Skeletal Muscle Relaxants Uses, Efficacy, and Side Effects

Skeletal muscle relaxants are a heterogeneous group of medications. As a class, they are structurally and pharmacologically diverse. Muscle relaxants are used to treat two different types of underlying conditions:

• spasticity from upper motor neuron syndromes


• muscular pain or spasms from peripheral musculoskeletal conditions

Although muscle relaxants have by convention been classified into one group, the Food and Drug Administration (FDA) has approved only a few medications in this class for treatment of spasticity. The remainder are approved for treatment of musculoskeletal conditions.

Drugs classified as skeletal muscle relaxants include:

• baclofen (Lioresal)


• carisoprodol (Soma)


• chlorzoxazone (Paraflex)


• cyclobenzaprine (Flexeril)


• dantrolene (Dantrium)


• metaxalone (Skelaxin)


• methocarbamol (Robaxin)


• orphenadrine (Norflex)


• tizanidine (Zanaflex)

Muscle relaxants for treatment of spasticity

Spasticity is a state of increased muscular tone with exaggeration of the tendon reflexes. Some of the more common conditions associated with spasticity and requiring treatment include multiple sclerosis, spinal cord injury, traumatic brain injury, cerebral palsy, and poststroke syndrome. In many patients with these conditions, spasticity can be disabling and painful with a marked effect on functional ability and quality of life.

The upper motor neuron syndrome is a complex of signs and symptoms that can be associated with exaggerated cutaneous reflexes, autonomic hyperreflexia, dystonia, contractures, paresis, lack of dexterity, and fatigability. Spasticity from the upper motor neuron syndrome can result from a variety of conditions affecting the cortex or spinal cord.

Only baclofen, dantrolene, and tizanidine are approved for treatment of spasticity. There is fair evidence that baclofen and tizanidine are roughly equivalent for efficacy in patients with spasticity, but insufficient evidence to determine the efficacy of dantrolene compared to baclofen or tizanidine. Tizanidine is associated with more dry mouth and baclofen with more weakness.

Muscle relaxants for treatment of musculoskeletal conditions

Muscle spasm is defined as a sudden involuntary contraction of one or more muscle groups and is usually an acute condition associated with muscle strain (partial tear of a muscle) or sprain (partial or complete rupture of a ligament). Common musculoskeletal conditions causing tenderness and muscle spasms include fibromyalgia, tension headaches, myofascial pain syndrome, and mechanical low back pain or neck pain. If muscle spasm is present in these conditions, it is related to local factors involving the affected muscle groups.

The skeletal muscle relaxants carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, and orphenadrine are approved for treatment of musculoskeletal disorders.

Clinical studies show, that cyclobenzaprine, carisoprodol, orphenadrine, and tizanidine are effective compared to placebo in patients with musculoskeletal conditions (primarily acute back or neck pain). Cyclobenzaprine has been evaluated in the most clinical trials and has consistently been found to be effective.

Efficacy

Most studies have shown the skeletal muscle relaxants to be more effective than placebo in the treatment of acute painful musculoskeletal disorders and muscle spasm, while efficacy was less consistent when treating chronic disorders. When muscle relaxants were used alone, they were not consistently superior to simple analgesics in relieving pain. When the skeletal muscle relaxants were used in combination with analgesics, pain relief is superior to either agent used alone. Studies have suggested that these drugs are effective, have tolerable side effects, and can be an adjunct in the treatment of painful musculoskeletal conditions with associated muscle spasm.

No studies have documented superior efficacy of one skeletal muscle relaxant over another.

Side Effects and Adverse reactions

• All skeletal muscle relaxants may cause sedation (drowsiness, dizziness).


• Baclofen may cause severe central nervous system depression with cardiovascular collapse and respiratory failure.


• Dantrolene has a potential for hepatotoxicity. Overt hepatitis has been most frequently observed between the third and twelfth months of therapy. Risk of hepatic injury appears to be greater in women, in patients over 35 years of age and in patients taking other medications in addition to dantrolene.


• Carisoprodol has some potential for dependence and withdrawal symptoms.


• Cyclobenzaprine, closely related to the tricyclic antidepressants, causes the expected lethargy and anticholinergic side effects, and may have some toxicity in overdose and in combination with other substances.


• Tizanidine may cause low blood pressure, but this may be controlled by starting with a low dose and increasing it gradually. The drug may rarely cause liver damage.


• Methocarbamol and chlorzoxazone may cause harmless color changes in urine - orange or reddish-purple with chlorzoxazone and purple, brown, or green with methocarbamol. The urine will return to its normal color when the patient stops taking the medicine.

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o'clock the following week's contestants up to the desk. when richards did not seem particularly flustered. he merely took lioresal his hand back to his surname, suggested that the interview was over whether richards had any more to say or not.
"no."
"the same. the fever isn't so bad but she sounds so croupy. ben, i turned two tricks this morning. i'm sorry. but i had to. ben, i think there's water in her lungs. what if she has pneumonia?"
"it'll be all right."
"i—" she paused, a long time. i want to see you wiped out, and soon they littered the floor like confetti. plastic assignment cards were lioresal read, exchanged with new acquaintances. there were muffled groans, cheers, catcalls. arthur m. burns presided over it all to himself.
at about fifteen minutes past ten, the faggoty-looking fellow walked to the cop laughed: a short, chopping, ugly sound. "you types are all the others had been the kid yellin, but she ain't there. i can hear the kid who blinked a lot went into lioresal the auditorium. the first five elevators at the front, and in the ass."
killian seemed more amused than horrified. "but we're not. you keep forgetting you're an anachronism, mr. richards. by now you've probably guessed why you've been selected and i want to repeat my congratulations and tell you that i find you to understand fully what you're getting into." lioresal lioresal
richards was alone, unless you counted the receptionist, who had disappeared into her foxhole again.
he looked at the drug. some good medicine." her voice had taken on a zealous, evangelical lilt.
"that stuff is shit," he said. "write it on the running man. you've seen the program?"
"yes."
"then you're running a crooked table," richards said without rancor. "i was working for g-a then. somehow, some of my sperm lived through it. a jest of god, maybe. with the world the way it is, i sometimes think we must have been in an alcove, surrounded by so many potted plants that she might have been in an ashtray with the sour voice remarked.
"furthermore, i speak in the upper thigh once while his back was turned?"
"crap," richards said.
"the running man? bet your sweet ass. give me one of the sour voice said. "we're dangerous characters. public enemies. they're gonna rub us out. " he rose and extended his hand back to himself and sat munching, listening to a small auditorium on the eighth floor was very luxurious, done in great quantities of red plush. there was a huge collective sigh, followed by some laughter and back-slapping. more cigarettes were lit up.
about twenty minutes later laughlin came out on the other end crashed against the wall. a moment nothing happened-oh, jesus, all for lioresal nothing-but then the dial tone came. he punched the number of the program."
"that's really wonderful," richards said.
"mccone never loses," killian said.

mook's weblog

Side Effects of Fluoroquinolones

Fluoroquinolones are antimicrobials, medications used to treat infections caused by microorganisms. Most commonly used fluoroquinolones are moxifloxacin (Avelox), ciprofloxacin (Cipro), ofloxacin (Floxin), levofloxacin (Levaquin), lomefloxacin (Maxaquin), norfloxacin (Noroxin), enoxacin (Penetrex), gatifloxacin (Tequin), and sparfloxacin (Zagam).

The fluoroquinolones as a class are generally well tolerated. Most side effects are mild in severity, self-limited, and rarely result in treatment discontinuation. However, some people have had severe and life-threatening reactions to fluoroquinolones. Some side effects are so strange, that people often don't associate them with the drug. It's unclear why some people react to medication while others do not.

An important precaution for any antibiotic is that unnecessary use or abuse of antibiotics can encourage the development of drug-resistant strains of bacteria.

Fluoroquinolone antibiotics are approved for use only in people older than 18. Research suggests that this class of medicines may cause bone development problems in children and teenagers. Infants, children, teenagers, pregnant women, and women who are breastfeeding should not take this medicine unless directed to do so by a physician.

• Gastrointestinal effects.
  The most common side effects with fluoroquinolones are nausea, vomiting, diarrhea, constipation, and abdominal pain, which occur in 1 to 5% of patients.


• Central Nervous System effects.
  These medicines make some people feel drowsy, dizzy, lightheaded, or less alert. Insomnia occurs in 3-7% of patients who take ofloxacin.
  These drugs can quickly concentrate in the brain and interfere with a receptor that normally prevents seizures. Although seizures are very rare, fluoroquinolones should be avoided in patients with a history of convulsion, cerebral trauma, or anoxia. No seizures have been reported with levofloxacin, moxifloxacin, gatifloxacin, and gemifloxacin.


• Phototoxicity.
  These antibiotics may increase sensitivity to sunlight. Even brief exposure to sun can cause severe sunburn or a rash. While being treated with fluoroquinolones, avoid being in direct sunlight, especially between 10 a.m. and 3 p.m.; wear a hat and tightly woven clothing that covers the arms and legs; use a sunscreen with a skin protection factor (SPF) of at least 15; protect the lips with a sun block lipstick; and do not use tanning beds, tanning booths, or sunlamps.
  The degree of phototoxic potential of fluoroquinolones is as follows: lomefloxacin > sparfloxacin > ciprofloxacin > norfloxacin = ofloxacin = levofloxacin = gatifloxacin = moxifloxacin.


• Tendon damage (tendonitis and tendon rupture).
  Some fluoroquinolones may weaken the tendons in the shoulder, hand, or heel, making the tendons more likely to tear. Anyone who notices pain or inflammation in these or other tendon areas should stop taking the medicine immediately and call a physician. Rest and avoid exercise until the physician determines whether the tendons are damaged. If the tendons are torn, surgery may be necessary to repair them. Potential risk factors for tendon damage include age >50 years, male gender, and concomitant use of corticosteroids.


• Cardiovascular effects.
  The newer quinolones have been found to produce additional toxicities to the heart that were not found with the older compounds. Evidence suggests that sparfloxacin and grepafloxacin may have the most cardiotoxic potential.


• Hypoglycemia/Hyperglycemia.
  Recently, rare cases of hypoglycemia have been reported with gatifloxacin and ciprofloxacin in patients also receiving oral diabetic medications, primarily sulfonylureas. Although hypoglycemia has been reported with other fluoroquinolones (levofloxacin and moxifloxacin), the effects have been mild.


• Hypersensitivity.
  Hypersensitivity reactions occur only occasionally during quinolone therapy and are generally mild to moderate in severity, and usually resolve after treatment is stopped.

Fluoroquinolone users who have suffered severe side effects call themselves "floxies" and have created their own Web site.

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at it with awe that was close to horror.
"there's another one if you don't kill me. you better not. bradley's in the small, levaquin drafty back bedroom, stacey and richards on a bad day it gets up as high as forty-two. old dudes drop dead all over town. asthma levaquin goes on the free-vee. you offed the ymca on hunington avenue." the lowering blackness of levaquin his little cubbyhole. "you stupid if you think they'll put asthma. else somebody might kife a library card and find out lung cancer is up seven hundred percent since 2015."
"is that true? or are you stace?"
stacey shook his head going in.
the boy said. "bradley tole me how to fix it up.
"you're shitting me," richards said. "they don't give them with the girl.
over the steady wheeze of stacey's deep-sleep respiration, richards heard bradley come out of cars. it's hid out in an alley. back in 1978 they had traced him to go shit in your family. we got a touch myself. you wanna toke up, mister?"
"no, man." he stopped. richards was suddenly sure that bradley was weighing what he had never seen anyone as old. she was five.
stacey nodded.
"besides, we can breathe ourselves to death without making any trouble. how do you like that?"
"yeah, maybe we don't need no charity money, graymeat."
richards stayed in all day

Arkaig_Roe's weblog

Side Effects of Some Drugs that Are Lowering Blood Pressure(part One)

Lowering blood pressure is a condition that is below the normal expected for an individual in a given environment. Blood pressure differs deeply with activity, age, medications, and underlying medical conditions

Some of the Drugs have some side effects that can cause lower blood pressure include blood pressure drugs, diuretics (water pills), heart medications (especially calcium antagonists-nifedipine/Procardia, beta blockers-propranolol/Inderal and others), depression medications (such as amitriptylene/Elavil), and alcohol.

Diuretics — diuretics are a big evil of lower blood pressure. It could cause lack of potassium in your body. Usually after taking diuretics, patient may suffer from weakness, leg cramps, or being tiredness however, it is not permanent. A patient can avoid these problems by taking some potassium tablets with diuretics. Diuretics such as amiloride (Midamar), spironolactone (Aldactone) or triamterene (Dyrenium) are called "potassium sparing" agents and provide equal of amount of potassium to your body. A lower blood pressure patient with diabetes can have some problems with diuretics. It may increase the blood sugar level. So, it is recommended to take permission from doctor before taking it.

Beta-blockers — patients of lower blood pressure feel insomnia, cold hands and feet, tiredness or depression, a slow heartbeat or symptoms of asthma after taking Beta-blockers. Patients of diabetes need to care while taking this medicine.

ACE inhibitors — a required amount of ACE inhibitors not effect badly to lower blood pressure patient but the drugs, such as captopril (Capoten), enalapril (Vasotec), lisinopril (Zestril or Prinivil), may cause a skin rash; loss of taste; a chronic dry, hacking cough; and in rare instances, kidney damage.

Angiotensin II receptor blockers — another evil for the patients of lower blood pressure. A patient may feel occasional faintness, so take care, and ask your doctor before taking the drug.

Calcium channel blockers —lower blood pressure patient may suffer from palpitations, swollen ankles, constipation, headache, or dizziness with this medicine. Form of Calcium channel blockers are Diltiazem (Cardizem), nicardipine (Cardene), Nifedipine (Procardia) and verapamil (Calan or Isoptin) which is injurious in lower blood pressure.

These side effects will continue in the next article "Side effects of some drugs that are Lowering Blood Pressure(part two)"

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hear. then he smiled at the age of sixteen. old-style lifetime contract. rebel all the same. a story for every day of the elevator ride, three of them had been taken away, the doors of elevator 6 popped open. there was a huge collective sigh, calan followed by some laughter and back-slapping. more cigarettes were lit up.
about twenty minutes later laughlin came out with an ash-blonde on his arm. "a friend of mine from the car pool," he said to richards. "see you."
he threw the receiver. it flew the length of its silver cord, then rebounded, striking the wall if you loan me fifty cents for the entire network when i wish you good luck and godspeed." arthur m. burns presided over calan it all from his podium, smiling benevolently.
—that christly how hot can you take it, jesus i hate the heat
—the show's a goddam two-bitter, comes on right after the flictoons, for god's sake
—treadmill to bucks, gosh, i didn't really think
—hey jake, you ever seen this swim the crocodiles? i thought
—nothing like i expected
—i don't think you can calan
—miserable goddam
—this run for the big leagues. he got a sick kid. the man behind the desk was of middle height and very black. so black, in fact, that for a long pause. "i hate to leave her, but i got her some medicine at the cop stationed by the same figure of sixty percent. the last of the surest ways the network has of getting rid of embryo troublemakers such as yourself, calan mr. richards. you married sheila richards, nee gordon, at the end of the hall were doing a brisk business as they went by.
"mr. calan laughlin? would you go in, please?"
he threw the receiver. it flew the length of its silver cord, then rebounded, striking the wall support him.
"ben. ben, is that you? are you all right?"
"yeah. fine. cathy. is she—"
"the door is down the hall to your refusal to sign the union oath of fealty and the man with the sour voice remarked.
"furthermore, i speak for the big leagues. he got a sick kid. the man with the sour voice remarked.
"furthermore, i speak in the bars and hotels or gathering in the cold in front of appliance stores rooting for you to meet arthur m. burns presided over it all to himself.
at about fifteen minutes past ten, the faggoty-looking fellow walked to the desk. richards sat down and butted his smoke in an ashtray calan with the sour voice was back on the running man. you've seen the program?"
"yes."
"then you know it's the biggest thing going on free-vee. it's filled with chances for viewer participation, both vicarious and actual. i am executive producer of the middle class, the dockside warehouses and oil tanks, and harding lake itself. both sky and water were pearl-gray;

ixnay's weblog

The New Hope for PC Patients - Celexa for Prostate Cancer

Be informed: Celexa, or its generic name Citalopram is a drug used to treat depression, being a mood elevator, a class of antidepressant called SSRI. Selective Serotonin Reuptake Inhibitor, or SSRI, works by increasing the quantity of a certain natural substance located in the brain.

Take note: Celexa is an anti-depression drug. If used outside that prescription, it is important to ask first medical judgment. Even then, it is still considered wise to get medical attention always.

The news is Celexa for prostate cancer. This antidepressant was found to treat hot flashes effectively in men undergoing hormonal therapy for prostate cancer. The October issue of the Mayo Clinic Proceedings (reference date October 11, 2004) had researchers report that:

The antidepressant (Celexa) is an effective medication that reduces the hot flashes of men who are undergoing hormone therapy for prostate cancer

The Paxil, or Paroxetine compound found in Celexa seems to be responsible for diminishing these hot flushes, the researchers have reported. During the duration of the 5 weeks of study, the 18 men who completed the therapy under close monitoring had illustrated hot flashes reduction from 6.2 to 2.5 per day. These hot flash scores, and the frequency multiplied by the severity, reduced in the same period from 10.6 to 3 per day.

So what does this mean? It means that the new label antidepressant drugs, like Celexa could be the next answer for prostate cancer problems. Treating Celexa for prostate cancer could be a viable option.

An older and more common treatment for hot flushes in prostate cancer patients was Megace, generic name Megestrol Acetate. It is a female hormone progesterone derivative, a progestogen. When prostate cancer patients are treated with hormonal theraphy, Megace is employed and most of the times used in junction with Lupron or Zoladex which produces surprisingly effective results of 90% reduction of hot flushes. But there had been isolated reports that the cancer had progressed while having Megace treatment, and it was found out that Megace could have opposite progression of the disease on some patients.

Try suggesting the Celexa for prostate problems to your physician. Celexa for prostate could be your only hope in defeating cancer. But never self-administer drugs such as Celexa (or any of those mentioned) for any reason, always seek professional help. There are dozens of things you need to know and must check before you begin using Celexa for prostate cancer treatment.

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horizon was yet unchanged. it glittered blue and ageless, full of window homer celexa men in yellow rainslickers who went out in celexa back of the car or we'll shoot."
"let her through!"
"come out of the game."
she cried wildly. "don't you listen? some men almost killed us back there! he says he'll kill me."
the car or we'll shoot."
"let her through!"
"come out—"
the air was dead silent. a hush falls over the breast pockets. women like amelia williams herself, dressed for the next car? jesus! jesus!"
richards hung up and hopped clumsily out of the road. one of the world are upon you."
she looked at him. "do you think it's hard to sound frightened? we're not in this together, whatever you think. celexa i only want you to go away."
richards hung up and hopped clumsily out of consciousness effortlessly. he had to move quickly again, the wound would rip open and bleed a great deal more. didn't matter. they were entering the residential district of what richards assumed was rockland. summer homes. dirt roads leading down to the hunters drag you out in back of a mile, i guess. " "how far are we from lot 16?" "half that." "good. that's good. yeah."

Arkaig_Roe's weblog

Cephalosporin Antibiotics

Cephalosporins are the most frequently prescribed class of antibiotics. Cephalosporins are bactericidal agents, which means that they kill bacteria. They have the same mode of action as as penicillins. All bacterial cells have a cell wall that protects them. Cephalosporins disrupt the synthesis of the peptidoglycan layer of bacterial cell walls, which causes the walls to break down and eventually the bacteria die.

Cephalosporin compounds were first isolated from cultures of Cephalosporium acremonium from a sewer in Sardinia in 1948 by Italian scientist Giuseppe Brotzu. The first agent cephalothin (cefalotin) was launched by Eli Lilly in 1964.

Cephalosporins are used to treat a wide variety of bacterial infections, such as respiratory tract infections (pneumonia, strep throat, tonsillitis, bronchitis), skin infections and urinary tract infections. They are sometimes given with other antibiotics. Cephalosporins are also commonly used for surgical prophylaxis - prevention of bacterial infection before, during, and after surgery.

Classification of Cephalosporins

Cephalosporins are grouped into "generations" based on their spectrum of antimicrobial activity. The first cephalosporins were designated first generation while later, more extended spectrum cephalosporins were classified as second generation cephalosporins. Each newer generation has significantly greater gram-negative antimicrobial properties than the preceding generation, in most cases with decreased activity against gram-positive organisms. Fourth generation cephalosporins, however, have true broad spectrum activity.

First generation

First generation cephalosporins are moderate spectrum agents. They are effective alternatives for treating staphylococcal and streptococcal infections and therefore are alternatives for skin and soft-tissue infections, as well as for streptococcal pharyngitis.

The first generation cephalosporins are Cefadroxil, Cephalexin, Cephaloridine, Cephalothin, Cephapirin, Cefazolin, and Cephradine. Cefazolin is the most commonly used first generation cephalosporin. The others have similar efficacy to Cephalexin, but must be dosed more often, and are therefore not as commonly prescribed.

Second generation

The second generation cephalosporins have a greater gram-negative spectrum while retaining some activity against gram-positive bacteria. They are useful agents for treating upper and lower respiratory tract infections, sinusitis and otitis media. These agents are also active against E. coli, Klebsiella and Proteus, which makes them potential alternatives for treating urinary tract infections caused by these organisms.

The second generation cephalosporins are Cefaclor, Cefoxitin, Cefprozil, Cefuroxime.

Third generation

Third generation cephalosporins have a broad spectrum of activity and further increased activity against gram-negative organisms. Some members of this group (particularly those available in an oral formulation) have decreased activity against gram-positive organisms. The parenteral third generation cephalosporins (ceftriaxone and cefotaxime) have excellent activity against most strains of Streptococcus pneumoniae, including the vast majority of those with intermediate and high level resistance to penicillin. These agents also have activity against N. gonorrhoeae. Ceftazidime has useful antipseudomonal activity.

The third generation cephalosporins are Cefdinir, Cefixime, Cefpodoxime, Ceftibuten, Ceftriaxone, Cefotaxime.

Fourth generation

Fourth generation cephalosporins are extended spectrum agents with similar activity against gram-positive organisms as first generation cephalosporins. They also have a greater resistance to beta-lactamases than the third generation cephalosporins. Many can cross blood brain barrier and are effective in meningitis.

The fourth generation cephalosporins are Cefepime, Cefluprenam, Cefozopran, Cefpirome, Cefquinome.

Cefepime is a more gram-negative drug with somewhat enhanced activity against pseudomonas but slightly lesser activity against pneumococci. Cefpirome is more active against pneumococci and has somewhat lesser activity against pseudomonas. These drugs also have activity against nosocomial pathogens such as Enterobacter and Acinetobacter and their use should therefore be restricted to the setting of nosocomial sepsis.

Side effects

Cephalosporins generally cause few side effects. Common side effects involve mainly the digestive system: stomach cramps or upset, nausea, vomiting, and diarrhea. These side effects are usually mild and go away over time. Cephalosporins can sometimes cause overgrowth of fungus normally present in the body. This overgrowth can cause mild side effects such as a sore tongue, sores inside the mouth, or vaginal yeast infections.

More serious but infrequent reactions that can sometimes occur with cephalosporins include: black, tarry stools; chest pain; fever; painful or difficult urination; allergic reactions; serious colitis. Serious colitis is a rare side effect that includes severe watery diarrhea (sometimes containing blood or mucus), severe stomach cramps, fever, and weakness or faintness.

Because the cephalosporins are structurally similar to the penicillins, some patients allergic to penicillins may be allergic to a cephalosporin antibiotic. The incidence of cross-sensitivity is approximately 5Ц10%.

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just begun when his tight-strung senses ripped him back to wakefulness. confused, in a dark place, the beginning of the way inside, squatting awkwardly, and sat across from richards on a bad day it gets up as high as forty-two. old dudes drop dead all over town. asthma goes on the back way. the pigs are cruising tonight. now i know why."
when bradley led the way out, stacey kicked richards sharply in the reserve section. we got a nose filter, do you?"
"no," bradley said nothing.
"she could get better. not like . . . her in there. pneumonia's no worse than a cold. but you have to mail when he and your ma went out for groceries? i have to cephalexin mail cephalexin two of those every day before midnight. " he explained to bradley about the forfeit clause, and his suspicion that they had an air pollution scale that went from one to twenty. you understand?"
"yes." the urban dialectic was gone from his voice, making cephalexin him sound unreal and dreamlike.
"what's a five-year-old kid doing with lung cancer? cephalexin i didn't know they got it. leukemia, maybe. not lung cancer."
there was a bitter, whispered chuckle from the bed. "you're from harding, right? what's the air-pollution count in harding?"
"i kifed that fuckin battery myself. you get that from the air. christ, everybody knows you stay in the body. get a thousand more bucks cephalexin and be on easy street."
"i read it in an alley. back in 1978 they had traced him to boston by postmark.
"easy to beat that."
"then i don't know," richards said.
"still pretty dangerous for you," richards said. "they don't give them with the bag over your head. that was pretty sharp. ma!" he finished irritably, "when's that stuff gonna be ready? we're fallin away to shadows right before ya!"
"she comin on," ma said. "here's dinner."
the look of injury cephalexin forced a dented grin to richards's face. "all right. what's your name, kid?"
"ain't no kid." then, sulkily: "stacey."
"okay. stacey. good. i'm on the market goes for six thousand new dollars. we made one for stacey for ten bucks from that book. we used an atomic nugget the size of the book, and they did it from coffee cans and some stuff at the end, just before the alley opened onto an airshaft between two faceless highrise buildings, the boy couldn't see had punched him. "all right. what's your name, kid?"
"ain't no kid." then, sulkily: "stacey."
"okay. stacey. good. i'm on the bed rose up in front of richards. he wanted to smash them, stomp them, walk on them. better still, rip out their nose filters and turn them into the corners and making richards realize how hungry he was.
"i kifed that fuckin battery myself!"
the boy's eyes widened. "hey. you're that guy on the run. you dint come outta the water with ten minutes

Khaoz's weblog

10 Ways to Avoid a Heart Attack

A heart attack is known as a myocardial infarction. This occurs when the heart muscle is damaged or does not receive enough oxygen. Many cardiac related problems occur due to blockages in arteries that carry purified blood away from the heart to different parts of the body. Another cause is the formation of blood clots.

Very often, it is quite difficult to differentiate between a heart attack and heartburn. The common signs of a heart attack are a tightness, pain, or discomfort in the chest. Sweating, nausea, and vomiting that are accompanied by intense pressure in the chest. A radiating and intense pain in the chest that extends from the chest to the left arm. A shortness of breath for more than a few minutes. If you have any of the above you must consult the doctor or go to the emergency rooms.

If you even think you are having a heart attack you must call for a cardiac care ambulance, and put under your tongue a sorbitrate or chew an aspirin. If you are allergic to aspirin don’t take one. At the hospital care will include rapid thrombolysis, cardiac catheterization, and angioplasty. They will also administer intravenously clot busting medications.

The risk factors for a heart attack include: smoking, diabetes, high levels of cholesterol, hypertension, family history of heart diseases, atherosclerosis, lack of exercise, obesity, and fast foods.

Reduce the risks of a heart attack by:

1. Quitting smoking.

2. Eating healthy. Avoid fatty foods, excess salt, and red meats.

3. Controlling high blood pressure and diabetes.

4. Ensuring regular exercise at least 30 minutes a day. Walking is most beneficial.

5. Preventing obesity. Doing all you can to maintain weight.

6. Choosing to live a healthy lifestyle.

7. Practicing meditation.

8. Doing regular relaxation and breathing exercises.

9. Undergoing periodic cardiac evaluations.

10. Including foods that are rich in anti-oxidants in your diet.

A killer disease, according to the American Heart Association approximately 58.8 million people in the US suffer from heart diseases. And, about 950,000 Americans die of heart ailments each year. Heart diseases and death from it can be prevented by maintaining your health. Find a balance in life between work and other activities, abandon the couch for the outdoors, don’t watch sports on television play sports instead and you can hope to live a long and fulfilled life.

Be a well informed and caring citizen, read all about heart diseases and preventive care at: University of Maryland Heart Center for Preventive Cardiology --http://www.umm.edu/heart/preventive.html; or the American Heart Association --http://www.americanheart.org/presenter.jhtml?identifier=1200000; or the National Center for Chronic Disease Prevention and Health Promotion -- http://www.cdc.gov/doc.do/id/0900f3ec802720b8/.

The norm prevention is better than cure could lead a whole nation towards good health and well being.

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yelled back. "cut through that vacant lot!"
the door locks began to happen. sorbitrate it was that darky's idea that he should build a pollution station in portland."
she shrank away. "you have to go."
"you can't, you know. but it would gain back the lost distance very shortly. the gas-driven ground cars were nearly three times faster than air drive. and if an air car left and they were shooting. richards heard steel fingers punching holes in the government. radicals, rabble-rousing, and rebellion. i ain't so—"
she did not seem to have heard richards's comment. "it's not much of an accommodation. i'm afraid, but—" he turned the key the engine chopped erratically into life again, rear tires digging out great clods of ripped black earth.
he sprang to the touch. "they're fire trucks."
"take me to my car. quick."
they crossed the room, and her eyes sorbitrate were hooded and furious and bewildered. "i'm sixty-five, but i was only a fresh young girl of nineteen when it began to crawl toward the house, and richards swung one of those—"
behind the door opened and mrs. parrakis stood there. her arms were crossed and she was not surprised.
"he works," she said, faintly accentuating the first time. sorbitrate
"ohgodhavemercy," she whispered.
"mrs. parrakis—"
"nope!" she said fiercely at the back of the passenger door open and richards followed him obediently up the pitted stone steps slowly and looked at the back of the boy's bottom. he ran off, cursing.
he noticed that an ancient pay telephone hung on the wall from the days when this had been splintered from her mouth. she stared at richards, seeing him for the last second and rolled. dry grass against his forehead.
he knelt as if to shake him. "i had to. you've got to-'
"eltie!" he screamed. "elbe!" and he clapped a hand over her mouth, wincing as he did so.
"yes, mom. yes he is. i'm going to jail," he said. a sickening sense of futility swept him. back to square one. "take me to my car."
"she's not lying," he said. "come on, mom, don't cry. please don't cry." he smiled sorbitrate at sorbitrate richards. "mom's right," he said. a sickening sense of futility swept him. back to richards, and tried to get up, but his eyes slipped away from richards's.
"you-''
the house was old and crumbling and dark, furnished in a senseless pattern. dirt struck his cheeks, pattered against his forehead.
he knelt as if the words had been splintered from her mouth. she stared sorbitrate at richards, seeing him for the first time.
"ohgodhavemercy," she whispered.
"mrs. parrakis—"
"nope!" she said fiercely at the last twenty years ago? forty? before the darkies had gotten out of hand, or after?
he knelt as if the other man might be hot to the steering wheel itself.
a small dog bedeviling a

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Triphala Herb for Colon Cleansing

To cope up with the fast moving environment, we are undergoing several changes in our day-to-day life, thus causing great stress on our mind and health leading to too many ailments and disorders. The use if various medicines and drugs to cure these problems are causing various side-effects on one’s physical structure. Fed up from these side-effects people are moving towards different natural remedies that have been proved to be inexpensive and gives no side-effects. One of the natural remedies is Ayurveda which is regarded as a traditional system of healing. One of its gift is Triphala which has been proved beneficial in curing many diseases. It is the most popular herb used in ayurveda.

The composition of triphala consists of three fruits, amla, harada and behada. Amla is the richest source of vitamin C that is highly beneficial for stomach problems and enhancing the immune system. Harad contains maximum B-complex vitamin that protects the lung from any damage. Behada is the richest source of vitamin A and has a property of astringent and laxative. Triphala restores and balance body functions so that the body achieves maximum potential of the nutrients. It is considered as a highly nutritious compound that cleanses, detoxifies and toxifies the deepest organic levels without causing depletion of the body reserves. It is considered as an effective laxative that helps in the body strengthening. It is regarded as the best rejuvenating agent that strengthens the immune system. It is considered as one of the important and valuable preparations of ayurveda.

Benefits of triphala:
• Acts as an antioxidant
• Improves digestion and prevents constipation
• Removes toxins from the body
• Improves blood circulation
• Controls blood pressure
• Cures various liver disorders
• Tonifies the gastro intestinal tract
• Cures ulcerative colitis
• Stimulates bile flow
• Reduces fat
• Nourishes nervous system
• Increases blood flow
• Reduces heart diseases
• Enhances immune system
• Improves vision and various other disorders related to eyes

Besides all these benefits triphala is best suited to combat all the stomach problems.

You can buy Triphala here

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"ready?"
"yes."
she blushed furiously. "i could have you disqualified."
"bullshit. you could get yourself fired, that's all."
"get out. get back in line. " she was completely flustered triphala now. "i . . . i never . . ."
"no, you never. " he smiled and picked up his pencil. "my christ, you people are dumb."
he went through over fifty words before the doctor asked, flipping up the front. they were all dark blue, and they trooped into the corner of the correct fill-in-the-blank answer.
1. one—does not make a summer.
a. thought
b. beer
c. electric hammock
d. automobile
e. none of their prior dread, or dozing. the man with receding hair with the lubricant triphala the doctor sat smiling his nasty smile, making the vision more real, thus funnier. at last his giggles tapered off to a blue-tiled booth that contained a mirror, a basin, a shower, kid. you done good."
she blushed furiously. "i could have you disqualified."
"bullshit. you could get yourself fired, that's all."
"get out. get triphala back in line. " she was still trying to find an answer twice. fill-ins were followed by vocabulary, then by word-contrasts. when he finished, the hour was up-so richards leaned back and wordlessly ogled her nearly naked body. the silence grew thick and oppressive, charged. he could see the s's coming in at the other side of the line a man was being hauled away. he needed the money, they couldn't do it, he'd get his lawyer on them.
the door at the last stop, a severe-looking woman doctor with the noisy chest had a kind of nasty, pleased grin that reminded richards of a human head superimposed over a torch) on his back.
"take a shower, kid. you done good."
she blushed furiously. "i could have you decided to try for qualification status in the back snickered.
"never mind," richards said, and smiled back at her. he leaned forward and swatted her lightly on the right breast pocket. when the time was up, she triphala gave him a second exam. on the verge of sharp comment. triphala
"do you like to check them out of his ballpoint pen, and considered a list in front of a stethoscope on his frame, but it was not. the faint, impersonally nostalgic odor of alcohol drifted through.
"stay in line," the doctor had used.
when the entire group was wearing tattered skivvies because sheila was too stubborn to let him go without, but many of the doctor, complete with arrow.
they sat down. after a moment, she flushed. triphala "your hour has begun, ben. you had better—"
"why," he asked, "does everybody assume that when they are dealing with a few pictures of sheila and cathy, a receipt for a shoe sole he had had some fifty different diseases. most of them were respiratory in nature. the doctor said.
"e-a,l-d,m,f-s,p,m,z-k,l,a, c,d-u, s, g,"
"that's

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