Author Archives: mimin

Stress is a common theme in my life. I have to admit that, for me, personally, it has become a chronic condition. Recently, I have finally made the step of realizing that stress is the evil dictator ruling a vicious cycle. A revolution is necessary:

Stress is something we have all experienced at some point in our lives. From a biological perspective, stress is a phenomenon that occurs when we experience circumstances that disturb our physical and mental equilibrium. These circumstances, which are referred to as stressors, include heavy workloads, relationship problems, illnesses or upcoming, life-changing events such as weddings, divorces or childbirth. Stress is naturally occurring and can even be helpful in certain situations such as being under pressure to finish an essay, but if stress is not relieved it becomes chronic. Chronic stress can have negative effects on our physical and psychological condition, relationships, work or school situation and other aspects of our social life.

Stressors initiate physical and psychological responses which manifest in different ways. For one, our physical condition can be affected by stress, which manifests in tension, headaches, high blood pressure and other physical ailments. On top of that, stress is known to worsen life-threatening illnesses such as cancer, stroke and heart attack. For instance, some studies have shown, that survivors of heart attacks were able to decrease their chance of recurrence by 74% by being counseled in stress management. Furthermore, stressors are generated in the nervous system and can lead to several psychological effects such as depression, irritability, anxiety, sleeping problems and memory loss, if they are prolonged. For example, the Columbia University College of Physicians & Surgeons claims that "[... ] stress may adversely affect hippocampal structure and function, producing deficits of both memory and cognition", which demonstrates that the brain is strongly influenced by chronic stress. Unfortunately, the physical effects of stress can actually lead to the psychological effects of stress and vice versa. In fact, conditions like obesity and anorexia are often caused by depression while depression can be caused by chronic stress. These manifestations of chronic stress can then have further adverse effects on a person's social life and employment.

More than just being able to affect each other, the physical and psychological effects of chronic stress can also disturb interpersonal relationships in many ways. In the first place, the physical effects of stress can actually result in a lack of closeness within a relationship. For example, having constant headaches or tension may cause a person to be less attentive and communicative. Since communication is such an important aspect in relationships, the lack of it may lead to problems. In like manner, the psychological effects of stress can be a trigger of arguments and other tense situations between two or more people. For instance, when a person is constantly irritated from chronic stress it is difficult to deal with him or her, which is undoubtedly a potential trigger for arguments. Dealing with a stressed person often results in stress in the other person as well. Therefore it is likely that chronic stress does not only affect the person initially suffering from it, but also lead to stress in the person being confronted by it.

Another effect chronic stress can have on a person's life is slowing or even inhibiting a person's performance in school or work situations. Generally speaking, the physical and psychological discomfort of chronic stress can have the potential to lead a person to need prolonged sick leave, but it can also cause an inability to deal with everyday work and school situations. For instance, the general irritability caused by chronic stress may result in a person being unable to handle constructive criticism or work in a team. In the event that a person suffering from chronic stress loses employment, the change of situation in itself can be a further trigger of stress. In regards to school, the stress-inducing tasks of finishing essays or studying for exams can lead an already stressed person to feel hopeless and give up on his or her scholastic endeavor. In fact, an Associated Press-mtvU poll suggests that 85% of students report feeling stress on a daily basis and that 42% of them actually feel hopeless to a point of considering to give up.

It is obvious that chronic stress does more than just affect the body and mind of the person suffering from it. But even more than just causing problems in relationships and work -or school situations, other aspects of social life are affected by chronic stress as well. For one, the depression and irritability as well as the physical symptoms caused by chronic stress have the potential to lead a person to become less interested in social events and isolate themselves. Furthermore, the manifestations of chronic stress can also cause a lack of interest in relationships. This fact is especially troubling because research conducted by the National Institute on Aging suggest that "social isolation constitutes a major risk factor for morbidity and mortality [... ]." Therefore it can be said that, in the event of a person losing interest in social events and relationships because of chronic stress, the overall well-being of the affected person is in danger. Another effect of stress is the growing disregard of it as a normal part of life. It has become commonplace to be stressed for many reasons and, unfortunately, this causes people to ignore the symptoms and write them off as temporary when, in fact, they are very much capable of becoming a serious and permanent problem in a person's life.

Given these points it is obvious that chronic stress is the leader of a vicious cycle. Routine situations as well as troubling circumstances can trigger an overload in the nervous system which can lead to a person feeling discomfort in many ways. The effects of stress, in themselves, create further stressors which worsen the physical and psychological condition and affect interpersonal situations. It is essential that stress is alleviated before it becomes chronic so that it does not have drastic effects on a person's well-being. Fortunately, there are many ways to manage stress including meditation, exercise and proper nutrition, which can be essential in preventing chronic stress and improving quality of life.


What Happens During a Panic Attack?

"I'll never live through this."

"I'm losing my mind."

"I've completely lost control."

"There's no way I can escape."

"Everyone will think I'm nuts."

In the U.S. more than 4 million people have these frightening thoughts while suffering a myriad of distressing physical symptoms. Attacks strike suddenly, with a rush of adrenaline, all occurring without any obvious sign of danger. Our automatic fight or flight reaction is triggered for no apparent reason. People who are prone to these attacks are usually extremely sensitive to physical sensations or fluctuations occurring in their body. How an individual perceives these symptoms determines their anxiety level. If you attach catastrophic thoughts to these feelings, like the ones listed above, you are very likely going to activate your fight or flight response by releasing adrenaline.

Symptoms that Commonly Occur when Panic Strikes:

  • Pounding or rapid heartbeat
  • The shakes
  • Chest pain or tightness
  • Light-headedness or faint
  • Vision blurred
  • Difficulty breathing
  • Flushed and/or sweating
  • Fluttering stomach or sinking feeling

What causes a panic attack? Considering these distressing physical symptoms, it's perfectly understandable why someone might start thinking catastrophic things are happening or about to happen. It is this kind of intense fear that drives the anxiety to become sheer panic. You may not be asking, "Am I having a panic attack or a heart attack?" You may just be focusing on your bodily sensations of panic attack chest pain and immediately assume you're suffering a heart attack.

Many people in the midst of an attack wind up in an emergency room absolutely certain something dire is happening to them. Logically, you see that you're not in any physical danger so you can only assume that something must be seriously wrong with you physically. When we focus our catastrophic thoughts on ourselves, it only fans the flame. Each thought compounds the severity of our symptoms, increasing the adrenaline rush, which just makes our physical symptoms intensify, which leads to more catastrophic thoughts, which drives you into a full on panic attack.

It is absolutely crucial that you learn to recognize the initial signs of an attack. a good habit is to keep a record of the encounters. By keeping a record or log of your attacks, you can identify what actually happens that leads up to you having a full-blown attack. This information can help you devise coping strategies that you can employ to stop a panic attack before it strikes. Utilizing your toolbox you can learn to prevent it at whatever level of anxiety you are experiencing, on a scale of 0, which is feeling calm to 10, which would be a major panic attack.


A mental condition can be induced by a substance use disorder as much as a person with mental illness is likely to abuse any substance. Most of the times, it is difficult to ascertain which came first. The co-occurrence of a mental health condition along with a substance abuse problem is called dual diagnosis.

Here, we take a look at some of the mental disorders which can be induced by a substance use disorder:

    1. Substance-induced delirium: Also known as delirium tremens, it is a rapid onset of confusion that stems from alcohol withdrawal. Symptoms can last for a couple of days and the problem usually occurs when a person consumes excessive alcohol and tries to quit it abruptly. People often hear voices or see things that are illusionary and not felt by others. This suggests that while quitting alcohol, one should seek expert guidance to manage withdrawal.


    1. Substance-induced persisting dementia: The symptoms of a substance-induced persisting dementia are akin to those of normal dementia. The only difference is that it is caused by the abuse of substances. A person abusing substances may have trouble with memory, personality changes, and other physical or psychological problems, just like a regular dementia patient.


    1. Substance-induced psychotic disorder: Commonly known as toxic psychosis, it is a form of substance use disorder where the symptoms are ascribed to substance abuse. The toxins produced in the body as a result of the substance abuse affect the mind of an addict in such a manner that it results in psychotic disorder.


    1. Substance-induced anxiety disorder: Anxiety disorders can also be triggered by substance abuse and the symptoms can be equally ominous. It includes symptoms of a normal anxiety disorder, such as generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic attacks or phobias. It may occur during the intoxication period or during withdrawals. Symptoms should not be taken lightly, considering the fact that they are induced by substance abuse. Repercussions of not getting treated on time could land someone in the soup.


    1. Substance-induced mood disorder: Many over-the-counter (OTC) prescription medicines and certain drugs are blamed for causing depression and other mood disorders. Reports of substance-induced mood disorder have been doing the rounds since the 1950s and are long known.


    1. Hallucinogen persisting perceptual disorder: Hallucinogen persisting perception disorder (HPPD) is a condition characterized by a continual presence of sensory disturbances. A person using hallucinogenic substances experiences persistent changes in his perception that are most commonly visual.


  1. Substance-induced sleep disorder: Substance abuse almost always causes sleep problems in addicts. Insomnia is a definite fallout of substance abuse. A person suffering from it has difficulty in sleeping or at times tends to oversleep. The variety of sleep disturbances is caused by abuse of substances.

The co-occurring disorders can be quite difficult to handle and treatment also becomes a bit of a challenge. A treatment cannot be effective unless both the conditions are addressed simultaneously. Merely treating one condition without addressing the other would not yield desired results. Hence, seeking help from the right treatment center at the earliest holds the key.


You trust your brain more than anyone else's brain, even if you know that you are not intelligent. You believe that your brain works on your behalf and you also believe that nobody else cares more about your wellbeing than your own brain.

You believe that your thoughts help you understand the world where you are and solve your problems.

You also believe that your ego is more important than anyone else. This fact predetermines all your thoughts. Your thoughts are secret attempts to satisfy your ego.

Since you know that you have to hide from the world that your main intention always is to satisfy your ego, you pretend that you care about everyone else's wellbeing. You cannot reveal your inner thoughts to anyone.

You believe that your brain is a secret tool that always has your main interests in mind and helps you survive and triumph.

However, the truth is that your brain is a very dangerous organ. Your thoughts don't help you solve all your problems the best way, in all situations.

Your thoughts cause problems because you are absurd, evil, and ignorant, and you believe in unrealistic things.

God gave you a human conscience that must be developed during your life, but your satanic anti-conscience doesn't let you evolve. It keeps trying to destroy your conscience through craziness. This is why it keeps sending numerous absurd thoughts to your conscience all the time.

However, you cannot understand that many thoughts that pass through your mind are not produced by your human conscience. The anti-conscience is a demon in your brain trying to transform you (the human being created by God, who lives in your conscience) into a demon too.

The anti-conscience is your violent, immoral, and cruel conscience.

You have to help God transform your satanic anti-conscience into a positive part of your human conscience by acquiring consciousness through dream translation.

When you acquire consciousness you understand the moral implications of your actions and you control your behavior. You respect God's moral rules and you really care about the wellbeing of your community.

You stop caring about how you feel and you care about how God feels because He must transform incorrigible demons like us into perfect human beings. You understand that you have the moral obligation to attain sanctity and help God put an end to poverty and terror.

You stop being a selfish predator, and you become a generous and helpful human being.

While your conscience keeps listening to the absurd thoughts of your anti-conscience, you cannot think without being misled and bothered by the demon.

This scientific discovery explains many religious mysteries, besides giving you explanations for many unexplained phenomena.

Even your human conscience is deficient because it must be developed during your life thanks to your participation in this process. Your conscience is problematic and incomplete. So, you have to learn many things in order to become more intelligent and sensitive, and develop your conscience.

You are not using the biggest part of your brain to your advantage. The primitive demon that wants to kill you is using all of your brain power to generate mental illnesses within your conscience and control your behavior.

You, the human being created by God to transform the demon into a human being like you must be the one who will use all of your brain power, and not your evil self.

Until today you believed that your evil self worked on your behalf, the same way you believed that you had to trust your own brain. However, my discoveries show you that your evil self works against you, even though it pretends to help you find smart solutions.

These 'smart solutions' will make you lose your mind in the future, but this is not visible from the beginning. They are based on absurd suggestions that merely seem to be logical conclusions.

Therefore, you cannot trust your brain and you must be afraid of your evil self. All its suggestions always have the intention to destroy your conscience and control your behavior, replacing your ego.

You can trust God's wisdom in the dream messages because He is your doctor. God tries to help you fight the demon and stop being exposed to dangerous situations.

God gives you simple and clear explanations about what is happening in your brain. He helps you understand how to behave, and He helps you get prepared for the future.

Christina Sponias continued Carl Jung's research into the human psyche, discovering the cure for all mental illnesses, and simplifying the scientific method of dream interpretation that teaches you how to exactly translate the meaning of your dreams, so that you can find health, wisdom and happiness.


Are you familiar with post-traumatic stress disorder commonly referred to as PTSD?

As of 2007, "An estimated 7.8 percent of Americans will experience [have experienced] PTSD at some point in their lives, with women (10.4%) twice as likely as men (5%) to develop PTSD. About 3.6 percent of U.S. adult aged 18 to 54 (5.2 million people) have PTSD during the course of a given year." (1.) (The Nebraska Department of Veteran Affairs). These statistics obviously have changed as it is now 2016. Recognise these numbers are only the cases that have been reported. This situation is so much worse than you can ever imagine. Don't take my word for it. Do your own due diligence.

Who is affected by PTSD and why should you care? Front line workers such as paramedics, firemen, policemen, nurses, dentists, chiropractors, army personnel are all affected by PTSD at some point in their careers. This list is not inclusive of every specialty by any means nor is it in order of who is affected the most. Secondly, anyone who has experienced trauma within a household such as child abuse, rape, child neglect, or living with a member who has PTSD is at risk.

Why should you care? PTSD can cause individuals who experience it to have nightmares, depression, turn to substance abuse to lessen the effects of re-living the trauma that caused the PTSD, live in fear that they may harm their love ones, or be afraid of leaving their home. Many think it is a mental disease. It is not. Do your due diligence.

What if there is a way to help people with PTSD? Would it be worthwhile looking into? How valuable is it to give them back their life free of the symptoms of PTSD? How valuable is it to have a holistic approach and help the entire family, including small children who can't speak up for themselves?

-With great power comes great responsibility-Stan Lee

Imagine if you could connect with the people who need you the most. Do your due diligence and do a search on Google for organizations willing to help these people and their families.You may be surprised at what comes up.


download (15)Every week I meet hundreds of remarkable people. Many know they are remarkable, some the world knows are remarkable, but unfortunately most don't yet know that the have potential to be remarkable.

Each of us has the opportunity and ability to live fulfilled, passionate lives. Inside us is the potential for achieving success, success as defined and created by our own initiative, interest, intellect, and action.

A personal coach can help you define and achieve the life you desire. Through reflection, provocation, guidance, and accountability your coach can help you become the remarkable person you are destined to become.

If you have demons shouting scripts into your ears, from inside your head, this isn't meant as a substitute for therapy or medication. The suggestions here are meant to augment your existing regimen and are meant to make you uncomfortable. From the depths of depression or despair, self-pity rises up and attempts to drag you down. The surest defense against overwhelming and melancholy is to be of service to others. Having a purpose, other than yourself, is a motivation to get up and get on with your day.

All of life is series of small steps, small steps, side steps, a bigger step, a backward stumble and dozens of more smaller steps until you arrive at the destination - joy.

Ask yourself - " when I think of someone who could use my help, what name jumps out?". Be honest, you got a flash, an answer that intuition and karma are calling you towards. Accept that name and ask a second question." what is the least I can do to be of service to them?" Today's least might be too big a step to undertake but by breaking the task into bite size pieces you won't bite off more than you can chew.

Imagine that you heard Tom as an answer to the first question and invite him for Sunday dinner was the action. If you are overwhelmed by the thought of planning, preparing, serving and entertaining for a big dinner there may still be a way to be of service and build towards a dinner in a couple of months.

Can you do some baking; everyone has favorite cookies and then call Tom and make a delivery. In this scenario you control the situation and timeline, you reduce the effort but you still add value to someone you is waiting for your assistance (even if they don't know it is you). The act of thinking about someone else, considering their circumstances, pressing forward and finding a way to make a difference and then acting on it is life fulfilling. You are a better person for your action, you will feel better (not perfect) and Tom will have a glimmer of hope in every delicious morsel.

Baking isn't the solution to all problems (it just seems like it should be) and when you answer the who and how questions you will likely end up with a different approach. The process of making it bite size is successful when you are honest with yourself.

Write the preferred goal (what you imagined was your call) on the left hand side of a page - Feed Tom Sunday Dinner. On the left side write, honestly where you are today (your current state) Feeling Overwhelmed. Between the two columns begin creating a list of steps that will get you from today to the preferred future. Bake, call Tom, buy lunch, have coffee, arrange a date, grocery shopping, plan a meal, find recipes, prepare food, clean house, purchase wine... As your list grows pick a couple that you 'feel' you could begin with. Lets use Call Tom and Bake. Place Call Tom of the right side of the paper and your current state ( feeling unprepared) on the right. What are the steps in between? Look up Tom's number, think about what I want to say, write some notes for the conversation, pick a time, dial the phone, let him know you care...

The process can continue creating a micro plans that will be the first step to your today's action.

As I am sure you recognize this s an ongoing wash, rinse, repeat pattern that can be applied to almost all areas of your life.

The two takeaways - think of someone else and act to serve them.

Breathe and Be Better,


Sharing your time and talent by volunteering for your community is as beneficial to you as it is for the people you are helping. Aside from expanding your social circle and doing a good deed, doesn't it just feel good to help someone else? Volunteering can be one of the most personally rewarding experiences you can have, and the best part is, you are helping make the world a better place.

Realize your intrinsic value by serving others

Countless celebrities and people of material importance who seem to "have it all" get to a point in their lives where they realize they must give back to be fulfilled personally. Helping one another is a deep human purpose, yet you don't need to be rich and famous to make a difference. By volunteering, you raise your self-worth by satisfying a basic calling among humankind.

No good deed is ever too small

Making a positive impact in society does not need to be on a global scale. Everyone has things within their own community that they would like to improve or help out with. When you choose to volunteer your time, talent and energy to better something within your own community, your self-esteem will sky rocket, you'll help others, and you'll improve your own surroundings.

Social Rewards from Volunteerism

Getting involved in a community cause which you are passionate about allows you to meet people with shared interests and values that you might not otherwise run into at work or socially. It's a great way to expand your network of friends or even professional contacts that may benefit you in the future.

Expand your horizons

You may not have the opportunity to develop new skills or try different things due to job or money constraints. Volunteering is a great way to try your hand at something you've always wanted to do, or even expound on a skill you would otherwise only do as a hobby.

Develop leadership skills

What better way is there to boost to your self-esteem than to take responsibility for a project, organize other volunteers, and make something happen? You may even be able to use your success as a leader on a volunteer project on your resume, and in future professional endeavors. Many of our youth are finding volunteerism helps them with college enrollment and to improve their resume when looking for that first job.

There are many reasons to become a volunteer. So get out there and do some good - for your community and yourself.


As a total health nut, cyclist and trail runner (just below Ironman Level Class), I am often asked; "Sure, anyone can get their body into great shape if they have the time to exercise and eat a good diet, but what about your brain? How does one improve their cognitive function and raise their IQ?" Well, we are told that your genetics determine your upper-end IQ, but if you want to get to all that and improve your cognitive function, I'd suggest a few supplements that I currently take. Let's talk.

You see I recommend the following supplements:

- Ginkgo Biloba
- Ginseng
- Chromium Picolinate
- Dong Quai

For brain supplements - they work great. Recently, I read an old article in Consumer Advisory Online titled; "Brain Supplement Reviews Buyer's Guide 2015 - How to Buy Brain Supplements Online," which stated:

"Consumer Advisor Online does not often review nutritional supplements, but since we have received dozens of requests for our opinion on the new brain and memory nootropics supplement craze sweeping the nation, we decided to weigh in and help demystify this so- called 'wonder pill'.

We started hearing the buzz when Daytime TV Doctors, started touting these new pills that improve concentration, memory recall, focus, mental clarity and energy. And though we love the good Doctor and his purple gloves, we don't love the droves of hucksters who prey on his loyal viewers trying to make a quick buck, often selling low-grade versions of his medical discoveries. So, we researched over 38 popular brands being sold both online and in retail stores. We are going to sing like a canary about; What THEY don't want you to know!"

This all makes perfect sense to me. Not long ago, a friend asks; "When I googled best brain supplements, this article came up. I am curious as to what you think because it doesn't mention any of the products that you recommend that I take."

Well these are combo supplements with many ingredients and I wonder if that is the best approach. For instance, Ginseng - stabilizes blood flow and increases adrenaline, which isn't only a brain thing, but without good blood flow, the brain doesn't do well, and helping it get oxygen helps. Ginkgo Biloba is known by Eastern Medicine to help with brain memory, I am surprised the article didn't mention it at all. Same with the other one I mentioned. The Chromium Picolinate has always been considered a good brain supplement.

This article seems to be using research that has specific enzymes or proteins flipping switches of genes known to help the brain. Who is to say that the supplements I mentioned do not contain some of those naturally, rather than going directly with exact or specific thing achieving the same results? I'd have to research this more, it is interesting, even if I don't trust internet crap in magazines much. I will have to look into the cited studies more.

Don't know more than what I've studied in the past, just know that my brain out performs everyone else's for some strange reason. Could be the running, cycling, sex, sleep, and attitude, personal formatting to reward my brain for problem solving and piquing my brain chemicals in any challenge presented?


An Abyss is a pit that is so deep that it visually appears as darkness, even during the light of day. Although not possible, an abyss is said to be bottomless. An abyss is also a descriptive term for division between two or more people or between two or more groups of people. German philosopher Friedrich Nietzsche gave us a chilling warning when he said, "If you stare into an abyss, the abyss stares into you." But, what does that mean?

Friedrich Nietzsche was an unfortunate man who was so plagued by illness that he turned to the one thing that he could, his mind, to express himself. His philosophy has profoundly affected people in both the 20th and 21st centuries, about equally so for evil as well as good, with much credit for the evil part due to his twisted sister's refinement of his words after his death to fit her own dark philosophy. I think his words about an abyss mean this: If you concentrate on any subject too much, be that out of hate or love, you risk becoming that thing. Speaking of that, I do not recommend that you concentrate on the writings of that tortured soul.

Have you heard of a Blue Hole? Web search that, to see a good visual representation of an abyss. It is a watery sink hole that is so deep that light will not pass down to the bottom of it, and it's depths are devoid of sea life. A famous and much-photographed blue hole is located near Belize. After I viewed it, I instantly understood the captivation of staring into an abyss. Another example of an abyss is "Sally's well," described in the book and film titled "Cold Mountain," in which Ada Monroe looked down the well, and saw what she wanted to see.

I was compelled to write this article because of what I have seen over many years in someone I love. She suffered illness, tragedy, and emotional neglect to a point that she concentrated on those things. With the help of unscrupulous and unethical physicians, she acquired pills and potions to combat her illnesses, including those that she imagined that she had or were convinced that she had, the latter of which lined up nicely with the latest pharmaceutical on the market.

She gobbles these pills by the handful every day, convinced that they are what keeps her alive. But, what life does she have? She spends her day telling anyone who will listen about the woes of her health, the woes in the health of others, and the imagined woes of strangers, all of which serve to isolate her further from those she truly loves, who are also those who love her. She stared into the abyss, and the abyss consumed her. This article is a warning to you. Don't stare into an abyss, and warn your loved ones not to do it.


download (16)Searching for a right therapist is like searching for the right pair of jeans. It can get frustrating and tiring, but when you finally do, the discovery is more than worth it. It doesn't matter what modality your therapist uses, be it counseling, psychotherapy, expressive therapy, hypnotherapy or assessments, you need to find someone whom you can trust, someone with whom you are comfortable enough to share your feelings and deepest thoughts.

It is important to build a strong therapeutic relationship with your therapist. Sometimes, the bond is the most important factor. Here are some sample questions you can ask yourself before actually engaging fully in a therapist:

• Does the therapist really understand you?
• Does the therapist really care about you and your problems?
• Does the therapist accept you unconditionally?
• Does the therapist listen to you and give you full attention?
• Is the therapist judging or biased?
• Do you feel comfortable and safe with this therapist?
• Can you be honest with the therapist and not hide any information from him/her?

People skills are definitely a must in psychology and mental health. However you also need to check the background of the therapist before you start sharing your secrets with him/ her. Below are some vital points you need to be aware about:

• Experience: Paper qualifications are important, so are years of experience and practical work. Search for a therapist who has experience working with clients who has the same issues as yours. Eg: a therapist who specializes in phobias will have loads of other case studies and can definitely assist you better.
• Be aware of treatment plans: Ask your therapist what he/ she is planning to do with you. You are entitled to know the treatment styles. Most therapists use a variety of treatment options which could also lengthen the whole procedure.