aesthetics or pleasure? think of fast and tight female pussy spasms as fun, why aren’t hiccups during sex a sexy idea? if dry anal is more fun and friction-full for the giver but also a pain in the ass for the hiccuped-receiver, why aren’t analgesics a sexy idea? if analgesia is conscious anaesthesia, why aren’t ludes over lubes the key to anal paresthesia? what makes an idea sexy? aesthetics or pleasure? which you choose? can you pleaz be honest?

http://www.thinkaloo.com

Fruit seeds (Cyanide)

What are they found in? Apple seeds, cherry stones, and the kernels inside the pits of apricots, nectarines, peaches, and plums.

Why are they poisonous? The American Medical Association (AMA)’s Handbook of Poisonous and Injurious Plants states that eating a large quantity of apple seeds (and other seeds) can be fatal due to the presence of the toxin cyanogenic glycoside, or cyanide. The exact lethal dose is unknown, although swallowing the seeds of a single apple is generally harmless for an adult. Children are more vulnerable: 15 apricot kernels are sufficient to kill them.

What are the symptoms? Excessive sweating, abdominal pain, vomiting, and lethargy. In severe cases, convulsions, incontinence, coma, and even death.

How to avoid them: Avoid eating any fruit seeds or kernels. If you are juicing or baking apples, remove the core first.

Pufferfish (Tetrodotoxin)
What are they found in? Fish that are members of the Tetraodontiformes order, particularly pufferfish. Although not commonly consumed by humans, toadfish, parrotfish, angelfish, and xanthid crabs can cause the same type of poisoning.

Why are they poisonous? Although the flesh of pufferfish may not be dangerous, their liver, intestines, skin, and gonads can cause a more violent poisoning than any other marine species. This is due to the high levels of the poison tetrodotoxin contained in these organs.

What are the symptoms? Pufferfish poisoning can cause paresthesia (a numbing, burning, tingling, or crawling sensation on the skin), paralysis, convulsions, and death within 4 to 6 hours.

How to avoid them: Although pufferfish is generally not allowed into the United States, be careful if you happen to be fishing in the Indo-Pacific ocean regions, the Atlantic Ocean, the Gulf of Mexico, and the Gulf of California. If you are in Japan, avoid the delicacy known as fugu , which is pufferfish from which the viscera has been removed to reduce risks of poisoning.

Mushrooms & fungi (Mycotoxins)
What are they found in? Poisonous mushrooms, as well as mold on corn, peanuts, barley, wheat, oats, and beans.

Why are they poisonous? Poisonous mycotoxins are naturally present in poisonous mushrooms and can be produced by molds on many types of cereals, nuts and grains.

What are the symptoms? Different types of poisonous mushrooms can cause a variety of symptoms including hallucinations, profuse sweating, vomiting, abdominal cramping, convulsions, coma, and even death. Mycotoxins produced by molds can also cause a wide range of afflictions, including esophageal and liver cancer, loss of appetite, diarrhea, inhibition of immune system, and death.

How to avoid them: Never eat wild mushrooms you aren’t absolutely certain are safe. Buy grains and nuts from a reliable source, store them in a cool, dry place, and don’t keep them for more than a few months.

Histamines (Scombrotoxin)
What are they found in? All foods that contain high levels of histamines, like Swiss cheese or certain types of spoiled foods such as fish, particularly tuna or mahi mahi.

Why are they poisonous? Scombroid (or histamine) poisoning occurs when foods that contain high levels of histamine are ingested. You may have heard of histamine in relation to allergies. In fact, histamine is an amine that is released by our immune system when we have an allergic reaction, and which dilates blood vessels and stimulates gastric secretions. Histamine is formed by the growth of certain bacteria and their interactions with amino acids in food. This can occur during the spoilage of foods like fish or the production of foods such as Swiss cheese.

What are the symptoms? Tingling or burning feeling in the mouth, drop in blood pressure, appearance of a rash on the upper body, itching, headache, as well as possible nausea, vomiting, and diarrhea.

What are the symptoms? It is one of the most common types of fish poisoning in the United States, but you can get scombroid poisoning from a wide range of foods.

How to avoid them: There is not much you can do to avoid it besides steering clear of the most common culprits, namely tuna, mahi mahi, sardines, mackerel, and Swiss cheese.

Marine finfish (Ciguatera)
What are they found in? Subtropical and tropical marine finfish, such as barracudas, groupers, mackerel, snappers, jacks, triggerfish, and many other species of warm-water fishes.

Why are they poisonous? Not all these fish are poisonous, but those who have consumed naturally-occurring toxins found in many dinoflagellate (algae) species can cause what is known as ciguatera (pronounced see-gua-terra) fish poisoning.

What are the symptoms? Symptoms include a variety of gastrointestinal, cardiovascular and neurological disorders. A few examples are paresthesia (numbness and tingling of skin), nausea, vomiting, diarrhea, headache, increased sensitivity to extreme temperatures, arrhythmia, and reduced blood pressure.

How to avoid them: Only buy these types of fish from reliable sources.

-www.askmen.com-

Dr. Grohol interviewed Dr. Phil Ninan, Wyeth’s VP of Medical Affairs on Pristiq, its efficacy, and surrounding issues. It was quite an interesting interview (and long) but here are some highlights that I chose to comment on. I’ll be making some comments in between Dr. Ninan’s answers due to the extensive length. Some parts of the answers have been truncated.

Dr. Grohol: There’s been more talk in recent years about greater concerns about withdrawal syndrome. And so I was wondering what the research has shown what the withdrawal profile on Pristiq looks like compared to other drugs in its class.

Dr. Ninan: First of all, I think, one should distinguish what is a withdrawal syndrome from what we would call discontinuation symptoms. Withdrawal is traditionally associated with medicines that one has got physiologically dependent on. And there is a whole set of not only symptoms, but physiological changes that occur that can be potentially dangerous.

You see that with alcohol, you see that with benzodiapams, the anti-anxiety and sleep medications that can cause physiological dependence. …

We should distinguish that from discontinuation symptoms, where those medical risks are not present. And these are not medicines that you become physiologically dependent on, but you can get adaptive changes that have occurred, that then the body and the brain needs to readapt to not having those medications onboard.

And you see this with blood pressure medications where if you suddenly stop certain blood pressure medications you can get a rebound increase in blood pressure that is very transient. …

So, what we have here are discontinuation symptoms that have been reported with antidepressant medications that get out of the system very quickly. And most medicines that get out the quickest are more likely to have discontinuation symptoms, because the brain is not having a chance to adapt to not having that medication occupy the receptors in the brain.

And the longer you’re on the medication, the more the adaptation has taken place, and therefore the more likely you are to have the discontinuation symptoms. So, we know that there were medicines that were the biggest culprits in terms of having discontinuation symptoms. Effexor was one. Paxil is the other.

Perhaps things are different in the medical field. Patients seem to view discontinuation symptoms and withdrawal syndrome as one and the same. Dr. Ninan is arguing semantics to me.

So, patients who are coming off Effexor and Paxil have described various words like “brain shivers” and things like that, which we consider to be under a term called paresthesia, which are physical symptoms that you might be having within your body. And you can also have associated anxiety depressive symptoms.

I’m not wholly familiar with paresthesia but if this definition in Wikipedia is correct, “brain shivers” doesn’t fall under this term. There’s no citation for this on Wikipedia, but I agree with this statement:

Paresthesia and “electric shock sensations” are clinical terms used to describe this symptom, though paresthesia by definition is clinically incorrect.

Now unfortunately, the scales that we use to measure these are not very good. Because what we find is that anywhere from 20 to 30 percent of patients who are on placebo are also demonstrating some of these symptoms. …

20 to 30 percent? For real? On placebo?

And so we would recommend clinically that if a patient is planning to stop the medication, they should do it under medical supervision so that they’re being guided about what are the mechanisms that you can use to reduce the discontinuation symptoms, so that they don’t cause excessive distress, and they can be managed medically.

It’s worth noting that even with medical management, discontinuation and/or withdrawal symptoms (whatever you want to call it) can still persist at a severe rate based on the individual.

Dr. Ninan: That again is a very good question, and let me just give you a little bit of background. One, when we look at the rating scales. So, for example, we look at the item of suicidality that might be in the Hamilton Depression or the Montgomery-Asberg Depression Rating Scale, we see significant improvements in those groups over the group that got placebo.

I don’t know much about depression rating scales but I know that I am skeptical of them. If you’d like to see examples of how it’s possible manipulate them, check out a bunch of these posts from Clinical Psychiatry & Psychology.

What happened in 2004 was the FDA looked at this issue beyond just these rating scales, and looked at what caused suicidal behaviors. And this is where the details become really relevant. So, you might have somebody who has taken the pill in the morning, doesn’t realize that they’ve taken it, and then therefore they go back and take the pill again later in the day. Some charts would code that as an overdose, even though there was no intent to harm themselves.

Manipulation #1. Especially if this is coded under placebo and not under the actual drug. Remember, it’s “some charts,” not all.

There were situations where somebody would get frustrated and bang their head against the wall. And that was coded as being a suicidal gesture versus somebody who had a very serious intent to harm themselves, and actually completed suicide.

Manipulation #2. Banging a head against the wall? Isn’t this a little far-fetched for a depression scale?

So, what the FDA did to try and balance this out… And so we have this variability when we have 30 or 40 sites that are assessing patients coming into studies. You can see a wide variety of things that are put into the case report form. And so what the FDA did was they came up with a comprehensive list of words that might be associated with suicidality.

And then if those words came in a case report form, then narratives of that event was written up. And then blindly, three raters would rate those on a scale that was agreed on by the FDA to decide whether a suicidal attempt had been made, what was the intent of that, how serious was it, and those kinds of issues.

And the idea of having three raters was: you would start with two and if there was a disagreement then the third one, his or her work, would be the one that would be made to use to make a decision like that. So, that technique, and the rating is done at Columbia University. …

Thank God the FDA stepped in and provided oversight on this problematic issue.

There is a greater number in the people who are treated with Prestiq (sic) compared to placebo. And we don’t know how exactly to code some of what has been termed suicidality, so I can’t give you exact numbers. …

I should also, to completely transcend, we did have one patient who did commit suicide, who completed suicide. That patient had been randomized to Pristiq and completed suicide about four or five days after they had been randomized. But, it’s not clear whether that person took even a single dose of Pristiq. And that was part of the information that we gave to the FDA.

I’m glad it was reported. I hope any post-marketing adverse events that may come as a result of Pristiq are also reported to Wyeth and the FDA.

The Internet is so convenient, so easy but yet it is so dangerous.

It came to light in Singapore that a man and a woman in their early 20s had suffered symptoms of psychosis such as hearing of voices, hallucinations, confusion and thyrotoxic symptoms such as anxiety and increased heart rate after using a product named Relacore, a product they bought over the Internet.

So what is wrong with this anti-’belly fat and stress control’ dietary supplement?

This product was not declared to have included a Western drug, a potent substance known as Sibutramine. Sibutramine is a prescription drug marketed under trade names such as Meridia in the USA, Leptos in India, Reductil (read Want to slim down? Don’t count on weigh-loss drugs) in Europe and other countries. It is used as an appetite suppressant in the management of obesity. That means that it works by making you feel more ‘full’ with less food (it reduces appetite and enhances satiety).

On Wikipedia, it is documented that frequent encountered side effects from sibutramine are: dry mouth, paradoxically increased appetite, nausea, strange taste in the mouth, anorgasmia and delayed ejaculation, upset stomach, constipation, trouble sleeping, dizziness, drowsiness, menstrual cramps/pain, headache, flushing, or joint/muscle pain.

It can substantially increase blood pressure and pulse in some patients. Therefore all patients treated with sibutramine should have regular monitoring of blood pressure and pulse.

Infrequent but serious ones that require immediate medical attention: cardiac arrhythmias, paresthesia, mental/mood changes (e.g., excitement, restlessness, confusion, depression, rare thoughts of suicide).

Symptoms that require urgent medical attention are seizures, problems urinating, abnormal bruising or bleeding, melena, hematemesis, jaundice, fever and rigors, chest pain, hemiplegia, abnormal vision, dyspnea and edema.

Could what they have consumed a counterfeit version? Health Science Authority (HSA) is investigating now. In HSA’s press release today, it has said that “Given the borderless nature of the Internet and the ease with which this product could be bought and sold in different countries around the world, HSA has alerted its international network of enforcement counterparts to be on a lookout for the adulterated product and where appropriate, to act against websites selling this product within their respective jurisdictions.”

This is the second case in the last 6 years concerning slimming product that created adverse reaction. Slim 10 pills in 2002 hit headlines in Singapore after it killed a woman and caused severe liver damage to local actress Andrea De Cruz which would have killed her if not for an emergency liver transplant done with the liver donation from her then-fiance actor Pierre Png (now husband). The China-made diet pills contained fenfluramine, an appetite suppressant that has been banned in the U.S. since 1997 for damaging heart valves and which doctors later confirmed also caused liver failure.

Steven lost his taste for The Big Mac after a visit to his dentist. Dentist unable to explain: Could this be Dr. Watson’s first case of unexplained paresthesia? I was entering my sophomore year of engineering. This transition year would be taking me from broad-based general education to a more highly-focused mechanical engineering course through advanced studies in mathematics, science and systems. By all measurements, I was well positioned with my peers and my grades were above average. My freshman year was now over and I was literally pacing myself for the complexity of projects which eventually would see my skills put into practice. At this stage in my studies, I was like a sponge in the ocean soaking up all and every lecture I attended. Being pulled and pushed with every movement of the tide around me. No clear route was calculated on my internal GPS; however there was a steady wind which seemed to be pushing me on a definite course. Or so it appeared to me.

It was difficult to conceal my identity; I was from a small Midwestern town and attended a private high school with my siblings where we enjoyed a comfortable life as children of parents who were both professionals. My mother was a restorative hygienist and my dad, Dr. Watson, owned a well established dental practice.

I was now off campus and was fortunate to share a modest third story attic-like apartment with Steven, a student who was also in engineering, one year ahead of me. Our apartment was no more than 500 sq.ft. but comfortable and spotlessly clean, with a clear view across town where one could see the familiar Golden arches and where many a university student caught up on notes, while enjoying the special burger of the day. Steven was no exception. He loved to eat at the MacDonald’s; He was hooked on their Big Mac and ate there at least four or five tines a week. Our apartment consisted of a sitting area, a kitchen, a washroom and one bedroom with two single beds. I was beginning to feel more in charge of my life and free to come and go as I pleased. My room mate was friendly but somewhat quiet and deep within his thoughts, or so it appeared to me.

Our schedules were quite different, and we did not have a lot of time together other than the occasional small talk while having a coffee. We were not big on booze but enjoyed the odd beer. He had a part time job at a small computer repair store and would be home usually by midnight. The tempo and the anonymity of the North East were very fascinating and everyday I could feel maturity seeping into every move I made. I was at ease with myself and happy, especially when I heard from my folks.

Although it was never overtly pushed on me, the atmosphere at home during high school was subtlety an expectation of going on to undergraduate school in the East. I was the oldest of my siblings and now that I can reflect, both my parents were lovingly using me as their flagship.  “If Jim sets the pace, the others will follow”. I was fortunate in that I did not have to work during my semesters away from home. My mother saw to that. There were to be no excuses for failing grades. I lacked for nothing. However in no way was I pretentious. In fact I was often seen and not heard. Deep within me I knew I was popular albeit, shy. I was no “Brad Pitt”, but confident was I, or so it appeared to me.

It was during our second semester of my sophomore year that I started to have some concern about my room mate. He suffered from bruxism, commonly known as grinding of the teeth, typically accompanied by the clenching of the jaw. It is an oral para functional activity which is common in many humans. Bruxism  (Wiki) is caused by the activation of reflex chewing activity; it is not a learned habit. Through osmosis, I had picked up many dental terminologies over the years from both of my parents. This condition (grinding) was not unknown to me; however the situation was causing me restless nights. I talked to my dad during one of our weekly “how are you” conversations and he suggested that Steven should see a local dentist, because of possibly damage to his teeth. It was not difficult to share my concern with Steven, because his girlfriend also thought he should see a dentist.

We (Steven, his girlfriend Veronica and I) had now become much closer. Steven opened up a bit more and at times could be quite comical. I was seeing the other side of him. We started to hang out on a more regular basis. Steven had appreciated my father’s professional advice and did in fact go to see a dentist associated to our engineering faculty. The diagnosis was confirmed. There was some small initial damage which had started to erode the enamel of his molars. The dentist was able to have a guard fitted in Steven’s mouth with which he could sleep comfortably at night. A follow-up appointment was scheduled in a couple of weeks to make sure the protective appliance was fitting comfortably. However the dentist noticed there was an old amalgam filling on his LR bi-cuspid which was overhung and was a floss shredder. The dentist advised Steven it should be replaced with a more modern white filling. Amalgams are for the most part now dated. The trend is to natural color composite fillings. This was good news for Steven because the silver amalgam was a nuisance and unsightly for a youngster. The date was set for the replacement filling and all would be well, or so it appeared to me.

Steven showed up for his 9:00 AM dental appointment which would have given him ample time to get back to class and by noon the anesthetic would have worn off giving him sufficient time to enjoy his big Mac. However things did not go as was planned. Steven still had a numb jaw and although he tried to disregard this persistent strange feeling, it was apparent that he had indeed lost all taste for his favorite Big Mac and fries.  On the third day Steven called his dentist to explain jokingly that he had lost all taste for any food and in particular, his craving for a Big Mac fix. The dentist reassured him that some people react that way to local anesthetics but the numbness and tingling sensation would soon disappear and normal full sensitivity would be back. Steven apprehensively took his word, but after day five, the condition had not improved and Steven was in a panic and wanted another opinion.

Without knowledge of the total situation, my father was privileged only to “hear-say” and cautioned me that it could be a case of paresthesia, which is a potentially serious pitfall for which dentists hope never to encounter during the life of their practice. My dad did not want to be involved for obvious reasons. I was now on the horns of a dilemma. After-all Steven was my trusted friend and room mate.

Unexplained paresthesia:

Steven was now withdrawn and depressed. He had lost weight and his essays were suffering. Veronica accompanied him to the guidance counselor and a decision was made that he should see a neurologist. Paresthesia was in fact the diagnosis. This condition was explained to Steven and the prognosis was good because he had a simply and uncomplicated infiltration of the anesthetic and was not exposed to a full nerve block. There were still unanswered questions. Why would this occur? There was no truma to any neres.

Steven did his research and discovered that around this time a new local anesthetic called Septocaine had been approved by FDA for dental use in the U.S. Unlike most other anesthetic solutions which have a concentration of 2%, this new one was a 4% concentration. In other words, theoretically and pharmacologically speaking, all things being equal, or as the scientists would say, in vitro, one could use half the volume of the 4% solution to achieve what the 2% was capable of. Each one of us can have slight anatomical variations in the oral cavity, hence different responces.

For some unknown reason, dentists are in the habit of referring to volume (cartridges) used rather than by mg/ml. (actual mg given).As it turned out, Steven awoke now in its tenth day, to discover the paresthesia had been miraculously reversed and full sensitivity had returned to his tongue and soft tissue around his lip. No point of mentioning where he headed after he discovered there were no more pins and needles. All therapeutic compounds are accompanied with an index. The lesson to be learnt is that the product monographs included in any medication by FDA and are intended to be read. The term Minimal Effective Dose is alive and well. Following these instructions may avoid expensive and time consuming litigation.

Comments to author.  mailto:localanesthtics@yahoo.ca    M.Sc. PharmD

When I was first diagnosed with M.S., I was flabbergasted to discover that high heels were no longer my friend.  One lovely, snowy Saturday I was wearing a pair of stilettos and by Monday evening in the hospital, I was having trouble staying balanced in bare feet.  I’ve tested out all the shoes in my closet.  Some days some work.  Other days, sneakers are the only option.  And, I can’t really plan ahead.  It all depends on my equilibrium for that particular day. In the many weeks that have followed I’ve reached a happy medium.  While it will be rare that I ever wear stilettos confidently again, I’m trying to find heels that don’t send me toppling onto the floor with every step.  High heels make me feel feminine; feeling feminine is important to me.

Feeling feminine isn’t coming easy for me these days and here’s why.  Women typically cross their legs when sitting – often one leg over the other.  I can’t do that anymore; at least not for serious periods of time. Within minutes, if not seconds, the leg that is crossed falls asleep.  The one beneath it follows rather rapidly.  I try crossing my feet at the ankles, like the sisters taught me in grade school.  That’s just not comfortable and despite what the nuns told us, girls, boys can still see up your dresses in that position.  I haven’t worn a skirt since my diagnosis because I can’t figure out how to sit! To make matters worse, my arms frequently fall asleep, too.  I’m constantly squirming around in my desk chair, and worse, in meeting chairs.  I look like a Kindergartener who forgot to go to the bathroom during recess. 

The “fall asleep” factor of M.S., like so many different things, is difficult to explain.  When ‘normal’ people have a limb that’s fallen asleep, they’ll shake it, move it, and if it’s a foot, they’ll sometimes jump up and down upon it.  The limbs of the ‘normals’ will then typically wake up.  Mine don’t. They eventually do, but it can take hours. I’ve stopped trying to shake life into my arms and stomp feeling back into my feet.  Although, sometimes the natural reactions of being human just take over and it’s just unavoidable. The frustration takes control and I’ll bang my arm against the wall, or worse, another body part.  I’ll stomp my foot so hard the concrete shifts beneath me.  I think people are getting used to me shifting, leaning, shaking and rubbing limbs frequently.  But still others respond with “what’s wrong with you?”  This problem has a formal name: paresthesia. It all goes back to my damaged neurons failing to send proper signals to my brain. 

I’m tired of all the fidgeting, though, so I’ve been trying out other sitting positions this week. The only one that seems to work at least consistently (at least when I’m sitting in a chair) is what I call the “Johnny Bench” position – the most non-feminine position that’s out there.  It’s too difficult to describe, so here’s a photo. 

Obviously, I don’t walk around carrying a bat, nor do I wear a baseball hat, but picture a professional woman, in a business suit, sitting in this position in a meeting.  My elbows on my knees give my arms some sort of support, so they don’t seem to fall asleep as easily.  My legs stay awake longer as well.  My back, which aches regularly, welcomes the relief of this position. Two days per week this position is out.  I inject each thigh once a week and for 24 hours following the treatment, my tops of my legs ache – no elbows are going there. While this position is somewhat of a solution, I look bizarre!  I try stretching out sometimes, leaning way back in my chair with my legs extended.  So, I either look like Johnny Bench or one of those lazy business folks who sprawls out in a meeting. 

I haven’t mastered how to use the Johnny Bench position while typing, though.  And, unfortunately, both of my hands are now numb.  No feeling = no typing (at least not the correct letters anyway).  Time for me to talk a walk through the halls to help those neurons figure out how to send blood to my arms and fingers!