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Lower urinary tract symptoms LUTS ; related to bladder dysfunction LUTS are fairly common among men of 50 years and over. Incontinence is not usually prominent but, if it is present, urodynamics can be helpful to establish the underlying vesical urethral dysfunction, in particular, bladder outflow obstruction BOO ; or detrusor overactivity. Exhibit 9 2 merck & co, inc other financial disclosures third quarter 2005 net product sales detail millions of dollars ; 3q `05 vs 3q `04 total total foreign foreign product % chg $ % chg $ % chg $ aggrastat 7% 21 n a - 7% arcoxia -8% 56 n a 8% 56 cancidas 31% 142 23% cozaar hyzaar 6% 751 3% crixivan stocrin 40% 91 9% emend 60% 22 46% * 4 fosamax - 777 4% 461 -5% 316 invanz 51% 25 39% maxalt 10% 92 10% primaxin 12% 182 21% propecia - 67 -12% 29 11% 38 proscar 3% 186 8% -1% 88 singulair 11% 692 10% timoptic timoptic xe -9% 35 7% 2 -10% 32 trusopt cosopt 13% 156 10% vasotec vaseretic -12% 149 n a 12% 149 vioxx * - * - * - zocor -14% 1, 050 -10% 770 -24% 280 hepatitis vaccines 34% 65 38% viral vaccines 11% 186 11% other vaccines 7% 88 9% - 17 * 100% or over n a - not applicable total sales: volume, price, exchange 3q `05 % chg. Prescription medicine datasheets bleedingedge » drugs » arava abilify aciphex actonel actos acutect agenerase aggrastat alamast alimta alinia aloxi alrex amerge angiomax antagon apidra arava argatroban arixtra aromasin atacand avandia avelox avodart axert azopt benicar bextra boniva cancidas celebrex celexa cetrotide cialis clarinex colazal comtan crestor cubicin curosurf definity detrol elestat elidel ellence emend emtriva erbitux ertaczo - evoxac exelon extraneal factive faslodex ferrlecit foradil frova fuzeon geodon gleevec hectorol hepsera infasurf innohep inspra integrilin iressa kaletra keppra ketek - lantus levitra levulan lotemax lumigan maxalt micardis mobic mylotarg namenda natrecor neotect kit novolog orfadin ortho evra orth tri-cyclen - panretin pletal precedex priftin protonix provigil radiogardase rapamune raptiva refludan relenza renagel rescula - reyataz sensipar singulair solage somavert sonata spectracef spiriva - starlix strattera sucraid sustiva synercid tamiflu targretin tasmar temodar tequin thalomid thyrogen tikosyn travatan trileptal trisenox uroxatral valstar velcade viagra vioxx visudyne vitravene welchol xeloda xenical xopenex yasmin zaditor zavesca zelnorm zemplar zetia ziagen zometa zonegran zyvox arava brand name * approval by fda does not mean that the drug is available for consumers at this time. Another aggravating factor is a high frequency of migraine attacks. A World Health Organization study of women under the age of 45 found a greater risk of stroke in women who had more than 12 migraines a year and or had migraines for more than 12 years. "Every time you have a migraine, " says Dr. Tietjen, "if you have it over and over again, you may be increasing the risk of having a stroke." Dr. Tietjen points to a recent study reported in the Journal of the American Medical Association, which suggested that migraine may be a progressive brain condition. MRIs were done on randomly selected migraineurs and on individuals without migraine. Migraine patients, particularly those who had aura or frequent attacks, had more lesions in the cerebellar region of the brain that looked like signs of stroke. The researchers also looked at deep white matter lesions, which can be found in areas of the brain outside of the cerebellum and are considered the result of silent strokes. Women between the ages of 30 and 60 who had migraine, with or without aura, had more of these deep white matter lesions than men, and more than women without migraine. These strokes are "silent" in that victims don't experience outward symptoms, but, cautions Dr. Tietjen, "years down the line they may." The incidence of the lesions was higher in those women who had frequent attacks and higher yet in those who used oral contraceptive pills, because www maxalt com.
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You or your health care provider notified the Merck Pregnancy Registry for MAXALT that you had received MAXALT at some time during your pregnancy. The Merck Pregnancy Registry is trying to collect as much information as possible to help health care providers decide if there are any risks to the mother or baby from the use of this drug during pregnancy. We are asking you to please consider enrolling in the Registry. Although there is no immediate benefit to you from participating, the information we obtain from the registry will be sent out to physicians, nurses, and genetics counselors to help them and patients like you evaluate the risk, if any, associated with the use of the drug during pregnancy. Unless required by law, only Merck & Co., Inc. and government regulatory agencies will have access to confidential information which identifies you by name. Names will not be released to the public and will only be used by Merck & Co., Inc. to obtain follow-up information from you, your health care providers, and your baby's health care providers. If you agree to participate, you or your doctor will fill out a questionnaire asking about your use of the medication. Other questions will ask about this pregnancy and your previous pregnancies. Around the time you are due to deliver the baby, a second questionnaire will be sent to your doctor s ; asking about your pregnancy, labor and delivery, and the health of your baby. We might ask for copies of your or your baby's medical records. In order to explore the long-term health of babies whose mothers received this medication during pregnancy, we may request information from the baby's pediatrician for up to two years after the birth. Again, unless required by law, only Merck & Co., Inc. and government regulatory agencies will have access to information which identifies you by name. Your participation in the Pregnancy Registry and in providing us with information is entirely voluntary, and your refusal to participate will not cause any change in your medical care. You can decide not to participate further at any time, even if you agreed to participate at first. If you have any questions about the Registry or your rights as a participant, you can call Kris Shields, RESS Associate for Pregnancy Registries at 484 - 344 - 3419 to obtain additional information. Your signature below means that you agree to allow us to: 1 ; enroll you in the Pregnancy Registry, 2 ; contact your and your child's health care providers, and 3 ; to obtain copies of your medical records related to this pregnancy and copies of your child's medical records for up to two years of age. Your signature allows your and your child's health care providers to accept a copy of this form as if it were the original. Yes, I agree to participate in the Pregnancy Registry for MAXALT. No, I do not agree to participate in the Pregnancy Registry for MAXALT and rizatriptan.
Using automated laboratory data, during the measurement year, the member is numerator compliant if the most recent LDL-C level is 130 mg dL. If an automated result for the most recent LDL-C test is 130 mg dL or is missing, or if an LDL-C test was not done during the measurement year, the member is not compliant. Using automated laboratory data, during the measurement year, the member is numerator compliant if the most recent LDL-C level is 100 mg dL. If an automated result for the most recent LDL-C test is 100 mg dL or is missing, or if an LDL-C test was not done during the measurement year, the member is not compliant. If the most recent test during the measurement year is identified by a CPT Category II code, use Table CDC-G to evaluate whether the member is numerator compliant 3048F indicates the member is numerator compliant; 3049F, 3050F indicate the member is not numerator compliant!
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Alsmede een in de Verenigde Staten gevestigde vennootschap First International Trade S.A., blijkens het factuurpapier overigens met een vertegenwoordigend kantoor in Congo-Brazzaville. De Bradbury-transacties moesten betaald worden op een Luxemburgse bankrekening. Uit prod. 17 zijdens Glaxo, eveneens kopien uit de boekhouding van Asklepios, blijkt echter dat in ieder geval bepaalde voor Bradbury bestemde medicijnen afkomstig waren uit Ivoorkust bijvoorbeeld de exportverklaring Eur. 1 A No. 0354439 d.d. 6 november 2001: Pays . ; dont les produits sont considrs commes originaires: Cte d'Ivoire . ; Pays . ; de destination: France hoewel op hetzelfde formulier als Destinataire staat aangegeven Bradbury met een Luxemburgs adres ; , met onder het kopje Observations vervolgens de opmerking: Origine: Cte d'Ivoire ; . Andere toeleveranciers van uiteindelijk ; Asklepios waren blijkens deze als prod. 17 overgelegde documentatie Afrique Aide uit Guinee douaneaangifteformulier d.d. 30 november 2001, waarin tegelijkertijd als land van verzending uitvoer Frankrijk wordt opgegeven en als land van bestemming Belgi ; , Pharmacie de Gbossime uit Togo daaropvolgend douaneformulier uit prod. 17 met onleesbare datum ; , Sougoumar Keita te Senegal douaneformulieren d.dis. 21 en 26 februari 2002, 8 april 2002 2x , terwijl verder in prod. 17 nog op een aantal douaneformulieren zonder nader aanstonds te traceren afzender anders dan met een lang nummer ; staat aangegeven dat het medicijnen betreft met als land van verzending uitvoer Kongo 1x ; , Guinee 1x ; , Ivoorkust 3x ; , Togo 6x ; en Senegal 7x ; . Uit prod. 18 van Glaxo, eveneens kopien uit de administratie van Asklepios, blijkt tenslotte dat substantile bedragen rechtstreeks aan Afrikaanse banken dienden te worden betaald. Ook is door Glaxo terecht bij pleidooi aangevoerd dat uit prod. 44 van Asklepios c.s. pv verhoor Bellavoine ; blijkt dat de HIV-remmers na aankomst in Dakar vanuit de loods van de door Glaxo ingeschakelde vervoerder Saga Air in opslag zijn gekomen bij Transcontinental Transit, alwaar AAA over deze medicijnen kon beschikken. Ook dat wijst bepaald niet op een transit status. 3.13 Benard heeft in de geschetste omstandigheden niet mogen afgaan op de enkele mededeling van Bellavoine dat het transitgoederen zou betreffen. Zeker niet nu eveneens uit meerbedoelde eigen administratieve bescheiden van Asklepios blijkt dat door Asklepios substantile bedragen moesten worden betaald in Afrika zelf of op Luxemburgse bankrekeningen. Daarbij is medebeslissend de kennelijk lucratieve marge die door Asklepios kon worden gemaakt ondanks haar op zichzelf geringe zakelijke inspanningen, gegeven het haar al aangedragen zijn van klanten ; , zoals door Glaxo becijferd en door Asklepios c.s. onvoldoende steekhoudend weersproken. Ook al zou de stelling van Asklepios c.s. juist zijn dat in de medicijnen-parallelhandel zeer grote marges haalbaar zijn, dan had zij als ervaren marktspeler juist met HIV-remmers uit Afrika onraad moeten ruiken. Naar het oordeel van de rechtbank hebben Asklepios c.s. daarmee willens en wetens het risico op de koop toe genomen dat geprofiteerd werd van fraude en zodoende een zorgvuldigheidsnorm jegens Glaxo geschonden. Voor de vestiging van hun aansprakelijkheid uit onrechtmatige daad merkinbreuk ; jegens Glaxo is dat naar het oordeel van de rechtbank voldoende. De vraag of ook overigens, buiten merkinbreukcontext, onrechtmatig is gehandeld jegens Glaxo door Asklepios c.s. zoals Glaxo heeft aangevoerd maar zijdens Asklepios c.s. is bestreden, onder meer met een beroep op art. 6: 163 BW en de dat verband besproken correctie-Langemeijer, kan bij die stand van zaken naar het oordeel van de rechtbank buiten beoordeling blijven. Voor zover zijdens Glaxo is aangevoerd dat Asklepios c.s. onrechtmatig hebben gehandeld door te profiteren van wanprestatie, heeft te gelden dat enkel profiteren daarvan geen onrechtmatige daad constitueert en onvoldoende aanvullende feiten zijn gesteld die dat anders zou kunnen maken. De merkinbreuk zelf is in de gegeven situatie voldoende voor vestiging van aansprakelijkheid terzake waarvan Asklepios schadeplichtig is. Voor het overige is de enkele prijsstelling van de door Asklepios betrokken medicijnen, ook al is die.
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After 14 to 18 years of infection, half of the surviving patients in an Australian cohort infected with HIV-1 carrying natural deletions in Nef are showing CD4 cell decline and viral load rise Learmont et al. NEJM 1999; 340: 1715-22 ; . Thus, although highly attenuated, Nef-deleted or-mutated viruses are unsuitable as vaccine strains. Johnson et al. J Virol 1999; 73: 4952 ; showed that the degree of protection by even further attenuated SIV strains, carrying deletions in Nef, Vpr, Vpx and or the U3 LTR ; region, against challenge with intact SIV was inversely related to the extend of attenuation. Animals infected with virus carrying deletions in Nef, U3 and Vpr were all protected against superinfection. One of the 4 animals infected with SIV deleted in Nef, vpx and U3 could be superinfected with intact SIV by vaginal challenge, while half of the monkeys infected with Nef, Vpr, Vpx and U3 deleted SIV were not protected against superinfection. Challenge route and dose had also influence: Protection against vaginal challenge and lower doses was easier to achieve than protection against intravenous challenge and higher dose. It seems that mucosal protection can be achieved in monkeys using attenuated SIV strains, but further research will be needed to find the correct balance between attenuation of the vaccine strain minimizing the risk of disease progression caused by the vaccin strain itself ; and protection against superinfection maximizing immune response and mexitil.
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Chewing produces pain or if jaw palpation or movement mimics the headache pain. Brain Tumors can cause headaches that are frequently worse with coughing or straining and are often worse in the morning after lying flat all night. A tumor can cause a build up of pressure from constricting the outflow of cerebral spinal fluid. CT Computer Tomography ; or MRI Magnetic Resonance Imaging ; studies can help diagnose this condition. Cerebral Aneurysm is a dilatation or widening of a blood vessel wall that can lead to bleeding or rupture. The pain is usually described as the "worst headache in my life." The headache is often accompanied by neck stiffness and neurological deficits. A CT scan is useful to diagnose this condition although more sophisticated tests like MRI, angiogram and lumbar puncture may also be needed. Trigeminal Neuralgia or tic douloureux involves the nerves of the face and usually occurs only on one side. The associated pain is severe, stabbing and described as "electric shocks." Trigeminal Neuralgia is more common in people over 40. Treatment consists of pain relief and medications like carbamazepine Tegretol ; , gabapentin Neurontin ; and phenytoin Dilantin ; . MEDICATIONS USED TO TREAT HEADACHES Treatment for acute migraine pain in those patients not requiring preventative therapy, centers around analgesic pain medications, antiemetics, and serotonin receptor medications. Analgesic preparations are over the counter medications like Tylenol, Ibuprofen and Midrin. Other prescription pain medications include Ultram, opiate containing medications and compound medications like Fiorinal. Antiemetic medication can be used to prevent the nausea and vomiting that often accompany a migraine. They are also used to treat the migraine itself. One example Compazine, comes in a pill, suppository and an injectable form. Serotonin receptor medications Triptans and Ergots ; act on the blood vessels and can be taken at any point during the acute headache. Examples of these Triptans are Imitrex, Zomig and Maxalt. They are not used to prevent headaches. Ergots have been used for many years and act like the Triptans in that they block dilatation of the cerebral blood vessels. Cafergot and DHE are both examples of Ergots. Both the Ergots and the Triptans should be prescribed very cautiously in patients with heart or vascular disease, high blood pressure, diabetes, men over 40 and postmenopausal woman. These medications may cause flushing, numbness and chest tightness when administered. WHEN TO SEEK MEDICAL ADVISE Headache after head trauma. Headache accompanied or followed by loss of consciousness or confusion. Headache associated with a convulsion. Sudden and severe headache. Headache with neck stiffness. Headache in a person who typically does not have headaches. Persistent or recurring headaches in a child. Headache which interferes with normal activities and mexiletine.

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Check with your doctor before combining it with the following: fluoxetine prozac ; fluvoxamine luvox ; paroxetine paxil ; propranolol inderal ; sertraline zoloft ; special information if you are pregnant or breastfeeding the effects of rizact maxalt, rizatriptan ; during pregnancy have not been adequately studied.
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Texas Medicaid Pharmaceutical and Therapeutics Committee Recommendation Summary August 24-25, 2007 Therapeutic Drug Class Antimigraine Agents, Triptans Brand Name AMERGE ORAL ; AXERT ORAL ; FROVA ORAL ; IMITREX NASAL ; IMITREX ORAL ; IMITREX SUBCUTANE. ; MAXALT MAXALT MLT ORAL ; RELPAX ORAL ; ZOMIG NASAL ; ZOMIG ZOMIG ZMT ORAL ; AVINZA ORAL ; DURAGESIC TRANSDERM. ; FENTANYL TRANSDERM. ; KADIAN ORAL ; MORPHINE ER ORAL ; OPANA ER ORAL ; OXYCODONE ER ORAL ; OXYCONTIN ORAL ; ULTRAM ER ORAL ; APAP CODEINE ORAL ; ASA CODEINE ORAL ; BUTALBITAL COMPOUND W CODEINE ORAL ; CODEINE ORAL ; COMBUNOX ORAL ; DARVON-N ORAL ; DIHYDROCODEINE APAP CAFFEINE ORAL ; FENTANYL BUCCAL ; FENTORA BUCCAL ; HYDROCODONE APAP ORAL ; HYDROCODONE IBUPROFEN ORAL ; HYDROMORPHONE ORAL ; MEPERIDINE ORAL ; MORPHINE IR ORAL ; OPANA ORAL ; OXYCODONE APAP ORAL ; OXYCODONE ASA ORAL ; OXYCODONE IR ORAL ; PANLOR DC ORAL ; PENTAZOCINE NALOXONE ORAL ; PENTAZOCINE APAP ORAL ; PROPOXYPHENE ORAL ; PROPOXYPHENE APAP ORAL ; TRAMADOL ORAL ; TRAMADOL APAP ORAL ; ARTHROTEC ORAL ; CELEBREX ORAL ; DICLOFENAC ORAL ; ETODOLAC ORAL ; FENOPROFEN ORAL ; FLURBIPROFEN ORAL ; IBUPROFEN RX ORAL ; INDOMETHACIN ORAL ; KETOPROFEN ORAL ; KETOROLAC ORAL ; MECLOFENAMATE ORAL ; MEFENAMIC ACID ORAL ; MELOXICAM ORAL ; NABUMETONE ORAL ; NAPROXEN RX ORAL ; OXAPROZIN ORAL ; PIROXICAM ORAL ; PREVACID NAPRAPAC ORAL ; SULINDAC ORAL ; TOLMETIN ORAL ; ENBREL INJECTION ; HUMIRA INJECTION ; KINERET INJECTION ; RAPTIVA INJECTION ; ACTONEL ORAL ; ACTONEL W CALCIUM ORAL ; BONIVA ORAL ; DIDRONEL ORAL ; EVISTA ORAL ; FORTEO SUBCUTANE. ; FORTICAL NASAL ; FOSAMAX ORAL ; FOSAMAX PLUS D ORAL ; MIACALCIN NASAL ; FOSRENOL ORAL ; PHOSLO ORAL ; RENAGEL ORAL ; ANDRODERM TRANSDERM. ; ANDROGEL TRANSDERM. ; TESTIM TRANSDERM. ; ARANESP INJECTION ; PROCRIT INJECTION ; EPOGEN INJECTION ; ARIXTRA SUBCUTANE. ; FRAGMIN SUBCUTANE. ; LOVENOX SUBCUTANE. ; ANZEMET ORAL ; CESAMET ORAL ; EMEND ORAL ; KYTRIL ORAL ; MARINOL ORAL ; ONDANSETRON ODT ORAL ; ZOFRAN ZOFRAN ODT ORAL ; ASACOL ORAL ; CANASA RECTAL ; COLAZAL ORAL ; DIPENTUM ORAL ; LIALDA ORAL ; MESALAMINE RECTAL ; PENTASA ORAL ; SULFASALAZINE ORAL ; AVODART ORAL ; CARDURA XL ORAL ; DOXAZOSIN ORAL ; FINASTERIDE ORAL ; FLOMAX ORAL ; TERAZOSIN ORAL ; UROXATRAL ORAL ; AKNE-MYCIN TOPICAL ; AZELEX TOPICAL ; BENZACLIN TOPICAL ; BENZAMYCINPAK TOPICAL ; BENZOYL PEROXIDE TOPICAL ; CLINAC BPO TOPICAL ; CLINDAGEL TOPICAL ; CLINDAMYCIN PHOSPHATE TOPICAL ; DIFFERIN TOPICAL ; DUAC TOPICAL ; ERYTHROMYCIN TOPICAL ; ERYTHROMYCIN-BENZOYL PEROXIDE TOPICAL ; EVOCLIN TOPICAL ; INOVA TOPICAL ; INOVA 4 1 TOPICAL ; NEOBENZ MICRO TOPICAL ; NUOX TOPICAL ; RETIN-A MICRO TOPICAL ; SULFACETAMIDE TOPICAL ; SULFOXYL TOPICAL ; TAZORAC TOPICAL ; TRETINOIN TOPICAL ; TRIAZ TOPICAL ; ZIANA TOPICAL ; CICLOPIROX CREAM SUSPENSION TOPICAL ; CLOTRIMAZOLE-BETAMETHASONE TOPICAL ; ECONAZOLE TOPICAL ; ERTACZO TOPICAL ; EXELDERM TOPICAL ; KETOCONAZOLE TOPICAL ; KETOCONAZOLE SHAMPOO TOPICAL ; LOPROX GEL TOPICAL ; LOPROX SHAMPOO TOPICAL ; MENTAX TOPICAL ; NAFTIN TOPICAL ; NYSTATIN TOPICAL ; NYSTATIN-TRIAMCINOLONE TOPICAL ; OXISTAT TOPICAL ; PENLAC TOPICAL ; VUSION TOPICAL ; XOLEGEL TOPICAL ; ELIDEL TOPICAL ; PROTOPIC TOPICAL ; ALTABAX TOPICAL ; MUPIROCIN TOPICAL ; Current PDL Status PDL Recommendation ON OFF ON OFF OFF ON ON ON OFF ON ON OFF OFF OFF ON OFF OFF OFF OFF OFF OFF ON ON OFF OFF ON ON ON OFF OFF OFF OFF OFF OFF OFF OFF ON ON ON OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF ON ON OFF OFF ON ON OFF OFF ON ON OFF OFF ON ON ON OFF OFF ON ON ON OFF OFF OFF OFF ON OFF ON ON ON OFF ON ON ON OFF NR OFF OFF ON OFF OFF ON ON ON OFF ON ON OFF ON ON ON OFF OFF ON ON ON OFF OFF ON ON OFF ON OFF OFF ON OFF OFF OFF OFF OFF OFF OFF OFF ON ON ON OFF ON Pended ON Pended OFF Pended ON ON ON OFF ON OFF ON ON ON OFF OFF ON ON ON OFF OFF NR OFF ON ON OFF OFF NR OFF OFF ON ON OFF ON ON ON OFF OFF ON OFF OFF OFF OFF OFF ON ON ON OFF OFF OFF ON ON OFF ON ON ON OFF OFF OFF OFF OFF ON OFF OFF OFF ON ON OFF OFF OFF OFF ON ON OFF ON ON ON OFF OFF OFF OFF OFF OFF OFF OFF ON ON ON OFF ON OFF ON OFF OFF OFF OFF OFF ON ON ON OFF OFF OFF OFF ON OFF OFF OFF OFF OFF OFF OFF OFF ON ON OFF OFF OFF OFF OFF OFF ON ON ON OFF OFF ON ON OFF OFF ON ON ON OFF NR ON. 11 eponym insufficiently medicated. But i found that if i take maxalt which is prescribed to me if provides some relief in a couple of hours. NHS 24 Phone: 0845 4 24 nhs24 NHS 24 is a nurse led service for members of the public. It is a free helpline offering health information, advice and help over the phone. Scotland's Health on the Web show ot.nhs This website provides public access to publications relating to CHD such as the strategy for CHD and stroke in Scotland. Scottish Association for Mental Health SAMH ; Cumbrae House 15 Carlton Court Glasgow G5 9JP Phone: 0141 568 7000 Best time to telephone: 2pm-4.30pm, Monday to Friday ; Email: enquire samh samh Provides patients and carers with information on all aspects of mental health. Rizatriptan maxalt ; may also be useful in this regard.
This section was taken from a contribution by Saran Braybrook, PhD, MRPharmS8 1996 ; In the UK there is large variation in prescribing between HAs and individual practices within a given area. This is despite the fact that up to 80% of patients consulting GPs have common conditions which could potentially be treated in standard ways.9 Whilst it is accepted that many factors affect prescribing, and all must be taken in to account when discussing variation, the extent of variation in the quantity and choice of drugs prescribed suggests that there is a great deal of sub-optimal prescribing.9 A wide range of factors have been shown to influence the prescribing decision-making process, many of which are not related to clinical effectiveness.10, 11, 12, 13, Since few guidelines in medical practice have been based on reliable clinical evidence and cost effectiveness, this may contribute to the wide-ranging outcomes of many prescribing decisions.16 Conversely where information on effective practice has been available, it has often taken many years to become widely adopted as illustrated by the example of thrombolytic therapy post myocardial infarction.17, 18. Her first romantic foray was with noah jonathan rhys meyers ; only serves to introduce lizzie not only to sex but to drug use, something especially unwise for one on such an emotional precipice.
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