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Earlier on the same day her husband, Lord Guilford Dudley, whom she had married on the 21st of May 1553 , was beheaded on Tower ...

Earlier on the same day her husband, Lord Guilford Dudley, whom she had married on the 21st of May 1553 , was beheaded on Tower ...

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Bangkok Yanhee Hospital has been offering penis enlargement surgery for some time. The latest craze, however, are Botox injections into the penis. Prices are about 300 USD. Effects last half year.

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Anesthesia Awareness?hat If I Am Awake During Surgery?

Updated on November 4,

TahoeDoc HealDove

Anesthesia Awareness - Awake Under Anesthesia

Fear of being awake under anesthesia, called anesthesia awareness or intraoperative awareness, causes a lot of anxiety for patients facing surgery.

Having anesthesia is scary for most people. As an anesthesiologist, I usually meet patients right before their surgeries. People facing surgery have many apprehensions and fears. More and more are concerned about anesthesia awareness.

I repeatedly hear that patients are often more apprehensive about the anesthesia than the surgery itself. And of all the fears that people have about the anesthetic side effects and anesthetic complications, the one I hear most often is, "I'm afraid of waking up during the surgery."

Anesthesia awareness has received a great deal of attention in the press over the last few years and even a full-length movie, called "Awake," capitalized on this fearful concept (I have reluctantly included the trailer here). But what is it really? Why and to whom does it occur? Keep reading to find out why it most likely won't happen to you.

"Awake" - Sensationalizing Anesthesia Awareness

What Is Anesthesia Awareness?

Anesthesia awareness, also called intraoperative awareness refers to a specific situation where a person is under general anesthesia for surgery and regains consciousness during the surgical procedure.

The definition of general anesthesia includes induction and maintenance of loss of consciousness. This means that you should not be able to wake up until the surgery is over. You do not respond to voice or painful stimuli.

For various reasons, some people do regain consciousness when they are under general anesthesia. For most people, this involves a very brief, hazy memory. Some people are aware of what is being said, but cannot move or indicate that they are awake. Still, there is usually no sensation of pain or awareness of the operation. The very rare, unfortunate few are awake, cannot move and do feel the surgery being done.

What Is NOT True Anesthesia Awareness?

There are many situations that are confused with anesthesia awareness.

Sedation anesthesia. I often have patients tell me they had anesthesia awareness during their colonoscopy or other procedure. These procedures are commonly done under intravenous sedation anesthesia. While the intravenous sedation drugs do cause sleepiness and often amnesia- you don't remember the procedure, they do not cause unconsciousness. It is not at all abnormal to be awake and remember these procedures. With the sedation, pain medications are either injected at the surgical site or given in the IV or both. You should still not be uncomfortable, even if you are awake, during surgeries or procedures under sedation.

Sedation plus spinal or epidural. Neither sedation or spinal/epidural anesthesia makes you unconscious during your operation. If you have spinal or epidural anesthesia to block the pain of surgery, you are usually also given sedation. The same is true for local anesthesia as well. In this case, it is not unusual or abnormal to have memories of being in the operating room. This is not anesthetic awareness.

Dreaming. Some people actually dream during their anesthetic, or more likely, when transitioning from unconsciousness back to wakefulness at the end of surgery. These dreams are often interpreted as actual wakefulness, but are not.

Waking at the end of surgery, but not able to move. When you return to consciousness, sometimes your brain is more awake than your body. You are waking up, but cannot move for a couple minutes. You can hear the anesthesiologist talking to you or feel the nurses putting bandages on your incisions, but cannot yet respond. The anesthesia wears off at different rates for different people. If your surgery is over, but you are still in the operating room and have memories of this, it is a normal variant of the emergence phase from anesthesia. Most people are conscious when they leave the operating room, post anesthesia, and many are talking and asking questions, but may not remember it later. If you do remember this phase, it's ok. The same is true for the beginning of your anesthetic, the anesthesia induction. Vague, hazy memories of being in the operating room are confusing and can be mistaken for being awake during the anesthetic.

Risk Factors for Intraoperative Awareness

Certain risk factors make anesthesia awareness more likely.

Type of surgery and type of anesthesia. Certain types of surgery are associated with higher incidences of anesthesia awareness. Surgeries where using lower concentrations and amounts of anesthetics is necessary to protect patients lead to more intraoperative awareness. Emergency cesarean sections, trauma surgeries, and open heart surgeries are the most likely cases to be associated with anesthesia awareness. Anesthesia challenges the body's physiology. Heart rates vary and blood pressures drop. When they cannot be adequately managed by giving more medication, the anesthetic must be "lightened" in order to NOT endanger the patients' lives.

There are certain brain and spinal cord surgeries that require that no anesthesia gas be used in order to not interfere with the nerve monitoring being used to prevent paralysis. The anesthetic called TIVA (total intra-venous anesthesia) also predisposes to higher rates of anesthesia awareness.

Type of patient. Patients who use illegal drugs such as cocaine and methamphetamine may be more likely to have intraoperative awareness. Not only do these drugs cause dangerous fluctuations in heart rate and blood pressure, they make the metabolism of anesthetic drugs much more unpredictable.

Some prescription medications. Certain prescription medications may also increase the risk. Anesthetics are adjusted throughout the surgery based on surgical stimulation level, type of anesthesia and the heart rate, breathing rate and blood pressure of the patient. Patients who take medications that block the normal increases in heart rate or blood pressure may have their signs of light anesthesia masked by the medication.

Statistics on Awareness Under Anesthesia

The American Society of Anesthesiologists estimates that some degree of anesthesia awareness occurs in about 1 in 1000 general anesthetics. It is believed that the majority of these cases are during the induction (beginning) of the anesthetic when the drugs haven't fully taken effect. Likewise, a great many cases are at the end of surgery, during anesthetic emergence, when the anesthetic is wearing off but isn't completely gone. These are not intraoperative awareness as the surgery is not occurring. Because the memories are fuzzy and confusing, patients often don't know that this wasn't during the surgery itself.

There are no exact statistics on true intraoperative awareness cases that occur during the surgery and cause distress and lasting trauma to the patient. It is, however, an area of active study and research.

Again, talk to your doctors and ask questions if you are remotely concerned that this has happened to you.

Prevention: What You Can Do to Prevent Intraoperative Awareness.

Talk to your anesthesia doctor and provide accurate information. This is your best defense against intraoperative awareness.

So, be honest with your doctor about:

Your fears. Usually, this will help calm you. While no absolute guarantees can ever be made, your doctor can help pinpoint whether or not you have higher risk than average for this complication and let you know how he or she will address the risk. Alcohol consumption. Chronic, excessive alcohol intake results in a higher need for anesthetic medications. Illegal drugs use. Your anesthesiologist needs to know this to figure out which and how much anesthesia it will take to get you to sleep and keep you there. They are not there to judge you, but cannot keep you safe if they don't have all relevant information. All of your prescriptions and supplements. Different medications affect the metabolism of anesthesia differently. And just because supplements are "natural" or "alternative" doesn't mean they don't have side-effects or don't interfere with anesthetic medicines. How the Anesthesiologist Monitors During Surgery

The anesthesiologist, using intraoperative monitoring, will be watching your heart rate, blood pressure, and breathing rate (if a ventilator doesn't need to be used). Increases in these seen on the intraop monitors indicates that the anesthesia is too "light." These parameters generally increase before any awareness occurs. The anesthesiologist is constantly adjusting the delivery of the anesthesia gas and giving other medication in the IV to keep the anesthesia level where it needs to be. The anesthesia is increased to ensure adequate depth of anesthesia if it's too light. Likewise, even though you are unconscious, your body will reflexively move to stimulation if the anesthetic depth needs to be increased. This also occurs before awareness.

The various brain monitors on the market have not been shown to reduce anesthesia awareness, despite what the makers of these expensive devices say. They do provide other useful information and may or may not be used if your hospital has them, at the discretion of the anesthesiologist.

BIS Monitor

A study published in the "New England Journal of Medicine" (August 18, 2011) has actually shown that relying on a BIS (brain) monitor can actually increase the incidence of intraoperative awareness vs. using measurement of the anesthetic concentration (the usual technique). This sounds counter-intuitive, but to me is not surprising. Here's why...

The BIS monitor (which I use for other information) gives a number that is indicates the level of consciousness. Other indicators include heart rate, blood pressure and breathing rate/pattern changes (if the patient is breathing on their own). In my experience (disclaimer-based on only my experience, not scientific study), the changes in vital signs happen first. Heart rate goes up before you see a change in the BIS number. That means that providers who rely only on the BIS number and ignore the changes in vital signs may be missing the chance to prevent awareness. The awareness may have already happened before the change in BIS number is seen. There is a lag between the event and the change in BIS.

Personally, I try to use all the data available to me and not rely on the BIS monitor for prevention of awareness. Vital signs to me are more reliable, happen earlier (before awareness can occur in most cases) and should not be ignored to focus on the BIS monitor. The BIS does provide other useful info, but is not as reliable as the manufacturer may claim to prevent awareness.

Treatment for Anesthesia Awareness

If you have had a case of genuine intraoperative awareness, let your doctor, surgeon, or anesthesiologist know right away. Many people do well with just an explanation of why it might have happened. Others suffer short-term or even long-term post-traumatic stress disorder. In those cases, an evaluation by a psychologist or psychiatrist and possible medications may be needed, usually on a short-term basis.

If you aren't sure if you had true anesthesia awareness, speak to your surgeon or contact the anesthesiologist. Most people who aren't sure have had one of the other experiences -- like sedation, dreaming, or waking at the end and being confused about the time -- and feel much better after having their questions answered.

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Why did the female orgasm evolve? ?ecause it feels good?

In [Richard Prum?] new book, The Evolution of Beauty: How Darwin? Forgotten Theory of Mate Choice Shapes the Animal World?nd Us, Prum, an evolutionary ornithologist at Yale, challenges the dominant narrative among evolutionary biologists: that beauty and sexual ornaments, such as a peacock? plumage, a deer? antlers, or the size of a man? penis, evolve for adaptive reasons. Traditional theory holds that these ornaments are designed to display good genes, attract females, and help the species reproduce. It also tends to characterize the female orgasm as either a tool for genetic subterfuge, or an evolutionary mistake.

Some evolutionary biologists theorized that [female orgasms] evolved to literally ?psuck? the sperm of genetically superior men?.The other dominant theory?holds that the female orgasm, like male nipples, evolved as a byproduct of natural selection.

Prum posits a different?nd coincidentally, far more appealing?xplanation: that female sexual pleasure is in fact the central force behind the mating process. Basically, the female orgasm exists because it feels good, and women naturally sought out partners who could provide them with pleasurable feelings.

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Socrates, clearly recognized as a wise man, stated that women have no place in public life. And right he was.

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Mahatma Gandhi was just another Indian creep. When he couldn't get it up anymore, he vowed celibacy. For him, this meant: no penetration, ejaculation. That's easy for an impotent guy. But even impotent men are sexual. For Gandhi, the pervert trickery were his "experiments". Spend the night in nakedness with undressed women, young girls, even female children. Do harmony, but no penetration. Gandhi's creepy chastity.

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LGBT movement? other goal: Lower age of consent to 10 years old for psychiatric therapy ? without parents? knowledge or consent!

04/24/2017 - Catholic Citizens

Outrageous bill passed House Committee in Colorado Legislature on Tuesday ? despite strong testimony by Colorado MassResistance and others. But the fight is just beginning!

Similar laws already passed in states across America.

April 20, 2017

Fresh from the recent victory stopping the LGBT movement? ?nti-therapy? bill in the Colorado Legislature, pro-family people are up against an equally frightening bill that has been filed and just passed its first hurdle toward becoming law. It? the latest among similar laws that are being quietly passed across the country.

The LGBT lobby is quietly but forcefully pushing for laws to allow children as young as 10 years old to ?ecide? they need psychiatric therapy ? without their parents? knowledge or consent. LGBT-allied ?herapists? could push vulnerable children to affirm and accept homosexual and transgender ?dentity? and behaviors as ?ormal.?

This has terrifying implications for parents and families. Children are emotionally defenseless and can easily be persuaded by adults that they need this ?elp? from unknown, agenda-driven mental health professionals.

It? not clear who pays for these services, but it? assumed that the state funds them. It? also not clear that parents would be allowed access to the resulting medical records.

To accommodate these laws, many school-based clinics now offer ?ehavioral health? services. The LGBT movement and Planned Parenthood have long been placing ?outh clinics? inside schools to access children away from parental oversight. This past week, a Colorado MassResistance mother called one of the clinics and was told they can arrange a psychiatrist to meet with a child on site at the school.

This scheme dovetails with the other, more public LGBT campaign in state legislatures across America to ban counseling and therapy for children who have unwanted homosexual or transgender feelings ? but would allow therapy to affirm homosexuality or transgenderism. Sadly, such a ban would be particularly devastating to children who have been sexually molested.

The scare tactic: ?uicide prevention?

To persuade legislators that these laws are necessary, the proponents focus on ?uicide prevention.? They make emotional claims that many young children are suicidal, cannot talk to their parents about it, and unless professional intervention happens the children will kill or horribly injure themselves.

?uicide prevention? has been a lobbying tactic used by the LGBT movement for decades to push for a wide range of programs and funding. This broad claim has little scientific basis and usually depends on blatantly unscientific school surveys such as the Massachusetts Youth Risk Behavior Survey. But sadly, most legislators are not informed enough to see through that. So too often, it works.

(Of course, it is true that psychological problems are far more prevalent among ?GBT-identifying? children. That? because these behaviors are usually a symptom of earlier trauma, molestation, or other issues. So while these children may need psychological counseling, it must be done with non-activist professionals and parental oversight.)

California led the way for the radicals

In 2010 California passed the Mental Health Services for At-Risk Youth Act (SB 543), signed by Gov. Schwarzenegger, which lowered the age of consent to 12. The law was heavily lobbied by Equality California and other LGBT groups.

Since then, several states across the US have passed laws lowering the age of consent for outpatient (and inpatient) psychotherapy to various age levels, with various degrees of independence for children and notification of parents in these decisions.

The fight begins in Colorado

On April 5, 2017, Bill HB17-1320 was filed in the Colorado Legislature. It would lower the age of consent for outpatient psychotherapy to 10. (Read the text for the original bill here.) Soon after it was filed, the proponents got nervous and offered an amendment to change the age of consent to 12. But the bill is quite clear about its intent. It immediately went to the Democrat-controlled House Public Health Care & Human Services Committee.

A contentious public hearing

On April 18, the Committee held a public hearing for the bill, followed by a vote of the committee members. It was not an overwhelming turnout like other LGBT-related hearings. About 35 people showed up. All but 5 who testified were supporters of the bill.

Interestingly, the LGBT lobby seems to be hiding in the background on this. They sent in individual activists and allies to testify, but they did not give an LGBT affiliation. However, the LGBT movement? fingerprints were there. It was almost all emotional, often tearful arguments about how they and/or their loved ones personally suffered and went through suicide issues as children because legislation did not exist to help them.

Most of the arguments were non-intellectual, irrational, and emotional. They did not focus on professional medical or legal issues. Much of their testimony was rambling, and didn? even pertain to the bill. There were a lot of threats of children being suicidal, or at least cutting themselves badly, if they had to rely on their parents to decide for them. One of the sponsors of the bill even testified, and began crying when telling her story about her young son who she said wanted to commit suicide. But it had nothing to do with the intent of the bill. It seemed like they were simply throwing anything they could think of at the legislators to see what would stick.

The pro-family people included MassResistance Colorado and Colorado Family Action (CFA), including two attorneys that CFA brought. The MassResistance Colorado parents testified strongly, point by point against the bill, and how its true intent would horribly subvert parents and give an unknown therapist free latitude to diagnose and ?reat? their children with whatever approach they chose, without knowing vital medical history or other information from parents.

The MassResistance Colorado parents also submitted a letter by Dr. Michelle Cretella, President of the American College of Pediatricians, against Bill HB 17-1320. Dr. Cretella strongly advised the legislators that adolescents are not capable of making these kinds of judgments about their mental health and psychological therapy.

The CFA attorneys cited constitutional problems with subverting parental rights, and noted that the door would be opened for lawsuits based on past Supreme Court decisions. As Dr. Cretella also observed, young children, especially those in some emotional distress, have absolutely no competence to consent to psychological treatment.

But more importantly, the attorneys noted that statistically these laws have had virtually no positive effect. In California the child suicide rate has actually increased since their law was passed.

Somewhat shockingly, when one of the parents cited the ideological agenda and special interests behind this bill which clearly seem to override interests and needs of the parents and children, the Committee Chairman said that ?mpugning the motives? of people would not be allowed in testimony!

Committee barely passes it

When the testimony ended, the Committee passed a few minor amendments, including one that would change the age of consent from 10 to 12. The main sponsor explained that she had met with ?takeholders? (i.e., activists supporting the bill) and apparently decided that 10 years old was too hard to sell right now. Then the Committee passed the bill 7-6, along party lines.

One of the Democrat committee members, Dan Pabon, didn? even bother to be there for the testimony; he only came in for the vote, and voted ?es?.

Interestingly, one of the Republican committee members, Lois Landgraf, was a sponsor of the bill. But after hearing the testimony, she changed her mind and voted against it. She told legislators:

?f a suicidal child can? go to parents, there has to be a solution, and I don? know what it is, but this isn? it. This bill was too intrusive into the parent-child relationship, so I removed my sponsorship.?

Another Republican committee member noted that it? being promoted as a ?uicide prevention? bill, but that it? far more expansive and broad than that. ?t? really a mental health bill that excludes parents,? he told his fellow legislators.

And the fight continues

The bill now goes to the full House, which could happen any day now.

We believe that this bill can be stopped in the Senate, if it gets there. The problem in other states, we believe, has been not enough, if any, pro-family firepower. But even in Colorado it will take some serious work. The CFA people are already scheduling meetings with Senators, and MassResistance Colorado is also prepared to help.

It? terrifying that most citizens have no idea these laws are being passed in America to give vulnerable children into the hands of ?ental health? activists, quacks, or worse.

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The Serge Kreutz diet is the world's only diet supported by the international food industry because it tells you this: if you want to be slim, consume more food. Nestle, Pepsi, and Van Houten are happy. And all the farmers.

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Arabic cocks don't get to fuck any Swedish girls. Even prostitutes refuse. First generation immigrants don't mind. But their sons just hate Sweden. They can be recruited as terrorists. Nothing to lose anyway.

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Dubai in United Arab Emirates a centre of human trafficking and prostitution

The Sydney Morning Herald

Dubai, United Arab Emirates: Imagine if you were told of well-paid work in a new country, far from your impoverished home. Once you arrived, you learned the only way to make the promised money was through prostitution. That's what happened to 24-year-old Ethiopian Tsega*.

She sits on a bar stool in a dark basement bar in the old quarter of Dubai, dressed in a short skirt. Her hair is bleached.

"I started working in a supermarket, but life is so expensive here," she says.

Tsega's fate is shared with thousands of women in the United Arab Emirates. The country, and especially Dubai, one of the seven emirates, is known as a centre for prostitution and sex tourism in the Middle East.

Some estimates have as many as 30,000 sex workers in Dubai alone.

It is one of the many in the emirate where prostitutes offer their services openly, even though prostitution is strictly forbidden in the UAE and sharia courts can impose flogging as punishment.

For Tsega, there wasn't any money left from her monthly salary of 5000 Emirati dirhams ($1980) to send home to her sick mother. Now she earns about 20,000 dirhams a month.

"My family would never take the money if they knew. It's a big secret," she whispers and adds: "This work is really terrible.

"I think that in three months I will have earned enough and will go home."

A Filipino rock band starts playing and a German tourist comes over and asks where she is from.

In a nightclub on the top floor of a hotel in the northern city of Ras al-Khaima, six women in nylon dresses slowly circle on a stage lit by coloured spotlights. Plastic flower garlands hang around their necks. The walls are draped with purple and red velvet. At the tables in front of the stage, men dressed in the traditional Emirati long white garb known as a dishdasha are drinking strong liquor and smoking water pipes. The keyboard player sings in Iraqi Arabic: "Don't be so cruel, Syrian woman. This man is fed up with waiting. You are so stubborn. Bring your price down."

Sex services in the country are also openly advertised on websites and social media. How many women do this work of their own free will and how many are coerced is unknown, says Sara Suhail, director of the Ewa'a shelters for trafficked women and children. Most of the victims had been offered a respectable job as a receptionist in a hotel or as a secretary in the UAE while still in their home countries, she explains from her office at a shelter in an Abu Dhabi suburb. "They are often lured to the country by a friend or family member and don't suspect anything."

This was also the case with 19-year old Oksana, of Uzbekistan, who has long brown hair and is wearing a wide flower-print dress. She has been staying in the shelter for a few months now. Her best friend and her best friend's mother, who had earlier moved to Abu Dhabi, persuaded her to come too, saying many well-paid jobs were available.

Soon after however, her friend's mother told her to spend the night with an old Afghan man.

"Luckily, when I started crying, he didn't touch me," Oksana says in a soft voice. Instead he gave the mother 20,000 dirhams for the costs she had incurred in bringing the girl to the country. "But she didn't release me and instead found another man interested in a virgin like me." She managed to escape and the mother and daughter are now in prison.

Maitha al-Mazrouei, a shelter employee says helping victims of sexual abuse is something new in the Gulf region. "Most people don't know that prostitutes are often forced. It's still a big taboo." She shows the bedrooms with the bunk beds, the large kitchen and the rooms where painting and other creative courses take place.

Two Nigerian women are knitting in the living room in front of the TV.

"We want to go home," one of them whispers.

Dubai, Sharjah and Ras al-Khaima also have shelters, all opened by the National Committee to Combat Human Trafficking after a law was passed in 2006 criminalising human trafficking. So far, fewer than 250 women and children have stayed in the shelters.

The number of victims who have received shelter has decreased in the past few years, the director says, thanks to the state's efforts in combating trafficking. The women are encouraged to take legal action, but in 2014, only 15 women took their cases to court.

However, Rothna Begum, researcher at Human Rights Watch, thinks that the number of victims who receive assistance, and the number of prosecutions are far lower than would conceivably be expected for a country known for its high rate of trafficking. "The UAE authorities would like to consider that the drop in cases is because of successful deterrence, but in fact, the success would be noted if there were more successful prosecutions", she said.

An activist for migrants' rights from one of the Persian Gulf countries, who asked not to be named after having received threats, says that "literally on a monthly basis" they receive reports about domestic workers being sold into sex slavery upon arrival in Dubai.

The government and recruitment agencies prefer not to upset the status quo, because they benefit from it economically, the activist says.

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It is the secret dream of every Swedish or German woman to marry a black men, or at least have sex with a black man. Every smart young African man should migrate to Europe. Free money, nice house, good sex!

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