Thomas Myron Coffman, MD
- Professor of Medicine
- James R. Clapp Distinguished Professor of Medicine, in the School of Medicine
- Professor in Cell Biology
- Professor in Immunology
https://medicine.duke.edu/faculty/thomas-myron-coffman-md
However doctor for erectile dysfunction in gurgaon buy genuine extra super avana, even though a mutation may be identified erectile dysfunction doctor tampa discount extra super avana 260mg without a prescription, there may or may not be a therapy to target it impotence definition inability order extra super avana 260 mg free shipping. Furthermore finasteride erectile dysfunction treatment buy extra super avana 260mg mastercard, even when there may be a therapy that allegedly targets the mutation erectile dysfunction drugs without side effects 260mg extra super avana amex, it may not work for reasons which are not yet understood erectile dysfunction medications comparison purchase extra super avana 260 mg without a prescription. Some are ?germline changes, which are inherited changes in genes that are in normal tissues and differ from person to person. Specifically, regarding tumor adaptive resistance, he stated that, ?Tumor cells adapt to the targeted therapeutic in a way that allows them to bypass that stress. The question is, ?What do you do with that information to be able to personalize these therapies? We can identify mutations in tumors or in the plasma, but what we do with that information is not clear. That is why it is important to continue to use clinical trials Over the last 15 years or so, we have been focused on protein coding genes. We even tend to focus on larger genomic testing, but each human cell has 20,000 genes?making it a large and complex system. There are thousands more noncoding genes, which we don?t know much about, and that is another area where we are trained to focus on if they are expressed, what they regulate, and what they do. We need to be able to understand all of this to truly develop personalized medicine in the future. Even when drugs are a good match for a specific mutation, they are not consistently viable. Targeted therapies may be even less successful in patients who have exhausted all standard treatments. In a large study published in 2017 in Cancer Discovery, precision medicine failed to help 93% of the 1,000 patients who signed up for the study. The test is designed to provide information about several genetic mutations that may help guide treatment of patients with cancer. The FoundationOne test sequences clinical tumor samples to characterize the exons of 315 cancer-associated genes and introns from 28 genes involved in rearrangements. The study evaluated nine patients with breast cancer, pancreatic cancer, thymic carcinoma, lung cancer and salivary gland cancer (n = 1 for each). But among the remaining eight patients harbored 45 alterations, only 10 (22%) of which were concordant (in agreement) between FoundationOne and Guardant360 platforms. In two (25%) of the other eight patients, there was absolutely no concordance among the described alterations. And although total of 36 drugs were recommended for the eight patients, only nine (24%) of these drugs were recommended for the same patients by both platforms. Notably, in five patients (more than 50%), there was no overlap whatsoever between the drugs recommended by the FoundationOne test and those recommended by the Guardant360 test. The researchers concluded that the output from genetic testing can differ markedly depending on which genetic test is applied. Furthermore, they stated that these findings are clinically relevant because both the FoundationOne and the Guardant360 tests are performed on thousands of cancer patients each year. Promising research is underway as per the Research and Potentially Helpful Therapies section of this book. Recognizing that cancer and its treatments may have major effects on patients and those who are close to them, the intention of integrative care is to incorporate conventional and supplemental therapies meant to improve health, quality of life, and clinical outcomes. Supplemental integrative therapies may include acupuncture, exercise, massage, meditation, nutritional counseling, and others. It may be possible to work remotely via phone, email and Skype with a Naturopathic Oncologist who lives in a different location than the patient. Chemotherapy drugs tend not to be selective regarding the cells they target, and both cancer cells and normal cells are killed by chemotherapy. Chemotherapy is sometimes given as a single drug and sometimes as a combination of up to two or three drugs, either together sequentially. The doctor should explain the advantages and disadvantages of these drugs so that the patient and physician can jointly decide together which treatment course is. Potential heart damage Because chemotherapy drugs can potentially cause heart damage, all patients who are candidates for chemotherapy should have prior careful clinic evaluation and assessment of cardiovascular risk factors or comorbidities. In one study, a cardiologist teamed up with a medical oncologist and identified a handful of studies that reported success using a beta blocker called Carvedilol. It is believed that CoQ10 helps to maintain a healthy cardiovascular system, and there is evidence of CoQ10 deficiency in heart failure. Therefore, patients should be carefully pre-checked to ensure these organs are functioning properly, and they should be carefully and continually monitored while on chemo. Additionally, patients are encouraged to discuss exercise with their doctor because a recent study comparing neuropathy symptoms in exercisers (those who undertook walking and gentle resistance-band workouts) vs. Other side effects: Before taking any chemotherapy drug, patients should first discuss potential side effects with their doctor as well as the reason(s) why their doctor is recommending the drug(s). This conversation should also include specific examples of when patients should notify their doctor immediately or go to the Emergency Room (such as if the patient is experiencing difficulty breathing). Therefore, patients about to be put on a chemotherapy regimen should discuss any relevant pre-testing before starting a new drug. Risks include acute early-onset toxicity and potentially severe, life-threatening, or even fatal adverse reactions, so pre-testing is crucial. I experienced grades 3-4 leukopenia, neutropenia, anemia, febrile neutropenia, hand-foot syndrome, fatigue, etc. My oncologist was frightened by my response to the chemo, thinking it would kill me before the cancer ever had a chance to . Reducing dosage and/or frequency: If a patient will be starting chemotherapy (or is on chemotherapy and experiencing significant side effects), they should consider asking their doctor about the possibility of decreasing the dosage and/or reducing the frequency that it is given. They received 8-12 mg/m2 doxorubicin/week for a treatment period of up to 7 months until a progression of the disease occurred. In 2 of 17 evaluable patients, an objective response with a duration of 3+ and 5 months respectively was achieved. In 9 patients, a stabilization of the disease was observed, whereas the disease progressed in 6. The tolerance for this regimen was remarkable, with neither serious acute toxicity nor any signs of congestive cardiomyopathy even in those patients who were treated beyond a cumulative dose of 450 mg/m2. Therefore, it may be best to start with a drug that is generally less toxic, and whose dosage can readily be decreased if a significant side effect arises. Some medications may help prevent Copyright 2019 Anne Loeser Updated April 2019 Page 60 or slow down osteoporosis, so physicians may prescribe drugs called bisphosphonates or the drug Xgeva to help preserve bone density. Regular exercise can help strengthen and protect the bones, as can getting enough calcium, Vitamin K2, and Vitamin D. Premature Menopause: Chemotherapy can cause premenopausal women to go into menopause, but if they are using birth control, it would still be wise to continue doing so because undergoing chemotherapy when pregnant may cause birth defects, and on rare occasions women who appear to be menopausal can still become pregnant. Women whose birth control contains hormones should speak with their doctors about switching to a form of birth control that is hormone-free. Hair loss (alopecia): Although not all chemotherapy drugs cause hair loss (alopecia), many of these drugs induce significant hair loss or baldness. As a result of the cooling system, blood vessels in the scalp constrict, resulting in decreased hair follicle activity which helps reduce hair loss. Typically, when one type of chemo fails, their doctor puts them on another chemo drug, then another, ad infinitum. Since chemo drugs can cause considerable side effects, their cumulative effect upon the patient needs to be carefully considered. Although there is no hard and fast rule regarding when to stop chemotherapy (and possibly [re-] try a different type of therapy such as hormonal, targeted, or immunotherapy, or cease treatment altogether), the author located the following studies: A retrospective review of randomized studies compared shorter versus longer chemotherapy. These studies have generally shown that prolonged treatment is associated with extended Time to Progression but has little effect on Overall Survival. A recent systematic review of eight randomized trials including 1,942 patients demonstrated no significant reduction in the risk of death with prolonged therapy. When chemotherapy is given for these reasons, it is called palliative chemotherapy. Not much research has looked at whether palliative chemotherapy for end-stage disease actually succeeds in improving quality of life. At the beginning of the study, the researchers asked the people in the study about their quality of life as well as their level of well-being, both physically and psychologically. For patients who were the sickest and had a lower quality of life when the study started, the caregiver rating of their last week of life was about the same, whether or not the people had received palliative chemotherapy. So, the end-of-life chemotherapy didn?t seem to improve quality of life for these people. And for people who were in relatively good health and had better quality of life when the study started, more than half (56%) had worse quality of life in their final week of life after receiving palliative chemotherapy. There was no difference in survival between the people who received palliative chemotherapy and those who didn?t. In general, guidelines generally indicate that chemotherapy should be stopped if there were no benefits from three back-to-back regimens, and/or when it is determined or felt that these regimens are doing more harm than good. Some people prefer to receive treatment up until the last day of their lives, while others will stop and prefer to spend the last weeks or months of their lives with their families, with their pain and other symptoms controlled without chemotherapy. Microtubule Inhibitors such as Docetaxel, Eribulin, Ixempra, Paclitaxel and Navelbine stop cells from dividing into two cells. Treatment should be based on previous therapy, differential toxicity, other medical conditions, and patient preferences. In a minor surgical procedure, the port is implanted, which means it is placed completely beneath the skin, and the catheter is inserted inside a blood vessel. People who tend to form blood clots, have a body size that will not allow for proper port placement or access, or have had radiation to the site where the port is intended to be placed may reconsider having a port. Tunneled Catheters: this type of catheter is surgically inserted into a vein in the neck or chest and passed under the skin. This is because the patient may receive significant benefits with fewer side effects with just one drug. Below is information about pre-testing tumor cells prior to administering taxane treatment, along with a comparison of the three taxane drugs. Therefore, patients considering a taxane-based regimen may wish to discuss the following research with their doctor. Researchers at Sanford-Burnham Medical Research Institute have discovered a mechanism that explains why some breast cancer tumors respond to specific chemotherapies and others do not. The findings highlight the level of glutamine, an essential nutrient for cancer development, as a determinant of breast cancer response to select anticancer therapies such as taxanes. Although researchers have been aware that many tumor cell types are dependent on glutamine for growth and survival, they did not know how glutamine uptake was regulated. We found that this interaction causes degradation of the glutamine carrier proteins, leading to an insufficient supply of glutamine and the sensitization of breast cancer tumors to death. Significantly, the Sanford-Burnham Medical Research Institute has begun screening for inhibitors of glutamine carrier proteins as a potential new target for breast cancer treatment. However, there is a small risk of permanent hair loss resulting from the use of Taxotere. Only 9% of patients on Abraxane experienced neutropenia (an abnormally low count of neutrophils which area type of white blood cell that helps fight off infections), whereas 22% of patients taking Taxol had neutropenia. Whereas Taxol is administered with a toxic chemical solvent (liquid solution) in addition to the drug, Abraxane uses nanoparticle albumin-bound (?nab) technology. This technique uses albumin, the most abundant protein in the body, to deliver the drug directly to cancer cells. With Abraxane, 50% more of the drug can be administered, more of the active drug is transported into the cancer cells, and patients generally experience fewer side effects. Taxane drugs include Taxol (Paclitaxel), Taxotere (Docetaxel), and Abraxane (Nab-Paclitaxel; Protein-Bound Paclitaxel). Therefore, patients who have taken, or are taking, a Taxane drug should be especially vigilant about reporting symptoms such as headaches, blurred vision, speech or cognitive difficulties, numbness, and/or dizziness to their physician. Xeloda may cause ?Hand Foot Syndrome, which is evidenced by peeling and/or blistering of skin on the hands and feet. Data presented in a retrospective review demonstrate that the dose of Xeloda can be reduced, either when used alone or in combination with docetaxel, to minimize adverse events without compromising efficacy in terms of Time to Progression or Overall Survival. In one study, 32 patients who had at least 2 prior chemo regimens received a median of 6 cycles of the drug. Patients should ensure that their doctors order tests before and during treatment to check whether their heart is working well enough to safely receive these drugs. The use of a specific agent can be repeated if recurrence happens more than 12 months after the last treatment. This conversation should also include specific examples as to when patients should notify their doctor immediately or go to the Emergency Room (such as if the patient is experiencing difficulty breathing). And as always, before taking any new drug, patients must make sure to tell their doctor about their medical history, other medications and supplements they are taking, and any concerns they may have. At this point, other options such as chemotherapy (and potentially clinical trials) should be considered. In some cases, a listed drug can be combined with another drug as described in the Hormone Receptor Positive Breast Cancer section of this Guide. But because they are ?selective, they allow estrogen to communicate with other cells (such as bone, liver and uterine cells) that also have estrogen receptors. Fulvestrant may be given alone or paired with Ibrance, Kisqali, or Verzenio in specific circumstances. The ?estrogen paradox refers to the fact that on the one hand estrogens are known to stimulate the growth of breast cancer, whereas on the other hand high doses of estrogens are an effective treatment for this disease. When estrogen-lowering drugs no longer control metastatic breast cancer, the opposite strategy might work.
Therefore erectile dysfunction doctor near me 260 mg extra super avana overnight delivery, the body detoxification process is continuous diabetes and erectile dysfunction relationship cheap extra super avana 260mg online, being widely recognized that different substances latest erectile dysfunction medications discount extra super avana 260mg mastercard. The liver is an extremely important organ in the body impotence vacuum pumps cheap extra super avana uk, responsible for vascular erectile dysfunction psychological treatment purchase extra super avana 260 mg with visa, metabolic and secretory functions erectile dysfunction treatment atlanta buy generic extra super avana canada. In addition, it is also responsible for the detoxification of all the chemical substances at which we are constantly exposed (not only those ingested through diet and as a result of the environment interaction, but also those resulting from endogenous metabolic processes, such as drugs and other cellular metabolisms). Moreover, the presence of multiple chemical sensibilities and allergies is frequent in patients with chronic candidiasis, which is a direct indicator of problems in detoxification reactions. The damage of liver is an underlying factor in chronic candidiasis, as well as in chronic fatigue, because when the liver is damaged by chemical toxins and others, the immune function is severely compromised. Thus, enhanced liver function is vital, not only 23 before, but also during and even after procedures that destroy yeasts, in order to increase the likelihood of success in candidiasis treatment [49,57,59,60,62]. Some procedures could help in the improvement of detoxification process by liver (Table 3). Natural anti-yeast agents Natural anti-yeast agents with proven activity against C. Nevertheless, to be effective as primary therapy, predisposing factors to chronic candidiasis, diet and lifestyle should also be taken into account. However, the occurrence of Herxheimer reaction is very frequent when an effective anti-yeast therapy is used, due to the rapid elimination of the microorganisms, and subsequent absorption of large amounts of yeast toxins, cell particles and antigens. The mentioned reaction can be eliminated through supporting liver function, following dietary recommendations and starting anti-yeast medications in low and gradually increasing doses [49,57,59,60,97]. The most commonly used substances and phytotherapics in the complementary treatment of candidiasis are presented in Table 4. Besides the mentioned phytotherapics there are other plants with documented antifungal activity, particularly against C. Nevertheless, there are still several unknown compounds from plants, that could act synergistically, among themselves and with other natural compounds, against yeast infections [57,59,60,97,110]. Other aspects should also be considered namely, rest and liquids intake mainly vegetable diluted juices, soups and plant infusions. Moreover, it is necessary to promote a positive mind and help patients to cope stress. Alcohol, simple sugars, tobacco and cholesterol should be avoided due to their capacity of stimulating C. The support to thymus gland function is also provided by 500 mg of crude polypeptide fractions, twice daily [57,59,60,62,96,111]. The body ability to detoxify and eliminate some substances is mostly dependent of healthy diet and lifestyle. As previously mentioned, liver is the responsible for the detoxification of all chemical substances. Therefore, the optimization of liver function, promoting their protection and using lipotropics factors, accelerates the elimination and fat deposition in liver, and could offer significant benefits [57,59,60,97]. In some cases, 25 the use of formulas containing natural plant fibers derived from psyllium seed, kelp, agar, pectin and plant gums, is necessary to help elimination of toxic substances and protect the bowel wall from irritation. Moreover, these fiber formulas promote natural bowel movements and, if anti-yeast therapies are employed, they guarantee that dead yeast cells are excreted and not absorbed; 3-5 g of soluble fiber at bedtime are required for the treatment of candidiasis [57,59,60,87,88,112,113]. Particularly, Lactobacilus acidophilus, Bifidobacterium bifidum, Lactobacillus bulgaricus and Streptococcus thermophilus are very important, not only as antifungals, antibacterials and antivirals, but also in digestion and in production of vitamins and other substances important to maintain gut and the all body healthy. The recommendation is a product containing 4-10 billion viable active organisms, 30 minutes after a meal. However, some foods, like yogurt and kefir, could also be a good source of probiotics, but is necessary to take care, mainly due to fact that the yogurt itself does not have the necessary amount of bacteria and, in other hand, the presence of sugar promotes the overgrowth of C. Therefore, the yogurt should have the proper bacteria and should not be sweetened [57,59,60,87,88,112,113]. Lastly, the use of nutritional supplements or herbs seems to be the best option to help and control C. In most cases, these therapeutic interventions are effective to threat candidiasis, including chronic candidiasis. However, if the patient cannot achieve a significant improvement and/or eradicate the infection, it is necessary to perform a deeper evaluation [57,59,60,62]. If the organism is still present, after repeat stool cultures and measure antigen levels, antibiotics could be prescribed, combined with other recommendations [57,59,60]. Despite until now the 26 majority of studies focused essentially in the role of oils of plants, currently other natural matrices preparations have been studied, namely, aqueous and alcoholic extracts. It is very important to underline that the use of plants and other botanical preparations are used, since ancient times, by primitive societies, due to healing properties and therapeutic and psychotherapeutic benefits. It is important to address the fact that plants are widely used to obtain a large variety of drugs, being used in folk medicine for a long time [26?29,32?35]. Concerning that plants represent an economic, easily and which are accessible for all of people, they can be used into a variety of diseases, constituting an excellent source of biomolecules able to act like natural antifungal agents and, at the same time, to encourage the search for other alternative treatments. They can be used, both to complement a conventional treatment with antifungal agents, and singly like a natural alternative treatment. In both situations, the counseling and following of a growing control diet are crucial to ensure successful of therapy. Moreover, despite the increasing interest of several studies towards the identification of several compounds with therapeutic potential and their synergistic effect, in combination with other compounds, many properties of plants remain unknown, as well as their main compounds. Thus, not only it is necessary to deepen the study of other preparations of known plants but also investigate other therapeutic effects provided by plants and the major responsible compounds. Concluding remarks All people are exposed to a variety of candidiasis predisposing factors, and some of them are impossible to avoid. As this infection is very uncomfortable and, in some cases, offers a considerable health risk, the major and most important aspect is prevention. Therefore, there are several aspects to consider and include in the daily routine, which at first might seem insignificant, but that could provide a strength protection. To combat the infection different procedures are necessary according to the pathologic conditions of the patient; if all daily care is considered, the probability of the infection occurrence will be considerably reduced. However, in face of an infection, a rapid intervention is necessary and, for this, other alternatives to antifungals and antimicrobials are necessary. Opportunistic yeast infections: candidiasis, cryptococcosis, trichosporonosis and geotrichosis. Candida albicans: a review of its history, taxonomy, epidemiology, virulence attributes, and methods of strain differentiation. Candida albicans-epithelial interactions: dissecting the roles of active penetration, induced endocytosis and host factors on the infection process. Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Nosocomial Candida albicans acquisition in a geriatric unit: epidemiology and evidence for person-to-person transmission. Candida glabrata and Candida albicans co-infection of an in vitro oral epithelium. Dispersion as an important step in the Candida albicans biofilm developmental cycle. Candida species: current epidemiology, pathogenicity, biofilm formation, natural antifungal products and new therapeutic options. Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care. Reviews resistance of Candida species to antifungal agents: molecular mechanisms and clinical consequences. Chemical composition and in vitro antimicrobial, antifungal and 30 antioxidant properties of essential oils obtained from some herbs widely used in Portugal. Antifungal activity of Coriandrum sativum essential oil, its mode of action against Candida species and potential synergism with amphotericin B. Review of pharmacological properties and chemical constituents of Pimpinella anisum. Candida glabrata and Candida albicans; dissimilar tissue tropism and infectivity in a gnotobiotic model of mucosal candidiasis. Comparison of the epidemiology, drug resistance mechanisms, and virulence of Candida dubliniensis and Candida albicans. Oropharyngeal candidiasis: a review of its clinical spectrum and current therapies. The epidemiology of Candida species associated with vulvovaginal candidiasis in an Iranian patient population. Chronic vulvovaginal candidiasis: characteristics of women with Candida albicans, C. Prevalence of Candida species and potential risk factors for vulvovaginal candidiasis in Aligarh, India. Antifungal susceptibility and genotypes of Candida albicans strains from patients with vulvovaginal candidiasis. Genital colonisation and infection with candida in heterosexual and homosexual males. Colonisation of extragenital sites by Candida in women with recurrent vulvovaginal candidosis. Pathological analysis of the Candida albicans-infected tongue tissues of a murine oral candidiasis model in the early infection stage. Biofilm formation of Candida albicans is variably affected by saliva and dietary sugars. The importance of strain variation in virulence of Candida dubliniensis and Candida albicans: results of a blinded histopathological study of invasive candidiasis. Lactoferrin in human milk: its role in iron absorption and protection against enteric infection in the newborn infant. Copper and iron are the limiting factors for growth of the yeast Saccharomyces cerevisiae in an alkaline environment. High environmental iron concentrations stimulate adhesion and invasive growth of Schizosaccharomyces pombe. Th1 immunity induction by ginsenoside Re involves in protection of mice against disseminated candidiasis due to Candida albicans. Candida albicans versus non-albicans bloodstream infections: the comparison of risk factors and outcome. Epidemiology of clinical isolates of Candida albicans and their susceptibility to triazoles. Oropharyngeal candidiasis and oral yeast colonization in Iranian Human Immunodeficiency Virus positive patients. Virulence factors for Candida spp recovered from intravascular catheters and hospital workers hands. Commercialized rapid immunoanalytical tests for determination of allergenic food proteins: an overview. Serum IgE and IgG responses to food antigens in normal and atopic dogs, and dogs with gastrointestinal disease. Therapeutic effects on murine oral candidiasis by oral administration of cassia (Cinnamomum 36 cassia) preparation. Correlation of Antimicrobial Activities of Various Essential Oils and Their Main Aromatic Volatile Constituents. Antioxidant and antimicrobial activities of essential oil and extracts of fennel (Foeniculum vulgare L. Antimicrobial Activities of Roman Chamomile Oil From France and Its Main Compounds. Antibacterial and antifungal activity of ethanolic extracts from eleven spice plants. Antimicrobial and antioxidant properties of rosemary and sage (Rosmarinus officinalis L. Efeitos do cha de tomilho sobre a aderencia in vitro de Streptococcus mutans ao esmalte dentario e Candida albicans a resina acrilica. In vitro antimicrobial activity of Thymus vulgaris, Origanum vulgare and Rosmarinus officinalis against dental caries pathogens. The antimicrobial activity of four commercial essential oils in combination with conventional antimicrobials. Role of Probiotics in health improvement, infection control and disease treatment and management. Representative scheme of interactions between the main variables related to candidiasis. Main general guidelines for personal hygiene [49,59,60,62] Procedures Avoid contact with other body parts, as well as with other persons Superficial infections Maintain the skin clean and dry During menstruation, compresses without cosmetic products should be used Avoid frequent use of vaginal douches and intimate hygiene products (they alter the normal vaginal pH, causing unbalance and favoring the onset of infection) Maintain external vaginal area completely dry Vaginal candidiasis Avoid prolonged use of bathing suit or damp or wet underwear the act of cleaning up should always be done backward Avoid sexual relations during antifungal therapy Bed linen, bathroom and personal clothing should be washed with very hot water, separated from the others at Personal belongings home and disinfected after use Avoid tight clothing and use cotton underwear 40 Table 2. Dietary considerations in the treatment of candidiasis [57,59,60,62,97] Food characteristics Food products Refined carbohydrate sources Refined sugars (sucrose, fructose, corn syrup), fruit juice, honey, maple syrup Fungi and/or yeast sources Alcoholic beverages, dried fruits, To avoid cheeses, peanut Lactose and antibiotic sources Dairy products Allergenic foods Dairy products, eggs, chocolate, fried and processed foods, wheat, peanuts To limit Carbohydrate sources Corn and potatoes Vitamin sources Vegetables, fruits (apples, pears, cranberries, cherries, blueberries and To consume other soft fruit) Protein sources Fish, meat and biological poultry Fiber sources Whole grains, ground flaxseeds 41 Table 3. Substances and phytochemicals commonly used in alternative treatment of candidiasis Substance Dosage/Description High-potency complex of multivitamins Hypoallergenic formulas, free of yeasts and minerals formula Zinc picolinate 45 mg/day Selenium 200 ?g/day Caprylic acid Formula of slow liberation (1 g with meals) Probiotics (intestinal flora) Products containing Lactobacillus Fiber supplement Guar gum, pectin or psyllium seeds (1 teaspoon before bedtime) Phytotherapics Dosage/Description Tabebuia impetiginosa (lapacho) 15-20 g of bark in 0. Whereas the longer discourses of the Buddha con tained in the prose sections of the Canon usually pro ceed methodically, unfolding according to the sequen tial structure of the doctrine, the Dhammapada lacks such a systematic arrangement. The work is simply a collection of inspirational or pedagogical verses on the fundamentals of the Dhamma, to be used as a basis for personal edification and instruction. In any given chapter several successive verses may have been spo ken by the Buddha on a single occasion, and thus among themselves will exhibit a meaningful develop ment or a set of variations on a theme. But by and large, the logic behind the grouping together of verses into a chapter is merely the concern with a common topic. In some cases (Chapters 4 and 23) this may be a metaphorical symbol rather than a point of doctrine. There also seems to be no intentional design in the or der of the chapters themselves, though at certain points a loose thread of development can be discerned. The teachings of the Buddha, viewed in their completeness, all link together into a single perfectly 7 coherent system of thought and practice which gains its unity from its final goal, the attainment of deliver ance from suffering.
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The parts of the bird that work together so that the bird can function comprise an organ system erectile dysfunction causes generic 260mg extra super avana. For example erectile dysfunction definition buy cheap extra super avana line, the lungs and nose and trachea are part of the respiratory system that keeps the bird breathing erectile dysfunction juice drink discount extra super avana uk. Organ Function Examples of clinical system signs Respiratory Breathing Gasping erectile dysfunction hypertension medications generic 260mg extra super avana fast delivery, coughing Digestive Eating erectile dysfunction meds online purchase generic extra super avana pills, defecating erectile dysfunction treatment in singapore purchase extra super avana with paypal, Thin birds, abnormal weight gain feces Skin & Protection from the Sores, feather loss feathers environment Nervous Coordination, standing, Twisted neck, rolling, can?t hold walking head up Reproductive Laying eggs, producing Decreased egg numbers, chicks chicks don?t hatch Muscles & Walking, flapping wings Cannot stand, swollen joints skeleton Immune Protection from disease, Frequent infections response to vaccination Example of an organ system: the digestive system includes all of the parts of the bird that are involved in eating, drinking and digesting. The function of the digestive system is to provide fuel for all of the other systems. Humanely euthanize the bird (See Handout Y: ?Humane Euthanasia of Individual Birds). With scissors, cut through one corner of the mouth so that the oral cavity can be examined. Continue the cut down the neck of the bird from the mouth to the chest, through the skin only. Using a scalpel or one side of a small scissors, cut into each infraorbital sinus, just below the eye. Make another cut through the skin of the abdomen that connects the two cuts on the thighs. Pull the breast skin up and the abdominal skin down so that the midsection of the bird is exposed. Using scissors, make a cut in the abdominal body wall that follows the bottom edge of the rib cage. Now that the ribs have been cut through, remove the rib cage and breast muscles as one piece. Observe the air sacs as you do this, because they will be disrupted as the rib cage comes off. Pull downward so that the digestive tract comes away from the bird and can be examined in detail. If desired, remove the digestive tract from the bird entirely by cutting down near the cloaca. You may need heavy scissors or a scalpel to get through the tough muscle of the ventriculus. With strong scissors, carefully chip and peel off the top of the skull to expose the brain. Duck viral Virus Any, Wild and 5-100% with the Sudden mortality, often with few or no signs Biosecurity, enteritis (duck although domestic highest mortality in Digestive: watery diarrhea, decreased appetite, thirst (vaccination) plague) adults ducks and older birds Reproductive: decreased egg numbers more geese Nervous: difficulty walking, tremors severely Respiratory: pasted eyelids, nasal discharge affected 4. Pigeon Virus Any Pigeons Mortality may reach Adults neglect squab, resulting in their deaths. Vaccination, Disease domestic young birds where Respiratory: sneezing, coughing, difficulty breathing biosecurity (lentogenic or birds mortality may reach Nervous: twisted necks mesogenic) 20% Reproductive: decreased egg numbers 6. There may be no signs in Biosecurity, Pathogenicity domestic may be up to 60% in waterfowl. Infectious Virus Any but Chickens 0-25% Birds may be depressed with ruffled feathers. Vaccination, bronchitis virus most Respiratory: gasping, coughing, sneezing, wet eyes medication for severe in Reproductive: thin-shelled, rough and misshapen eggs, decreased egg secondary chicks numbers bacteria 9. Vaccination 30 weeks unvaccinated flocks Nervous: paralyzed in one or both legs or wings, difficulty standing. Avian Leukosis Virus >30 weeks Chickens Usually <3% Unthriftiness, weight loss, enlarged abdomen Chicks from clean of age although it may Reproductive: decreased egg numbers flocks, biosecurity exceed 20% in some cases 11. Duck virus Virus Young, <6 Ducks Close to 100% in Death may be the first sign of disease. Nervous: birds fall on their sides, kicking ducks, 50% in 1-3 wk old, very (vaccination) low in >4 wk old 12. Infectious Virus Mostly 3-6 Chickens Usually 0-25% but in Prostration and death Vaccination, bursal disease weeks some cases, may be Digestive: vent picking, soiled vent feathers, whitish or watery diarrhea biosecurity up to 100% 13. Avian Virus Mostly 1-3 Chickens May reach 50% in Nervous: difficulty walking, paralysis, tremors Vaccination Encephalomye-litis weeks young birds 14. Vaccination, except turkeys 10-50% in Skin: scabby, raised pocks on the face biosecurity newly respiratory form. Digestive: Loss of appetite hatched Respiratory: nasal discharge, difficulty breathing 15. Medication, cholera weeks are ducks, Mortality is highest Respiratory: Gasping, difficulty breathing remove reservoirs, most geese, in turkeys, ducks. Navel is inflamed and the abdomen is Medication, omphalitis than 2 100% or it may be distended. Respiratory: Facial swelling, nasal discharge, coughing, foamy eyes Vaccination, Mycoplasmosis pigeons, Reproductive: Decreased egg numbers, decreased hatchability biosecurity turkeys Skeletal: joint swelling 18. Medication, Chlamydiosis pigeons, cases may have 5 Nervous (young ducks): trembling, imbalanced gait biosecurity turkeys 30% morality Respiratory: swollen eyelids, nasal discharge, difficulty breathing Digestive (young ducks): yellow-green diarrhea. Infectious Bacteria Any, Chickens Rapid onset and Respiratory: Facial swelling, especially around the eyes, nasal Vaccination, Coryza disease high mortality. Protozoa Young birds Pigeons Can be up to 50% Young birds lose weight and may die. Sanitation, Trichomoniasis without treatment Digestive: thick, yellow areas inside the mouth, difficulty closing mouth medication 21. Coccidiosis Protozoa Young Most, Variable depending Depression, weakness, decreased weight gain, dehydration. Self immunization, birds, older although on how severe the Digestive: may have mucoid or bloody diarrhea. Protozoa Turkeys: 3 Turkeys, Mortality is generally Depression, weakness Medication, put Histomoniasis 12 weeks. External Insects, Any Any Usually low unless Birds can become weak and unthrifty if heavily infested. Cleaning of parasites arachnids infestations are severe Skin: Mites, ticks, fleas and lice can cause itching, loss of environment feathers. Internal Various Any but the Any Mortality is variable Depression, failure to gain weight, anemia. Toxin from Young birds Any although Variable Nervous: difficulty walking, convulsions, feather picking Remove Aflatoxicosis fungus more signs more Reproductive: Reduced fertility and hatch rates. Botulism Toxin from Any Any, although It depends on how many Nervous: paralysis, especially of the neck. Birds will be Remove source fungus that more severe birds consume the toxin flaccid. Chemical Pesticides, Any Any Depends on the toxin, Signs vary depending on the toxin. Remove source toxins disinfectants the amount consumed of toxin, may and other or inhaled, and the need to clean number of birds environment exposed. Occasionally, injured birds may appear Secure housing domestic few birds but do not or body parts may be discovered after an attack. Vitamin Lack of Any Any Usually low in free Vitamin E: Death before 4 days of age Supplement deficiency complete ranging birds. May be Nervous: difficulty walking and standing, 15 30 days of age vitamins in the nutrition moderate to high in Reproductive: Decreased hatchability. When the source of the disease is the hatchery, the disease is called brooder pneumonia. Clinical signs and lesions: Aspergillosis occurs as an acute disease of young birds and a chronic disease in mature birds. Characteristically, there are no rales or respiratory sounds associated with aspergillosis. Mature birds also show respiratory distress, reduced feed consumption, and may have a bluish and dark color of the skin (cyanosis). Lesions typically consist of friable grey, yellow to greenish nodules or plaques, and fibrin deposition and pus in air sacs, lungs, and trachea. Similar lesions can occur in other organs such as the liver, peritoneal cavity and other sites. Mycelial growth with sporulation may be apparent on air sacs, bronchi and in the fungal lesions. Differential diagnosis: Avian aspergillosis signs are nonspecific and depend on the system involved. Pulmonary aspergillosis is usually differentiated from other avian respiratory diseases by the granulomatous lesions at necropsy, but needs to be differentiated from other mycoses and mycobacteriosis. However, exudative fibrinous or purulent air-sacculitis and pneumonia need to be differentiated from mycoplasmosis, colibacillosis, fowl cholera, and chlamydiosis. Aspergillosis affecting the skin needs to be differentiated from ectoparasitic infestations, smothering, cannibalism, and molting (natural loss of feathers) in birds. Cause, transmission, and epidemiology: Aspergillosis fungi are ubiquitous in the environment and grow well at room temperature and higher. All birds (domestic poultry, pigeons, canaries, and zoo bird species), animals, humans, and plants are susceptible. All litter and nest materials (peat moss, peanut hulls, sawdust, peat, bark, and straw) are known to have become contaminated with Aspergillus. Feed and water should be suspect when attempting to identify the source of contamination. Infection is usually caused by inhalation of large amounts of fungal spores, contaminated eggs during incubation and dust from the poultry shelters, coops, and areas where birds aggregate. In smallholder farms in Africa, aspergillosis occurs in free-range poultry during the planting and the harvesting periods. The main sources of the fungi are contaminated poultry environments and moldy cereals that are given to the birds as supplementation. In planting season, farmers use most of their cereals to plant farms; the remnants are used for household use, and rejects are thrown to animals including poultry. In harvesting periods, there are plenty of cereals but poor storage under humid, warm conditions favors fungal growth that can lead to poultry infection when bad grains are used as animal feeds. Diagnosis: Clinical signs and lesions of aspergillosis can indicate the disease; confirmation is by microscopic demonstration of the fungus in the lesions or histologic sections. Fungal species that can cause aspergillosis are Aspergillus fumigatus, and to a lesser extent, A. Old cultures become dark brownish-gray and the texture ranges from velvety to granular or powdery. They terminate in an inverted flask-shaped vesicle, from which sterigmata or phialides arise on the top half of the vesicle. Treatment: Clean and disinfect the house and spray it with 1:2000 copper sulphate or other suitable fungicide. Few and expensive birds can be treated with Nystatin or Amphotericin-B or other anti-mycotic agents. These are given together with antibiotics to prevent secondary bacterial infections. The litter can be sprayed lightly with an oil-base germicide to control dust and air movement of fungal spores. Prevention: It is important to thoroughly clean and disinfect the brooding area between broods. Recovery: Cases will re-occur if fungi can grow in feedstuffs or litter on the farm because it is not handled properly. Clinical signs and lesions: Signs commonly appear during the first week of life and between the second and third weeks. Affected chicks may first show a dull expression of the eyes, followed by progressive incoordination, sitting on hocks, tremors of the head and neck, and finally paralysis or prostration. In advanced cases, many chicks will lie with both feet out to one side (prostrate) and die. All stages (dullness, tremors, prostration) can usually be seen in an affected flock. In adult birds, a transitory drop (5-20 percent) in egg production may be the only clinical sign present. However, in breeding flocks, a corresponding decrease in hatchability is also noted, as the virus is egg-transmitted until hens develop immunity. Cause, transmission, and epidemiology: the disease is most prevalent in chickens less than 6 weeks of age. Pheasants, corturnix quail, and turkeys are natural hosts as well, but less susceptible than chickens. The virus can be transmitted through the egg from infected hen to chick, accounting for disease during the first week of life. The disease can also be spread through a flock by direct contact of susceptible hatchlings with infected birds, accounting for the disease at 2 3 weeks of age. Diagnosis: Avian encephalomyelitis is definitively diagnosed by histopathology of the brain of infected and affected chicks. It can also be diagnosed by a correlation of typical clinical presentation and serology. Recovery: Once a flock has been infected with avian encephalomyelitis on a premises, future flocks are likely to become infected both through the presence of the virus in the environment and also because chicks can get the virus from their dams. Vaccination is the best method to prevent the recurrence of clinical disease in new birds. Clinical signs and lesions: Avian influenza is categorized as low (mild) or highly pathogenic. It causes facial swellings, blue combs and wattles, diarrhea, respiratory distress and sometimes nervous disorders. Mortality can range from low in the mild form to nearly 100 percent in the highly pathogenic form. Differential diagnosis: Avian influenza must be distinguished from Newcastle disease as clinical signs and lesions are very similar. It should also be differentiated from Mycoplasma infections (chronic respiratory disease) and fowl cholera.
The blazing brightnesse of her beauties beame erectile dysfunction diabetes qof purchase cheap extra super avana on line, And glorious light of her sunshyny face To tell erectile dysfunction treatment ginseng cheap extra super avana on line, were as to striue against the streame impotence supplements 260 mg extra super avana mastercard. My ragged rimes are all too rude and bace erectile dysfunction questionnaire uk discount extra super avana uk, Her heauenly lineaments for to enchace bisoprolol causes erectile dysfunction buy genuine extra super avana on line. Ne wonder; for her owne deare loued knight erectile dysfunction in diabetes patients buy extra super avana us, All were she dayly with himselfe in place, Did wonder much at her celestiall sight: Oft had he seene her faire, but neuer so faire dight. So fairely dight, when she in presence came, She to her Sire made humble reuerence, And bowed low, that her right well became, And added grace vnto her excellence: Who with great wisedome, and graue eloquence Thus gan to say. But eare he thus had said, With flying speede, and seeming great pretence, Came running in, much like a man dismaid, A Messenger with letters, which his message said. All in the open hall amazed stood, At suddeinnesse of that vnwarie sight, And wondred at his breathlesse hastie mood. But he for nought would stay his passage right, Till fast before the king he did alight; Where falling flat, great humblesse he did make, And kist the ground, whereon his foot was pight; Then to his hands that writ he did betake, Which he disclosing, red thus, as the paper spake. To thee, most mighty king of Eden faire, Her greeting sends in these sad lines addrest, the wofull daughter, and forsaken heire Of that great Emperour of all the West; And bids thee be aduized for the best, Ere thou thy daughter linck in holy band Of wedlocke to that new vnknowen guest: For he already plighted his right hand Vnto another loue, and to another land. Therefore since mine he is, or free or bond, Or false or trew, or liuing or else dead, Withhold, O soueraine Prince, your hasty hond From knitting league with him, I you aread; Ne weene my right with strength adowne to tread, Through weakenesse of my widowhed, or woe: For truth is strong, her rightfull cause to plead, And shall find friends, if need requireth soe, So bids thee well to fare, Thy neither friend, nor foe, Fidessa. When he these bitter byting words had red, the tydings straunge did him abashed make, That still he sate long time astonished As in great muse, ne word to creature spake. At last his solemne silence thus he brake, With doubtfull eyes fast fixed on his guest; Redoubted knight, that for mine onely sake Thy life and honour late aduenturest, Let nought be hid from me, that ought to be exprest. What meane these bloudy vowes, and idle threats, Throwne out from womanish impatient mind? But if your selfe, Sir knight, ye faultie find, Or wrapped be in loues of former Dame, With crime do not it couer, but disclose the same. To whom the Redcrosse knight this answere sent, My Lord, my King, be nought hereat dismayd, darkwing. Till well ye wote by graue intendiment, What woman, and wherefore doth me vpbrayd With breach of loue, and loyalty betrayd. It was in my mishaps, as hitherward I lately traueild, that vnwares I strayd Out of my way, through perils straunge and hard; That day should faile me, ere I had them all declard. Then stepped forth the goodly royall Mayd, And on the ground her selfe prostrating low, With sober countenaunce thus to him sayd; O pardon me, my soueraigne Lord, to show the secret treasons, which of late I know To haue bene wroght by that false sorceresse. She onely she it is, that earst did throw this gentle knight into so great distresse, That death him did awaite in dayly wretchednesse. And now it seemes, that she suborned hath this craftie messenger with letters vaine, To worke new woe and improuided scath, By breaking of the band betwixt vs twaine; Wherein she vsed hath the practicke paine Of this false footman, clokt with simplenesse, Whom if ye please for to discouer plaine, Ye shall him Archimago find, I ghesse, the falsest man aliue; who tries shall find no lesse. The king was greatly moued at her speach, And all with suddein indignation fraight, Bad on that Messenger rude hands to reach. Eftsoones the Gard, which on his state did wait, Attacht that faitor false, and bound him strait: darkwing. Who seeming sorely chauffed at his band, As chained Beare, whom cruell dogs do bait, With idle force did faine them to withstand, And often semblaunce made to scape out of their hand. But they him layd full low in dungeon deepe, And bound him hand and foote with yron chains. And with continuall watch did warely keepe; Who then would thinke, that by his subtile trains He could escape fowle death or deadly paines? Thus when that Princes wrath was pacifide, He gan renew the late forbidden banes, And to the knight his daughter deare he tyde, With sacred rites and vowes for euer to abyde. His owne two hands the holy knots did knit, That none but death for euer can deuide; His owne two hands, for such a turne most fit, the housling fire did kindle and prouide, And holy water thereon sprinckled wide; At which the bushy Teade a groome did light, And sacred lampe in secret chamber hide, Where it should not be quenched day nor night, For feare of euill fates, but burnen euer bright. Then gan they sprinckle all the posts with wine, And made great feast to solemnize that day; They all perfumde with frankincense diuine, And precious odours fetcht from far away, That all the house did sweat with great aray: And all the while sweete Musicke did apply Her curious skill, the warbling notes to play, To driue away the dull Melancholy; the whiles one sung a song of loue and iollity. Great ioy was made that day of young and old, And solemne feast proclaimd throughout the land, That their exceeding merth may not be told: Suffice it heare by signes to vnderstand the vsuall ioyes at knitting of loues band. Thrise happy man the knight himselfe did hold, Possessed of his Ladies hart and hand, And euer, when his eye did her behold, His heart did seeme to melt in pleasures manifold. Her ioyous presence and sweet company In full content he there did long enioy, Ne wicked enuie, ne vile gealosy His deare delights were able to annoy: Yet swimming in that sea of blisfull ioy, He nought forgot, how he whilome had sworne, In case he could that monstrous beast destroy, Vnto his Farie Queene backe to returne: the which he shortly did, and Vna left to mourne. Now strike your sailes ye iolly Mariners, For we be come vnto a quiet rode, Where we must land some of our passengers, And light this wearie vessell of her lode. Here she a while may make her safe abode, Till she repaired haue her tackles spent, And wants supplide. And then againe abroad On the long voyage whereto she is bent: Well may she speede and fairely finish her intent. But let that man with better sence aduize, That of the world least part to vs is red: And dayly how through hardy enterprize, Many great Regions are discouered, Which to late age were neuer mentioned. Yet all these were, when no man did them know; Yet haue from wisest ages hidden beene: And later times things more vnknowne shall show. Why then should witlesse man so much misweene That nothing is, but that which he hath seene? And thou, O fairest Princesse vnder sky, In this faire mirrhour maist behold thy face, And thine owne realmes in lond of Faery, And in this antique Image thy great auncestry. The which O pardon me thus to enfold In couert vele, and wrap in shadowes light, That feeble eyes your glory may behold, Which else could not endure those beames bright, But would be dazled with exceeding light. Guyon by Archimage abusd, the Redcrosse knight awaytes, Findes Mordant and Amauia slaine With pleasures poisoned baytes. Whom Princes late displeasure left in bands, For falsed letters and suborned wile, Soone as the Redcrosse knight he vnderstands, To beene departed out of Eden lands, To serue againe his soueraine Elfin Queene, His artes he moues, and out of caytiues hands Himselfe he frees by secret meanes vnseene; His shackles emptie left, him selfe escaped cleene. Him therefore now the obiect of his spight And deadly food he makes: him to offend By forged treason, or by open fight He seekes, of all his drift the aymed end: Thereto his subtile engins he does bend His practick wit, and his faire filed tong, With thousand other sleights: for well he kend, His credit now in doubtfull ballaunce hong; For hardly could be hurt, who was already stong. Still as he went, he craftie stales did lay With cunning traines him to entrap vnwares. And priuie spials plast in all his way, To weete what course he takes, and how he fares; To ketch him at a vantage in his snares. But now so wise and warie was the knight By triall of his former harmes and cares, That he descride, and shonned still his slight: the fish that once was caught, new bait will hardly bite. Vpon the way him fortuned to meet, Faire marching vnderneath a shady hill, A goodly knight, all armd in harnesse meete, That from his head no place appeared to his feete. His carriage was full comely and vpright, His countenaunce demure and temperate, But yet so sterne and terrible in sight, That cheard his friends, and did his foes amate: He was an Elfin borne of noble state, And mickle worship in his natiue land; Well could he tourney and in lists debate, And knighthood tooke of good Sir Huons hand, When with king Oberon he came to Faerie land. Him als accompanyd vpon the way A comely Palmer, clad in blacke attire, Of ripest yeares, and haires all hoarie gray, That with a staffe his feeble steps did stire, Least his long way his aged limbes should tire: And if by lookes one may the mind aread, He seemd to be a sage and sober sire, And euer with slow pace the knight did lead, Who taught his trampling steed with equall steps to tread. Such whenas Archimago them did view, He weened well to worke some vncouth wile, Eftsoones vntwisting his deceiptfull clew, He gan to weaue a web of wicked guile, And with faire countenance and flattring stile, To them approching, thus the knight bespake: Faire sonne of Mars, that seeke with warlike spoile. He stayd his steed for humble misers sake, And bad tell on the tenor of his plaint; Who feigning then in euery limbe to quake, Through inward feare, and seeming pale and faint With piteous mone his percing speach gan paint; Deare Lady how shall I declare thy cace, darkwing. Would God thy selfe now present were in place, To tell this ruefull tale; thy sight could win thee grace. Or rather would, O would it so had chaunst, That you, most noble Sir, had present beene, When that lewd ribauld with vile lust aduaunst Layd first his filthy hands on virgin cleene, To spoile her daintie corse so faire and sheene, As on the earth, great mother of vs all, With liuing eye more faire was neuer seene, Of chastitie and honour virginall: Witnesse ye heaue[n]s, whom she in vaine to helpe did call. How may it be, (said then the knight halfe wroth,) That knight should knighthood euer so haue shent? None but that saw (quoth he) would weene for troth, How shamefully that Maid he did torment. Her looser golden lockes he rudely rent, And drew her on the ground, and his sharpe sword, Against her snowy brest he fiercely bent, And threatned death with many a bloudie word; Toung hates to tell the rest, that eye to see abhord. Therewith amoued from his sober mood, And liues he yet (said he) that wrought this act, And doen the heauens afford him vitall food? He liues, (quoth he) and boasteth of the fact, Ne yet hath any knight his courage crackt. Where may that treachour then (said he) be found, Or by what meanes may I his footing tract? That shall I shew (said he) as sure, as hound the stricke[n] Deare doth chalenge by the bleeding wound. He staid not lenger talke, but with fierce ire And zealous hast away is quickly gone To seeke that knight, where him that craftie Squire Supposd to be. They do arriue anone, Where sate a gentle Lady all alone, With garments rent, and haire discheueled, Wringing her hands, and making piteous mone; Her swollen eyes were much disfigured, And her faire face with teares was fowly blubbered. The knight approching nigh thus to her said, Faire Ladie, through foule sorrow ill bedight, Great pittie is to see you thus dismaid, And marre the blossome of your beautie bright: For thy appease your griefe and heauie plight, And tell the cause of your conceiued paine. For if he liue, that hath you doen despight, He shall you doe due recompence againe, Or else his wrong with greater puissance maintaine. Which when she heard, as in despightfull wise, She wilfully her sorrow did augment, And offred hope of comfort did despise: Her golden lockes most cruelly she rent, And scratcht her face with ghastly dreriment, Ne would she speake, ne see, ne yet be seene, But hid her visage, and her head downe bent, Either for grieuous shame, or for great teene, As if her hart with sorrow had transfixed beene. Till her that Squire bespake, Madame my liefe, For Gods deare loue be not so wilfull bent, But doe vouchsafe now to receiue reliefe, the which good fortune doth to you present. For what bootes it to weepe and to wayment, When ill is chaunst, but doth the ill increase, And the weake mind with double woe torment? When she her Squire heard speake, she gan appease Her voluntarie paine, and feele some secret ease. Eftsoone she said, Ah gentle trustie Squire, What comfort can I wofull wretch conceaue, Or why should euer I henceforth desire, To see faire heauens face, and life not leaue, Sith that false Traytour did my honour reaue? False traytour certes (said the Faerie knight) I read the man, that euer would deceaue A gentle Ladie, or her wrong through might: Death were too little paine for such a foule despight. That short reuenge the man may ouertake, Where so he be, and soone vpon him light. Certes (saide she) I wote not how he hight, But vnder him a gray steede did he wield, Whose sides with dapled circles weren dight; Vpright he rode, and in his siluer shield He bore a bloudie Crosse, that quartred all the field. Now therefore Ladie, rise out of your paine, And see the saluing of your blotted name. Full loth she seemd thereto, but yet did faine; For she was inly glad her purpose so to gaine. Her purpose was not such, as she did faine, Ne yet her person such, as it was seene, But vnder simple shew and semblant plaine Lurckt false Duessa secretly vnseene, As a chast Virgin, that wronged beene: So had false Archimago her disguisd, To cloke her guile with sorrow and sad teene; And eke himselfe had craftily deuisd To be her Squire, and do her seruice well aguisd. For all he did, was to deceiue good knights, And draw them from pursuit of praise and fame, To slug in slouth and sensuall delights, And end their daies with irrenowmed shame. And now exceeding griefe him ouercame, To see the Redcrosse thus aduaunced hye; Therefore this craftie engine he did frame, Against his praise to stirre vp enmitye Of such, as vertues like mote vnto him allye. So now he Guyon guides an vncouth way Through woods & mountaines, till they came at last Into a pleasant dale, that lowly lay Betwixt two hils, whose high heads ouerplast, the valley did with coole shade ouercast, Through midst thereof a little riuer rold, By which there sate a knight with helme vnlast, Himselfe refreshing with the liquid cold, After his trauell long, and labours manifold. Loe yonder he, cryde Archimage alowd, That wrought the shamefull fact, which I did shew; And now he doth himselfe in secret shrowd, To flie the vengeance for his outrage dew; But vaine: for ye shall dearely do him rew, So God ye speed, and send you good successe; Which we farre off will here abide to vew. Who seeing him from farre so fierce to pricke, His warlike armes about him gan embrace, And in the rest his readie speare did sticke; Tho when as still he saw him towards pace, He gan rencounter him in equall race. They bene ymet, both readie to affrap, When suddenly that warriour gan abace darkwing. His threatned speare, as if some new mishap Had him betidde, or hidden daunger did entrap. And cryde, Mercie Sir knight, and mercie Lord, For mine offence and heedlesse hardiment, That had almost committed crime abhord, And with reprochfull shame mine honour shent, Whiles cursed steele against that badge I bent, the sacred badge of my Redeemers death, Which on your shield is set for ornament: But his fierce foe his steede could stay vneath, Who prickt with courage kene, did cruell battell breath. Certes (said he) well mote I shame to tell the fond encheason, that me hither led. A false infamous faitour late befell Me for to meet, that seemed ill bested, And playnd of grieuous outrage, which he red A knight had wrought against a Ladie gent; Which to auenge, he to this place me led, Where you he made the marke of his intent, And now is fled; foule shame him follow, where he went. So can he turne his earnest vnto game, Through goodly handling and wise temperance. By this his aged guide in presence came; Who soone as on that knight his eye did glance, Eft soones of him had perfect cognizance, Sith him in Faerie court he late auizd; And said, Faire sonne, God giue you happie chance, And that deare Crosse vpon your shield deuizd, Wherewith aboue all knights ye goodly seeme aguizd. But you, faire Sir, whose pageant next ensewes, Well mote yee thee, as well can wish your thought, That home ye may report thrise happie newes; For well ye worthie bene for worth and gentle thewes. So courteous conge both did giue and take, With right hands plighted, pledges of good will. Then Guyon forward gan his voyage make, With his blacke Palmer, that him guided still. Still he him guided ouer dale and hill, And with his steedie staffe did point his way: His race with reason, and with words his will, From foule intemperance he oft did stay, And suffred not in wrath his hastie steps to stray. In this faire wize they traueild long yfere, Through many hard assayes, which did betide; darkwing. Of which he honour still away did beare, And spred his glorie through all countries wide. At last as chaunst them by a forest side To passe, for succour from the scorching ray, They heard a ruefull voice, that dearnly cride With percing shriekes, and many a dolefull lay; Which to attend, a while their forward steps they stay. But if that carelesse heauens (quoth she) despise the doome of iust reuenge, and take delight To see sad pageants of mens miseries, As bound by them to liue in liues despight, Yet can they not warne death from wretched wight. Come then, come soone, come sweetest death to mee, And take away this long lent loathed light: Sharpe by thy wounds, but sweet the medicines bee, That long captiued soules from wearie thraldome free. But thou, sweet Babe, whom frowning froward fate Hath made sad witnesse of thy fathers fall, Sith heauen thee deignes to hold in liuing state, Long maist thou liue, and better thriue withall, Then to thy lucklesse parents did befall: Liue thou, and to thy mother dead attest, That cleare she dide from blemish criminall; Thy litle hands embrewd in bleeding brest Loe I for pledges leaue. With that a deadly shrieke she forth did throw, That through the wood reecchoed againe, And after gaue a grone so deepe and low, That seemd her tender heart was rent in twaine, Or thrild with point of thorough piercing paine; As gentle Hynd, whose sides with cruell steele Through launched, forth her bleeding life does raine, Whiles the sad pang approching she does feele, Brayes out her latest breath, and vp her eyes doth seele. Which when that warriour heard, dismounting straict From his tall steed, he rusht into the thicke, And soone arriued, where that sad pourtraict Of death and labour lay, halfe dead, halfe quicke, In whose white alabaster brest did sticke darkwing. A cruell knife, that made a griesly wound, From which forth gusht a streme of gorebloud thick, That all her goodly garments staind around, And into a deepe sanguine dide the grassie ground. Pittifull spectacle of deadly smart, Beside a bubbling fountaine low she lay, Which she increased with her bleeding hart, And the cleane waues with purple gore did ray; Als in her lap a louely babe did play His cruell sport, in stead of sorrow dew; For in her streaming blood he did embay His litle hands, and tender ioynts embrew; Pitifull spectacle, as euer eye did view. Besides them both, vpon the soiled gras the dead corse of an armed knight was spred, Whose armour all with bloud besprinckled was; His ruddie lips did smile, and rosy red Did paint his chearefull cheekes, yet being ded, Seemd to haue beene a goodly personage, Now in his freshest flowre of lustie hed, Fit to inflame faire Lady with loues rage, But that fiers fate did crop the blossome of his age. Whom when the good Sir Guyon did behold, His hart gan wexe as starke, as marble stone, And his fresh bloud did frieze with fearefull cold, That all his senses seemd bereft attone: At last his mightie ghost gan deepe to grone, As Lyon grudging in his great disdaine, Mournes inwardly, and makes to himselfe mone: Till ruth and fraile affection did constraine, His stout courage to stoupe, and shew his inward paine. Out of her gored wound the cruell steele He lightly snatcht, and did the floudgate stop With his faire garment: then gan softly feele Her feeble pulse, to proue if any drop Of liuing bloud yet in her veynes did hop; Which when he felt to moue, he hoped faire To call backe life to her forsaken shop; So well he did her deadly wounds repaire, darkwing.