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ADD – ADHD Medication Treatment – 7 Tips on Finding the Challenging Sides of the Therapeutic Window

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The Sides of the Window are Puzzling and Require a Few More Office Questions. The reason to ask the questions is simple: we want to know exactly how the medication is working in the context of time of day, duration of effectiveness, and predictable expectations from the specific medication in question.

All of these questions arise from the essential philosophic overview of medication delivery systems: if you know the science, and have clear objectives, you can measure the treatment outcome objectively, and correctly adjust the medications according to that specific individuals biochemical and metabolic individuality. Measure that ‘Window’ for predictable outcomes.

The simplified version of that statement: Cookie cutter medicine based upon weight, age, body size is outdated, and simply ineffective. – So let’s get the details right every time by starting from the same place using the same predictable grid for measurement of effectiveness. These 7 Tips for the Sides of the Therapeutic Window, coupled with measurements from my other articles here on 7 Tips from the Top and the Bottom of the Therapeutic Window will outline precise treatment objectives. I have been using these ‘Window Strategies’ with thousands of patients for more than 12 years, and I can assure you, they work like a correctly timed clock. Predictable outcomes should be the standard of care.

The 7 Tips For The Sides of The Therapeutic Window for Stimulant Medications.

  1. The Sides of the Window Are Based Upon Time: The Expected DOE – Duration of Effectiveness of that specific medication for that specific persons metabolic rate, and must be customized for every person from the outset and throughout the duration of treatment. Every person burns medications at different rates that cannot be predicted by superficial appearances of weight or size. I have an ex-Navy [Nuclear] Commander who stands about 6’6,” and looms over me, – has to duck when he comes in the door, – he takes only Adderall 10 mg XR and the DOE is a reasonable 10 hr. We want to have a specific match between expected duration and clinically effective duration.
  2. Know the Medication DOE Expectations from the Outset: Authorities and studies disagree on some of the next points on specific medications I am about to discuss. Pharmaceutical companies have done their homework, and are focused on these same DOE objectives, – I simply disagree with some of their DOE findings based upon my own abundant office experience. Many studies range in the thousands of patient hours over years of treatment using a determined focus on this ‘Window’ grid. See the 7 Tips for the Top of the Window Article for more details on specific medications.
  3. Start Working: Measure Precisely the Time DOE At Every Meeting: Easy questions: “When did you take it and when does it stop working?” If taken at 7 AM and it lasts until 3 PM – that is the DOE. The Math is Simple: 5 hrs in the AM %2B 3 in the PM = 8 hrs. A medication might work for 8 hrs, but still keep the person out the Top of the Window if the IR is pushed too high.
  4. The First Side Objective – AM Onset: All meds should be working in 30-45 min after taking the medication. IR [Immediate Release] Tablets have a fast onset, but the sides of the window are too narrow, and the DOE [Duration of Effectiveness] Is out just too fast – meaning it simply lasts only a short part of the day. IR meds need 2-3 times a day dosing because the DOE is far too short. If the AM Onset is more than 45 min the dose is either too little, it isn’t working at all, or it can be too much – see point 4 of the 7 Tips for the Top.
  5. Regulating the AM Onset: Breakfast is Essential, Protein Breakfast Works Best More Often: With meds, since we are now paying attention to the rate of metabolism, the DOE, we are much more interested in “rate limiting steps.” Breakfast is an imperative rate limiting step that is essential for all psych meds to prevent irritation of the gastric mucosa [stomach lining]. With breakfast that early side of the ‘Window’ is more gentle, and less involved with uncomfortable peaks of medication excess.
  6. The Second Side Objective – The PM Release – When They Stop Working: The extended release capsules from Concerta to Adderall XR are all mechanically released, and have unpredictable release times based upon acid base variables in the stomach and bowel – and upon the transit time of the bowel contents. Long transit time often means greater sensitivity to meds and a relative accumulation of meds over time, with a narrowing of the ‘Window.’ Metabolic challenges with bowel function almost always change the PM release time, when the meds stop working. Vyvanse is not as vulnerable to rate changes based upon acid/base balance or transit time.
  7. The Mystery Objective: The PM Release with Vyvanse: Vyvanse deserves it’s own tip because it is so effective, with such an excellent, predictable 12-14 hr DOE. Think of this simple point when measuring the DOE with Vyvanse – the metabolically released stimulant is so different that many don’t “feel it working” and therefore miss when it “quits working.” Remember with Vyvanse: look for the original cognitive, “mental” objectives, not the somatic, buzzy effects. When Vyvanse quits in the PM the ability to finish tasks is gone.
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MapleStory Guide – Anego

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Anego (aka Female Boss) is a popular boss in Showa. It spawns in the third map of the Showa mansion, surrounded by its vastly weaker minions. It is a formidable foe, with very high attack power, defence and speed.

So let’s have a look at what Anego’s capable of. Anego has two main attacks plus a rather high touch damage of about 10,000-11,000, a fairly long range gun attack dealing around 5,200 and lastly, a short range slap dealing roughly 18,000. If you’re melee without a ridiculous amount of hp washing, then I know what you’re thinking. Some other things about Anego, it has very high defence and moves extremely quick.

So with such high damage how does anyone kill it? Luckily Anego suffers a “glitch” so to speak, which will be explained in detail below.

HP: 75,000,000

Minimum HP: 19,000 (Melee) Any (Ranged)

Now to talk about that “glitch”, if you attack Anego and run back to the portal, you’ll notice Anego is unable to follow all the way to the left. This is due to a pathing issue in the maps layout, near the edge of the bar stool is an invisible barrier for Anego, which it is unable to pass. Obviously that makes the entire left side a perfect sniping spot! Basically every single ranged class can make use of this and this is also the basis for party kills of Anego. The spot where you’ll want to stand is directly in front of the couch near the portal, if you edge past this you may be hit by Anego’s gun attack, but the slap will miss you by miles.

For melee it’s not so easy, the only viable way to fight Anego as a melee character is to corner it and tank it, burning potions while pounding away. Obviously you need 19,000hp before even considering this.

As a side note, it is possible to berserk Anego as a Dark Knight, but is difficult to do effectively. Lure Anego to the bar stools, and attack while jumping. If timed right you will not be hit by the slaps while still hitting Anego.

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WoW Bot – InnerSpace Guide

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First off, I’d like to explain some terms. Innerspace is an operating system, not a bot. Many people will be peeved if you say that. Openbot is a program/plugin/whatever that runs on innerspace. Openbot is a bot. Get these down and you’ll save the openbot vets some hair.

Innespace is NOT free. And I did’t find a crack yet. Yes you will need to pay for it if you’d like to use it. It will cost you $10 for a 3-month subscription. This is cheaper than glider elite. If you’d like to subscribe to use this bot Lavishsoft.com register an account, and subscribe from there.

Once you have an account subscribed, you can start this guide.

-Setting up Software-

1. Download and install the latest version of Innerspace.

2. Download the latest version of ISXWoW and ISXWarden. Always keep these up to date!

Install ISXWoW by running the installer if you downloaded that, or if you downloaded the zip, extract ISXWoW.dll into the Extentions folder and the other files into your Interface folder.

Install ISXWarden by simply extracting the .dll to the Extensions directory of your Innerspace installation.

3. Launch innerspace, right click on the little crosshairs icon, and click configuration.

4. Click on the “Game Configuration” tab and select World of Warcraft from the dropdown menu. Click Startup.

-Ingame Openbot Setup-

1. Once Innerspace is loaded with WoW and you’ve checked ISXWarden to be okay, log ingame and bring down console again.

2. Type into console:

run openbot/openbot

This should load the ingame interface.

Going into the rest of the steps for Openbot Configuration takes a lot of detailed explanation. By way of a quick search, you would find that the full steps are available at most sites offering WoW Bot and other gaming tools.

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Whistler Via Ferrata – Terror And Elation While Climbing The Iron Way

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“Okay, we’ll stop here and pull out our ice axes and crampons,” announces Jeff, our guide for the afternoon. He slides off his backpack and dumps it in the snow at his feet. I shrug my pack off and marvel at how I can be so warm while standing at the foot of Whistler mountain’s high alpine glacier. True, back at the Adventure Hut I had added a few layers of clothing after noticing the wisps of snowflakes drifting from the sky.

But now, an hour later and a brisk hike among the white-laced rocks, I was sweating. I ask my best-friend Amy if she’d like a swig of water. She nods and I dig the bottle out of our pack. I also pull out a couple energy bars to quell the rumbling in my stomach. I must have anticipated it would be a few hours and a few hundred feet until the next meal.

You can’t find this quiet anywhere near civilization.

Amy and I munch loudly in the natural stillness. It’s the silence that allows you to finally hear what every other animal must hear, every insect, as they go about their business in the absence of human activity. It feels as old as the earth and indifferent as the mountain itself.

Jeff instructs us on fitting our crampons; basically spiked metal shoes that are essential for glacier-walking. I’d never heard of them before this moment – before we’d decided to attempt Via Ferrata, “The Iron Way” – a tour offered by Whistler Alpine Guides Bureau. First developed by Italian soldiers during World War I, the activity consists of rock climbing via an engineered vertical pathway, utilizing permanently fixed cables and metal rungs for movement. (Or that’s how it works in theory anyway).

All three of us tie each other together with elastic rope. “In the fresh snow, it’s difficult to spot the crevasses in the glacier,” says Jeff. I envision a moment of plunging into an icy abyss and make sure my the rope is tightly clamped to my waist before we head out. Our crampons dig into the ice with assuring crunches. Like a blind man with a cane, Jeff pokes his ice axe in the snow to detect any cracks.

Soon we are standing at the foot of the climbing path.

A lone ladder is tied to the rock, stretching upwards to the first ledge, followed by metal rungs continuing upwards as if staples left by a giant. We remove our crampons and secure our ice axes to our backpacks. Jeff graciously goes first, gliding up with ladder with only the barest use of hands. Amy goes next, a little slower. I wait at the bottom of the ladder, peering at the surrounding boulders for any glimpse of the hoary marmot, (for which Whistler Mountain was named), known for its distinctive high-pitched whistle.

The ladder quivers. I look up and Amy is perched at the top, one hand outstretched to the first metal rung. She’s hesitating. “You okay?” I call up to her. “I’m not sure about this,” she answers flatly. “I don’t think I can do it.”

Jeff is a few feet higher, hanging from the rock like a confident gibbon. “It’s cool, just take your time,” he says. I wonder how many times he is confronted with this exact predicament. “My heart is pounding…” Amy answers, her voice cracking. Jeff is reassuring. “It’s quite safe, really. You’d be surprised at what you can do.”

There’s a defining moment in the air.

Amy must choose whether to attempt the shaky descent down the ladder, shrink from the pounding of her heart, and feel like she’s ruining the experience. She’s skimming over in her head how she’ll walk back down the glacier in stinging defeat, head to the Adventure Lodge and wait for us to complete the climb.

Jeff and I will arrive, tired and elated, and we’ll talk about how incredible it was to scale the peak, to feel the hard stone beneath our fingers, marvel at the tiny plants that make a home on these eternal stone. I’ll tell her how the vast view of the surrounding mountains was enough to silence any internal debate about the existence of an intelligent hand guiding the universe, or if not intelligent, than the incredible luck to emerge on a small beautiful ball drifting in a beautiful universe.

But Amy doesn’t choose such a fate for herself. She quells her beating chest, strengthens her resolve. She firmly grips the first metal rung, that giant’s staple lodged in the rock, and pulls herself over the lip, her feet dangling for a second before gaining a toehold. Fear and gravity are thwarted. She looks back down at me and smiles.

I climb the ladder and feel a bubble of adrenaline rise in my throat. But whether I’m aware of the true danger, or I possess a certain flare for attempting the unordinary (which happens less often then I’d like), I have little difficulty in crossing the threshold. All three of us begin our climb. The basics: always keep your belt ropes clamped on the safety line running parallel to the metal rungs, and only one person per increment of safety line. This prevents falls for more than 6 feet at once. A comforting thought.

Unhook, reach, lift, hook. Unhook, reach, lift, hook.

The steady rhythm takes on a momentum of its own, almost like meditation. I immediately understand why frequent climbers talk about being “in the moment” while scaling a sheer rocky face. There is little to think about when the mind must navigate an ever changing vertical terrain, constantly readjusting weight here, balancing a foothold there, like deciphering a rubix cube. The minutes drift away and the glacier below grows ever smaller.

Eventually, we arrive at the summit. The clouds part and the sun greets us warmly. We wander among the snow drifts as if emerging into another land, as if explorers entering the gates of Shangri-la. Only there are no gold tapestries, chests of jewels, or eternal youth here, only the satisfaction of conquering a thumbnail of earth on one Saturday morning in September.

~ Via Ferrata is offered in Whistler daily from June 24 through October. This thrilling activity is suitable for guests of all abilities and does not require any special skills or prior experience. All technical equipment is included. Your guide will give detailed instructions on use of equipment and technique for climbing.

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