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Sedentary Lifestyle is Dangerous to Your Health: My Canadian Pharmacy Overview

Today, sedentary work is extremely popular — most people happily prefer to stay in the office to physical loads. But very few realize that office workday brings more harm than, for example, the work of movers. Inactive work can lead to such surprises as obesity, cardiovascular problems, trouble with joints and many other diseases. The same troubles and even more may arouse also due to cycling: https://my-medstore-canada.net/studies-show-bike-seats-can-cause-ed-and-my-canadian-pharmacy-drugs-might-help.html.

Modern man moves very little. Today, you can use personal or public transport to overcome great distances, it is not necessary to walk. During a working day, we sit at the table. Returning home, again sit on the sofa or at the computer desk, instead of walking with relatives.

The main «side effects» of a sedentary lifestyle: extra pounds, muscle weakness, dull complexion. Lack of exercise leads to chronic diseases. Scientists have found out: prolonged sitting causes chest pain in women. This can be pulmonary embolism. According to Canada Medstore, due to prolonged physical inaction, the percentage of possible development of venous thromboembolism increases, which is not just unpleasant, but deadly.

Negative Effects Of a Sedentary Lifestyle

Obesity

Excess body weight is one of the most common consequences of a sedentary lifestyle. Lack of physical activity slows down metabolism and blood circulation, thereby reducing the amount of calories burned, the excess of which is stored as fat. Obesity, in turn, is associated with an increased risk of developing various diseases, including cardiovascular diseases, hypertension, high blood cholesterol level, diabetes mellitus, certain cancers, gallbladder diseases and arthritis. Psychological disorders, such as depression and low self-esteem, can also occur if a person is concerned about his excess weight and fat deposits.

Any muscular activity, on the contrary, is aimed at maintaining the normal weight, because it burns calories, and the more intense it is, the more calories we burn.

The heart

According to My Canadian Pharmacy statistics, one of the most serious consequences of a sedentary lifestyle is a high risk of developing cardiovascular diseases, for example, ischemic heart disease or chronic hypertension. This, as a rule, occurs due to the lack of sports activities, in connection with which the heart does not receive the necessary blood supply. Also, under such conditions, the fat-burning enzymes responsible for the destruction of triglycerides in the blood become inactive. As a result, there are blood deposits on the walls of the vessels, which complicate blood circulation and can cause atherosclerosis, and in serious cases, a heart attack.

The result of performing physical exercises is more effective work of the cardiovascular system, increase in high-density lipoproteins, or «good» cholesterol, and a reduction in undesired triglycerides in the blood.

Muscles and bones

With a lack of physical activity, the muscles of the body become weak, which leads to a decrease in the ability to perform everyday tasks. In addition, a sedentary lifestyle is harmful to posture and may eventually lead to problems with the back, as the muscles supporting the spine are also weakened.

Canada Medstore claims, that osteoporosis is another possible consequence of a sedentary lifestyle. Staying in a sitting position for a long time, the bones do not experience any difficulties in maintaining the body. Over time, this leads to a loss of strength of bones and they become more brittle. The likelihood of developing arthritis also increases.

Regular exercise will help maintain the health of bones and joints, increase muscle strength and endurance, and charge you with energy for achieving life goals.

Diabetes

Exercising allows the body to control blood sugar level. Absence of the same activity leads to its increase, because, the less you move, the less sugar is used by the body. Increased blood sugar, in turn, loads the pancreas, which affects the secretion of the hormone insulin, thereby increasing the likelihood of developing diabetes.

Cancer

Some cancer types, such as colon and breast cancer, are also common among people leading a sedentary lifestyle.

The aging process

Telomeres, located at the ends of chromosomes and protecting them from any damage, become shorter as the body ages. It has been proved that with a sedentary lifestyle, telomeres shorten faster, as a result of which the aging process accelerates and age signs appear earlier.

Mental disorders

Sedentary lifestyle negatively affects mental health. People who do not receive any loads are more prone to depression and anxiety. My Canadian Pharmacy research has shown that regular muscle activity can reduce stress and the incidence of many mental disorders. Endorphins, released during exercise, naturally improve the mood and help to feel happier and more relaxed. In addition, sports have an impact on the production of the hormone serotonin, an unbalanced level of which can lead to depression, affect memory and appetite. In addition, a better appearance will help improve self-esteem and increase self-confidence.

Insomnia

A sedentary lifestyle can cause problems with sleep, since under such conditions the body may not feel the need for rest. Regular exercise, on the contrary, helps to get rid of insomnia and improve the quality of sleep. However, it is necessary to avoid training just before bed, because the body is too hot, which will not allow you to fall asleep quickly.

Financial expenses

Lack of activity and related health problems can also lead to financial losses. Financial expenses may be required for the medical services (prevention, diagnosis and treatment) related to the diseases that have arisen, and include the costs of doctor visits, the purchase of pharmaceuticals, and rehabilitation services. In addition, there may be implicit costs associated with loss of earnings due to the waste of working time for eliminating the medical problems that have arisen and prevent to perform work duties.

The benefits of physical activity

Canada Medstore studies have shown that almost all people can benefit from systematic exercise, regardless of whether they participate in intensive training or adhere to a moderate recovery load. Regular physical activity has a beneficial effect on most (if not all) organ systems and therefore helps prevent a wide range of health problems, including:

Reduces the risk of mortality from cardiovascular diseases;

Prevents high blood pressure;

Reduces the likelihood of developing diabetes;

Reduces the risk of colon and breast cancer;

Helps maintain a healthy weight;

Contributes to the construction and maintenance of healthy bones, muscles and joints;

Reduces depression and anxiety, and also contributes to mental well-being.

Systematic muscular load helps to prevent illness and improve health, it can actually reduce health care costs.

How to reduce the negative effects of a sedentary lifestyle?

If possible, take a 10-minute break every hour. During the break, try to move as much as possible.

If there is no possibility to get up from the workplace, it is necessary to perform the so-called Kegel exercise: strain the pubic-coccygeal muscles, as if drawing the anus inside. This exercise, perhaps, is the best exercise for the prevention of prostatitis and strengthening potency. It increases blood circulation to the genital organs, preventing stagnation of blood. Do the exercise every hour, for 30 repetitions at a time.

If the situation allows, do some small exercises:

Rotation of the pelvis. Rotate the pelvis first into one, then to the other side, doing the same number of repetitions. Such exercise normalizes blood circulation in the pelvic organs;

Squatting. It leads to muscle tone, increases blood circulation to the genital organs;

Torso bends to the sides. Touches muscle back muscles, increases flexibility;

Slopes forward. Lean forward and touch the floor with your hands. Improves back muscles, increases flexibility and mobility.

Sedentary lifestyle can cause irreparable harm to your health. Do not neglect the advice and be healthy!

Helpful tips from My Canadian Pharmacy for fans of a sedentary lifestyle

Reduce the number of hours spent sitting;

Do not rush to get on public transport;

At the weekend, give up the car;

Move as much as possible on foot;

Forget about the elevator and the escalator — get up and down the stairs;

Instead of cinema, go to the exhibition.

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Antidepressants from My Canadian Pharmacy: All You Need to Know

If you suffer from depression, antidepressants from My Canadian Pharmacy https://my-medstore-canada.net/products/anti_depressants can relieve some of your symptoms. However, antidepressants are not a panacea for depression, and they have their side effects and contraindications.

Learn the facts about antidepressants and weigh all the benefits and possible negative consequences to make a right choice.

Truth about Depression and Antidepressants

Is depression caused by a chemical imbalance in the brain?

You’ve probably heard about this in television, read in magazine articles, maybe even heard it from your doctor: depression is caused by a chemical imbalance in the human brain, and drugs can fix it. According to the theory of chemical imbalance, a low level of the chemical serotonin leads to depression, and medications for depression work, returning the serotonin level back to normal. However, the truth is that researchers know little about how antidepressants actually work. There is no analysis by which you can measure the amount of serotonin in the living brain. There is no way even to find out what is low and what is the normal level of serotonin.

But even if My Canadian Pharmacy antidepressants increase serotonin levels in the brain, this does not mean that depression is caused by a lack of serotonin. After all, aspirin can cure a headache, but that does not mean that headaches are caused by a deficiency of aspirin. In addition, many studies contradict the theory of chemical imbalance of depression. Experiments have shown that a low serotonin level in a person does not always reduce mood. When it comes to depression, the imbalance of serotonin does not give us a complete picture of the disorder. Experts agree that depression is much more than just «bad» brain chemistry. Serotonin is just one of many factors that can play a role in this disorder. Recent research points to other biological components of depression, including inflammation, increased stress hormones, suppression of the immune system, impaired activity in certain parts of the brain, malnutrition and a reduction in brain cells. And this is only the biological causes of depression. Social and psychological factors, such as loneliness, lack of physical activity, poor diet and low self-esteem, also play a huge role in the onset of depression.

How effective are antidepressants?

Scientists agree that if depression takes a severe form, treatment with My Canadian Pharmacy antidepressants can be useful and even save life. However, studies show that antidepressants do not help many people. A large study conducted in the United States in 2006 showed that even after using two different drugs, less than 50 percent of people with depression reported loss of symptoms. In addition, many of those who reported a positive response to treatment found themselves in depression a short time later, despite ongoing drug therapy. Other studies show that the effect of drugs on depression was greatly exaggerated. Some researchers have concluded that when it comes to mild and moderate depression, antidepressants are only slightly more effective than placebo. If you have a severe depression that disrupts your ability to function, you may need treatment. However, many people use antidepressants, while psychologist counseling, sports, or self-management skills can work just as well or even better — without side effects. A psychologist’s consultation can also help you get to the «bottom of the iceberg» — those underlying issues and contradictions that lead to depression and develop tools to get rid of depression.

Side effects of antidepressants

There are the following types of drugs used in the treatment of depression: selective serotonin reuptake inhibitors, «atypical» antidepressants, as well as old-generation drugs: tricyclic antidepressants and monoamine oxidase inhibitors (MAOI). Prozac from My Canadian Pharmacy is the most widely used selective serotonin reuptake inhibitor: https://my-medstore-canada.net/products/prozac.html.

All antidepressants have common side effects, and they are severe enough for many people:

Nausea;

Insomnia;

Anxiety;

Decreased sex drive;

Dizziness;

Weight gain or loss;

Tremor;

Sweating;

Drowsiness;

Fatigue;

Dry mouth;

Diarrhea;

Constipation;

Headache.

Selective serotonin reuptake inhibitors affect the production of serotonin in the brain. Serotonin helps regulate mood, but it also plays an important role in regulating digestion, pain, sleep, mental clarity and other bodily functions. As a result, this class of antidepressants cause a number of side effects. Common side effects include sexual problems, drowsiness, difficulty sleeping, nausea. Although some side effects disappear after the first few weeks of treatment, others persist and may even worsen. For people over the age of 65, this class of antidepressants is an additional concern. Studies show that these drugs can increase the risk of falls, fractures and bone loss in old age. Selective serotonin reuptake inhibitors can also cause severe symptoms of withdrawal if you stop taking them suddenly.

Side effects of atypical antidepressants

Another class of newer drugs for depression — atypical antidepressants — affects other neurotransmitters separately or in addition to serotonin. Some of the brain chemicals that they affect are norepinephrine and dopamine. Side effects vary depending on the particular drug. Nevertheless, many of the atypical antidepressants can cause nausea, fatigue, weight gain, drowsiness, nervousness, dry mouth and blurred vision.

Side effects of drugs from the depression of the old generation

Tricyclic antidepressants and MAOI (monoamine oxidase inhibitors) belong to the antidepressants of the old generation. Their side effects are much more serious than those of newer antidepressants, so they are prescribed only as a last resort, when other types of treatment have not been successful.

When you stop using antidepressants

Once you have started taking antidepressants, it may be difficult for you to spot, many people have symptoms that make withdrawal of antidepressants difficult. If you decide to stop taking antidepressants from My Canadian Pharmacy, it is very important to cancel the medicine gradually. If you stop taking it suddenly, you may experience a number of unpleasant symptoms, such as a crying attack, severe anxiety, dizziness, fatigue and pain. These symptoms are known as an antidepressant withdrawal syndrome.

Symptoms of canceling antidepressants:

Fear, excitement;

Depression, mood swings;

Flu-like symptoms;

Irritability and aggression;

Insomnia, nightmares;

Nausea and vomiting;

Dizziness, loss of coordination;

Spasms and pain in the stomach;

Sensations of electric shock; Tremor, muscle spasms.

With quitting antidepressants, depression and anxiety often occur. With depression caused by withdrawal of drug therapy, symptoms are often worse than the initial depression that initially led to treatment with antidepressants. Unfortunately, many mistakes in the withdrawal of antidepressant lead to the return of symptoms of depression and the need to resume treatment, creating a vicious cycle. In order to avoid symptoms of withdrawal of antidepressants, never stop taking your medicine suddenly. Instead, gradually reduce the dose, leaving at least 1-2 weeks between each dose reduction so that the body gets used to a new lowered dose of the drug. This process can take up to several months, and must be performed under the supervision of a physician.

Antidepressants and suicide risk

There is a danger that the treatment with antidepressants from My Canadian Pharmacy can increase the severity of depression in some people, rather than to alleviating the symptoms. Today, there is a law in the US that requires that all medications for depression contain a warning sign about an increased risk of suicide among children and young people. The risk of suicide is particularly high during 1-2 months of treatment. Anyone who takes antidepressants should closely monitor suicidal thoughts and behavior. This is especially important if a person is treated for depression for the first time, or if the dose has recently been changed. Signs that treatment with antidepressants only aggravates depression include anxiety, insomnia, hostility and extreme arousal, especially if the symptoms appear suddenly and the condition quickly deteriorates. If you notice any signs of anxiety in yourself or a loved one, immediately consult your doctor. These are such signs as:

Thoughts of suicide or attempted suicide

Aggravation of depression;

Aggravation of anxiety;

Aggression and anger;

Dangerous impulsive actions;

Irritability;

Excitement or anxiety;

Problems with sleep;

Hyperactivity;

Other unusual behavioral changes.

Study all possible ways of treating depression

Antidepressants are not a way to get rid of depression. Medications can relieve or remove some of the symptoms, but can not change the underlying cause of depression in your life. Antidepressants will not be able to solve your problems if you have depression due to a desperate situation at work, a pessimistic outlook on life, or unhealthy relationships. Depression does not appear just like that — this condition always has some reasons. Taking medication for depression, you change your state at the organic level, boosting your mood with chemicals, as if pushing the problem to the background. But as soon as you stop taking the pills, everything goes back to normal, because the reason remained, you did not understand the source of the depressive state. Here you can consult a psychologist, as well as change your lifestyle. Studies show that psychological care gives as good results as antidepressants in relieving the symptoms of depression, and much better prevents the relapse of depression after the end of therapy. However, if your depression is so severe that you do not have the energy to take the help of a psychologist, taking antidepressants from My Canadian Pharmacy for a short time can raise your mood to the required level so that you can focus on psychotherapy.

In addition to counseling, other effective treatments for depression include sports, meditation, relaxation techniques, stress management, support groups, and self-management skills. Although these procedures require more time and effort at the initial stage, their advantage of treatment with antidepressants is that they increase mood without any adverse consequences.

How to help yourself with depression?

The way out of depression begins with the fact that every day you make a choice in favor of positive thinking and a healthy lifestyle. If you start building close supportive relationships, learn to cope with negative thoughts, and also start taking care of your physical health, you slowly but surely help yourself overcome depression. How can you help yourself with depression? For this you can learn self-regulation, and hypnosis can help you in this. If you spend a little time studying the principles of hypnosis, you can understand why hypnotherapy is so effective in depression. In a nutshell, this can be expressed as follows: firstly, the very state of the trance you enter into when hypnosis is therapeutic, because while you relax, your brain starts to work in the alpha rhythm (the work of the right and left hemispheres of the brain is synchronized). Secondly, in a state of trance, your subconscious mind becomes more susceptible to therapeutic suggestions, so this type of therapy gives faster and more stable results than others.

How to understand that you need antidepressants?

If you are planning an antidepressant as an option for treatment, make sure that you carefully examined all treatment options for depression. Below you will find a number of questions that can help you make the right decision.

Ask the following questions to yourself and the psychologist:

Is my depression severe enough to prescribe antidepressants?

Is antidepressants the best option for getting rid of my depression?

Am ready to bear side effects?

What non-drug treatment can help me get rid of depression?

Do I have the time and the desire to conduct other types of treatment, such as psychotherapy, sports?

How can I help myself to get rid of depression?

If I decide to take medicine, do I have to visit a psychologist?

Ask the doctor the following questions:

Can my health be the cause of my depression?

What are the side effects and health risks of those antidepressants that you recommend to me?

Are there any products or other substances that I need to avoid?

How does this drug interact with other medicines that I take?

How long should I take this medicine?

Will it be difficult for me to stop taking this medication?

Can my depression return if I stop taking medication?

If you use antidepressants from My Canadian Pharmacy

If you decide to take antidepressants, you should find out everything you can about your medicine. The more you know about your antidepressant, the better you will cope with the side effects, avoid dangerous interactions with other drugs and minimize other safety concerns.

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My Canadian Pharmacy about Bronchial Asthma: Symptoms, Causes, Treatment

Bronchial asthma is a disease of an inflammatory immune-allergic nature, characterized by a chronic, paroxysmal course in the form of bronchial obstructive syndrome and suffocation. According to My Canadian Pharmacy, this disease has become a truly serious problem of society, because it is characterized by a progressive course. It is very difficult to cure asthma completely.

The first symptoms of bronchial asthma

The success in treatment of bronchial asthma with Ventolin inhaler or Advair is very often determined by the timely detection of this disease.

The earliest signs of asthma include such symptoms:

Shortness of breath or suffocation. They arise against a background of complete well-being and rest at night,during physical exertion, staying in the conditions of polluted air, smoke, indoor dust, pollen of flowering plants, change in air temperature;

Dry cough. It occurs synchronously with dyspnoea and is characterized by supersaturation. The patient wants to cough up, but can not do it. Cough can acquire a wet character only at the end of the attack;

Frequent shallow breathing with prolonged exhalation. During an attack of bronchial asthma, patients complain not so much of the difficulty of inspiration as of the impossibility of a full exhalation, which becomes prolonged and requires great efforts;

Chrypses with breathing. They are always dry by the type of wheezing. In some cases, they are even remote and you can listen to them being at a distance from the patient. With auscultation, they are heard even better;

Characteristic position of the patient during an attack. In medicine, this position is called orthopnea. In this case, patients sit down, lowering their legs, firmly grasping their hands behind the bed. Such fixation of the auxiliary muscles of the extremities helps the chest exhale.

Causes of Asthma

According to My Canadian Pharmacy, the reasons for which small bronchi acquire increased irritability are numerous. Some of them act as background conditions supporting inflammation and allergization, and some provoke an asthmatic attack directly. Each patient is individual and requires different asthma inhalers (Advair, Ventolin, Proventil), which depends on the cause and nature of asthma: https://my-medstore-canada.net/canadian/products/anti_allergic_asthma.

Hereditary predisposition. Children have an increased risk of developing this disease if their parents have it. This type of disease is atopic in nature. It is very difficult to trace the factors that provoke attacks of suffocation. Such asthma can develop at any age, both childish and mature.

Factors from the group of occupational hazards. A significant increase in the incidence of bronchial asthma as a result of exposure to harmful production factors was confirmed: hot or cold air, various small dust particles, chemical compounds and vapors.

Chronic bronchitis and infection. Viral and bacterial pathogens that cause inflammation in the bronchial mucosa and provoke an increase in the reactivity of their smooth muscle components. This is evidenced by cases of bronchial asthma arising on the background of bronchitis with a prolonged course, especially with signs of bronchial obstruction.

Quality of inhaled air and ecological conditions. Residents of countries with a dry climate and the rural population are sick much less often than residents of industrial regions and countries with a damp and cold climate.

Smoking. Systematic inhalation of tobacco smoke leads to inflammatory changes in the mucous membrane of the bronchial tree. Therefore, every smoker has chronic bronchitis. Some of them transform the process into bronchial asthma. Smoking can act as a factor that supports a constant inflammatory process and as a provoker of each attack.

Asthma from dust. Scientists have proved the cause-effect relationship of room dust with bronchial asthma. The thing is that the room dust is a natural habitat for home dust mites. In addition to these microscopic agents, it contains many allergens in the form of lean epithelial cells, chemicals and wool. Street dust becomes a provocateur of bronchial asthma only if it contains allergens: animal hair, pollen of flowers, grasses and trees. Getting into the bronchial tree, they provoke a massive migration of protective immune cells into the mucous membrane, which throw out a large number of mediators of allergy and inflammation.

Medications. Sometimes, the culprits of bronchial asthma are medications. It can be aspirin and any of the non-steroidal anti-inflammatory drugs. Very often, such asthma is isolated.

How to treat asthma?

Treatment of this disease is a strictly step-by-step process, which should be accompanied by appropriate adjustments in terms of treatment activities with each stage and stage of the disease. Only such an approach will help in the rational use of financial resources with minimal effects. After all, the main drugs for asthma (Advair, Ventolin, Proventil) can cause a lot of severe reactions, which can be reduced by the right combination of medicines.

In the treatment of bronchial asthma, a pathogenetic approach is used. It involves the mandatory use of drugs that not only relieve the symptoms of the disease, but also turn off the mechanisms for their reappearance. There is no way you should limit yourself to using only adrenomimetics (Salbutamol, Ventolin inhaler). Patients are attracted by the rapid effect of these drugs, but it will also be temporary. As the receptors of the bronchial tree get used, the effect of b2-agonists becomes weaker, until its complete absence. It is essential to have basic therapy (including Advair).

My Canadian Pharmacy answers the popular questions about asthma

Can I cure bronchial asthma with Ventolin or Advair? It is impossible to answer this question in the affirmative with absolute certainty. With all the effectiveness of these treatment methods, it is impossible to completely exclude the contact of a person predisposed to this disease. However, you can use these drugs to control the disease, to minimize its manifestations. Timely treatment, active prophylaxis of exacerbations, accessible kinds of sports, respiratory gymnastics will also help reduce the majority of symptoms of disease;

Is asthma inherited? No, asthma is not a genetically determined disease, since the genes of a patient with bronchial asthma have not been altered. However, a person can inherit features of the structure of the respiratory system, in particular bronchi, as well as increased sensitivity of the endocrine system and human immunity to irritants, that is, the predisposition of the body to the disease. The combination of risk factors together increases the likelihood of developing asthma;

Can I play sports if I have asthma? In this regard, specialists do not have a common opinion. On the one hand, an incorrectly selected kind of sport, physical training during exacerbations can provoke bronchospasm, on the other hand — metered physical loads normalize metabolism, increase immunity and tone of the muscular system. This is especially important for a growing child’s body;

Can I smoke if I have asthma? Both active and passive smoking is absolutely incompatible with bronchial asthma, as tobacco couples is the strongest allergen that has over 4000 chemicals in its composition. Cartridges of electronic cigarettes are no less harmful to patients with bronchial asthma, since their components are able to provoke an attack. Carbon monoxide, which is released when smoking hookah, has the same action;

Can I do inhalation if I have asthma? This form of administration of therapeutic drugs (Advair, Ventolin, Salbutamol, Proventil) is most effective in the treatment of bronchial asthma if contraindications are taken into account: the presence of neoplasms in the respiratory system, hyperthermia, cardiac and vascular pathology, diabetes mellitus, severe form of the underlying disease, predisposition to epistaxis. If you accurately observe the dosage of essential oils and medicines, inhalation will bring invaluable benefits;

Can I drink alcohol and coffee if I have asthma? Alcohol does not directly affect the respiratory system, however, its use provokes the development of inflammation, the toxins of ethyl alcohol adversely affect the state of all systems. In addition, most anti-asthmatic drugs are incompatible with alcohol. Coffee, by contrast, improves the function of the respiratory system, since it has caffeine in its composition. This effect lasts 3-4 hours. According to experts, coffee is a soft bronchodilator, which improves the respiratory process, expanding the bronchi;

Can I join the army if I have asthma? Boys who have a history of bronchial asthma are not eligible for military service if the disease has passed into the second or third stage of its development, since congestion in the bronchi, the risk of attacks of suffocation in contact with allergens threatens not only health, but also the life of a young man. At the first stage of the disease, the commission gives a deferment for a year or longer period. The desire of a man to serve may lead to the fact that he will be offered a facilitated mode of carrying out the service, during which the treatment of asthma will be continued.

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My Canadian Pharmacy — Best Potency Drugs!

My Canadian Pharmacy offers high quality medication including drugs to increase potency and treat erectile dysfunction.

Men’s Sexual Health

Potency is very important for every man. Buy often man face sexual disorders even if they lead an active and have a diverse intimate life. Even a slightly reduced erection can terrify men — they think that impotence is a sentence and can not be treated.

Erectile dysfunction causes are numerous. Bad ecology, genetic predisposition, serious diseases (diabetes mellitus, cancer, prostatitis), sedentary work, regular stresses and conflicts can affect men’s sexual health negatively. A man can suffer from erectile disorders even at the age of 20. Moreover, every year the number of young people with erectile dysfunction increases.

At the first erectile dysfunction signs, you should contact a specialist for qualified help. But not every man can go to the doctor with such a intimate issue — for most men this is a serious emotional shock. Of course, to consult a doctor is the best option, but you can take your sexual health under control.

My Canadian Pharmacy https://my-medstore-canada.net/aboutus has found a solution to the problem long ago. The online drugstore sells effective drugs to treat the most serious sexual disorders. These drugs are famous throughout the world: We speak of Viagra, Cialis, Levitra, Kamagra, Avana and their generics.

Canada Medstore Medication for ED

It’s not so easy to buy the necessary drug, especially if you do this for the first time. Men find it difficult to go to a pharmacy and discuss such a delicate topic. However, you do not have to do this anymore! Today, you can purchase any product without leaving your house. All you need is just to go to the website of my My Canadian Pharmacy, choose the medication and place an order. That means, you can stay incognito when buying a drug. Besides, you will purchase the product at the lowest price!

Canada medstore offers the best generic drugs for erectile dysfunction. Generics are cheaper than original drugs and produced by other pharmaceutical companies. Still. generics have the same composition and efficiency.

Why My Canadian Pharmacy?

All our medication is genuine and carefully checked. We offer the highest quality drugs;

We do not disclose the data about your offers. The history of purchases is protected, the orders are delivered in a dense envelope without an inscription on the contents;

Our prices are very low. We do not have to pay employees’ salaries, rent of premises, etc.;

We offer good discounts to regular customers. So you can save up to 15%!

My Canadian Pharmacy will deliver the drugs worldwide by post or courier;

We are open around the clock;

The personal account on the website allows you to control the process of ordering and delivery;

It’s very simple to make an order in our online pharmacy. Any visitor can understand the process of ordering!

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Viagra Pills from Canada: Description, Action, Side Effects

Viagra is the most popular drug for erectile dysfunction treatment which belongs to the group of PDE-5 inhibitors and has the form of biconvex blue tablets.

The medicine works only with sexual stimulation.The active component of Viagra is Sildenafil citrate.

What is Viagra effect?

Many men worry about potency: some suffer from premature ejaculation, others are not satisfied with erection quality, so the medicines for increasing potency are very popular on the pharmacological market.

Remember, Viagra from My Canadian Pharmacy is a medicine and should not be taken by healthy men. They can replace the drug with usual aphrodisiacs.

The main effect of Viagra is a strong erection that lasts for about four hours.

Generic Viagra is intended for men only and can not be taken by women.

Viagra has analogues: Cialis and Levitra, which belong to the same pharmacological group and act almost the same way. The drugs have different active substances and duration of action.

Cialis active substance is Tadalafil. Cialis has a very long validity: 36 hours.

Levitra is based on Vardenafil, which starts action very quickly: in 15 minutes after administration. The erection lasts from five to six hours.

You may also try to increase potency with the help of special exercises. Physical activity is a good addition to Viagra (Sildenafil).

Viagra Dosage

The most popular dosage is 25 mg.

Viagra pills from Canada are available in the following dosages:

Viagra 25 mg; Viagra 50 mg; Viagra 75 mg; Viagra 100 mg; Viagra 120 mg; Viagra 130 mg; Viagra 150 mg; Viagra 200 mg.

The cost of Viagra differs in all pharmacies. My Canadian Pharmacy offers the lowest price for Viagra (Sildenafil): https://my-medstore-canada.net

Generics are several times cheaper, but they have the same efficiency.

The maximum daily Viagra dosage is 100 mg. Overdose may provoke the same side effects, but in a more serious form. In case of an overdose, immediately consult a doctor, as you risk to experience the following Viagra side effects:

Nasal congestion;

Rhinitis;

Dizziness;

Increased heart rate;

Headache;

Red face and neck

Vomiting;

Eyesight disturbances.

NOTE: Side effects can be exacerbated if the drug is taken with alcohol.

Viagra from My Canadian Pharmacy is effective in 90% of cases. Before using the drug, consult a doctor (he should prescribe the correct dosage) and read the instructions for use!

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Cialis from My Canadian Pharmacy: Description, Effects and Benefits

What is Cialis?

Generic Cialis is medications for erectile dysfunction treatment which has the same pharmaceutical, biological and therapeutic properties as the original PDE5 inhibitor.

The active substance of Cialis is Tadalafil. This substance improves erection, gives an opportunity to preform a full sexual intercourse.

The drug from My Canadian Pharmacy is active for 36 hours and is considered the best ED medicine.

With one pill of Cialis, you can enjoy a firm and quality erection even the next day. The effect starts in 15 minutes, but the drug acts only in the presence of sexual arousal, like any PDE5 inhibitor, which means that the tablet should be taken at least 15 minutes before the intended sex.

Cialis is also available in Cialis Soft Tabs version. The difference of Cialis Soft and is the speed of action (Cialis Soft Tabs works faster). In addition, these tablets dissolve under the tongue and can be combined with alcohol and fatty foods. See more details about Cialis Soft Tabs vs Cialis: https://my-medstore-canada.net/cialis-soft-tabs-vs-cialis-what-is-the-difference.html.

Cialis Dosage

The minimum Cialis dosage is 10 mg (1/2 tablet).

The maximum Cialis dose is 20 mg (1 tablet). It is not recommended taking Cialis (Tadalafil) more than once a day, as the drug works up to 36 hours. Do not exceed the dosage.

Cialis: effects and benefits

The active substance of Cialis — Tadalafil — relaxes the smooth muscles of the penis. As a result, the muscles relax and blood enters the penis, which contributes to a strong erection. Erection disappears after sex.

The drug has a good tolerability and is not additive.

IMPORTANT: There is a nuance that should be taken into consideration when using Cialis tablets — the effect of the tablets does not occur without the sexual stimulation!

Manufacturers of Cialis proved that the drug is effective in 81% of cases.

Cialis from My Canadian Pharmacy will help:

Restore potency and high quality erection;

Perform a complete sexual intercourse;

Maintain a normal erection during sex;

Get satisfaction from sex.

Experience positive emotions;

Restore self-confidence;

Satisfy a sexual partner;

Increase sexual desire;

Relieve the fear of intimacy.

The duration of sex with Cialis can reach 3 hours!

NOTE: Prolonged use of Cialis can cause an increase in the penis due to the active blood flow. If the effect is not achieved, you should consult a doctor.

There are several forms of Cialis (Tadalafil) and a man can always choose the most acceptable option!

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My Canadian Pharmacy Coupon Code

Nowadays it is difficult to find high-quality medications and even if we do — prices for them are unbelievable. Everyone wants to get quality for small money, but we are well aware that quality = high price.

But today you can get what you wish. My Canadian Pharmacy provides only best quality low-cost medications. We do not make money at your expense, we try to make your life and health better. That is why in our pharmacy you will never find overpriced drugs!

When spring comes we all want to get something good. That’s why we offer you special discount for all products in the list to make you even happier. You may enjoy shopping in our store and spend even less money than before. Send us a request to our e-mail and you will get your My Canadian Pharmacy Coupon Code as soon as possible.

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Medicine and Society, Role of Drugs in Person's Life

The last few decades are characterized by very major pharmacological achievements. It contents completely new pharmacology sections for:

antibiotics;

sulfonamides;

psychopharmacological agents;

anticoagulants;

cytostatic;

luchezaschitnyh;

muscle relaxants.

In general, pharmacology has played and continues to play important role in what is happening right before our very eyes, the main transformation of human pathology.

With more in-depth penetration into mechanisms action of various pharmacological agents have been clarified, and in some cases, significantly expanded indications for their use.

Remarkable progress of pharmacology as a science has put as agenda number of new problems. Expansion of indications for the use of pharmacological agents, as well as the synthesis of whole classes of new drugs, among other things, led to the fact that results of their application went beyond special interests of pharmacotherapy, getting in some cases, value factor greater social sense.

Two Groups of Issues

On the one hand, due to increasing empowerment of massive use of new, extremely effective pharmacological agents for common diseases treatment and prevention, pharmacology is more formalized as preventive discipline.

On the other hand, widespread use of certain pharmacological group makes all more urgent problem of values, which may have impact on effect of these agents on large contingent of people. For example, thanks to series of organizational measures, crucial role is played by pharmacology provided new and effective means of destruction and carriers malaria parasite in treatment of malaria cases, in many countries the problem of malaria eradication has been solved.

Along with a number of basic and hygienic measures, a very important role in the successful fight against tuberculosis has played and continues to play tuberculosis drugs which may be bought via My Canadian Pharmacy online.

Therapy is enriched by new, combined with high chemotherapeutic activity and causing fewer side effects such as:

sulfonamides;

antibiotics.

They lead to sharp increase in therapeutic options to control various:

streptococcal;

staphylococcal;

pneumococcal;

meningococcal;

colibacillosis;

other infections.

From a social point of view, a very important question is about possibilities offered by pharmacology, to monitor evolution of a number of mass diseases, such as:

hypertension;

myocardial infarction.

Discovered during the past 10-15 years new antihypertensives dramatically expanded possibilities of therapist to monitor blood pressure and played a very important role in prevention of severe, often fatal hypertension complications. Coronary medications created in recent years on a new basis, also play and continue to play a very important role in therapeutic practice. And it means:

extension lives of thousands of patients;

provision of ability to work for hundreds of thousands of patients in prime of their creative powers.

Thanks to penicillin prophylaxis of rheumatic attacks, pharmacology succeeded in capturing a large extent evolution of pathological process, thousands of rheumatic patients avoid disability. Anticoagulants are in many cases made it possible to avoid development process and its thromboembolic complications. Now it becomes possible to order medications online especially via Canadian Pharmacies. One of the most popular is My Canadian Pharmacy (read more about it - https://my-medstore-canada.net/aboutus). All medications are of generic origin and sold over the counter. Canadian medications are the best one because they are produced by the most reliable and authoritative drug-manufacturers.

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Briefly about Contraception

Contraception is a method of birth control, aimed at prevention of unwanted pregnancy during sexual intercourse.

There is currently number of methods and means for contraception, most of them is achievement of past half century. Debates are still not ceased on usefulness and acceptability from various methods of demographic, medical, ethical and other points of view, but the vast majority of experts agree that contraception is better than another "method of family planning" - abortion.

The most common are the following types of contraception:

biological barrier methods;

chemical;

implantation (IUD);

hormonal methods;

surgical birth control.

Efficiency of different contraceptive methods is evaluated by Pearl index. Pearl Index is number of pregnancies occurring in 100 women who use certain method of contraception within 1 year.

This article provides Pearl Index value based on results of foreign scoping study conducted in 2010 on basis of 139 different works analysis on contraceptive methods effectiveness.

Physiological Birth Control Methods

Biological (physiological) methods based on knowledge of female reproductive system functioning physiological rhythms - the oldest, safest and least effective of all.

There are two basic varieties:

actual biological method (calculation of "safe days");

interrupted sexual intercourse method.

Biological (calendar) method is based on ovulation period establishment (release of egg from ovary into abdominal cavity) by measuring the so-called basal body temperature (rectal temperature) and keeping a diary of menstruation.

Abstaining from sexual intercourse during expected ovulation period (10-18 day of cycle, the period before rise of basal temperature above 37 ° C, and the first 2-3 days after lifting) helps avoid pregnancy.

Positive moments - "calendar method" is easy to use and has no side effects. The reasons for low reliability are fluctuations in physiological parameters and lack of care when measuring basal body temperature.

Contraception Method | Calendar Method

Pearl Index in case of correct administration | 0.7-3.1

Pearl Index without strict observation | 3.8-20.4 

Calendar method reliability is increased when using portable electronic devices, measuring daily basal temperature. According to collected data, these devices are able to build mathematical model of individual menstrual cycle and accurately predict woman's fertility for the next day. 

Physiological and another traditional method includes breastfeeding (lactation). The contraceptive effect in the first 6 months after delivery can be achieved only with constant and frequent feedings in daytime and at night. The latest in modern conditions is extremely rare, so this method is unlikely to be effective.

Mechanical Birth Control Methods

Barrier method is based on use of means, mechanically preventing penetration of sperm into uterus and fallopian tubes. The advantages of technique include ease of use and reliable protection against pregnancy.The most common method: use of male condoms.

Contraception Method | condomn

Pearl Index | 2.5-5.9

Chemical Contraception Methods: Spermicide

Chemical contraceptive methods based on use of spermicides - substances that kill sperm. Spermicides are available in different form:

ointments;

creams;

gels;

suppositories, which is inserted into vagina 1 hour earlier and not later than 10 minutes prior to sexual intercourse. The method is preferably used in combination with barrier contraception (condoms and spermicide), because spermicides use alone is ineffective.

You should be aware of inefficiency and insecurity of attempts to use various materials as spermicides. So widespread it is still "popular" belief that pregnancy can be prevented by introducing into vagina lemon drops, tampons soaked in solutions of various acids, Coca-Cola and other ingredients, both before and after sexual intercourse. This is not only wrong, but also dangerous. The only result that can cause similar actions - burn mucous membrane and development of inflammatory processes as a result of vaginal microflora violations.

Intrauterine Contraceptive Methods

Intrauterine contraceptive methods are based on introduction into uterus different devices that impede contact of sperm with egg and introduction of fertilized egg into uterine wall when contact takes place. Until recently, most of these devices took form of spiral.This birth control method is abortifacient, increasing various diseases risk and has a number of contraindications.

Hormonal Birth Control

Hormonal birth control is very effective. The most common are combined oral contraceptives (COCs), ie tablet formulations for oral administration, containing two types of hormones. Other types of drugs include one of them.

The mechanisms of action of these drugs include:

inhibition of oocyte maturation;

increasing viscosity of mucus, hindering sperm penetration;

changing structure of uterus lining, preventing attachment of fertilized egg.

Contraception Method | COC

Pearl Index at correct administration | 0-1.26

Pearl Index average indicator | 1.26-2.18

Surgical Contraception

Surgical contraception (sterilization) is tubal ligation in women or spermatic cord (this operation is called a vasectomy) in men. This method has virtually 100% efficiency, but in most cases is irreversible. Read about Emergency Contraception on My Canadian Pharmacy.

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My Canadian Pharmacy: Drug Lymphocyte Stimulation Test in the Diagnosis of Adverse Reactions to Antituberculosis Drugs

Tuberculosis (TB) is a worldwide infectious disease and is occasionally life threatening. Current standard therapy consists of isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA), which is very effective for treating patients with TB; however, as a result of these powerful regimens, serious side effects may occur. The most effective management of drug adverse reactions is discontinuation of the medication, and alternative medications with different chemical structures should be substituted. However, in TB treatment, first-line drugs, in particular INH and RIF, are the most important agents and their continued use should be attempted. Approximately 10% of drug side effects are immunologically mediated, in which the diagnosis of adverse drug reaction is usually based on clinical judgment and not only in vitro methods such as the drug lymphocyte stimulation test (DLST), but also in vivo methods such as a challenge test or skin tests. DLST is an in vitro method for diagnosing drug hypersensitivity. The scientific basis for DLST has been well established, and its usefulness has been demonstrated in various diseases with different drugs; however, for anti-TB drugs, only small studies have been reported, and there is little information on DLST for anti-TB drugs. In this study, we focused on the usefulness of DLST for determining drug-induced immune adverse reactions in patients with TB by comparing the results of the drug provocation test (DPT) and DLST. Materials and Methods This study was prospective and was approved by the ethics committee of our hospital, and informed consent was obtained according to hospital guidelines. Subjects Between January 2002 and August 2007, 455 TB patients without HIV infection who were admitted to Tenryu Hospital, National Hospital Organization for TB treatment were included in this study. TB was confirmed by the isolation of Mycobacterium tuberculosis from culture. Nineteen patients given parenteral treatment were excluded. The 436 patients (mean age, 70.0 years; range, 26 to 95 years; 280 men and 156 women) had initially received first-line standard anti-TB therapy, including INH (5 mg/kg/d), RIF (10 mg/kg/d), and EMB (15 mg/kg/d), with or without PZA (25 mg/kg/d). During the clinical course, patients with first-line drug-induced adverse reactions were treated with paraminosalicylic acid (PAS) [200 mg/kg/d], streptomycin (SM) [15 mg/kg three times a week], levofloxacin (LVFX) [8 mg/kg/d], ethionamide (TH) [10 mg/kg/d], and/or cycloserine (10 mg/kg/d), alternatively. Classification of Adverse Events Adverse events were categorized as those related to eruption, hepatitis, or drug fever. Eruption was diagnosed based on the clinical manifestations, showing generalized morbilliform erup-tion. Hepatitis was defined as a liver transaminase value more than three times the upper limit of normal. The clinical hallmark of drug fever was defined as recurrence of fever despite microbiological and radiographic improvement by therapy for several weeks. Fever due to infection, including TB, was excluded. Drug-related fever spontaneously resolved when drugs were stopped. GI events and hematologic toxicity were excluded because they are normally not considered to be immune-mediated side effects. DLST Heparinized, 12.0-mL blood from patients with a possible drug adverse reaction was sedimented at 2,000 revolutions per minute for 5 min, and then 3,000 revolutions per minute for 5 min to obtain autologous plasma. The remaining pellets were centrifuged at 1,800 revolutions per minute for 20 min, and lymphocytes were isolated via density gradient centrifugation. After washing with phosphate-buffered saline solution at 2,000 revolutions per minute for 5 min twice, the cells were set to a cell density of 106 cells/mL and were floated in RPMI 1640 medium (SIGMA; St. Louis, MO) with 20% autologous plasma and a penicillin-streptomycin mixture but not with serum from type AB blood. The floated cells (200 μL per well) were seeded in 96-well dishes and cultured with the added drug in a 5% CO2 incubator for 5 days. We normally used drug doses of 1, 10, and 100 μg, but occasionally a lower or higher concentration (0.01 μg or 200 μg, 500 μg, and 1 mg) was used. The appropriate drug concentration was evaluated as the inhibitory capacity of the drug on phytohemagglutinin stimulation of the cells; thereafter, [H] thymidine was added and the cells were incubated in 5% CO2. After 16 to 18 h, the cells were harvested and mitogenic activity was quantified by [H] thymidine incorporation (count per minute) using a scintillation counter (PerkinElmer; Tokyo, Japan). The positive control was phytohemagglutinin, and the negative control was the same condition without the drug. Experiments were performed in triplicate. The stimulation index (SI) is defined as count per minute of the stimulation/count per minute of the negative control. DLST findings were considered positive if the SI was > 180%. All patients were assessed within 1 week after the initiation of adverse drug reactions. None of the patients were treated with glucocorticoids before the DLST was completed. Identification of Drug Causing an Adverse Reaction When drug adverse reactions were observed, all drugs were temporarily stopped. Resolved symptoms and laboratory data after withdrawal were confirmed, and then DPT was performed with careful observation and under informed consent. The usual dosage of each agent was administrated at intervals of 3 to 4 days according to American Thoracic Society guidelines. If the same adverse reaction occurred, the drug was stopped and considered DPT positive, and the next drug was started. We identified the causative drugs in accordance with the results of DPT. Statistical Analysis Statistical analysis was performed using the Mann-Whitney U test; p values < 0.05 were considered significant.

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My Canadian Pharmacy about Cardiovascular Adaptation to Obesity and Hypertension: Obesity-Hypertension Connection

It is postulated that mild obesity may protect a given patient from the deleterious effect of hypertension by reducing systemic vascular resistance and thus decreasing hypertensive target organ damage. There are indeed some data to support this hypothesis. As mentioned earlier, we have shown that systemic vascular resistance and renal vascular resistance are lower in obese patients than in lean subjects having similar arterial pressures. Likewise, there is an inverse correlation between body weight and renal vascular resistance. Investigators have suggested that the lower vascular resistance in obese patients possibly decreases the risk of hypertensive retinopathy, nephrosclerosis, cerebrovascular disease, and other cardiovascular morbidity and mortality. On the other hand, the increased intravascular volume and preload in obesity should place these patients at high risk of congestive heart failure. These arguments outlined above support Volhards observations—made over 50 years ago—that pale hypertension predisposes to vascular disease and nephrosclerosis, and red hypertension to heart failure. As outlined earlier, obesity produces eccentric LVH regardless of the arterial pressure. In contrast, the cardiac response to arterial hypertension and increased afterload consists of concentric LVH. When obesity and hypertension occur in the same patient, both preload and afterload are elevated, thus presenting a double burden to the left ventricle. The dual workload imposed on the heart by obesity and hypertension causes severe cardiac hypertrophy. Over 50 years ago, Smith and William, at the Mayo Clinic showed that averaged 376 g in obese subjects without known heart disease and 467 g in those who were both obese and hypertensive. Congestive heart failure occurs in a high percentage of morbidly obese patients irrespective of arterial pressure. Investigators have demonstrated impaired left ventricular function and compliance, as well as high end-diastolic pressures in patients with significant obesity. We have recently demonstrated that patients who are more than 50 percent overweight have normal left ventricular function as measured by velocity of circumferential and fractional fiber shortening. However, the left atrial emptying index, a sensitive indicator of diastolic ventricular compliance, is markedly decreased in obese normotensive and obese hypertensive patients, thus demonstrating diastolic ventricular dysfunction in obesity. Although diastolic ventricular dysfunction occurs early in obesity, we showed that diastolic ventricular compliance is most markedly decreased in obesity-hypertension. Also, preliminary data from our laboratory indicate that contractility, when measured by a preload independent index (end-systolic stress/end-systolic volume index), is decreased early in obesity hypertension (Garavaglia, Nunez, Messerli, unpublished observations). This systolic and diastolic dysfunction and increased preload will tax the heart, and not surprisingly, will lead to premature congestive heart failure in obesity, and particularly, in obesity-hypertension. Weight Reduction Weight reduction in the obese hypertensive patient is clearly associated with a fall in arterial pressure, but the underlying mechanism remains obscure. The reduction in pressure has been attributed to alterations in body fluid partitions by reduced sodium intake and falls in the renin and aldosterone levels. Also, weight loss reduces the sympathetic drive to the cardiovascular system, allowing a redistribution of the intravas-cular volume from the cardiopulmonary area to the periphery, thereby reducing venous return (preload), cardiac output, and arterial pressure. As shown by McMahon and colleagues, weight loss may be associated with a small but significant decrease in left ventricular mass and septal and posterior wall thickness. However, Alpert and collaborators recently studied patients who were morbidly obese. In their study, a weight loss of 55 kg induced by gastric resection resulted in a reduction of left ventricular chamber size and improvement in systolic left ventricular performance but did not significantly reduce septal or posterior wall thickness. Regardless of the mechanism, weight loss clearly reduces the double burden imposed on the heart by obesity and arterial hypertension and decreases preload, afterload, and sympathetic stimulation, and may reverse cardiac hypertrophy. Unloading the heart from this twofold burden should become a major goal in the prevention and treatment of cardiac diseases.

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My Canadian Pharmacy: Cardiovascular Adaptation to Obesity and Hypertension

Hypertension

Substantial evidence exists to show that the fundamental response to an isolated increase in afterload consists of left ventricular hypertrophy (LVH) without chamber dilatation or concentric hypertrophy. These cardiac adaptive changes occur very early in hypertensive disease and can be seen in about 50 percent of juveniles whose blood pressure is elevated only to the borderline level. Since hypertrophy of the myocardial wall decreases the ventricular wall stress, it is a common notion to consider concentric LVH as an adaptive physiologic process serving to compensate for the increased afterload.

Data from the Framingham cohort, however, have indicated that patients with electrocardiographic evidence of LVH are at a greater risk for sudden death (and other cardiovascular morbidity and mortality) than subjects with a normal heart. We have shown that patients with borderline and essential hypertension have a similar prevalence and complexity of ventricular ectopic activity when compared to normotensive subjects without apparent heart disease. Also, ventricular ectopy is not increased in patients with mild to moderate concentric LVH by echocardiographic, but not electrocardiographic, criteria (Lavie and Messerli, unpublished observations). Therefore, early hypertensive concentric hypertrophy may indeed be a clinically silent adaptive process. We have recently demonstrated, however, that patients with LVH on ECG have 40 to 50 times more frequent and more complex (higher Lowns class) ventricular ectopy than patients with a normal or less hypertrophied myocardium. Clearly, once the ECG shows LVH, a pattern that is highly correlated with substantially increased left ventricular mass, the “critical mass” has been exceeded. This results in impaired coronary reserve, impaired ventricular functional reserve, and an increased electrical irritability, as manifested by high grade ventricular dysrhythmias. Read more about various diseases, including hypertension, cancer, vomiting, and their treatment on My Canadian Pharmacy http://my-medstore-canada.net/my-canadian-pharmacy-vomiting.html.

Obesity

Since heart rate remains unchanged when a patient becomes obese, the increase in cardiac output occurs by means of an expanded stroke volume. An elevated left ventricular filling pressure and end-diastolic volume in overweight subjects increases preload which gives rise to chamber dilatation. According to Laplaces law, chamber dilatation increases wall stress which increases afterload. The dilated left ventricle adapts to these stresses, if they persist, by an increase in muscle mass. Obesity, therefore, produces predominantly LVH and dilatation, or eccentric hypertrophy, reprta ef the level of arterial pressure (Fig 1), In a study of a heterogeneous population of 171 patients, we recently showed that body weight and body surface area were the most powerful determinants of left ventricle chamber size, wall thickness, and muscle mass. Indeed, patients who were more than 50 percent overweight had a 50 percent prevalence of LVH (defined as posterior wall thickness exceeding 11 mm). It has been known for many years that obesity takes a toll on the heart. Hippocrates noted many years ago that sudden death is more common in the obese than in the lean. We recently demonstrated that obese patients who lacked electrocardiographic evidence of LVH but who had distinct eccentric LVH on the echocardiogram had a markedly increased prevalence and complexity of ventricular ectopy when compared to those without LVH or to slender patients. These observations suggest a possible electrophysiologic abnormality as the cause of the epidemiologic findings in the Framingham cohort identifying obesity as an independent risk factor for sudden death and other cardiovascular morbidity and mortality.

Figure 1. Adaptation of the heart to obesity and hypertension (used with permission from Messerli).

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Cardiovascular Adaptation to Obesity and Hypertension: Systemic Hemodynamics in Obesity and Hypertension

Hypertension and obesity are two disorders that are directly related. For many years, it has been known that obese patients are more likely to be hypertensive than nonobese subjects, and weight gain might indicate whether or not borderline hypertension evolves into established essential hypertension. Normotensive overweight subjects have been shown to be at greater risk of becoming hypertensive than lean subjects. Also, hypertensive patients, as a group, consistently weigh more than age-, race-, and sex-matched normotensive subjects and tend to become more obese as the disease progresses. This indicates that either (1) hypertension predisposes to obesity, (2) obesity is a prehypertensive state, or (3) both disorders result from a common pathophysiologic mechanism. It is certainly possible that obesity begets hypertension, and hypertension begets obesity.

Despite the clinical and epidemiologic evidence, pathophysiologic mechanisms of the relationship between obesity and hypertension are poorly understood, and it is uncertain whether this relationship is causal or not. It is also unclear whether this association is good, innocent, or evil. In this report, we analyze the cardiovascular adaptation to these two disorders separately and when the two disorders occur together in a patient. The value of weight reduction as intervention in obesity hypertension is briefly reviewed.

Systemic Hemodynamics in Obesity and Hypertension

Systemic vascular resistance seems to be an indicator of the severity of systemic hypertensive vascular disease since it reflects either reversible arteriolar spasm or less reversible arteriosclerosis. Systemic vascular resistance can be calculated by dividing mean arterial pressure by cardiac output and is proportional to the radius of the blood vessel to the fourth power, to blood viscosity, and to the vessel length (Poiseuilles law). Although obesity and hypertension are related, the two disorders display different hemodynamic patterns (Table 1). The hallmark of essential hypertension is known to be an increased total peripheral resistance. Even in borderline hypertension, peripheral resistance is inappropriately high. With progression of hypertensive cardiovascular disease, cardiac output begins to fall, and total peripheral resistance becomes more elevated. As total peripheral resistance progressively increases, intravascular volume becomes progressively contracted. With progression of hypertension, renal blood flow falls and renal vascular resistance progressively increases.

Conversely, any increase in body mass (muscular or adipose tissue) requires a higher cardiac output and expanded intravascular volume to meet the elevated metabolic requirements. Thus, from a hemodynamic standpoint, obesity corresponds to a mild volume overload state. Provided that arterial pressure remains unchanged, an elevated cardiac output will result in a fall in total peripheral resistance in obese patients. Therefore, for any level of arterial pressure, cardiac output is higher and systemic vascular resistance lower in an obese than in a lean patient.

Table 1—Cardiovascular Adaptation in Obesity and Hypertension

Hypertension Obesity Hypertension And Obesity Peripheral Total peripheral resistance tt i t Intravascular volume I t Normal to f Renal blood flow I t Normal to I Glomerular filtration rate Normal to | t Normal to f Heart Preload Normal tt tt Afterload tt Normal to f tt Cardiac output Normal t t Stroke work t t tt Chamber volume 1 t t Wall thickness t Normal to f Normal to f

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Sleep-Related Breathing Disorders: Treatment

Although numerous alternatives, both medical and surgical, have been recently proposed in the treatment of obstructive sleep apnea, the tracheostomy remains the most likely to succeed. In appropriately selected cases, this treatment is successful in nearly all instances. Success in this case refers to a reversal of the symptom of daytime sleepiness and cardiopulmonary sequelae such as nocturnal hypoxemia, right ventricular failure, and systemic hypertension. Guilleminault and his colleagues have recently codified and reported on their extensive experience with tracheostomy for obstructive sleep apnea. An alternative surgical approach, the uvulopalatopharyngoplasty, has recently been described and in some cases obviates the need for a permanent tracheostomy. Pharmacologic approaches to the treatment of this condition have met with only variable degrees of success. Medroxyprogesterone has been shown to enhance respiratory drive in patients with obstructive sleep apnea, but there is little convincing evidence that it is consistently successful in relieving obstructive sleep apnea. A recent study has shown that protriptyline decreases the number of obstructive apneic episodes, but that was determined to be secondary to a decrease in the percentage of REM sleep, a well-established effect of tricyclic antidepressant drugs. Other nonsurgical approaches have recently been described involving the use of positive pressure to the upper airway. Sullivan et al have reported the successful use of continuous positive airway pressure (CPAP) in the treatment of patients with symptomatic obstructive sleep apnea. This study documents a virtual abolition of episodes of obstructive sleep apnea, as well as impressive symptomatic improvement in all patients studied. The application of expiratory positive pressure has also been shown to reduce episodes of obstruction of the airway and affect a remission of symptoms in the majority of the patients studied in a preliminary report. Recently, the use of a tongue-retaining device has been reported to be successful in some patients. Of these mechanical devices, only the report by Sullivan et al using CPAP appears to be consistently successful in reducing episodes of obstructive sleep apnea to a clinically significant degree and producing consistent symptomatic improvement. All of these mechanical devices suffer from the disadvantage of being cumbersome, which presents a considerable problem with compliance. None of these procedures has yet been shown to be effective with long-term follow-up. Loss of weight has been touted as an effective treatment for obstructive sleep apnea, since many of these patients are obese. In fact, nearly every clinician with any experience with this syndrome has noted examples of substantial improvement with loss of weight; however, it is the experience of most investigators in this area that weight loss is not consistently effective in resolving obstructive sleep apnea. Furthermore, compliance with weight loss programs is notoriously poor. Generally, our approach to treatment is to attempt weight loss in the obese, clearly symptomatic patient, whose sleep study does not reveal severe oxygen desaturation or malignant cardiac arrhythmias. Although this has not been particularly successful, we believe that the patient should be encouraged to take this option prior to a more aggressive surgical approach.

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Sleep-Related Breathing Disorders Explained by My Canadian Pharmacy

The dramatic description of sleep-related upper airway obstruction focused considerable attention on the investigation of other pulmonary diseases and the association of these with sleep-related respiratory disturbances. Wynne and his colleagues have described sleep-related breathing disorders resulting in severe oxygen desaturation (to approximately 50 percent arterial oxygen saturation) in patients with severe chronic obstructive pulmonary disease (COPD).

There appears to be little doubt that in some patients, this may play an important role in the development of the pulmonary hypertension and consequent right ventricular failure associated with severe chronic obstructive pulmonary disease (COPD). Other investigators have pursued these observations in more depth by specifically identifying patients most likely to develop nocturnal hypoxemia. Douglas and his colleagues have noted that patients with COPD characterized as “blue bloaters” tend to exhibit sleep-related oxygen desaturation more frequently than those described as “pink puffers.” These observations have contributed greatly to understanding the pathogenesis of the cardiopulmonary complications of COPD treatment. The best way to receive treatment is to command the service of My Canadian Pharmacy via http://my-medstore-canada.net/agnosia-its-types-explained-by-my-canadian-pharmacy.html.

Other intrinsic pulmonary diseases have also been studied with regard to their possible association with sleep-related breathing disorders. A recent study with asthmatic subjects documented that although there is no specific tendency for nocturnal attacks to occur in any particular state of sleep, oxygen desaturation was proportionally more frequent and severe during REM sleep. Other studies in patients with cystic fibrosis have shown that sleep-related spontaneous oxygen desaturation is sufficiently severe to play a prominent role in the development of the malignant pulmonary hypertension commonly encountered in these patients. These authors noted that the spontaneous episodes of oxygen desaturation most commonly occurred during REM sleep and inferred that this was due to decreases in pulmonary volume. Similar results have been noted in patients with kyphoscoliosis.

Summary

The study of sleep-related breathing disorders has substantially advanced the practice of pulmonary medicine, both in terms of improving diagnostic accuracy and in defining more appropriate and specific treatments for a variety of respiratory disorders. Although a presumptive diagnosis of these disorders can be made with a good clinical history, an overnight sleep evaluation is generally necessary in order to determine the presence and severity of a specific disorder. Awareness of sleep-related breathing disorders has revolutionized the practice of pulmonary medicine and has dictated that it become a specialty equally concerned with sleeping and waking respiratory functions. The clinician who remains satisfied with an evaluation of the patient only during the waking state ignores the myriad of disorders of ventilation known to be induced or exacerbated by sleep. The knowledgeable physician must now embrace the full 24-hour spectrum of mans physiologic and pathophysiologic functioning.

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Penile implant

The penile implant, or penile prosthesis, is the most effective treatment for erectile dysfunction that does not respond to other treatments. It is an outpatient procedure. Men can go home the same day or have a short, overnight hospital stay.

Most men are back to regular activities in about one to two weeks and able to have intercourse in six to eight weeks. The results of the surgery will vary depending on the patient. Most men and their partners are very satisfied with the return of sexual function.

Thought-provoking information on http://www.uwhealth.org/urology/penile-implants/20541

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My Canadian Pharmacy Cures Stenocardia