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Although her husband was cruel and verbally abusive, C worked hard to fool everyone for 15 years into believing that she had a perfect, ful lling relationship because she did not want anyone to think that she had failed in her marriage Prior to her divorce at age 35, C s bingeing and weight gain were at their worst In discussing her current relationship, C indicated that she really liked her boyfriend, but she was always worried that he was angry with her about her work Consequently, she went out of her way to please him so he would not be upset with her Similarly, she put in 14-hour days because she felt uncomfortable saying no to her customers requests to see her before and after their business hours.

is that the message will be distributed via word-of-mouth communications. Fashion media personnel perform an important role in the word-of-mouth process and the marketing efforts directed at them will be discussed in Nine, particularly with regard to public relations, trade fairs and exhibitions.

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A three-pronged treatment approach should be used in order to (1) promote healing of the current ulcer, (2) reduce pain and suffering, and (3) induce long-term remission In general, when faced with extensive systemic lesions or resistant/intractable local lesions, oral steroids and steroid-sparing adjunct treatments such as methotrexate should be used in combination Thus, consultation with a dermatologist with experience in the treatment of ulcerative mucocutaneous lesions should be initiated in the rst visit Treatment with topical anti-in ammatory agents and local anesthetics can then be used to treat the in ammation and pain associated with active lesions In this case, a pulse oral steroid regimen was used starting with a 40-mg dose, tapered very slowly over 4 months to 25 mg/day In addition, in order to decrease the probability of ares, she was started on weekly intramuscular methotrexate.

While her oral lesions rapidly responded to steroids (within 2 weeks), her vulvo-vaginal lesions were more resistant (4 6 weeks), necessitating a concurrent use of vaginal hydrocortisone suppositories In our experience, a prolonged titration regimen (up to 3 4 months) is required with vulvar lesions This patient was co-managed by our colleagues in dermatology Please note the discussion below about the role of topical agents in treating in ammation localized to the vulva (plasma cell vulvitis) and vagina (DIV) In our experience, commercially available topical anesthetic agents (especially Benzocaine) are allergenic and are not well tolerated Thus, we often use a compounding pharmacy in order to develop individualized treatment While a detailed discussion of compounding medications, including the pros and cons, are beyond the scope of this chapter, most specialized compounding pharmacies with a focus on women s health can serve as a valuable resource for busy clinicians (http://wwwpcab.

Toward the end of the initial phase, C and her therapist began to examine the link between her binge eating and her use of food as a way to avoid the con icted feelings of wanting to please her boyfriend and clients, but at the same time resenting them for the demands they made on her Given her history of unful lling relationships and an inability to manage her current interpersonal relationships effectively, the therapist identi ed interpersonal de cits as C s primary problem area C found it very dif cult to see how her eating was related to her dif culties in managing relationships She shared with the therapist that she did not have problems with relationships I have millions of friends.

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info/) Our typical regimen for the management of pain with active ulcers is as follows: 5% lidocaine and 10% benzocaine compounded in hydrophilic petrolatum For oral.

Given her history, C s therapist chose not to challenge that perception, but instead talked with her about how she seemed to have a dif cult time managing the stress of her work life and her current relationship The therapist speculated to C that her binge eating might be a way to manage this distress To highlight this, C s therapist shared some examples that C had discussed in previous sessions C was able to see this link and, along with her therapist, developed speci c goals to guide her work during the remainder of treatment..

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