Anabolic steroid - Wikipedia. This article is about androgens as medications. For androgens as natural hormones, see Androgen. Anabolic steroids, also known more properly as anabolic- androgenic steroids (AAS). They are anabolic and increase protein within cells, especially in skeletal muscles. AAS also have varying degrees of androgenic and virilizing effects, including induction of the development and maintenance of masculinesecondary sexual characteristics such as the growth of the vocal cords and body hair. The word anabolic, referring to anabolism, comes from the Greek . The American College of Sports Medicine acknowledges that AAS, in the presence of adequate diet, can contribute to increases in body weight, often as lean mass increases and that the gains in muscular strength achieved through high- intensity exercise and proper diet can be additionally increased by the use of AAS in some individuals. Their use is referred to as doping and banned by most major sporting bodies. The Gonadal Type is dominated by the sex glands (ovaries), located in the pelvic cavity. 103 Body Fat Hacks: A Cheat Sheet For A Svelte Physique; The Best Pre-Workout Supplement Not On The Market (Yet) Training and Testosterone (Part 2 of 4). Intermittent fasting for women. Is it good or bad for you? Patient resource for type 1 diabetes, type 2 diabetes, thyroid cancer, osteoporosis, adrenal disorders and other endocrine disorders. Includes information on. For many years, AAS have been by far the most detected doping substances in IOC- accredited laboratories. Testosterone is now nearly the only androgen used for this purpose and has been shown to increase height, weight, and fat- free mass in boys with delayed puberty. These sports include bodybuilding, weightlifting, shot put and other track and field, cycling, baseball, wrestling, mixed martial arts, boxing, football, and cricket. Such use is prohibited by the rules of the governing bodies of most sports. AAS use occurs among adolescents, especially by those participating in competitive sports. It has been suggested that the prevalence of use among high- school students in the U. S. Oral administration is the most convenient. Testosterone administered by mouth is rapidly absorbed, but it is largely converted to inactive metabolites, and only about 1/6 is available in active form. In order to be sufficiently active when given by mouth, testosterone derivatives are alkylated at the 1. This modification reduces the liver's ability to break down these compounds before they reach the systemic circulation. Testosterone can be administered parenterally, but it has more irregular prolonged absorption time and greater activity in muscle in enanthate, undecanoate, or cypionateester form. These derivatives are hydrolyzed to release free testosterone at the site of injection; absorption rate (and thus injection schedule) varies among different esters, but medical injections are normally done anywhere between semi- weekly to once every 1. A more frequent schedule may be desirable in order to maintain a more constant level of hormone in the system. In addition, because estered testosterone is dissolved in oil, intravenous injection has the potential to cause a dangerous embolism (clot) in the bloodstream. Transdermal patches (adhesive patches placed on the skin) may also be used to deliver a steady dose through the skin and into the bloodstream. Testosterone- containing creams and gels that are applied daily to the skin are also available, but absorption is inefficient (roughly 1. Individuals who are especially physically active and/or bathe often may not be good candidates, since the medication can be washed off and may take up to six hours to be fully absorbed. There is also the risk that an intimate partner or child may come in contact with the application site and inadvertently dose himself or herself; children and women are highly sensitive to testosterone and can suffer unintended masculinization and health effects, even from small doses. Injection is the most common method used by individuals administering AAS for non- medical purposes. Studies indicate that the anabolic properties of AAS are relatively similar despite the differences in pharmacokinetic principles such as first- pass metabolism. However, the orally available forms of AAS may cause liver damage in high doses. AAS were ranked 1. Long- term steroid abusers may develop symptoms of dependence and withdrawal on discontinuation of AAS. Recreational AAS use appears to be associated with a range of potentially prolonged psychiatric effects, including dependence syndromes, mood disorders, and progression to other forms of substance abuse, but the prevalence and severity of these various effects remains poorly understood. As a result, AAS users may get misdiagnosed by a psychiatrist not told about their habit.
Case reports describe both hypomania and mania, along with irritability, elation, recklessness, racing thoughts and feelings of power and invincibility that did not meet the criteria for mania/hypomania. Compared with individuals that did not use steroids, young adult males that used AAS reported greater involvement in violent behaviors even after controlling for the effects of key demographic variables, previous violent behavior, and polydrug use. The drug response was highly variable. However: 8. 4% of subjects exhibited minimal psychiatric effects, 1. The mechanism of these variable reactions could not be explained by demographic, psychological, laboratory, or physiological measures. There have been anecdotal reports of depression and suicide in teenage steroid users. A 1. 99. 2 review found that AAS may both relieve and cause depression, and that cessation or diminished use of AAS may also result in depression, but called for additional studies due to disparate data. Most of these side- effects are dose- dependent, the most common being elevated blood pressure, especially in those with pre- existing hypertension. For example, AAS may prematurely stop the lengthening of bones (premature epiphyseal fusion through increased levels of estrogen metabolites), resulting in stunted growth. Other effects include, but are not limited to, accelerated bone maturation, increased frequency and duration of erections, and premature sexual development. AAS use in adolescence is also correlated with poorer attitudes related to health. Development of breast tissue in males, a condition called gynecomastia (which is usually caused by high levels of circulating estradiol), may arise because of increased conversion of testosterone to estradiol by the enzyme aromatase. This side- effect is temporary; the size of the testicles usually returns to normal within a few weeks of discontinuing AAS use as normal production of sperm resumes. Alteration of fertility and ovarian cysts can also occur in females. The kidney damage in the bodybuilders has similarities to that seen in morbidly obese patients, but appears to be even more severe. Water- soluble peptide hormones cannot penetrate the fatty cell membrane and only indirectly affect the nucleus of target cells through their interaction with the cell’s surface receptors. However, as fat- soluble hormones, AAS are membrane- permeable and influence the nucleus of cells by direct action. The pharmacodynamic action of AAS begin when the exogenous hormone penetrates the membrane of the target cell and binds to an androgen receptor (AR) located in the cytoplasm of that cell. From there, the compound hormone- receptor diffuses into the nucleus, where it either alters the expression of genes. It has been hypothesized that this reduction in muscle breakdown may occur through AAS inhibiting the action of other steroid hormones called glucocorticoids that promote the breakdown of muscles. Through a number of mechanisms AAS stimulate the formation of muscle cells and hence cause an increase in the size of skeletal muscles, leading to increased strength. Depending on the length of use, the side effects of the steroid can be irreversible. Processes affected include pubertal growth, sebaceous gland oil production, and sexuality (especially in fetal development). Some examples of virilizing effects are growth of the clitoris in females and the penis in male children (the adult penis size does not change due to steroids. Men may develop an enlargement of breast tissue, known as gynecomastia, testicular atrophy, and a reduced sperm count. Compounds with a high ratio of androgenic to an anabolic effects are the drug of choice in androgen- replacement therapy (e. Determination of androgenic: anabolic ratio is typically performed in animal studies, which has led to the marketing of some compounds claimed to have anabolic activity with weak androgenic effects. This disassociation is less marked in humans, where all AAS have significant androgenic effects. The VP weight is an indicator of the androgenic effect, while the LA weight is an indicator of the anabolic effect. Two or more batches of rats are castrated and given no treatment and respectively some AAS of interest. The LA/VP ratio for an AAS is calculated as the ratio of LA/VP weight gains produced by the treatment with that compound using castrated but untreated rats as baseline: (LAc,t–LAc)/(VPc,t–VPc). The LA/VP weight gain ratio from rat experiments is not unitary for testosterone (typically 0. AAS, which have their androgenic: anabolic ratios scaled accordingly (as shown in the table above). Animal studies also found that fat mass was reduced, but most studies in humans failed to elucidate significant fat mass decrements. The effects on lean body mass have been shown to be dose- dependent. Both muscle hypertrophy and the formation of new muscle fibers have been observed. The hydration of lean mass remains unaffected by AAS use, although small increments of blood volume cannot be ruled out. After drug withdrawal, the effects fade away slowly, but may persist for more than 6–1. AAS use. Overall, the exercise where the most significant improvements were observed is the bench press. AR agonists are antigonadotropic – that is, they dose- dependently suppress gonadal testosterone production and hence reduce systemic testosterone concentrations. The 3 Body Types Explained. There are three general categories of Male & Female body types: Ectomorph, Mesomorph, and Endomorph. Many people think that “body type” just describes the way a person looks, but your body type can also provide information about how you respond to food intake and your hormonal and sympathetic nervous system (SNS) characteristics. These factors can be linked to metabolic differences between individuals, and influence how you respond to diet and training. Understanding your body type will help you to strategically & successfully plan your strength training and diet regiment, and once you establish your body type, you can adjust nutrient intake to maximize fitness composition and health related goals. Very few people fall perfectly into one of the three categories, and are often a mix of the 3 characteristics. Also, training along with good nutrition can completely change the appearance of one’s body. One important thing to remember is that regardless of your body type, composition, or overall health status, your ability to handle carbohydrate- dense foods is greatly improved during and after exercise, meaning that the best time to eat the majority of starchy/sugary foods is around the times that you’re physically active. Depending on your body type, your carb tolerance is different and your strategy should be different. Ectomorphs. Ectomorphs are skinny with a small frame, light build, small joints and lean muscle. Usually they have long thin limbs with stringy muscles, narrow shoulders with a fast metabolism making this body type the most resistant to weight gain. Ectomorphs are often able to overeat, while gaining little, to no extra weight, they tend to have little body fat, muscle and bone mass. Ecto’s need a large amount of calories to gain weight, and workouts should be short & intense focusing on big muscle groups. Supplements like Whey Protein are definitely recommended, and they should eat before bed to prevent muscle catabolism during the night (use casein protein). Generally, ectomorphs lose fat very easily so cutting back to lean muscle shouldn't be a problem. Ectomorph Traits. Small “delicate” frame and bone structure. Classic “hardgainer”Flat chest. Small shoulders. Thin. Lean muscle mass. Finds it hard to gain weight. Fast metabolism. Food Intake: Because Ectomorphs are at a disadvantage due to their thin body structure, they struggle to add size to their frame when attempting to achieve their dream physique, and it will take some hard work and dedication. Because of their fast metabolic rate and a high carbohydrate tolerance, they burn calories too efficiently, preventing them from putting on weight, so diet is especially important. With a High Carb Tolerance, you should be eating a greater percentage of high carb foods all throughout the day. Get more carbs during/post workout than any other time of the day. Carb timing should include some starchy, whole grain, unprocessed carbs that are eaten at every other meal, while veggies and/or fruits (3: 1 serving ratio) should be eaten at each meal. Stick to quality sources of protein and healthy fats, but the occasional cheeseburger or slice of pizza is not going to make an ectomorph fat. Also, ectomorphs should use High Calorie weight gainer shakes to help them build mass, so it's smart to invest in a weight gainer powder if you don't have time to cook or just need that extra calorie boost. Eat more, more frequently, aim for 6- 8 meals spread over the course of the day, and always eat breakfast! This should be your largest meal, consisting primarily of complex carbohydrates and protein. Cheat days using Junk food can be a useful tool to the ectomorph trying to put on size without worrying about body fat. With anything, there are rules to how you must employ junk food into your daily diet to aid in gaining size and not just satisfying your taste buds. The selection of junk food should contain adequate amounts of protein to meet your needs, and used during your cheat days. Training. Strength Training with limited Cardio is best for Ectomorphs, and it is recommend to use simple routines with heavy compound movements and minimal isolation movements per muscle group. Since strength training also burns calories. You can incorporate a shock technique day using supersets. Rest time should be kept between 2- 3 minutes as much as possible. Take at least 1 rest day in between the last lifting day, and the optional superset day. Mesomorphs. Mesomorphs have a medium sized bone structure, athletic body, and they typically have a considerable amount of lean mass. Mesomorphs tend to be testosterone and growth hormone dominant, which leads to a predisposition for muscle gain and the maintenance of a lower body fat. The Mesomorph form is the best body type for bodybuilding, and responds the best to weight training, and gains are usually seen very quickly, even for beginners. The downside to mesomorphs is they gain fat more easily than ectomorphs, so they must watch their calorie intake more closely. Because of this, it helps to use combination of weight training and cardio during workout routines. Mesomorph Traits. Athletic. Generally hard body. Well defined muscles. Rectangular shaped body. Strong. Gains muscle easily. Gains fat more easily than ectomorphs. Food Intake. Mesomorphs typically do best on a mixed diet, consisting of balanced carbohydrates, proteins, and fats, with a macronutrient split of 4. Always remember that even for the physically blessed mesomorphs, inadequate nutrition equals little gain at the gym. Low- fat proteins such as nonfat Greek yogurt, Kefir, eggs, poultry and seafood build strong muscles and encourage muscle growth. Complex carbohydrates such as spinach and other green vegetables, whole grain foods and low- sugar fruits provide the mesomorph with enough energy to make it through demanding workouts. High- fiber foods such as beans increase feelings of fullness, and these items can help to avoid sugary binges. Also, while most athletes find water adequate, mesomorphs who perform more intense workouts may require speedier electrolyte replenishment with sports drinks or Powerades, and I offer many easy, healthy, delicious recipes for these items here in my website. Mesomorphs also tend to have a moderate carb tolerance, meaning you should likely minimize high starchy/sugary carb foods outside the workout window, except after an overnight fast such as for breakfast. This means you’d try eating some higher carb/starchy carb foods in the morning, as well as during/post exercise. The rest of the meals would consist of less dense carb foods and more lean proteins, veggies, fruits, nuts and seeds. Training. Mesomorphs are naturally strong and respond quickly to exercise. Multiple weekly resistance training sessions using moderate to heavy weights with limited rest between sets, help mesomorphs build size. Do upper and lower body compound exercises using two to three sets of eight to 1. Endomorphs. Endomorphs have a larger bone structure with higher amounts of total body mass and fat mass, and this extra fat seems to resist most efforts to get rid of it. The endomorph body type is solid and generally soft, and gains fat very easily. Endo’s are usually a shorter build with thick arms & legs. Their muscles are strong, especially the upper legs, and are naturally strong in leg exercises like squatting. Football lineman and powerlifters are frequently classified as endomorphs. They also tend to be insulin dominant, leading to a greater propensity for energy storage, including both lean mass and fat mass, and also mean a lower carbohydrate tolerance. If your body isn’t instinctively telling you to get moving, you have to make sure that exercise is part of your daily routine. If your metabolism is sluggish, you need to eat the right foods that will fire up your metabolism. To put it plain as day, you need to bust your ass by exercising and eating right for your body type. Soft and round body. Gains muscle and fat very easily. Is generally short. Because they are not very carb tolerant, the best tactic is to avoid high carb/starchy carb foods outside the workout window (including breakfast). This means only proteins, fats, veggies and fruits outside the workout window. Also as we approach different stages in our lives, our hormones change and this can influence our body type. This includes stages such as puberty and menopause, as well as the male equivalent, andropause. Dense carb foods include whole grains like rice, whole grain breads, quinoa, amaranth, millet, corn, barley, dried fruits, yams, sweet potatoes, potatoes, recovery drinks, sugars, etc. Training. When it comes to training, endomorphs find it very easy to gain weight. Unfortunately, a large portion of this weight is fat and not muscle. To keep fat gain to a minimum, endomorphs must always train using cardio as well as weights. Endomorphic bodybuilders need to get their butts to the gym as often as they can without overtraining. Around four days of weight training throughout the week will ensure that the . Include cardio into each workout, and no matter if an endomorph is bulking or cutting, weight training should be the main focus. An increased amount of muscle mass will increase their base metabolic rate, decreasing their chances of storing/holding onto fat. Quick Reference Guide to Body Types.
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Placement of a urinary catheter early in the workup of a patient with ARF not only allows diagnosis and treatment of urethral and bladder outlet urinary obstruction but also allows for accurate measurement of urine output. If available, bedside ultrasonography can quickly identify a large and distended bladder. Routine use of urinary catheters should be tempered by consideration of the inherent risks of catheter- associated infections. Renal replacement therapy. The principal methods of renal replacement therapy (RRT) are intermittent hemodialysis (IHD), continuous venovenous hemodiafiltration (CVVHD), and peritoneal dialysis (PD). Each has advantages and limitations. IHD is widely available, has only moderate technical difficulty, and is the most efficient way of removing a volume or solute from the vascular compartment quickly. Unfortunately, dialysis- associated hypotension may adversely affect remaining renal function, particularly in patients who are hemodynamically unstable. This is one reason CVVHD is widely recommended in this setting. Continuous RRT techniques are more expensive, associated with increased bleeding risk, and not universally available; however, in addition to avoiding hypotension, they are believed to achieve better control of uremia and clearance of solute from the extravascular compartment. CVVHD may also preserve cerebral perfusion pressure more effectively. Although several studies have sought to directly compare CVVHD with IHD, no study has shown a convincing advantage of one therapy over the other. Peritoneal dialysis is inexpensive, widely available, and does not result in hypotension. However, it is not capable of removing large volumes of fluid or solute. Its use may be most common in children and in developing countries. Volume overload can be treated with nitrates and phlebotomy; hyperkalemia can be treated with calcium, insulin, glucose, bicarbonate, binding resins, and beta- agonists. Note that, in light of little evidence of effectiveness, the possible adverse effects of the ion- exchange resin, sodium polystyrene sulfonate, in sorbitol should be considered. There is emerging concern about use of this time- honored, but scientifically unproven, management of hyperkalemia. In a study of CVVH intensity in which patients with ARF were randomly given standard or supernormal levels of ultrafiltration, the patients with more intense RRT had significantly lower mortality rates. A second randomized trial compared daily IHD with traditional, every- other- day IHD in patients with ARF and found that the mortality rate (2. However, before these studies, no significant evidence indicated that increased dialysis dosage improved outcomes. Casalinga Foods - The Best Meal Delivery Service. Casalinga Food Services Inc. They are prepared daily, frozen and delivered to your home once a week. Just place in your freezer and take out for breakfast, lunch or dinner. 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The crudely- animated (originally by necessity, now by aesthetic design) series nominally following the lives of four foul- mouthed pre- teen boys living in the alternately depressing or bizarre Colorado town of the title has won awards, opened a hit movie, been nominated for an Oscar, and launched the show business careers of creators Trey Parker and Matt Stone; transforming them from Midwestern indie- film nobodies into in- demand Hollywood players whose musical The Book of Mormon remains one of Broadway’s hottest tickets. But as far as they’ve gone, South Park endures as a pet project that the idiosyncratic creators seem to view both as a kind of karmic burden (as suggested by episodes like “You’re Getting Old” and “Ass Burgers”) and a useful tool for venting their own personal cultural and political hangups to a mass audience. The series has proudly earned a reputation as a pop- culture agent- provocateur, eager to take mean- spirited swipes at almost any institution, idea or even individual person irrespective of political alignment or the potential for “collateral damage” – in some respects pre- figuring the directionless mayhem- for- mayhem’s sake chaos humor now practiced by denizens of web- cultures like 4chan and Reddit. It’s an approach made possible by the series’ accelerated production schedule, which allows Parker and Stone to add their in- the- moment takes on controversial topics to new episodes in a much more timely manner than any other pre- recorded TV series animated or otherwise. However, getting a “fresh take” also means getting a take without a lot of time or consideration spent on the broader implications of what’s being said – or whose ox is being gored. Combine that with the creators’ proudly- stated love of ticking off “both sides” of any given issue and it’s no surprise that, while the series has continued to produce strong episodes, the march of time and concurrent transformation of societal norms have transformed some of its most iconic moments from “shockingly funny” to awkward, uncomfortable or even downright hard to watch. With that in mind (and without any prejudice beyond reason to the “philosophy” of the material in question) here are fifteen infamous South Park moments that just don’t play like they used to. ROGER EBERT SHOULD LAY OFF THE FATTY FOODS (Season 2 – Episode 1. Here’s the thing about mercilessly mocking celebrities on your just- for- yuks cartoon show: If you run long enough, you’re going to end up dealing with having “knocked around” someone whose legacy changes dramatically after they pass away. That’s certainly the case with the late film critic Roger Ebert. While probably the world’s most famous movie critic apart from his partner Gene Siskel in life, Ebert’s profile was elevated from pop- culture novelty to giant of his field when he soldiered on after his body was ravaged by cancer. When he passed away, he became something like a Patron Saint of American film criticism – especially to the generation of younger writers who he mentored in his final years as support- writers for his popular website. All of which goes to make the title of “Roger Ebert Should Lay Off The Fatty Foods” read (fairly or not) as petty in a rather less humorous light than intended.
RAINFOREST SHMAINFOREST (Season 3 – Episode 1)A good rule of thumb for tracking the development of South Park storylines is that whatever the major issue of the day is, Trey Parker and Matt Stone will find a way for South Park to be on the other side of it – sometimes with the noble comedic intent of goading an audience to take a second look at even their positive biases, but much of the time because the pair seem to relish their “culturally unwelcome” (or at least as “unwelcome” as millionaire Broadway producers can be said to be) reputations. Rainforest Shmainforest” certainly felt like the later, even at the time: Ostensibly a riff on Parker’s dislike of a vacation to Costa Rica, the episode is mainly an indulgence in sniping South Park’s favorite target: People in the entertainment industry not named Trey Parker or Matt Stone, specifically environmental activists and the focus that community had placed on rainforest preservation throughout the 1. But while the episode itself remains amusing, viewers not around at the time are likely to be surprised to hear that rainforest activism – now widely accepted as a key aspect of mainstream climate science and biodiversity maintenance disciplines – was ever particularly controversial in the first place. JAKOVASAURS (Season 3 – Episode 4)One of the earliest enshrinings of Parker, Stone and South Park’s now- legendary comic prescience came at the expense of Star Wars: Episode Icharacter Jar- Jar Binks. Intuiting from the CGI- animated sidekick’s presence in the film’s trailer – specifically his delivery of the line “Issa people gonna die!?” – that audiences would end up hating Binks, the pair stuck an imitation of the line into the mouth of a background character in a similar scene in the South Park: Bigger, Longer & Uncut movie – making the feature- film spin- off feel downright cutting edge by spoofing The Phantom Menace’s unexpectedly negative reception earlier than almost anyone else. CHEF GOES NANNERS (Season 4 – Episode 7)At its best, South Park is a machine that skewers cultural taboos; and its absolute favorite is deflating the “Spielbergian Ideal” of childhood and children as the decent and innocent state of humanity as embraced by the Boomer and Gen- X generations as not only (in Parker and Stone’s view) false but the very engine that creates venal, destructive little creeps like Eric Cartman. But even they aren’t immune to “a small child shall lead them” storytelling, and that’s precisely how “Chef Goes Nanners” pays off: With a brewing race war over a proposal to retire South Park’s town flag (which depicts the lynching of a Black man by a white mob) thwarted by the realization that the wrongly presumed- racist boys were actually so “post- racial” in their outlook that the connotations of the flag never occurred to them. The story, obviously, was based on then- current controversies about retiring U. S. State and County flags that incorporated the Civil War- era Confederate Battle Flag. It’s one of the better uses of the series’ maxim that everyone in South Park is stupid – even the good guys – as a plot device. But while the question of what to do about State- backed Confederacy- nostalgia was largely viewed as a niche ideological debate at the turn of the Millennium, the issue has intensified in recent years and turned decidedly against the of “let’s calm down about this” resolution South Park (however irreverently) arrived at; to say nothing of the rather cringey- feeling “Being aware of racism made me the real racist!”. Today, the forcible dismantling of Confederate monuments is an increasingly widespread policy – and so are protests against such dismantling tinged with (real and often frightening) racist invective that’s a far cry from the “well meaning but dumb traditionalists” embodied by Jimbo and Ned in Nanners. Today, the forcible dismantling of Confederate monuments is an increasingly widespread policy – and so are protests against such dismantling tinged with (real and often frightening) racist invective that’s a far cry from the “well meaning but dumb traditionalists” embodied by Jimbo and Ned in “Nanners.” Obviously, it’s unreasonable to expect a 1. TV episode to have stayed “current” with 1. South Park classics. JARED HAS AIDES (Season 6 – Episode 1)There’s an old joke that the formula for comedy is “Tragedy + Time” – but sometimes it works in reverse. Jared Fogle was a guy who became famous by claiming that he owed a substantial weight loss achievement in part to eating regular meals at the Subway sandwich shop chain and subsequently got hired as the actual spokesman for the company. Cute wordplay, not a particularly memorable episode otherwise. Now, on the other hand, the episode just feels a hundred different kinds of uncomfortable given how much interaction the animated Jared spends around the South Park children: In 2. Jared (who did not sanction or provide a voice for the episode) plead guilty to possession of child pornography and having solicited minors for sex – and is now serving a 1. Not at all South Park’s “fault,” of course, but the fairly gentle (for South Park) goofing on someone who turned out to be a literal monster plays pretty awkward all the same; which is why it wasn’t too surprising when the “character” (who was also a celebrity cameo in the reference- packed 2. Season 1. 9. 1. 0. DEATH CAMP OF TOLERANCE (Season 6 – Episode 1. One could probably have put this whole list together with only Mr. Garrison- centric episodes. As South Park’s avatar of self- hating sexual repression, Garrison has been the frame on which Parker and Stone have hung their in- the- moment punching bag stand- ins for whatever the perceived “cause celebre” sexuality issue of the day happens to be: first a closeted gay man, then an out- and- proud gay man using his minority status to bully people, then a transgender woman doing much the same, now a stand- in for Donald Trump (we’ll get to that); pretty much every Garrison storyline comes pre- packaged with the expectation of uttering “wow – that was considered an acceptable characterization then?” at least once.“Death Camp of Tolerance” is considered one of the series’ turning- point moments, where the most common target of Parker and Stone’s ire was gradually switching from needling conservative bugbears to prodding the “sacred cows” of their largely progressive- leaning showbiz contemporaries – a move that served to (for a time) differentiate the irreverent series from their TV comedy peers, who had otherwise largely united around knocking the Bush Administration. 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Selector, it’s made tracking and monitoring very simple and interesting. Third Trimester . They can blink their eyes, which now sport lashes. And their wrinkled skin is starting to smooth out as they put on baby fat. They're also developing fingernails, toenails, and real hair (or at least some peach fuzz), and adding billions of neurons to their brain. Your blossoming baby will spend his or her final weeks in utero putting on weight. At full term, the average baby is more than 1. Prior Authorizations - Passport. Monday July 1. 0th,7: 3. Location: 7. 11 Scoop Brown Way; Lexington, KY 4. Saturday July 8th,8: 0. Location: Downtown Prestonsburg Park – Main Street; Prestonsburg, KY 4. Friday July 7th,6: 0. Location: 7. 20. 1 Outer Loop Highview Park; Louisville, KY 4. Babies weigh about 2 1/4 pounds by the start of the third trimester. They can blink their eyes, which now sport lashes. And their wrinkled skin is starting to smooth. Friday June 3. 0th,1. Location: 5. 25 Scott Street; Covington, KY 4. Wednesday June 2. General Contact Information. Mailing Information: Passport Health Plan 5100 Commerce Crossings Drive Louisville, KY 40229. Email You can contact us using our email form. Obamacare weight loss surgery guidelines require insurance companies to provide coverage for all individual, family and Small Group plans (plans with 50 or fewer full. Location: Waterfront Park; Louisville, KY 4. Tuesday June 2. 7th,3: 0. Location: 2. 00 E Broadway; Louisville, KY 4. Monday June 2. 6th,4: 0. Location: 3. 33 West Main Street; Springfield, KY 4. Saturday June 2. 4th,1. Location: 3. 01 York St., Louisville, KY 4. Saturday June 2. 4th,9: 0. Location: 1. 20. 0 Southwestern Plwy; Louisville, KY 4. Saturday June 2. 4th,1. Location: 9. 38 Morgantown Road; Bowling Green, KY 4. Monday June 1. 9th,1. Location: 1 Community College Drive; Hazard, KY 4. Monday June 1. 9th,5: 3. Location: 4. 12 1/2 Ashland Ave; Louisville, KY 4. Saturday June 1. 7th,9: 0. Location: 4. 01 E. Main Street; Louisville, KY 4. Saturday June 1. 7th,1. Location: 3. 8th and Market Street; Louisville, KY 4. Wednesday June 1. ARH is a not-for-profit healthcare system with hospitals, clinics, home health and other health services in Eastern Kentucky and Southern West Virginia. The Preferred Drug List is a medication list recommended to the Bureau for Medical Services by the Medicaid Pharmaceutical and Therapeutics (P & T) Committee and. Established in 1951, Dermatology Associates of Kentucky is one of the oldest, largest, and most comprehensive dermatologic practices in the United States. Valley Health provides primary and preventative health care including dental and optometry to southern West Virginia and Ohio. My child lost a baby tooth a year ago, and her permanent tooth still hasn't shown up. Is that normal? Location: 9. 69. B Cherokee Rd; Louisville, KY 4. Tuesday June 1. 3th,1. Location: 2. 26 Medical Plaza Lane; Whitesburg, KY 4. Saturday June 1. 0th,9: 0. Location: 2. 2nd Street; Louisville, KY 4. Saturday June 1. 0th,1. Location: Main Street; Winchester, KY 4. Saturday June 1. 0th,8: 0. Location: 1. 28. 0 Moores Mill Road; Midway, KY 4. Saturday June 1. 0th,1. Location: Bob Amos Park- 4. Bob Amos Drive; Pikeville, KY 4. Thursday June 8th,1. Location: 1. 14. 0 Cherokee Road; Louisville, KY 4. Tuesday June 6th,1. Location: 2. 01 E Main Street; Lebanon, KY 4. Monday June 5th,5: 0. Location: 9. 64 Clermont Road; Shepherdsville, KY 4. Monday June 5th,1. Location: 1. 13. 0 W Chestnut Street; Louisville, KY 4. Monday June 5th,1. Location: 1. 13. 0 W Chestnut Street; Louisville, KY 4. Sunday June 4th,2: 0. Location: East KY Expo Center- 1. Main Street; Pikeville, KY 4. Saturday June 3rd,5: 0. Location: 2. 07 Legends Lane; Lexington, KY 4. Saturday June 3rd,8: 3. Location: 4. 20. 1 Versailles Road; Lexington, KY 4. Friday June 2nd,9: 0. Location: Johnson County Senior Citizen Center; Paintsville, KY 4. Wednesday May 3. 1st,6: 0. Location: Waterfront Park; Louisville, KY 4. Wednesday May 3. 1st,9: 0. Location: 9. 40. 0 Mill Brook Road; Louisville, KY 4. Friday May 2. 6th,6: 0. Location: 7. 20. 1 Outer Loop Highview Park; Louisville, KY 4. Sunday May 2. 1st,1: 3. Location: 4. 20. 1 Versailles Road; Lexington, KY 4. Saturday May 2. 0th,1. Location: 1. 60. 0 Catherine Street; Louisville, KY 4. Saturday May 2. 0th,1. Location: Jefferson Mall, 4. Outer Loop; Louisville, KY 4. Saturday May 2. 0th,8: 0. Mercer Co. Fairgrounds “The Stable”; Harrodsburg, KY 4. Saturday May 2. 0th,9: 0. Location: 1. 01 R. Corman Drive; Nicholasville, KY 4. Friday May 1. 9th,9: 0. Location: 2. 80 W Jefferson Street; Louisville, KY 4. Thursday May 1. 8th,9: 0. Location: 9. 20 Blankenbaker Pkwy; Louisville, KY 4. Monday May 1. 5th,4: 0. Location: South Louisville Community Ministries, 4. Ashland Avenue; Louisville, KY 4. Saturday May 1. 3th,9: 3. Location: Waterfront Park; Louisville, KY 4. Saturday May 1. 3th,8: 0. Location: 4. 20. 1 Versailles Rd; Lexington, KY 4. Friday May 1. 2th,9: 0. Location: 3. 95 Paroguet Springs Dr.; Shepherdsville, KY 4. Friday May 1. 2th,9: 0. Location: 5. 17 Greenup Ave; Frankfort, KY 4. Friday May 1. 2th,8: 3. Location: 1. 95. 0 Newtown Pike; Lexington, KY 4. Thursday May 1. 1th,8: 3. Location: 1. 78. 6 Burlington Pike; Burlington, KY 4. Thursday May 4th,1: 0. Location: 1st Christian Church- Winchester Avenue; Ashland, KY 4. Friday April 2. 8th,6: 0. Location: 9. 09 Central Row Street; Erlanger, KY 4. Friday April 2. 8th,9: 0. Location: 7. 06 Park Avenue; Newport, KY 4. Friday April 2. 8th,8: 3. Location: Roy F. Collier Community Center- 3. East Main Street; Inez, KY 4. Friday April 2. 8th,9: 4. Location: 2. 23. 4 W Market St; Louisville, KY 4. Friday April 2. 8th,1. Location: 6. 50 Kennedy Rd. Lexington, KY 4. 05. Thursday April 2. Location: 5. 20 Taylorsville Road; Louisville, KY 4. Wednesday April 2. Location: Waterfront Park; Louisville, KY 4. Tuesday April 2. 5th,4: 0. Location: 1. 8 Elk Park Drive; Taylorsville, KY 4. Monday April 2. 4th,5: 0. Location: 1. 57 Bulldog Lane; Hazard, KY 4. Friday April 2. 1st,9: 0. Location: Morehead Conference Center- 1. East 1st Street; Morehead, KY 4. Friday April 2. 1st,4: 0. Location: 1. 01 W Main St; Richmond, KY 4. Friday April 2. 1st,9: 0. Location: 5. 00 Grandview Ave; Bellevue, KY 4. Thursday April 2. Location: 5. 20. 0 Morningside Way; Louisville, KY 4. Thursday April 2. Location: 9. 0 LBJ Road; Jackson, KY 4. Thursday April 2. Location: 1. 10 Reasor Avenue; Taylorsville, KY 4. Thursday April 2. Location: 8. 59. 6 KY- 1. Littcarr, KY 4. 18. Wednesday April 1. Location: 9. 72. 5 Dixie Highway Southwest Library; Louisville, KY 4. Tuesday April 1. 8th,4: 0. Location: 1. 00 Loop Road; Taylorsville, KY 4. Tuesday April 1. 8th,5: 0. Location: 8. 51. 0 Minors Lane; Louisville, KY 4. Monday April 1. 7th,1. Location: 5. 25 Scott Street; Covington, KY 4. Monday April 1. 7th,4: 0. Location: South Louisville Community Ministries, 4. Ashland Avenue; Louisville, KY 4. Saturday April 1. Location: Waterfront Park; Louisville, KY 4. Saturday April 1. Location: 4. 08. 9 Iron Works Pkwy; Lexington, KY 4. Friday April 1. 4th,1. Location: Magoffin County Community Center; Salyersville, KY 4. Thursday April 1. Location: 3. 95 Paroquet Springs; Shepherdsville, KY 4. Thursday April 1. Location: Floyd Ext Office; Prestonsburg, KY 4. Thursday April 1. Location: 1. 01. 8 South 7th Street; Louisville, KY 4. Wednesday April 1. Location: 1. 60. 5 Phelps Ave; Hopkinsville, KY 4. Wednesday April 1. Location: Paintsville Rec Center; Paintsville, KY 4. Tuesday April 1. 1th,5: 0. Location: 3. 50 Champion Way; Georgetown, KY 4. Tuesday April 1. 1th,5: 3. Location: 1. 81 Lees Valley Road; Shepherdsville, KY 4. Tuesday April 1. 1th,1. Location: Three Rivers Hospital; Louisa, KY 4. Monday April 1. 0th,1. Location: Morgan County Ext Office- 1. Prestonsburg Street; West Liberty, KY 4. Saturday April 8th,1. Location: Morehead State University Gym- 1. University Blvd; Morehead, KY 4. Saturday April 8th,1. Location: 3. 11. 4 US 4. Bedford, KY 4. 00. Saturday April 8th,1. Location: General Butler State Park 1. Kentucky 2. 27; Carrollton, KY 4. Friday April 7th,1. Location: General Butler State Park 1. Kentucky 2. 27 Carrollton, KY 4. Friday April 7th,9: 4. Location: 2. 23. 4 W Market Street; Louisville, KY 4. Friday April 7th,1. Location: 5. 00 West Gaulbert; Louisville, KY 4. Friday April 7th,1. Location: 2. 20. 45 Main Street #5. Hyden, KY 4. 17. 49. Saturday April 1st,9: 0. Location: 7. 15 Warsaw Road; Dry Ridge, KY 4. Saturday April 1st,1: 0. Location: 1. 15 Madison Street; Whitesburg, KY 4. Friday March 3. 1st,1. Location: Ashland Towncenter Mall- 5. Winchester Avenue; Ashland, KY 4. Wednesday March 2. Location: 1. 23. 7 Martin Luther King Jr. Paducah, KY 4. 20. Wednesday March 2. Location: 2. 51. 1 Tregaron Ave. Louisville, KY 4. Wednesday March 2. Location: 2. 22. 0 W. Market Street; Louisville, KY 4. Wednesday March 2. Location: 9. 40. 0 Mill Brook Road; Louisville, KY 4. Tuesday March 2. 8th,6: 0. Location: 3. 00 E. Third Street; Lexington, KY 4. Tuesday March 2. 8th,5: 3. Location: 5. 16 Madison Ave; Covington, KY 4. Monday March 2. 7th,6: 0. Location: 2. 18. 5 Versailles Road; Lexington, KY 4. Saturday March 2. Location: 3. 45 Thomas More Pkwy; Crestview Hills, KY 4. Friday March 2. 4th,9: 0. Location: Capital Plaza Hotel 4. Wilkinson Blvd; Frankfort, KY 4. Friday March 2. 4th,5: 0. Location: 2. 03 East Lexington Ave; Danville, KY 4. Thursday March 2. Location: Capital Plaza Hotel; 4. Wilkinson Blvd, Frankfort, KY 4. Wednesday March 2. Location: 3. 03 Conference Center Drive; Hopkinsville, KY 4. Tuesday March 2. 1st,6: 0. Location: 8. 03 US Hwy 6. East; Smithland, KY 4. Tuesday March 2. 1st,4: 0. Location: 9. 45 W Main Street; Mt. Vernon, KY 4. 04. Sunday March 1. 9th,4: 0. Location: South Louisville Community Ministries, 4. Ashland Avenue; Louisville, KY 4. Saturday March 1. Location: 4. 81. 0 Alben Barkley Drive; Paducah, KY 4. Thursday March 1. Location: 1. 95. 0 Newtown Pike; Lexington, KY 4. Thursday March 1. Location: 9. 70. 0 Bluegrass Parkway; Louisville, KY 4. Thursday March 1. Location: 3. 10 College Street; Barbourville, KY 4. Wednesday March 1. Location: HRMC- 5. KY RT 3. 21; Prestonsburg, KY 4. Tuesday March 1. 4th,5: 0. Location: 8. 20 Arnie Risen Blvd; Williamstown, KY 4. Tuesday March 1. 4th,8: 0. Location: 2. 00 West Broadway; Louisville, KY 4. Tuesday March 1. 4th,2: 0. Location: 5. 16 South 4th Street; Danville, KY 4. Saturday March 1. Location: 3. 95 Paroquet Springs; Shepherdsville, KY 4. Friday March 1. 0th,1. Location: St. Therese of Calcutta Church; 9. Fairdale Road, Louisville, KY 4. Thursday March 9th,5: 0. Location: 1. 70. 1 Rangeland Elementary, Rangeland Road; Louisville, KYTuesday March 7th,9: 0. Location: First Baptist Church; Sandy Hook, KY 4. Tuesday March 7th,8: 0. Location: 4. 43. 0 Sunset Ave; Paducah, KY 4. Tuesday March 7th,5: 0. Location: 3. 00 West John Fitch; Bardstown, KY 4. Tuesday March 7th,3: 3. Location: Bath Co. Community Health Resource Fair; 3. West Main Street; Owingsville, KY 4. Monday March 6th,6: 0. Location: 2. 74. 1 Benton Road; Paducah, KY 4. Saturday March 4th,9: 0. Location: 3. 04 S Main Street; Somerset, KY 4. Saturday March 4th,1. Location: East Ridge HS- 1. Lick Mountain Rd; Lick Creek, KY 4. Saturday March 4th,1. Location: 2. 02. 0 Frederica Street; Owensboro, KY 4. Friday March 3rd,9: 0. Location: 7. 90 Thomas More Pkwy; Edgewood, KY 4. Wednesday March 1st,6: 0. Location: 4. 13 Fairdale Road; Fairdale, KY 4. Monday February 2. Location: 5. 0 Paw Print Path; Warsaw, KY 4. Sunday February 2. Location: 6. 20 Lampton Street; Louisville, KY 4. Sunday February 2. Location: 4. 74. 2 Todds Rd. Lexington, KY 4. 05. Thursday February 2. Location: South Floyd High School- 2. Mt Raider Drive #1. Hi Hat, KY 4. 16. Thursday February 2. Location: 3. 42. 6 Wiswell Rd; Murray, KY 4. Wednesday February 2. Contrave (Weight Loss / Diet Pill) Information. Generic Name: bupropion and naltrexone (bue PRO pee on and nal TREX own)Brand Names: Contrave. What is Contrave? Contrave contains a combination of bupropion and naltrexone. Bupropion is an antidepressant medicine that can also decrease appetite. Naltrexone is usually given to block the effects of narcotics or alcohol in people with addiction problems. Naltrexone may also curb hunger and food cravings. Contrave is an anorexiant amd is used to help manage weight in obese or overweight adults with weight- related medical problems. This medicine is used together with diet and exercise. Contrave will not treat any weight- related medical condition, such as high blood pressure, diabetes, or high cholesterol. Contrave is not approved to treat depression or other psychiatric conditions, or to help you quit smoking. Important information. You should not use Contrave if you have uncontrolled high blood pressure, seizures, an eating disorder, opioid addiction, if you take narcotic medicine or other forms of bupropion, or if you have suddenly stopped using alcohol, seizure medication, or a sedative. Tell your doctor about all your current medicines and any you start or stop using. Many drugs can interact with bupropion and naltrexone, and some drugs should not be used together. Do not use Contrave if you are pregnant. Some young people have thoughts about suicide when first taking bupropion. Stay alert to changes in your mood or symptoms. Contour Light Body Sculpting ReviewsReport any new or worsening symptoms to your doctor. Do not take Contrave if you also take narcotic medicine or other forms of bupropion (such as Wellbutrin or Zyban), or if you are going through withdrawal from alcohol or drug addiction. Before taking this medicine. Do not use Contrave if you are pregnant. Weight loss during pregnancy can harm an unborn baby, even if you are overweight. Tell your doctor right away if you become pregnant during treatment. You should not use Contrave if you are allergic to bupropion or naltrexone, or if you have: untreated or uncontrolled high blood pressure; an eating disorder (anorexia or bulimia); a history of seizures; opioid addiction or withdrawal (or if you take methadone or buprenorphine); if you take other forms of bupropion (Wellbutrin, Aplenzin, Budeprion, Forfivo, Zyban, and others); orif you have suddenly stopped using alcohol, seizure medication, or a sedative such as Xanax, Valium, Fiorinal, Klonopin, and others). Do not use an MAO inhibitor within 1. Contrave. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine. To make sure Contrave is safe for you, tell your doctor if you have ever had: depression, bipolar disorder, or mental illness; suicidal thoughts or actions; a head injury; a tumor or infection in your brain or spinal cord; diabetes or low blood sugar; low sodium levels; liver or kidney disease; heart disease, high blood pressure, heart attack, or stroke; ordrug addiction, or if you normally drink a lot of alcohol.
Some young people have thoughts about suicide when first taking bupropion. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms. Bupropion and naltrexone can pass into breast milk and may harm a nursing baby. You should not breast- feed while using this medicine. Contrave is not approved for use by anyone younger than 1. How should I take Contrave? Take Contrave exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended. The Contour Weight Loss Center Program The program is not a diet: It is a lifestyle change designed to improve your health and help you shed those unwanted, unhealthy. Get rid of fat or cellulite painless method. Laser cellulite reduction and non surgical weight loss. Pain free, Non Surgical, body contouring. Surgical body contouring following major weight loss removes excess sagging fat and skin while improving the shape of the underlying support tissue. Contour Weight Loss Center Llc was founded in 2010, and is located at 16120 San Carlos Blvd # 5 in Fort Myers. It employs 2 employees and is generating approximately. Your $37 Includes: 1 x 30 Minute Weight Loss Consult; 1 x 20 Minute Contour Light Session ( also known as “Lipo Lights”) 1 x 10 Minute Whole Body Vibration Session. Do not crush, chew, or break the tablet. Swallow it whole. Do not take more than 2 tablets at once. Do not take Contrave with a high- fat meal, or you may be more likely to have a seizure. If you need to use narcotic medicine for any reason (such as pain, surgery, or treatment for drug addiction) you may need to stop taking Contrave for a short time. Follow your doctor's dosing instructions very carefully. Store Contrave at room temperature away from moisture and heat. If you have not lost at least 5% of your starting weight after 1. Contrave may not be right for you. Contrave dosing information. Usual Adult Dose of Contrave for Weight Loss: Initial dose: -Week 1: One tablet (8 mg naltrexone/9. Week 2: One tablet orally twice a day (once in the morning and once in the evening); then- Week 3: Two tablets orally in the morning and one tablet orally in the evening. Maintenance dose: Week 4 and onward: Two tablets orally twice a day (morning and evening)Maximum dose: Two tablets orally twice a day. Comments: -Discontinue therapy if a patient has not lost at least 5% of baseline body weight after 1. The effect of this drug on cardiovascular morbidity and mortality has not been established.- The safety and effectiveness of this drug in combination with other products intended for weight loss, including prescription drugs, over- the- counter drugs, and herbal preparations, have not been established. Use: An adjunct to a reduced- calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of: -3. See also: Dosage Information (in more detail)What happens if I miss a dose? Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. Do not take more than 4 tablets in 1 day. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1- 8. An overdose of this medicine can be fatal, especially if you also take a narcotic (opioid medicine). What should I avoid while taking Contrave? Follow your doctor's instructions about any restrictions on food, beverages, or activity. Do not take other weight- loss products or diet pills unless your doctor has told you to. Do not use narcotic medication, methadone, heroin, or other street drugs while you are taking Contrave. Doing so could result in dangerous effects, including coma and death. Drinking alcohol with Contrave may increase your risk of seizures. If you drink alcohol regularly, talk with your doctor before changing the amount you drink. Bupropion can also cause seizures in a regular drinker who suddenly stops drinking. Contrave side effects. Get emergency medical help if you have signs of an allergic reaction to Contrave: fever, swollen glands, mouth sores, muscle or joint pain; hives, rash or itching; chest pain, difficult breathing; swelling of your face, lips, tongue, or throat. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, severe drowsiness, or if you are hard to wake up. Stop taking this medicine and call your doctor right away if you have: a seizure (convulsions); blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights; changes in mood or behavior - anxiety, depression, panic attacks, trouble sleeping, agitation, thoughts about suicide or hurting yourself; a manic episode - racing thoughts, increased energy, unusual risk- taking behavior, extreme happiness, being irritable or talkative; liver problems - upper stomach pain, tiredness, dark urine, jaundice (yellowing of the skin or eyes); increased blood pressure - severe headache, blurred vision, pounding in your neck or ears, anxiety, nosebleed; orsevere skin reaction - fever, mouth or throat pain, burning eyes, skin pain, red or purple rash that spreads and causes blisters and peeling. Older adults may be more likely to have certain side effects. Common Contrave side effects may include: nausea, vomiting, diarrhea, constipation; headache, dizziness; dry mouth; orsleep problems (insomnia). This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1- 8. FDA- 1. 08. 8. See also: Side effects (in more detail)What other drugs will affect Contrave? When you start or stop taking Contrave, your doctor may need to adjust the doses of other medicines you take on a regular basis. Tell your doctor about all your current medicines and any you start or stop using. This includes prescription and over- the- counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide. More about Contrave (bupropion / naltrexone)Consumer resources. Professional resources. Related treatment guides. Where can I get more information? Your pharmacist can provide more information about Contrave. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Contrave only for the indication prescribed. Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Corset trunkplasty safely contours massive weight loss patients' bodies The corset trunkplasty (Corset Body Lift) is a body contouring procedure that can effectively address the redundant skin rolls in massive weight loss patients and significantly improve abdominal and waistline contours, all while limiting complications seen with other surgical approaches, says Alexander Moya, M. D. Moya, director of Geisinger's Center for Aesthetics and Cosmetic Surgery and Weight Loss Body Contouring Program, Danville, Pa. It was then modified to the circumferential belt lipectomy to address weight- loss patients more effectively. Good contouring results can be difficult to achieve in those who do not fit the ideal patient model of the commonly performed belt lipectomy, he explains. In many women, the procedure will result in the lack of an aesthetically pleasing waistline. An alternative option, Dr. Moya developed the corset trunkplasty technique, which can be used on a wider range of patients. This includes the ideal to the more complex patient with multiple skin rolls, and it works regardless of an individual's overall body size or amount of excess skin. Most female patients who undergo the procedure end up with the corset trunkplasty sought- after hourglass figure, Dr. HOW IT'S DONE The corset trunkplasty is performed entirely in the supine position and utilizes a standardized approach to determine the vertical abdominal resection (removal of the horizontal skin redundancy). Moya says this is key to the procedure. All preoperative markings are performed in the supine position once the patient is prepped and draped and include the vertical midline (extending from xiphoid down to the pubis), lower chest (extending from side- to- side, following the inframammary folds in women) and pubic reference lines. Moya, the vertical resection is determined in a very routine manner utilizing a simple tailor- tacking technique. This allows for maximum skin removal while guaranteeing closure of the defect without undermining. The horizontal skin redundancy extending from the lower chest to flanks is pulled tightly together towards the midline, inverted, and temporarily stapled. In this way, Dr. Moya can more accurately assess how much skin can be removed from the chest down to the pubis, he explains. The stapled skin is then marked and released. The marked areas are connected to one another on each side and to the top and bottom of the preoperative midline marking to form a vertical ellipse shape. This redundant skin pattern is directly resected off the underlying muscular fascia, temporarily resulting in a large defect that will often encompass the entire abdominal wall. Any ensuing abdominal wall plication can then be easily performed due to the extent of exposure, Dr. This step not only enhances overall contour, but also facilitates primary closure without undermining by reducing the size of the vertical defect, he explains. This aggressive resection of horizontal skin redundancy followed by simple primary closure provides the greatest improvement in abdominal and waistline shape while limiting wound complications. Moya performs two transverse incisions — one at the lower chest (which extends from the midline onto the upper back, depending on the amount of redundant lateral chest/upper back skin to be removed) and the other at the level of the pubis (which can extend from the midline onto the lower back, depending on the amount of redundant hip/lower back skin to be removed). While the midline incision has the greatest impact on reducing the size of the waist, the lower chest and pubic (lower trunk) incisions enhance the upper waistline contour and the lower waistline contour, respectively. This gives the technique great versatility, Dr. For example, one can limit the procedure by utilizing short incisions for removing the upper and lower midline . However, because the corset trunkplasty does not require undermining along the midline closure, complications are limited and are less than other techniques that require extensive undermining. Though the corset trunkplasty initially utilized drains, he has since improved the technique with the use of ultrasonic (Harmonic ultrasonic scalpel and shear, Ethicon Endo- Surgery) technology to minimize surrounding tissue damage and seal lymphatic channels as well as bidirectional barbed sutures (Quill Knotless Tissue- Closure Device, Angiotech) for tighter and motion- free closures, he explains. I have experienced no seromas in my last 8. POTENTIAL COMPLICATIONS Over the past six years and nearly 1. Dr. Moya has performed the corset trunkplasty, he has experienced a 3. The majority of these complications were very minor, including superficial wound dehiscence and small areas of skin necrosis, both requiring local care only, he says. As the surgical technique averages around four to five feet of incisions, Dr. Moya says he believes that these minor complications may be considered negligible when compared to such large resections. We have always been taught to limit scars or hide them if we can to get the best of both worlds with regards to contouring results. I have discovered that they will look beyond scars for a significant improvement in body shape, and the best way to achieve that is to perform a procedure that utilizes a vertical resection to address the complexity of skin redundancy. That's where the corset trunkplasty fits in. Moya is a consultant for Ethicon Endo- Surgery and Angiotech Pharmaceuticals. Because 90 percent of a watermelon’s weight is water, it’s one of the best fruits to eat if you’re trying to lose weight. A 100-gram serving contains only 30. The more wastes that are stored up in the body the more unnecessary weight you carry around, plus the toxicity of these wastes leads to a slow down of your body’s. Does Eating Salmon Help You Lose Weight? Salmon definitely deserves a place on your weight- loss menu. It won’t help you lose weight unless it’s just one part of a reduced- calorie diet supported by regular exercise, but salmon does have some qualities that can help you lose extra pounds. Its nutrient- dense calories are easy to work into your daily goals, and it’s packed with protein. As an extra benefit, salmon’s omega- 3 fatty acids may help increase weight loss. The challenge of cutting calories - - beyond discipline and fending off hunger - - comes from getting all the nutrients you need while reducing caloric intake. This is where salmon really shines as part of a weight- loss plan. You can enjoy a 3- ounce serving of coho or sockeye salmon for only 1. They’re also rich sources of niacin, vitamin B- 6, vitamin B- 1. Both types of salmon are sources of vitamin D, which is not naturally found in most foods. A 3- ounce serving of coho provides 6. D. You'll get 7. 5 percent of the RDA from a serving of sockeye salmon. Protein can help you lose weight because it makes you feel full longer. It also does not spike blood sugar, which is inevitably followed by a drop in blood sugar that stimulates hunger, according to the Harvard School of Public Health. A 3- ounce serving of sockeye or coho salmon supplies about 4. Coho and sockeye qualify as lean protein because they only have 4 grams and 6 grams of total fat, respectively. The fish oil you’ll get from eating salmon may boost your weight loss. In one study, young, overweight men who ate fish or took fish oil supplements lost 2 more pounds over four weeks than participants who did not consume fish, according to a study in the October 2. International Journal of Obesity.” Fish oil and exercise independently reduce body fat, but when omega- 3 fatty acids are used together with exercise, you may lose more weight than exercise alone, concluded researchers in an article in the “American Journal of Clinical Nutrition” in May 2. Sockeye and coho salmon each have about 1 gram of omega- 3 fatty acids in a 3- ounce serving. The Natural Resources Defense Council reports that you can freely eat fresh salmon because it’s low in mercury. But farmed salmon has a higher chance of being contaminated with polychlorinated biphenyls, which may cause developmental problems in children, cancer and liver damage. PCBs don’t degrade in the environment and end up in rivers and lakes where salmon are farmed. They accumulate in fatty tissues in the fish, so these tips from the Oregon Health Authority can lower your potential consumption of PCBs: Throw away all organs, remove all skin, cut away the dark fat along the backbone and discard all belly fat along the bottom of the salmon. Bake or broil the fish on a rack or grill to eliminate drippings. When the winter months roll around, and all the holiday decadence finally fizzles out, you may want to hunker down, purge your pantry, and clean up your eating habits. How to Lose Weight Naturally. Naturally losing weight is a healthy and safe method of weight loss. It generally involves making small tweaks to your diet, exercise. Do you want to learn how to lose weight fast? If so, check out these 49 secrets to boost your metabolism and achieve rapid fat loss. The Promise. The grapefruit diet has outlasted most fad diets. People were even trying it back in the 1930s. Its fans claim that grapefruit contains certain enzymes. Carve out time to prepare your lunch. Not only will making your own lunch help you save money, it'll ensure you know exactly what you're putting into your body and. The New Grapefruit Diet Review. The old 'miracle' grapefruit diet has been dismissed as a fad. But eating grapefruit as part of a healthy, balanced diet. Remember the Grapefruit Diet from way back that had us eating the citrus fruit at breakfast, lunch, and dinner? New research shows grapefruit is actua. Bodybuilding legend Lee Labrada shows you how to use a low carb diet to burn fat without losing muscle. Intermittent fasting diet for fat loss, muscle gain and health. Articles, research, diet advice, and free guides from IF-expert, Martin Berkhan. I decided to write this article outlining how much to eat to gain muscle but without gaining fat because it can be a little tricky. Right away, I’ll just say this. Tom Venuto\'s Burn The Fat Blog. When you pause and reflect on the past year as you look ahead to a new one, it really makes you think. It makes you appreciate how short life is, how valuable time is and how quickly the time can pass you by – with nothing to show for it, if you don’t plan otherwise. That’s why the passing of another year can sometimes feel like a wake up call as much as a fresh start. Here’s a fact: if you want to GAIN WEIGHT, then you should get on the treadmill. Most people believe that the key to losing fat and getting in shape is to spend. Workout To Lose Fat & Gain Muscle In 3. Days. Welcome to the site .. Unfortunately, it’s quite rare that I come across one actually works for me. It can be extremely difficult to lose fat and gain muscle at the same time because these are basically complete opposites. In order to lose fat you need to focus on a calorie deficit. In order to gain muscle you need to make sure you’re taking in a surplus of calories. Do you see where this is going? Guess what happens if you try to do both at the same time — you stay right where you are! In the past I have had some good success in doing a bulking up workout and diet plan for 3 weeks. For the first week I would concentrate on a low calorie diet while performing 3- 4 strength training and HIIT sessions. After that first week I would move straight into the bulking phase while eating a surplus of calories and training hard for 2 weeks. This can work well for gaining mass. In fact, this 3. 0 day, lose fat gain muscle workout is based off of a similar idea but I like it even better! Before we get too far I think I better put up a disclaimer. I’m going to use the term “at the same time” a little loosely here. The truth is yes, you can lose fat and gain muscle at the same time but your “gains” and/or “loses” are not going to be nearly as significant as if you were focusing all of your effort on just one goal. The problem with that is there are many out there who need to do both. By committing to this 3. Of course, you can follow this approach for longer if you need, but it’s a bit chaotic. How You Can Lose Fat And Gain Muscle. How to Burn Fat and Build Muscle. People all across the world try countless diets and workout plans, only to find that they never get the results they are looking for. A big problem with the traditional bulk/cut phase is that you pack on too much body fat and you don’t look all that great as you go through the stages. Your skin is either lagging behind during the cutting phases or your fat levels are too high during the bulking phases. You never really look good until you are completely done and at your goal weight for some time. Since you will most- likely be spinning your wheels if you try to lose fat while at the same time gain muscle, here is a workout and diet plan to get the best results in 3. What makes this plan work is that you are not going to dilute your efforts in an attempt to accomplish both goals in the same workout, same day or even in the same week. To make the quickest gains (and losses) in the least amount of time, you’ll be 1. The workout and diet plan will consist of 5 days of losing fat alternated with 5 days of gaining muscle. Days 1- 5 = Lose Fat. Days 6- 1. 0 = Gain Muscle. Days 1. 1- 1. 5 = Lose Fat. Days 1. 6- 2. 0= Gain Muscle. Days 2. 1- 2. 5 = Lose Fat. Days 2. 6- 3. 0 = Gain Muscle. This may seem like a hectic schedule but that is actually one of the factors that makes this so effective. Have you ever noticed that after not working out or watching your diet for a long period of time and then moving straight into a hardcore & focused program you get great results fast? That is because your body is in shock. By continually alternating your focus every 5 days you eliminate the body’s ability to adapt to one program. This is what makes both the gains and the losses as great as possible. Yes, you could focus on a muscle gain phase for 2 weeks and then switch it up to a fat loss phase for the next 2 weeks and get good results. But, you’ll get even better results in the same amount of time by changing it up even more. The Diet & Workout To Lose Fat. During the fat loss stage, diet is very important. In the end, you want to create a calorie deficit with your diet and compliment that with your exercise. I have found a few diets that work for me, but as long as you focus on eating quality foods and watch your proportions you should be fine. Second to making sure that your diet is in check is the actual workout you’ll be doing. I recommend the following strength training routine during this phase. Generally, these are the types of workouts that create the greatest muscle definition. The “lose fat phase” workout. Day 1 – Chest / Back / Cardio. Day 2 – Arms / Shoulders / Abs / Cardio. Day 3 – Cardio. Day 4 – Chest / Back / Arms / Shoulders / Cardio. Day 5 – Rest. Each of these workouts should contain 2 different exercises for each muscle group. You should do 4- 5 sets of 4- 5 reps for each exercise and rest for 1- 2 minutes between each set. These are going to be fairly brief workouts in which you will follow the resistance training above with an HIIT cardio session like I describe in another article about high intensity interval training. You should also do HIIT for day 3. The Diet & Workout To Gain Muscle. As with the fat loss stage, during the muscle gain stage, diet is very important. On the opposite end of the spectrum though, these 5 days you need to eat quite a bit of food. Really! This is not a green light to stuff your face with anything and everything you see, but you do not need to be overly concerned about what you are eating. Obviously, candy, potato chips, french fries and so on should not make up a large (or even medium or small) percentage of your diet, but you can get away with enjoying them sporadically. Focus on lean meats, quality carbs, fruits and a lot of vegetables. Perhaps even more important than diet in this phase is the workout. In order to transfer your lose fat gain muscle plan from the lose fat stage to the gain muscle stage you need to eat and lift differently. Here is a solid approach to pack on quality muscle mass during this phase. The “gain muscle phase” workout. Day 1 – Chest / Triceps / Shoulders. Day 2 – Back / Biceps / Abs. Day 3 – Cardio (HIIT)Day 4 – Chest / Triceps / Back / Biceps / Legs. Day 5 – Rest. Each of these workouts should also contain 2 exercises for each muscle group. To gain muscle, you need to do a higher volume of reps than when training for definition. I like to do 4- 5 sets of 1. I would categorize “legs” as an optional muscle group to work. Since you’re doing quite a bit of HIIT you want to be careful to avoid over- training them. Normally I wouldn’t even suggest doing direct leg work if you’re incorporating HIIT into your routine but when it comes to gaining muscle weight, legs are a great place to pack on the pounds. Wrapping This Up. In the end I feel that this is one of the better lose fat gain muscle workout plans out there. I’m not going to say that I think you’ll gain more muscle or lose more fat than by focusing on just one aspect, but when it comes to a 3. Generally, I recommend separating out your training into different phases like this Visual Impact Muscle Building review outlines. This program does a great job at focusing on building muscle mass (phase 1), still adding size but also density to the muscle (phase 2), and then really sharpening the muscle (phase 3). Overall, that’s going to bring you better results but it does take a while longer to achieve. I’m all about giving credit where credit is due, so I’d just like to say that I did get the “5 day” concept from one of Nick Nilsson’s e. Books . He’s got quite a few good books out and he really thinks out- of- the- box. This lose fat gain muscle approach is a bit of an overview on a concept, but the main idea and basis for this plan is what really stands out to me. By alternating every 5 days for 3. For a good workout routine to build muscle, checkout my bulking up workout routine that you can integrate into this 5 days on / 5 days off workout. In the bulking up routine I recommended 8 sets of 5 reps but you can use those exercises and apply the 5 sets of 1. I outlined here. Either way you’ll be able to build muscle. The 8 sets of 5 reps is more geared towards building a little more solid muscle but not quite as large of muscles. The Fidget Spinner Is Google's Latest Easter Egg Distraction. I wasn’t above squeezing an occasional round of Doom in between study sessions in college, and am certainly not shy about catching some Pok. They just added a new one. It rhymes with “digit sinner.”Fidget Spinner. The latest edition to Google’s list of Easter eggs is the iconic fidget spinner, now digitized for your perpetually spinning pleasure. Searching for “spinner” and clicking the toy makes it spin in your browser window; you can spin it with your finger on your smartphone, too. There’s also the option to change the fidget spinner to a numerical spinning wheel if you need a random number from one to twenty. You can’t modify any colors, but then again if it were any more interactive you’d probably waste even more time. Tic- Tac- Toe. Enter “tic tac toe” for Google’s take on the two- person board game. You can futz with the three difficulty settings and, if you’re sitting next to an equally unproductive coworker, compete against them on the same machine in two- player mode. Pac- man. Appearing as a Google doodle in 2. Pac- man” will bring up a playable version of the game in your browser. Instead of the traditional layout of pac- man games past, the field of play spells out, of course, Google. Aprenda como conseguir a segunda via do seu Pis PASEP. Passo a Passo detalhado. Ben Skywalker was a Human male Jedi Knight from Coruscant, active mostly during the Second Galactic Civil War and the period afterward. He was the son of former. Sound 1 (sound) n. Vibrations transmitted through an elastic solid or a liquid or gas, with frequencies in the approximate range of 20 to 20,000 hertz, capable. Chest Exercises Get the chest you want with these upper-body workouts and tips. Area associati è uno studio di architetti di Montevarchi (AR). Un gruppo di professionisti al servizio della clientela nei lavori di tipo edile e civile. I wasn’t above squeezing an occasional round of Doom in between study sessions in college, and am certainly not shy about catching some Pokémon if any are lurking. Certainly you're graduation dresses going to need to be started up evening dresses for doing this, Despite maxi dresses the fact that Faldo's laying was probably to. A vitamin is an organic compound and a vital nutrient that an organism requires in limited amounts. An organic chemical compound (or related set of compounds) is. Solitaire. I’m not exactly sure how Microsoft doesn’t have a patent on every implementation of the classic card game solitaire, but Google’s version (search for “solitaire,” of course) offers two difficulty settings as well as a timer, score, and number of moves made. In common usage, the word "human" generally refers to the only extant species of the genus Homo—anatomically and behaviorally modern Homo sapiens. Edit Article wiki How to Get Fit As a Teenager. Teen and preteen years are the years where you will do most of your growing, so in order to grow into a healthy adult. |
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