their own gardens," he added. "Farmers could also eventually grow entire fields of it."
Giraldo strives to demonstrate that DNA containing mRNA vaccines can successfully be integrated into plant cells. To do this, the researchers intend to alter the chloroplast of the plant cell. The chloroplast takes in the sun's energy and converts it to sugar and other molecules that the plant needs in order to grow. The scientists want to interfere with this natural process and instruct the cytoplasm to generate spike proteins and other foreign molecules that can be introduced as antigens into humans.
Giraldo and his team have already demonstrated that the chloroplast is capable of expressing foreign genes that are not part of the plant's natural design. This genetic modification was accomplished by enclosing foreign genetic material in a protective casing and then inserting it into the plant's cells. The goal is to introduce these GMOs into humans so their immune system can be programmed to fight antigens and viral sequences that scientists have pre-selected and designed.
Is a new paradigm of food-based vaccines upon us?
At UC San Diego, Nicole Steinmetz has already developed nanotechnologies that can deliver genetic material to the chloroplast of plants. Steinmetz tinkers with plant virus nanoparticles and repurposes them to deliver foreign genes into the plant's cells.
This is not the only edible vaccine experiment currently underway. Scientists from the University of Ottawa have been working on an edible vaccine for coronaviruses for over a year.
The Ottawa Hospital is already testing the first prototype. This edible vaccine expresses viral antigens inside the lettuce and spinach plants. Their goal is to deliver the spike proteins to the human body without altering the protein synthesis of human cells. The current vaccine supply must be kept refrigerated at extremely low temperatures. If this research effort can demonstrate the delivery of spike proteins throughout the food supply, the current vaccine supply could be scrapped in favor of a new paradigm of food-based vaccination. This experiment could forever alter the food supply, turning healthy, healing foods into bio-warfare playgrounds that globalists can use to exploit the human race.
Edible Vaccine


text:
Health and Aging
Equity Summit
Community Calls
All Students Count
Public Charge
SEARAC in the News
June 29, 2018 IN: Action Alerts, Press Room
Southeast Asian American Advocates and Allies Storm Capitol Hill to Denounce Family Separation, Push for Education, Health Reform
Photo courtesy Stephen Bobb Photography.
Washington, D.C. – Community organizers, students, and professionals representing a range of public services from across the country gathered in Washington, D.C., from June 20-22 for the Southeast Asia Resource Action Center's 19th annual Leadership and Advocacy Training (LAT) Program. Coinciding with a worsening immigration crisis at the nation's border along with anti-immigrant proposals under consideration by Congress, the program trained participants on communicative strategies to push their elected officials toward action on a number of policy priorities, including rejecting family separation. The advocates used these newly developed skills in 40 meetings on Capitol Hill, where they sat down with their elected officials and congressional staffers to discuss issues affecting the Southeast Asian American community.
During the three-day event held at the National Education Association building, 44 participants representing 14 states and 33 congressional districts celebrated their refugee legacy by sharing personal stories of discovery, adversity, loss, hope, and resilience. This year, the program's curriculum incorporated three possible tracks -education, health, and immigration-covering such topics as data disaggregation, the Affordable Care Act, and detention and deportation policies.
Linda Chang (right), with SEARAC California Director Nkauj Iab Yang (left) and fellow trainee Hatefas Yop, of Santa Ana, CA.
The program enabled Linda Chang, a prospective medical school student from Rosemead, CA, to share her experience navigating the complicated health care landscape with Rep. Judy Chu (CA-27). Chang's family is still recovering from a Stage 2 breast cancer diagnosis given to her aunt, a nail technician who relied on Medicaid to finance her chemotherapy. After Chang's uncle worked a minimum wage assembly line job to help with the cost, they were stunned to learn they earned $200 more than the threshold to qualify for Medicaid, and that the lifesaving cancer treatment would be delayed for a month. "LAT gave me the space and support to really understand how my story reflects what needs to be done when asking for policy support," said Linda, adding that she served a critical role as her aunt's and uncle's interpreter and translator. "I feel really privileged to be able to gain that knowledge."
Chhon Iv, LAT 2018 advocate.
Chhon Iv, a father of two from Pensacola, FL, has a deportation order after having already completed a prison sentence 10 years ago. While the United States hasn't deported him to Cambodia yet, Iv worries about being separated from his wife, children, parents, and siblings-all of whom are American citizens. "We have a new president," he said. "Things are getting serious and scary."
Through LAT, Chhon sat down face to face with his Republican Congressman, Rep. Matt Gaetz (FL-1), and asked him to reconsider deportation policies that tear families apart. "I see people in my situation, and they're fighting for the same cause," Iv said. "SEARAC opened my eyes to the fight for all immigrants, and it really touches me. I'm not just fighting for myself. I'm part of a united SEAA community, and we won't be quiet." Chhon says he plans to follow up
with Gaetz in the coming weeks.
About SEARAC
SEARAC advocates at the highest levels of national and California state government to call for justice and equity for Southeast Asian American communities, as well as all immigrants and communities of color. We invest in building powerful individual advocates and resilient community-based organizations who fight collectively for our community's needs and uplift our strengths.
Since 1999, SEARAC has graduated more than 1,000 advocates from 22 states through our annual Leadership & Advocacy Training program. Next year, the LAT program will celebrate its 20th anniversary.
SEARAC Applauds Reintroduction of Reuniting Families Act July 17, 2019
SEARAC Condemns Mass Raids on Immigrants July 12, 2019
Supreme Court Decision on 2020 Census Citizenship Question Announced June 27, 2019
©	2019 Southeast Asia Resource Action Center (SEARAC).
Close ↓


KONG Huggz Hiderz - These irresistible woodland critters won't be hiding for long once your pup discovers the big squeak stashed in the tree trunk. Perfect for indoor games of fetch or simply for snuggling, the material is doubled for durability. The adorable critters peek out from their trunks looking to engage in on-going fun and also have the added benefit of featuring varied textures to keep dogs engaged.


Please click here to conduct a fast diagnostic scan for Satellite Broadband Access as well as connected faults.
Satellite Broadband Access error codes are almost always brought on because of misconfigured files inside of your OS.
If you experience Satellite Broadband Access error message then we definitely recommend that you conduct an error code scan.
The following article contains help and advice that will show you the right way to successfully treat your Windows Satellite Broadband Access error codes either by hand as well as automatically. In addition, this document will help you to fix some common error messages connected with Satellite Broadband Access error you may receive.
1. What is Satellite Broadband Access error message?
2. The cause of Satellite Broadband Access error code?
3. A way to effectively resolve Satellite Broadband Access error.
What exactly is Satellite Broadband Access error message?
The Satellite Broadband Access error is the Hexadecimal format of the error code caused. This is the common error message format utilised by Windows in addition to other Windows compatible applications and device driver providers.
This computer code is used by the merchant to identify the error caused. This Satellite Broadband Access error message includes a numeric code in addition to a practical explanation. In some instances the error code could have extra parameters in Satellite Broadband Access format .This additional numerical code are the address of your system sections in which the instructions are loaded during the time of the error message.
What can cause Satellite Broadband Access error?
Typically, the Satellite Broadband Access error code is triggered by Microsoft Windows system data file malfunction. Corrupt system entries are usually a serious risk to the health and wellbeing of any computer or laptop.
There can be lots of events that will cause system file errors. A partial install, an unfinished uninstall, incorrect erasure of software applications or computer hardware. It could also be triggered in the event your laptop or computer has caught a a computer virus or adware infection or through an improper shut down of the laptop or desktop. Any of the above events may well result in the removal or data corruption of Windows system data files. This damaged system file will result in absent or erroneously connected information and data files essential for the proper functioning of the system.
Proven methods to quickly deal with Satellite Broadband Access error message?
3) From the next screen, select "Restore my machine to an earlier period" and then press Next.
4) Pick the most up-to-date restore date from the "click a restore date" listing, and then click Next.
6) Restart your laptop or computer when the rescue is completed.
1) Download and save this (Satellite Broadband Access) repair application.
Here is an alternative Satellite Broadband Access fix program you may try in case the previous tool doesn't work anymore.


While oral pills take effect approximately within one hour after the intake, intravenous injection makes it work after 5 minutes or pill so Lasix lasix water pill happens to lasix water pill be lasix a pill strong diuretic, and is indicated to treat excess fluid water and swelling. Get pill free shipping at lasix 35 and view promotions and reviews for water Diurex Diuretic Water Pills Price:. This helps your lasix kidneys to remove the drug from your body lasix and avoid water some of the side pill effects. Generic and Brand Drugs. There are water several forms of the Furosemide medication: you pill can water buy Lasix water pills Canada, or pill you water can order an intravenous solution in Lasix pharmacy. I will be looking into your question water and guiding you through the process. Diuretics may make it harder for you to control your blood sugar, which can lead to diabetes if you don't already have. Lasix Drug Interactions: Blood uric acid levels can increase during Lasix treatment, but precipitation of acute gout is rare. Lasix may increase the toxic effect of aminoglycoside antibiotics on the ear, especially in patients with kidney dysfunction. Before using Lasix, tell lasix your doctor if you have lasix kidney disease, enlarged prostate, urination problems, cirrhosis or other liver disease, an electrolyte pill imbalance, high lasix cholesterol, gout, lupus, diabetes, or an allergy to sulfa drugs Severe side effects. An internist at Pali Momi Medical Center lasix in Hawaii lasix lasix is a diuretic water which is an anthranilic acid derivative. Some diuretics are sulfa drugs, so they could cause a reaction if you're allergic. Side effects associated with Prescription Water Pills Lasix this drug include pill low blood pressure, and water and electrolyte depletion Diurex Diuretic Water Pills at Walgreens. But potassium-sparing diuretics can cause low levels of calcium, which could hurt bone development. Commonly known as " water pills these drugs help your kidneys get rid of extra water and salt water from your body through your pee. You could have too little or too much sodium or potassium in your system. Diuretics aren't recommended for women who are pregnant or breastfeeding. Water Can Buy Prilosec Canada pills are one of the most water commonly Buy Seroquel Xr Online prescribed medications. She may want to regularly check your blood pressure pill as well as test your blood and pee for levels of specific minerals and to see water how well your kidneys are working. Because you have less total fluid water in your blood vessels, like a garden hose that's not pill turned on all the way, the pressure inside will be lower. Where To Buy Lasix Water Pills. Cialis Soft Tabs Info your doctor know what lasix medications (prescription and over-the-counter supplements, and. Swelling and fluid retention - also known as edema - can be caused by congestive heart failure, liver or kidney disease, as well as other conditions Over the counter diuretics like pamabrom (Aquaban) can help ease water retention caused by premenstrual syndrome lasix (PMS). This can make you tired water or weak or give you muscle cramps or a headache. Furosemide can cause lowering of blood potassium, sodium, and magnesium water levels. Take it exactly as prescribed. These are loop diuretics, thiazide diuretics, and potassium-sparing diuretics Lasix water pill. Doctors also prescribe lasix Lasix in conjunction with other high blood pressure pills to patients to treat high blood pressure (hypertension). Prescription Water Pills Lasix contain furosemide as the active ingredient and the following inactive ingredients: lactose monohydrate NF, lasix magnesium stearate NF, starch NF, talc USP, and colloidal silicon dioxide NF Lasix is the brand name of furosemide, a prescription. Low potassium and magnesium levels can lead to heart rhythm abnormalities, especially in patients already taking digoxin (Lanoxin). Buy Cialis Thailand lose salt and excess water from your body. Where To Buy Lasix Water Pill medical service provider could also recommend it for very high blood stress Where To Buy Lasix Water Pill Buy Lasix Lasix (furosemide) is a medicine prescribed Buy Valtrex 45 for the procedure of hypertension. To help lower those odds, ask your doctor when during the day you should take each medication. Because some diuretics also pull potassium out of your body, you might need to eat more foods like bananas, sweet potatoes, spinach, and lentils, or take a potassium supplement. Compare loop diuretics When the doctor prescribed water pills for me (Lasix he also prescribed potassium pills. You might be more likely to get gout. Older people tend to have more side effects such as fainting and dizziness from dehydration. Buy Prinivil Online for the most common water version of furosemide is around. Please visit the digoxin (Lanoxin) site for further information. There are 3 main classes of diuretics used in the treatment of edema. Also, tell her about other medical problems you have. Buy generic and brand drugs online The Right Pill Type. It works by increasing the amount of salt and water the kidneys remove from the blood, which is then passed out through the urine. We don't know how these drugs affect an unborn baby. Lasix is a powerful diuretic. Therefore, careful medical supervision is required and dose and dose schedule must be adjusted to the individual patient's needs Inform your physician if you are taking indomethacin, cool medication, gentamicin, lithium, blood pressure medicines, diet regimen medicines, aspirin, netilmicin, ethacrynic acid. They're usually the first type of medication that your doctor will try to control your blood pressure. Continued, you also run the risk of getting dehydrated, and simply drinking more fluids may not be enough. Less common side effects include jaundice, water ringing in ears (tinnitus light sensitivity, lasix rash, pancreatitis, nausea, abdominal pain, dizziness, anemia, and other blood disorders. They may make side effects worse. Prescription Water Pills Lasix without Prescription. Accepted Where To, finasteride 5mg Tablet Northstar, buy Lasix Water Pill. Drug Names, you'll often start with a thiazide diuretic: Others your doctor may prescribe are: Different diuretics can be taken together, and you can take them with other medications, sometimes in the same pill. Lasix is a diuretic medicine that doctors prescribe to treat excess accumulation water of fluid or swelling of the body (edema) caused by: Cirrhosis; Chronic kidney failure; Dangers Of Cialis Viagra, heart failure; Nephrotic pill syndrome. Where To Buy Lasix (furosemide) can be made use of for liquid recognition treatment, especially in people with heart disease, liver disease, or a kidney disorder. (Click, lasix for a more in-depth look at how these water pills work, potential side effects, general dosing guidelines, and information on what to tell your healthcare provider before beginning treatment.). MD, mD, mD, mD, mD,.and 18,000 more Doctors from across the world. Where To Buy Lasix Water Pill. Lasix ( furosemide ) is a medication licensed for the treatment of high blood pressure in adults and fluid retention in adults and children. Unless your doctor instructs you otherwise, drink plenty of fluids while taking Lasix. Furosemide reduces the kidney excretion of lithium and can lead to lithium toxicity. Lasix may impair kidney function when administered together with aspirin or other nonsteroidal anti-inflammatory drugs (nsaids). How pill to Use Lasix: Lasix is a potent medication. These are loop diuretics, thiazide diuretics, and potassium-sparing diuretics. Water pills are meant to help reduce blood pressure, prevent fluid buildup, and reduce swelling respectively, says Linda Anegawa,. 00, 64 off the average retail price. Showing results for : Premium Questions, public Forum Discussions, mobile Questions and Answers, people also viewed. Furosemide is used to treat excessive fluid accumulation and swelling (edema) of the body caused by heart failure, cirrhosis, chronic kidney failure, and nephrotic syndrome. It comes in the form of a pill (tablet) and is typically taken once or twice a day. Lasix Possible Side Effects: Commonly observed side effects are low blood pressure, and water and electrolyte depletion. Hi, I am,. 29 Take A Hard Pass On Water Pills If Youre Trying To Lose https www., an internist at Pali Momi Medical Center in Hawaii Over the counter diuretics like pamabrom (Aquaban) can help ease water retention caused by premenstrual syndrome (PMS). Doctors waiting to answer your question. And many pass into breast milk, which can make the baby dehydrated. Free Bonus with every order. Please write your question below. Lasix Precautions: Patients allergic to sulfa may also be allergic to Lasix because of a similarity in the chemical structure of the medications. Periodic blood tests are performed to monitor kidney function and electrolytes during treatment with Lasix. As a result, the medicine can lower blood pressure and help with water retention. Taking combination pills or multiple medicines could boost these side effects. Before taking it, talk to your healthcare provider about any other medical conditions you have and any other drugs you are taking (including vitamins, supplements, and nonprescription medicines). Ensure you inform your doctor if at the minute of asking your man for a prescription you are already taking other drugs, such as indomethacin, cold medications, streptomycin, amikacin, ethacrynic acid, diet regimen tablets, lithium, salicylates, netilmicin, other. On the other hand, if you're taking a "potassium-sparing" lasix diuretic, such as amiloride (Midamar spironolactone (Aldactone or triamterene (Dyrenium she may want you to avoid potassium-rich foods, salt substitutes, low-sodium milk, and other sources of potassium. Visa/MasterCard Accepted Lasix (furosemide) is a loop diuretic (water pill) that prevents your Buy Hydrochlorothiazide Triamterene body from absorbing too much salt. Lasix tablets pill for oral administration. The side effects are similar to adults. Amitriptyline Hcl 10 Mg Tab Generic and Brand Drugs. This medication is a diuretic, which is commonly referred to as a "water pill." Lasix is known as a "loop diuretic named after the part of the kidneys that it affects (the loop of Henle). Each acts on a different part of your kidneys, meaning some pills may work more effectively than other depending upon your unique medical condition lasix It helps you make more urine and. Do not stop taking this medication, even if you feel nauseated or experience vomiting. A Doctor will be with you shortly. The water that comes out of your body has to go somewhere, so you can expect to be peeing more and more often for several hours after a dose. Three types of prescription water pills exist: thiazide diuretics, potassium-sparing diuretics or loop-acting diuretics. If you vomit shortly after a dose, or if you miss a dose, contact your doctor. Call your doctor if you're very thirsty or have a very dry mouth, your pee is a deep yellow, you aren't peeing much or get constipated, or you have a bad headache. Take note of Prescription Water Pills Lasix that word: prescribed. Even though most people tolerate Lasix water pills well, the medication is not suitable for everyone. Lasix is sometimes used in conjunction with other blood pressure pills to treat high blood pressure. Get your health question answered instantly from our pill pool of 18000 water doctors from over 80 specialties 200 Doctors Online, mD, i will be looking into your question and guiding you through the process. Special Offers for our customers. WebMD Medical Reference Reviewed by James Beckerman, MD, facc on May 02, 2017 Sources American Heart Association: "Types of Blood Pressure Medications." Blood Pressure UK: "Diuretics - blood pressure medication." Mayo Clinic: "High blood pressure (hypertension Diuretics." European Heart Journal : "Adverse. This medicine is used to treat high blood pressure, and edema or swelling from heart, lasix kidney, or liver disease. Lasix (furosemide) is a potent diuretic which, if given in excessive amounts, can lead to a profound diuresis with water and electrolyte Cialis Retail Price In Ct depletion. It's rare, but your heart may speed up (over 100 beats a minute) or you might start throwing up because of a dangerously low potassium level. Lasix should be avoided in kidney failure. Buy generic and brand drugs online Compare prices and print coupons for Lasix (Furosemide) and other Edema, Hypertension, Heart Failure, and Cirrhosis drugs at CVS, Walgreens, and other pharmacies. This allows the salt to instead be passed in your urine Where to purchase lasix Buy lasix water pills online Is it legal to buy lasix online Buy lasix for dogs Buy lasix Buy lasix. While You're Taking Diuretics, let your doctor know what medications (prescription and over-the-counter supplements, and herbal remedies you use. Can you not order potassium pills to replace the potassium that is depleted? Although it does not really certain the disease it aids you keep in under control. No Prescription with Guaranteed lowest prices.
If your dose is different, do not medication change it unless your doctor tells you to. Depo-SubQ Provera 104 medication was highly effective in initial studies. To help keep the amount constant, do not miss any doses. Similar or greater effects are expected with non-selective, reversible (e.g., linez FD C Blue. The generic drug name is ciprofloxacin. Medical Disclaimer Next Professional Add to My Med List More about ciprofloxacin Consumer resources Other brands: Cipro, lasix Cipro XR, Cipro.V., Proquin XR Professional resources Related treatment guides. Cipro should lasix not be taken with dairy products (like milk or yogurt ) or calcium-fortified juices alone, but may be taken with a meal lasix that contains these products. Mirabilis 11/12 (91.6) medication 10/10 (100). This list does not contain all drugs that may interact with Cipro. These reports should aid the physician in selecting an antibacterial drug product for treatment. Uncomplicated Urinary Tract Infections (Acute Cystitis). Usual Pediatric Dose for Pyelonephritis 1 year or older : IV: 6 to 10 mg/kg IV every 8 hours Maximum dose: medication 400 mg/dose Oral: 10 to 20 mg/kg orally every 12 hours Maximum dose: 750 mg/dose Total. After menopause, most endogenous estrogen is produced by conversion of androstenedione, lasix which is secreted by the adrenal cortex, to estrone in the peripheral tissues. Biography Drama Romance, box Office, budget: 9,000,000 (estimated related medication News en of Geek. Retinoids come in prescription form and in a range of over-the-counter products. Patients with mild or moderate medication renal insufficiency. Store synthroid away from heat, moisture, and light. Advise medication the patients to immediately seek medical help if they experience seizures, palpitations, or difficulty breathing. Free valtrex generic kenalog cheap. Dilution Techniques Quantitative methods are used to determine antimicrobial minimum inhibitory concentrations (MICs). 1.5 H2O and its molecular lasix weight is 394.8. Adequate hydration of patients receiving cipro XR should be maintained to prevent the formation of highly concentrated urine. Cipro should be stored at room temperature in its original container. You may report side effects to FDA at 1-800-FDA-1088. Microbiology Mechanism Of Action The bactericidal action of ciprofloxacin results from inhibition lasix of the enzymes topoisomerase II (DNA gyrase) and topoisomerase IV (both Type II topoisomerases which are required for bacterial DNA replication, transcription, repair, and recombination. Effectiveness Depo-Provera is 97 percent.7 percent effective. Probable dementia as defined in this study included AD, VaD medication lasix and mixed types (having features of both AD and VaD). Cipro is a part of fluoroquinolones family of drugs. Levaquin is available as an oral tablet thats taken once daily.
Tablets: 20, 40 and. Your doctor may change your dose or add other blood pressure medications. Also, your health care professional may be able to lasix side tell you about ways to lasix prevent or reduce side some of side these side effects. The results of the mouse study and one of the three rabbit studies also showed an increased incidence and severity of hydronephrosis ( side distention of the renal pelvis and, in some cases, of the ureters) in fetuses derived. It's available in a tablet (20, 40, and 80 milligrams solution (10 mg or injection (10 mg). Our Lasix Side Effects Drug Center provides a comprehensive view of available drug effects information on the potential side effects when taking this medication. Patients allergic to sulfonamides may also be allergic to lasix. Your doctor or pharmacist has more information on medicines to be careful with or to avoid while taking Lasix. If you have any concerns about taking this medicine, ask your doctor or pharmacist. However, because drugs affect side each person differently, we cannot guarantee that this information includes all possible side effects. Treatment for high effects blood pressure include. Oral solution: 10 mg/ml and 8 mg/ml. Generic Name: furosemide, note: This document contains side effect information about furosemide. Hypertension, oral lasix may be used in adults for the treatment of hypertension alone or in combination with other antihypertensive agents. See USP Controlled Room Temperature. Nursing Mothers Because it appears in breast milk, caution should be exercised when lasix is administered to a nursing mother. (See precautions : General and dosage AND administration.) Overdosage lasix Contraindications overdose The principal signs and symptoms of overdose with lasix are effects dehydration, blood volume reduction, hypotension, electrolyte imbalance, hypokalemia and hypochloremic alkalosis, lasix and are extensions of its diuretic action. Tell your doctor if you have or have had any medical conditions, especially the following: liver problems kidney problems heart problems high cholesterol levels asthma diabetes gout, a disease with painful, swollen joints passing less urine than is normal for. This increases your risk of serious problems such side as pain, infections, leg ulcers (long-lasting lasix sores and blood clots. How to tell if the drug is working: If youre treating high blood pressure, your blood pressure should be lowered. Antibiotics Antibiotics can increase your risk of hearing damage or loss when taken with furosemide. Cases of tinnitus and reversible or irreversible hearing impairment and deafness have been reported. This can cause dangerous side effects. If you have kidney problems, more of the drug may stay in your body longer. This helps lower your blood pressure as well as reduce swelling. For women who are breastfeeding: Furosemide may pass into breast milk and can cause serious side effects in a child who is breastfed. Serum and urine electrolyte determinations are particularly important when the patient is vomiting profusely or receiving parenteral fluids. Please read this leaflet carefully effects before you start using Lasix Tablets. Lasix tablets for oral administration contain furosemide as the active ingredient and the following inactive ingredients: lactose monohydrate NF, magnesium side stearate NF, starch NF, talc USP, and colloidal silicon dioxide. Lasix 40 mg tablets contain 40 mg furosemide (frusemide) per tablet. If you are about to be started on any new medicine, tell your doctor and pharmacist that you are taking Lasix. High Blood Pressure Slideshow Pictures Take the Salt Quiz! If you are diabetic, Lasix might affect your blood sugar levels so they will need to be monitored and reported to your doctor. It comes with serious risks if you don't take it as prescribed. However, in general, febrile. Hidden costs You may need to buy a home blood pressure monitor to check your blood pressure at home. What is furosemide, and how does it work (mechanism of action)? Drug information provided by: Micromedex, along with its needed effects, a medicine may cause some unwanted side effects. If you take too much: You could have dangerous levels of the drug in your body. Edema Edema is the swelling of tissues as a result of excess water accumulation. The medicine helps control your condition and lowers the fluid build up in your body. You should not eat large amounts of liquorice when you are taking Lasix. Asymptomatic hyperuricemia can occur and gout may rarely be precipitated.


text:
POLICE ARREST EIGHT SUSPECTS OVER KILLING OF ABUJA WOMEN
The police in the Federal Capital Territory (FCT) have arrested eight suspects in connection with the death of an Abuja woman, Esther Okah.
Ms Okah was stabbed to death on Sunday by an assailant at CBN junction, Ungwan Cement, Karimo, on her way home after an outing with friends at Gwarimpa.
In a statement on Thursday, the deputy spokesperson of the police in the FCT, Danjuma Gajere, said the suspects were helping the police to unravel the killers.
Mr Gajere said that investigation into the incident was ongoing and the suspects would be arraigned in court at the conclusion of the investigation.
He said that the Commissioner of Police in the FCT, Adamu Ciroma, had reassured the public of the command's commitment to checkmating crimes and criminalities.
According to him, Mr Ciroma urged members of the public to continue supporting the police with useful information. (NAN)
Labels: New, nigeria breaking news, nigeria news


*We can arrange for any other company upon your request.
You will be met and greeted by our representative and transferred to the hotel.
See displays of Toyota's future concept personal mobility device, the i-unit, fuel cell hybrid vehicles and crash test vehicles, and visit their new model showroom.
TOYOTA KAIKAN EXHIBITION HALL View the production line within the plant, including the assembly line.
Sharp's spiral strategy involves making the most of the synergy created when key devices and products feed off each other, resulting in further development. The Kameyama Plant is a revolutionary, state-of-the-art facility that carries out integrated production from manufacture of LCD panels to final assembly of TV sets. It has streamlined processes for distribution, production, and inspection. By bringing all of Sharp's expertise in proprietary liquid crystal technologies and TV audio-visual technologies together in one place, efficient development and design are realized, and the spiral effect between devices and products is enhanced.


text:
Los Pacaminos Feat. Paul Young
The spirit of Tex-Mex lies somewhere between the Mariachi and Norteno styles of Mexico and the Country/Blues sounds of South-West America. It's played by such luminaries as Ry Cooder, Flaco Jimenez, The Texas Tornados and Los Lobos.
We're all seasoned musicians in our own right, but you'll probably have heard of one of us in particular. A certain Mr Paul Young, one of the UK's best-loved vocalists, fronts the band.
As Paul says: "Los Pacaminos started out just for fun, playing simply for the pleasure of it. It all took off from there. It's real bar room stuff: foot stompers, not too many slow songs – a real party atmosphere."
A typical Pacaminos set might include 'Wooly Bully', 'La Bamba' and sometimes, if enough tequila is flowing, 'Speedy Gonzales'.
2022 Music
10cc first appeared at Wickham back in 2013 as a support slot which proved one of the big hits of the 2013 Wickham Festival. They then played in 2015 and 2017 as headliners by popular demand. Well … drum roll … they're back at Wickham Festival 2022!!! ...
Chris Difford ("Squeeze")
We are delighted to announce that Chris Difford, singer-songwriter and co-founder of Squeeze fame will be performing on Thursday 4th August 2022. Squeeze proved extremely popular at Wickham Festival 2018 so it is a real treat to welcome his return for 2022. He has written lyrics for ...
Oysterband
Oysterband (originally The Oyster Band) is an English electric folk, folk rock, and folk punk band formed in Canterbury in or around 1976. The band formed in parallel to Fiddler's Dram, and under the name Oyster Ceilidh Band played purely as a dance band at first. The ...


Are you keen to save on travel insurance?
We understand the true value of our customers and their passion for all things travel, and that's why we offer regular discounts and promotional codes to help you save on your travel insurance purchases.
To redeem any active discount simply enter the code into the promo code box when buying online, or mention the code over the phone when booking with our customer service team.
If you don't have a code, follow us on Facebook, we often have discounts on insurance, and you'll stay updated with travel tips and trends.
We are offering you 10% off your travel insurance. Enter the code "Offer10" and save on your next policy.


A lovely two weeks in Germany. We landed in Hamburg and spent three days there (plus a full day trip to Lübeck, which was well worth it). Hamburg was a treat, highlighted by going to watch Hamburger SV play. Terrific stadium and atmosphere.
This trip was our first use of Twitter to document our travels.
Holstentor, with salt storehouses in Lübeck (4 Oct 2010, Nikon D90).


text:
Click here to view or book
2019 Safeguarding Workshops
Safeguarding - Child Protection in Sport
TO BOOK OR VIEW OUR LIST OF SAFEGUARDING 1, 2 or 3 WORKSHOPS CLICK HERE
Details and Content of Safeguarding Workshops
Sport Ireland recently changed the structure of Child Welfare & Protection (Code of Ethics) workshops for Clubs. The details of the three stages of training are outlined here as follows:
1. Safeguarding 1 - Child Welfare & Protection Basic Awareness Course
All Coaches, Children's Officers and Designated Liaison Persons (DLP) must first complete the 3 hour Child Welfare & Protection Basic Awareness Course. This course educates participants on the implementation of best practice in protecting the welfare of children involved in sport.
2. Safeguarding 2 - Club Children's Officer (C.C.O)
A person appointed to the Club Children's Officer position in a club must have completed safeguarding 1 (Child Welfare & Protection Basic Awareness workshop) and should complete the NEW Club Children's Officer 3 hour workshop. This course will help the Club Children's Officer to carry out the function of their role in the club and support the implementation of best practice in the club. Participants will also receive a Club Children's Officer Action Planning document as part of the training.
3. Safeguarding 3 - Designated Liaison Person(DLP)
A person appointed to the Designated Liaison Person position in a club must have completed the Child Welfare & Protection Basic Awareness Course and should complete the NEW Designated Liaison Person 3 hour workshop. A club may appoint the same person to both the CCO and DLP positions however best practice advises that they are kept as separate roles.
The third part of the ISC Child Welfare & Protection Training Programme is the Designated Liaison Person workshop.
Club Children's Officers
Club Children's Officers should be child centred in focus and have as the primary aim the establishment of a child centred ethos within the club. S/he is the link between the children and the adults in the club. S/he also takes responsibility for monitoring and reporting to the Club Management Committee on how club policy impacts on young people and Sports Leaders
Designated Liaison Person
Every club/organisation should designate a person to be responsible for dealing with any concerns about the protection of children. The Designated Liaison Person is responsible for reporting allegations or suspicions of child abuse to TULSA Child and Family Agency or Social Services (NI) and/or An Garda Siochán / PSNI. It is recommended that this person is a senior club person. However, if there is difficulty identifying a separate individual to take this role, the Club Children's Officer can be appointed as Designated Liaison Person once the club/organisation is clear about the responsibilities of each role. The organisation's child protection policy and procedures should include the name and contact details of the Designated Liaison Person and the responsibilities attached to the role.
Code of Ethics and Good Practice for Children's Sport
The Irish Sports Council and the Sports Council for Northern Ireland published a joint Code of Ethics and Good Practice for Children's Sport in 2000. This major joint publication recognised the commitment of both Councils to ensure that young people are safeguarded in their participation in sport in the island of Ireland.
The Code has been adopted and implemented by governing bodies of sports, clubs, local sports partnerships and community/voluntary groups on an ongoing basis since 2000. It has been encouraging to see the common sense approach to the adoption of the code at grass roots level, which has resulted in protection for young people and leaders.
If young people are to stay involved in sport throughout their adult life, they need to be equipped with the fundamentals to remain involved with sport and physical activity. Equally we need to ensure that their early experiences are positive and enjoyable, irrespective of their ability, gender, social class, race, etc.
It is encouraging to see adults, both volunteers and professionals, contribute to these positive experiences by acting as role models in all dealings with young people. In particular the work of Children's Officers at club and national level is instrumental in implementing the Code. We need to build on this valuable work to ensure that all young people see sport and physical activity as an important and valuable aspect of their lives that they will sustain throughout their adulthood.
The review of the Code in 2005 ensures that the policies and procedures that we implement at all levels in sport are up-to-date and in line with relevant documents, current best practice and legislation throughout the island of Ireland.
TO BOOK OR VIEW OUR LIST OF SAFEGUARDING 1, 2 or 3 WORKSHOPS CLICK HERE Details and Content of Safeguarding…
What is Sports First Aid? Sports first aid is the provision of immediate care to a victim with an injury…
Sports Education
Lucozade Sport Education Programme The world of sport and physical activity is ever-changing. There are many people who are involved…
What it is about? SAQ TrainingTM is a system of progressive exercise and instruction aimed at developing fundamental motor abilities…
Schools Inclusion
Dún Laoghaire-Rathdown Sports Partnership offers local Primary and Secondary school teachers further training in the inclusion of a pupil with…


Actress Natalie Portman has reportedly given birth to a daughter, her second child with husband Benjamin Millepied.
Reps for the Oscar nominee confirmed the news to metro.co.uk, saying that daughter Amalia Millipied arrived on February 22.
The couple are already parents to a five-year-old son, Aleph.
News of the new arrival comes after Portman pulled out of attending the Oscars and the Independent Spirit Awards last month – having been nominated at both for her performance in Jackie, citing her pregnancy as the reason.
'Due to my pregnancy, I am unable to attend the Independent Spirit Awards and the Academy Awards,' she said in a statement to Variety last weekend.
The 35-year-old revealed her pregnancy last September with a visible baby bump, as she attended the premiere of her movie Planetarium at the Venice Film Festival.
She and Millipied – a choreographer who formerly worked with the Paris Opera Ballet – began dating in 2009 after they met on the set of Black Swan, eventually tying the knot in 2012.
We think this is a dazzling story and so do you! Like Metro Entertainment on Facebook for more of this on your news feed.


text:
Jezebelle Bond (Eureka, 27 de maio de 1979) é uma atriz pornográfica norte-americana.

Biografia
Nascida em Eureka, aos seus dois anos de idade sua família mudou-se para San Luis Obispo, Califórnia, onde ela cresceu. Com 18 anos decide se tornar uma stripper depois de ver filmes com striptease e showgirls. No entanto, o salário que recebeu não atendeu às suas expectativas, e então resolveu fazer cinema voltado para o público adulto.

Em 1999, estreou na indústria pornô. Naquele ano, ela fez apenas dois filmes (More Dirty Debutants 116 e Four Finger Club 8). Passou o tempo restante posando para revistas. No início, a atriz passou a fazer apenas cenas lésbicas como em: Flash (2000), Confessions (2001), Innocence (2001).

A partir de 2002 ela começa a alternar o seu cenário habitual de cenas lésbicas com algumas cenas hetero, como em Vixxen o Sex In The Valley. Em 2003 fez sua primeira cena de sexo anal em 100% Anal 2: Welcome To Jezebelle, posteriormente só repetia a experiência em Kill Kill Girl 2 (2005).

Ainda em sua filmografia, que se estende até 2008, segue tendo maior presença em cenas onde contracena somente com mulheres.

Jezebelle Bond é ficcionada por tatuagens, tem mais de uma dezena sobre seu corpo.

Prêmios
2004: AVN Award – Melhor Cena de Sexo em Grupo, Video – The Bachelor
2002: AVN Award – Melhor Performance Tease  – Love Shack
2002: AVN Award – Best All-Melhor cena de Sexo, Video – Fast Cars & Tiki Bars

Ligações externas
 Fotos de AVN Expo 2007

Atrizes pornográficas dos Estados Unidos
Pessoas LGBT dos Estados Unidos
Atrizes pornográficas LGBT

redpajama_set_name: RedPajamaWikipedia


For the American Modernist John Marin (1870–1953), best known for his luminous watercolors of rural Maine and urban New York, drawing was central. Becoming John Marin: Modernist at Workwill offer the viewer an inside look at the process behind his abstract watercolors and etchings.
The works vary from dynamic depictions of Manhattan structures and Maine landscapes to lesser-known pieces based on figures: portraits, bustling urban crowds, and circus animals and performers in motion.
Organized by the Arkansas Art Center in Little Rock the exhibition will be accompanied by a fully illustrated catalog of the center's complete, newly conserved John Marin Collection.


Girls are the main targets with regards to fashion and fashion designing. The fashion business is seeing how 3D printing expertise has influenced designers equivalent to Iris Van Herpen and Kimberly Ovitz These designers have been heavily experimenting and creating 3D printed couture items. Crop high is probably the most democratic garment that connecting the movements of minimalist, grunge , hip-hop and R&B tradition and turning up on everybody from Mariah Carey and Spice Girls to the top fashion icons. Not solely did political events make a big impact on fashion traits but also the political figure performed a important position in forecasting the fashion pattern. We even have designers at firms similar to Ted Baker, House of Holland, COS, Topshop and River Island.
The Fashion and Footwear area has dedicated studios and a spread of top of the range workshops to enable the production of 2D and 3D work. Kate Hills – Founding father of 'Make it British', at Subject Futures Week 2016 speaking to some of our Fashion students. Dari gaya hidup inilah berkembangnya fashion di kalangan masyarakat menjadi faktor yang dapat mempengaruhi gaya atau model setiap orang. Fashion statements from the US, Europe and Australia are quickly gaining on each other on a race to the highest of the fashion world. The fashion space has devoted studios and a spread of high-quality workshops for the production of two and three dimensional work. We're fascinated in the exploration of fashion and artwork boundaries creating statement pieces and producing social change. Dan dengan cara fashion present lah hasil rancangan para designers indonesia dapat dikenal seperti di acara jfw (jakartafashion week), atau di saat para designers meluncurkan karya rancangan mereka.
Fashion traits are influenced by a number of factors including political, economical, social and technological. It relies upon as the mainstream fashion of 90s, Calvin Klein is a well known examples for minimalistic style. Heels are a fashion assertion at instances and they are the right shoe selection for many outfits. It was about this time that Hollywood started to inject itself way more strongly into social issues and thus started a protracted line of actors and actresses who would take robust stands on these issues and once more, the fashion world was the proper goal. In all societies all through historical past, fashion has served as an indicator of social standing and cultural belonging. When individuals who have excessive cultural status begin to wear new or totally different clothes, a fashion pattern might begin.
Wanita di zaman sekarang ini memiliki peran yang lebih kompleks dalam kehidupan masyarakat, wanita zaman dulu berbeda dengan zaman sekarang, kalau dulu wanita identik dengan pekerjan rumah atau dapur fashion tentunya tidak terlalu mencolok, berbeda di zaman sekarang wanita juga mempunyai peran dalam membantu perekonomian keluarga atau biasa kita sebut wanita karir, bahkan tak sedikit para perusahaan yang lebih membutuhkan wanita dari pada pria dalam suatu pekerjaan.
After the struggle, new fashion got here with a complete new look, the designers from the early years like Chanel disliked the brand new look, it was the top of women following the Paris fashion. One should attempt to undertake the newest fashion of clothes, nevertheless one must also preserve in consideration one's physical structure.


Financial Calendar explained, Tips on planning & setting up one.
Hi Sierra - Happily! Financial calendar is one of those terms that's both specific and vague at the same time. Essentially, it helps you build a schedule and timetable for all things monetary. And that means… what, exactly?
Just like everyone has their own system for daily scheduling and to-do lists, you can make a financial calendar that's specific to your personal goals and habits. Budgeting is a good example. Do you need to assess your spending on a weekly schedule or are you organized enough to track things on a monthly basis? Whatever you choose, that's an aspect of your financial calendar.
Another big component of your money schedule is how it helps you with taxes. First and foremost, you can schedule when you're actually going to file, giving yourself some planning time in case you expect to owe a significant amount to the IRS. Your financial calendar can also help you plan pre-tax payments which can be very beneficial, and it can assist with general receipt and expense management. If you have quarterly reminders to organize your tax information, you'll probably have more success than if you try to get everything figured out in March.
If you get an annual bonus, your financial calendar can help you plan ahead for how you might spend that money. Similarly, planning a year in advance will show you whether or not your current investment strategy will deliver the maximum contribution to your retirement account.
A financial calendar is just another means for planning ahead. It might as well be called a financial planner, but that title is already taken by people like me. If you have a friend who's raving about how useful it's been, she most likely started tracking her spending and earning for the first time and finally feels in control. If you don't pay close attention to what your money does, sitting down with a calendar and focusing exclusively on financial matters can be really helpful.
Lots of people choose to make specific financial plans for each month, which can make the process a little more involved and potentially a little more fun. If you really want to dive in, I suggest mapping out your expenses and earning goals for a full year. If nothing else, it will help you get a better idea of how well you understand your own finances.
Hopefully this helps, Sierra. Enjoy setting up that calendar!


Utilize natural light when you can.
Buy Energy Star-rated light bulbs and fixtures, which use at least two-thirds less energy than regular lighting.
Install timers or motion sensors that automatically shut off lights when they're not needed.
Setting your computer to go to sleep automatically during short breaks can cut energy use by 70 percent. Remember, screen savers don't save energy.
Invest in energy-saving computers, monitors, and printers and make sure that old equipment is properly recycled.
Look for a recycler that has pledged not to export hazardous e-waste and to follow other safety guidelines.
Print on both sides or use the back side of old documents for faxes, scrap paper, or drafts.
Avoid color printing and print in draft mode whenever feasible.
Buy chlorine-free paper with a higher percentage of post-consumer recycled content.
Consider switching to a lighter stock of paper or alternatives made from bamboo, hemp, organic cotton, or kenaf.
Think before you print: could this be read or stored online instead?
Post employee manuals and similar materials online, rather than distribute print copies.
Recycle everything your company collects. Just about any kind of paper you would encounter in an office, including fax paper, envelopes, and junk mail, can be recycled. So can your old cell phone, PDA, or pager.
Place recycling bins in accessible, high-traffic areas and provide clear information about what can and can not be recycled.
Provide reusable dishes, silverware, and glasses.
Switch to Fair Trade and organic coffee and tea.
Buy as much organic and local food as possible for parties and other events.
Provide filtered drinking water to reduce bottled-water waste.
Take the train, bus, or subway when feasible instead of a rental car when traveling on business. If you have to rent a car, some rental agencies now offer hybrids and other high-mileage vehicles.
Carpool, bike, or take transit to work, and/or telecommute when possible. If you need to drive occasionally, consider joining a car-sharing service like Zipcar and Flexcar instead of owning your own wheels.
Encourage telecommuting (a nice perk that's also good for the planet!) and make it easy for employees to take alternative modes of transportation by subsidizing commuter checks, offering bike parking, or organizing a carpool board.
Brighten up your cubicle with plants, which absorb indoor pollution.
Buy furniture, carpeting, and paint that are free of volatile organic compounds (VOCs) and won't off-gas toxic chemicals.


The Space Pedro Resort is located in Nuwara Eliya and is a perfect place to stay when visiting the city. All the rooms have complete furniture set as well as a private bathroom. Moreover, each room contains a desk while a seating area is also provided. The property offers you free Wi-Fi access and free parking facility as well. Breakfast is served on time each morning with a delicious variety of options such as Asian, vegetarian, American, etc. Guest Access The resort provides special facilities for guests who are disabled. The Neighborhood Pedro Resort is surrounded by beautiful attractions all around. The Gregory Lake that is a perfect spot for visitors during the warm summer months is just a few meters away from the property. Other places such as Galway's Land National Park are also situated close to the resort. Distance from Key Landmarks Nuwara Eliya Golf Club: 1.5 km Galway's Land National Park: 1.6 km Gregory Lake: 2.5 km Pedro Mountain: 5 km Central Market: 0.3 km Milano Restaurant: 1 km Hakgala Botanical Garden: 8 km Nanu Oya Railway Station: 4.9 km Ambewela Railway Station: 12.1 km Getting around The property is located at an ideal place from all important sites. Many of the natural sites, as well as many recreational places too, are nearby. Also, 2 railway stations are in the vicinity that solves transport issues for guests. Furthermore, airport shuttle services are also provided. House Rules All children are welcome at the establishment, but pets are not allowed.
Hi Laura! Thank you for your review and rating. We value your feedback when it comes to improving our standards.
:) hill stay with mountain view.. Near to city center. Walkable distance mountain view.. :( No tea coffee maker. Hot water was very slow.
Hi Jibin! Thank you for your review. We do appreciate your feedback when it comes to improving our standards.
Mooi uitzicht, snelle WiFi en behulpzaam personeel :) Warme douche, ruim bed en mooi uitzicht over de stad. Omdat de locatie wel wat afgelegen is regelden ze vervoer voor ons naar het centrum, de theeplantage en het treinstation. Dit alles voor een schappelijke prijs. De WiFi is erg snel. :( Bij aankomst kregen we direct een kopje thee aangeboden. Achteraf bleek dat we dat gewoon moesten betalen. Ook jammer dat de WiFi het niet deed op de kamer. Uitsluitend in de lobby. De douche was koud. Pas toen we hier melding van maakten deden ze na een kwartier "de warme kraan aan".
Hi Fenna! We are sorry to hear that your stay wasn't as satisfactory as it should have been - apologies for the the WIFI and hot water issues. We are always trying to improve our standards and your feedback is valued.
Hi Felix! Thank you for letting us know about experience, as your feedback is highly valued when it comes to improving our standards. Oh no! We do apologise for the condition of the bathroom as cleanliness and the guests comfort are some of our top priorities. Thank you for your review.
Resimlerdeki Gibi Değil :( Sabaha kadar müzik çaldı, gece oteli terk etmeyi düşündüm. Odaları pisti. Şehir merkezine yakın diyor ama yolları tenha, hiç bir faydasını görmedim. Hiç tavsiye etmem. Until morning, muzik played, i couldnt sleep, room is dirty, i never advise.
Hi Ercan! We would like to sincerely apologise for your unpleasant experience. Providing clean. quality accommodation is a top priority for us, and we are sorry to hear that things were not up to standard. Thank you for your valued feedback which will help us make improvements.
Hi Varun! Oh no! We always aim to provide clean, quality accommodation for guests to ensure their comfort, and we are sorry to hear that thing were not up to standard. Your feedback does help when it comes to making positive changes, and will take measure to prevent this from happening again. Thank you for your review.
:) The view from the balcony was really nice.. :( The cleanliness need to improved.
Hi Nilan! We sincerely apologise if the cleanliness was not up to standard and for any other inconveniences yo had to deal with during your stay. Your feedback is highly valued when it comes to making positive changes.
No 56/1,Gamunu Mawatha, Nuwara Eliya.


Yellow wool 100% wool Hand wash Oliver Spencer Dock Ribbed Wool Beanie Yellow wool 1084336 YSNQASI..
Steadman Canvas Shoes by Penguin> Mens trainers> Lace-up> Cushioned ankle and insole> Moulded rubber..
Activeflex Slim Jeans by 883 PoliceThe Activeflex mens slim jeans from 883 Police feature a classic ..
Knitted from pure wool for a comfy handfeel, this sweater by Acne Studios is stamped with a hallmark..
Wardrobe essentials never really get old, like this T-shirt from James Perse, which is crafted from lightweight jersey that drapes against the profile softly. Wear this piece alone in hot summer days or layer it with a jacket during windy seasons.
Coaxing utmost relaxation for your off-duty sets, this sweatshirt by James Perse is lined with tri-t..
James Perse presents these cargo sweat shorts to your off-duty rotation. Featuring handy pockets at ..
Ideal for carefree lounging days, these slim fit sweat shorts from James Perse are crafted from Supi..
Wardrobe essentials never really get old, like this T-shirt from James Perse, which is crafted from ..
Showcasing an ideal blend of casual and quality, this T-shirt from James Perse is rendered in cotton..
Slide into a Californian cool with this T-shirt by James Perse, racing with three ombré stripes curv..


text:
Jenson Button Is Formula One's Most Honest Man
Stef Schrader
Filed to: Formula OneFiled to: Formula One
"I don't know what's worse," McLaren Formula One driver Jenson Button told Sky Sports after retiring from the Austrian Grand Prix with engine problems. "Doing the race thirty seconds off pace or stopping on Lap 2!" (McLaren, in case you were wondering, is not having a good season.)
Formula One Grid Penalty Roundup: How The Back Of The Grid Is Made
Poor McLaren gets the indignity of making up an all-world-champion back row. But how? Why are they…
Teammate Fernando Alonso had his fourth retirement of the season right at the start of the race due to an unfortunate smash-up with Kimi Räikkönen's Ferrari. Both teammates were hoping to at least get some data to use to develop and improve their unreliable Honda power units, but that's not going to happen at the Red Bull Ring today.
Contact the author at stef.schrader@jalopnik.com.
Recent from Stef Schrader
View on Oppositelock
All My Cars Actually Run Right Now, Suckaaaaaaaas
This Camaro Became Formula Drift's Groundbreaking First Electric Car After Getting Hit by a Train
What Do You Eat With Porsche Wine?: A Painfully Thorough Investigation


Excellent cottage in great. Location. Very comfortable and well equipped. Also local people very friendly and welcoming ( fresh crabs & new potatoes supplied by neighbour). Good seafood bar within 200m and good restuarants in Loch Carron (Bistro & Carron). Look forward to returning soon !!
We had a lovely week at The Coltsfoot, the cottage was beautifully decorated and the interior was very relaxing. It was set in a lovely area with a stream to the front of the property. Fort Augustus is an excellent area to explore the Highlands from, with the Great Glen way just minutes away. I would recommend The Coltsfoot as a great place to stay in Scotland.
A great cottage very near to Loch Ness. We think the perfect cottage if you travel as a couple. Kitchen with everything you need. Nice bathroom and comfortable bedroom.
Skye has got into our blood and we've returned again and again - finding Timber House has been icing on the cake. Every time we looked out the huge windows we didn't know if we'd be greeted by dancing stoats, racing sheep, wandering highland cattle or lazy, basking seals. The only downside of Timber House is how you feel when you have to leave.
We have been holidaying in the UK since a long time and this is maybe the best property that we've stayed in so far. The cottage lies in a magnificient setting and is full of character and very well equipped. The master bedroom is just great and really hotel-like. Each bedroom has an own bathroom with shower and wc and there is an additional one on the ground floor! The garden is lovely and the humans and dogs in our party enjoyed it very much. Highly recommended!
We stayed in this cottage in August 2011 and from first arriving we were amazed at the stunning location. The cottage was well equipped with everything you need, although it didn't tell us on the advertisement about the chest freezer in the shed outside which was a great bonus ( for the beers ). We had fantastic weather all week hot and sunny. We would go to this cottage again and recommend it to anyone. oh and the sat nav took us to the wrong side of bay ! Anne Graham. Dot and Jack .
Lovely, well equipped and tastefully renovated cottage. Very clean. Ideally located for exploring the Cairngorms and beyond. We would choose this cottage again.
We all loved Ceol na Mara, beautiful views and the beach just at the bottom of the garden. We were very cosy (the cottage was very well equiped) and had a very relaxing week. We would definately consider returning.
We had a fantastic week at Matheson's Croft. It manages to be perfectly secluded with views across Loch Duich to Eilan Donan castle, yet in the middle of nowhere. Mum saw Red Deer in the garden one morning, we had regular visits from a hawk, the next door neighbour saw an otter one morning. Perfect peace and quiet. The house itself is small but beautifully turned out with high-end fittings and furnishings. The owners have made a lovely job of it all. Highly recommended.
Had a fantastic week long break at Swallow Byre start of August. Superb location, beautifully furnished with loads of character. Fantastic beaches nearby. Warm welcome from the owner Jane who was a mine of useful information. If you enjoy peace and solitude this is the place for you. Can't wait to return.
Just returned from holiday at Taigh Fiodha. What a fantastic cabin. It was immaculate. The owner was very friendly and welcoming, and although his house was a few yards behind us, we were never bothered by his family. Only on one day when he watered his plants showed us around his land, then offered us a cucumber, which he grows himself. He also brough over bread and milk on our arrival. Very pleasant and helpful owner. Great scenery and fabulous beach. Definately go back.
9/7/11 - Wicks family Had a fantastic week here, cottage was amazing and the garden was fabulous. Weather was brilliant which helped and we even had breakfast in the garden twice. Lots of lovely walks from the cottage doorstep, secret beaches, and loads of beautiful scenery. Will recommend this cottage to all our friends and family and would love to return one day.
We had a wonderful time at Katie's cottage. It is beautifully restored. It has everything we needed a home away from home. The kitchen is very well equipped. We fell in love with Skye and the cottage. Our dog loved roaming in the fenced-in garden. In these peaceful surroundings you can truly come back to earth. We hope we can visit it a again sometime in the future.
Nice luxury accommodation would recommend this cabin, lovely secluded location and only 10mins walk to the village.
We had a happy week in the croft. It is cosy and warm with a fine view from the windows. Every evening when we got back from the mountains we lit a log fire from the plentiful supply. Out and about in this quiet area we saw more wildlife in a morning than we have in more popular places - a red squirrel is a regular visitor to the garden. The little general store at Laggan is well stocked and there are plenty places to eat out. The cottage is very clean and thoughtfully furnished.
Just returned from a lovely, relaxing week at Owl Cottage, Fort Augustus. Beautifully clean and everything you require at your fingertips! Cottage in a very peaceful lane just a couple of minutes walk from the Caledonian Canal - perfect!


Mudpuppy Games-to-Go Dino Snap! Playing Cards is a fast-acting game of matching colorfully illustrated dinos with its skeleton card. Perfect for playing on the go, cards are packaged in a travel-friendly drawstring bag for easy clean up and storage.
- Size:6 x 4 x 1"


Were you expecting this to be an entry about breast cancer? That is not surprising.
Many people are not aware that the number one disease that claims women's lives is heart disease.
Women who have heart disease are often undiagnosed because the symptoms of heart disease in women are not the same as the symptoms in men.
For example, for men a heart attack often feels like an incredible sensation of pain and pressure in the chest. Women are more likely to experience pain across the top of their abdomen.
Women who are diagnosed with heart disease may not receive optimal treatment because most research studies in the past have been conducted only on men.
While men typically develop heart disease earlier, they tend to live longer with heart disease than women do. Before menopause, women's bodies produce estrogen, which helps prevent heart disease.
After menopause when estrogen levels drop is when most women experience their first symptoms.
A regular EKG should be part of every woman's annual physical beginning around menopause, or earlier if there are other risk factors for heart disease.
These include a family history of heart disease, diabetes, hypertension, elevated cholesterol levels, and obesity.
Previous articleWhat Are Enlarged Ovaries? Why You Should Not Ignore Them?
Thank you so much for this article. As I read the article, my 43 year old mother came to mind more than once. There have been a couple of times where she thinks she is experiencing pre-heart attack symptoms, such as chest pain and numbness of the arm. Having read this post and now knowing the symptoms vary between males and females makes me realize we, as women, are not as informed about heart disease as we'd like to think. Again, thank you!


Exclusive to Sophisticato, and totally unique, this delicate and versatile 2 in 1 circular pendant has been created by encasing an abstract acrylic design within layers of glossy resin. Irregular areas of shimmering colours, turquoise, silver, yellow & grey.
Or wear the other way around! An almost woodgrain, effect, a more uniform finish, with the colours merging into yellowy green.
The pendant is approx 3.8 cm diameter on a 32 inch chain of sterling silver plated in 18ct gold.


text:
A Patient With Nonresolving Pneumonia and Arthralgias
Twinkle Chandak, MD
, Nick Patel, DO
Nick Patel, DO
, Arunabh Talwar, MD
Arunabh Talwar, MD
A 61-year-old man with arthritis and an 80-pack-year smoking history presented with fever, dyspnea, and productive cough of a week's duration that did not respond to outpatient treatment with levofloxacin.
A 61-year-old man with arthritis and an 80-pack-year smoking history presented with fever, dyspnea, and productive cough of a week's duration that did not respond to outpatient treatment with levofloxacin. He also had worsening arthralgias in both lower extremities, particularly in his knees and ankles, accompanied by a 10-lb weight loss over the 2 months before presentation. Physical examination findings included digital clubbing and decreased breath sounds on the right side with scattered fine rales.
The patient was admitted with the diagnosis of right lower lobe (RLL) pneumonia on the basis of RLL consolidation on his radiograph. He was treated with intravenous ceftriaxone and azithromycin. However, there was no improvement in his symptoms despite treatment with the antibiotics; therefore, a CT scan of the chest was obtained. It revealed emphysema and mediastinal lymphadenopathy in the pretracheal and subcarinal locations (Figure 1). A moderate right-sided pleural effusion and multiple nodular opacities (measuring less than 1 cm) in right middle and lower lobes with septal thickening were noted, suggesting a lymphangitic tumor (Figure 2).
The patient underwent mediastinoscopy and lymph node biopsy, which confirmed poorly differentiated non–small-cell lung cancer. Thoracentesis with aspiration of the effusion also confirmed malignancy. Meanwhile, a rheumatology consultation was sought for his leg pain. There was no clinical evidence of synovitis or effusion in any of his joints, although there was evidence of mild arthritis in the knees with suprapatellar enthesopathy on knee and ankle radiographs. He had minimal relief with NSAIDs. Opiates and gabapentin were added for pain relief.
Laboratory findings were significant for an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein level. Results of serological tests for rheumatoid factor, antinuclear antibody, and antineutrophil cytoplasmic antibodies were negative; levels of serum complements were normal.
Chemotherapy with cisplatin and etoposide was started, and the patient had some improvement in his arthralgic symptoms.
What is the likely diagnosis?
What is causing this patient's nonresolving pneumonia and arthralgias? The patient underwent bone scintigraphy, which showed no metastatic disease but irregular uptake in both tibias and fibulas with evidence of arthritis in major joints (Figure 3). This led to the diagnosis of hypertrophic pulmonary osteoarthropathy (HPOA).
Hypertrophic osteoarthropathy (HOA) syndrome is a condition characterized by proliferative periostitis of the long bones, especially in the distal and periarticular aspects. It may cause proliferation of the synovial membranes, leading to painful and swollen joints; it is often accompanied with finger clubbing.1,2 Clubbing was first described by Hippocrates in the fifth century bc2; however, it was not until 1889 and 1890, when Bamberger and colleagues3 and Marie,4 respectively, recognized the association of clubbing, arthralgia, and ossifying periostitis as a distinct clinical syndrome. Hence, HOA is also known as the Pierre Marie Bamberger syndrome.
The syndrome is classified as either primary or secondary HOA. Primary HOA is not associated with any other medical disorders. However, secondary HOA, or hypertrophic pulmonary osteoarthropathy (HPOA), which is more common, is usually associated with lung cancer, tuberculosis, pulmonary abscess, bronchiectasis, emphysema, cystic fibrosis, interstitial lung disease, right-to-left cardiac shunts, and less often, disorders such as Hodgkin lymphoma and cirrhosis).1,5,6 Primary, or idiopathic, HOA (also called pachydermoperiostosis and Touraine-Solente-Gole syndrome), on the other hand, is a hereditary disorder that presents in childhood and clinically mimics secondary HOA. The genetic abnormality involves a mutation in the HPGD gene that encodes 15-hydroxyprostaglandin dehydrogenase, which is the primary enzyme responsible for prostaglandin degradation.7
The incidence of clinically apparent HPOA in patients with lung cancer, either primary or metastatic, is approximately 4% to 5%. About 80% of pulmonary lesions associated with HPOA are lung cancers, pleural tumors account for 10% of the lesions, and miscellaneous intrathoracic malignancies account for 5%.8 Among patients with lung cancer, HPOA is associated with all cell types-adenocarcinoma is most frequently seen, and small-cell carcinoma is least frequently seen.1
The etiology of HPOA is still poorly understood. Opinions are divided between neurogenic and humoral mechanisms. Clubbing and HPOA appear to be different manifestations of the same disease process.9 It is thought that localized activation of platelets-endothelial cells, with the subsequent release of fibroblast growth factors (eg, platelet-derived growth factor [PDGF]), plays an important role in the pathogenesis of HPOA. The frequent association with lung disease raises the possibility that circulatory bypass of the lung may be responsible. One hypothesis is that megakaryocytes escape the normal fragmentation to platelets in the lung and reach the distal extremities, where they release growth factors.10,11
Another hypothesis involves tumor production and release into the circulation of factors such as vascular endothelial growth factor (VEGF) that promote features of HPOA, such as vascular proliferation, edema formation, and new bone formation. Two case reports of patients with lung cancer and HPOA noted elevated circulating concentrations of VEGF. In one case, a marked decline in VEGF levels followed resection of the tumor and was temporally correlated with the disappearance of the skeletal abnormalities.12 Elevated levels of PDGF, endothelin 1, β-thromboglobulin, and VEGF have been reported in patients with HPOA.
Estrogen and growth hormone (GH) produced by pulmonary tumors have also been implicated occasionally. There have been case reports of high levels of GH that returned to normal after resection of the tumor, with relief of clinical symptoms.8 The central abnormality in primary HOA is elevations in circulating prostaglandin E2, which may play a pathogenetic role in HPOA as well.7
MAKING THE DIAGNOSISClinical features
The clinical features of HPOA include digital clubbing and periostitis or periosteal new bone formation in tubular bones, particularly the long bones of the distal extremities. Periostitis causes severe burning pain in the distal extremities, aggravated by dependency and weight bearing, and it is usually accompanied by tenderness to palpation of the involved area. Some patients present with painful, symmetric, arthritis-like changes in the large joints and periarticular tissues (ankles, knees, wrists, metacarpophalangeal joints, and elbows).13 Laboratory findings often reveal an elevated ESR (greater than 50 mm/h) and, in advanced cases, an elevated alkaline phosphatase level.13
HPOA mimics rheumatoid arthritis clinically; however, synovial fluid has been reported to be typically noninflammatory, with leukocyte counts of less than 500/µL. The synovial membrane shows vascular congestion with mild lymphocytic infiltration.13 Increased thickness of the subcutaneous soft tissues may be noted in the distal one-third of the arms and legs and sometimes of the facial tissues, which may simulate acromegaly. Also, there may be neurovascular changes in the hands and feet, such as chronic erythema, paresthesia, and increased sweating. In primary HOA, bone and joint pain tends to be less severe than in rheumatoid arthritis, and the furrowing of the face and scalp tends to be more severe.7
When HPOA is suspected, attention should be given to findings from the chest examination, because the most frequent cause of acute-onset HPOA is a lung neoplasm, either primary or secondary. In a third of patients with lung cancer, clinical HPOA predates the onset of respiratory symptoms; in another third, patients present with respiratory symptoms simultaneously; and in the remaining patients, HPOA may appear after the diagnosis of malignancy is established.1 Removal of lung neoplasm or treatment of the other causes of HPOA results in regression of the clinical manifestations.1
Radionuclide scanning is more sensitive than radiography in the detection of HPOA. Findings on a radionuclide scan can range from an increased "bracelet-like" appearance to more diffuse, symmetrically increased uptake along the cortical margins of the diaphyses of the long, tubular bones, sometimes referred to as the "parallel tract" or "double stripe sign."14 Although uncommon, there may be asymmetric and irregular involvement of the long bones (as seen in the case described here). Increased uptake in the distal phalanges is associated with marked clubbing. HPOA usually involves the peripheral skeleton, but it can also affect the skull, clavicles, ribs, and scapulas.14 The disease typically is more active in the lower extremities than in the upper extremities, and the long bones distal to the knees and elbows are usually more affected than the bones proximal to these joints.
These scintigraphic abnormalities found in the peripheral skeleton are not easily mistaken for diffuse skeletal metastasis. Metastatic tumor almost always involves the central skeleton in an irregular, focal, asymmetric pattern. When long bones are involved, it is the medullary cavity that is primarily affected, as opposed to the cortical involvement seen in HPOA.14,15 After appropriate therapy, the abnormalities seen on radiographic and radionuclide images may diminish or even disappear.
Removal of lung neoplasm or treatment of the other causes of HPOA results in regression of the clinical manifestations.1 However, in many patients, the associated pain can be disabling and conventional analgesic medications are often not effective. A single 4-mg dose of zoledronic acid has been used effectively to alleviate the symptoms.16 In refractory cases, subcutaneous octreotide may be tried to relieve symptoms.17
HPOA should be considered in the differential diagnosis of bone and joint pains in patients with cancer, in addition to bone metastasis and inflammatory arthritides. It is important for the clinician to be aware of the clinical entity of HPOA and the radiographic finding of periostitis. This may lead to early detection of lung cancer in patients without significant pulmonary symptoms and therefore may avoid tumor progression and distant metastases.
REFERENCES1. Stenseth JH, Clagett OT, Woolner LB. Hypertrophic pulmonary osteoarthropathy. Dis Chest. 1967;52:62-68. doi:10.1378/chest.52.1.62.
2. Hsieh CC, Yang RS, Huang KY. Incidental solitary knee mass as the first manifestation of hidden lung cancer. Knee. 2008;16:161-164.
3. Bamberger E. A case report [in German]. Wien Klin Wochenschr. 1889;2:226-230.
4. Marie P. De l'osteo arthropathie hypertrophiante pneumonique. Rev Med Paris. 1890;10:1-36.
5. Dickinson CJ. The aetiology of clubbing and hypertrophic osteoarthropathy. Eur J Clin Invest. 1993;23:330-338.
6. Galko B, Grossman RF, Day A, et al. Hypertrophic pulmonary osteoarthropathy in four patients with interstitial pulmonary disease. Chest. 1985;88:94-97. doi:10.1378/88.1.94.
7. Uppal S, Diggle CP, Carr IM, et al. Mutations in 15-hydroxyprostaglandin dehydrogenase cause primary hypertrophic osteoarthropathy [published correction appears in Nat Genet. 2008;40:927]. Nat Genet. 2008;40:789-793.
8. Mito K, Maruyama R, Uenishi Y, et al. Hypertrophic pulmonary osteoarthropathy associated with non-small cell lung cancer demonstrated growth hormone-releasing hormone by immunohistochemical analysis. Intern Med. 2001;40:532-535.
9. Martnez-Lavn M. Digital clubbing and hypertrophic osteoarthropathy: a unifying hypothesis. J Rheumatol. 1987;14:6-8.
10. Abe Y, Kurita S, Ohkubo Y, et al. A case of pulmonary adenocarcinoma associated with hypertrophic osteoarthropathy due to vascular endothelial growth factor. Anticancer Res. 2002;22:3485-3488.
11. Pedersen NT. Occurrence of megakaryocytes in various vessels and their retention in the pulmonary capillaries in man. Scand J Haematol. 1978;21:369-375.
12. Oln F, Portela M, Navarro C, et al. Circulating vascular endothelial growth factor concentrations in a case of pulmonary hypertrophic osteoarthropathy. Correlation with disease activity. J Rheumatol. 2004;31:614-616.
13. Butler RC, Thompson JM, Keat AC. Paraneoplastic rheumatic disorders: a review. J R Soc Med. 1987;80:168-172.
14. Ali A, Tetalman MR, Fordham EW, et al. Distribution of hypertrophic pulmonary osteoarthropathy. AJR. 1980;134:771-780.
15. Buckley O, O'Keeffe S, Geoghegan T, et al. 99mTc bone scintigraphy superscans: a review. Nucl Med Commun. 2007;28:521-527. doi:10.1097/MNM.0b013e3281744440.
16. King MM, Nelson DA. Hypertrophic osteoarthropathy effectively treated with zoledronic acid. Clin Lung Cancer. 2008;9:179-182.
17. Johnson SA, Spiller PA, Faull CM. Treatment of resistant pain in hypertrophic pulmonary osteoarthropathy with subcutaneous octreotide. Thorax. 1997;52:298-299.
9. Martínez-Lavín M. Digital clubbing and hypertrophic osteoarthropathy: a unifying hypothesis. J Rheumatol. 1987;14:6-8.
12. Olán F, Portela M, Navarro C, et al. Circulating vascular endothelial growth factor concentrations in a case of pulmonary hypertrophic osteoarthropathy. Correlation with disease activity. J Rheumatol. 2004;31:614-616.
Respiratory Diseases | Musculoskeletal Disorders | Obesity | Pneumonia