No family history of coronary or aortic disease. Best viagra price online Physical examination revealed asymmetric arm blood pressures, a grade iii/vi diastolic murmur, and markedly diminished femoral pulses with absent lower extremity pulses. viagra online paypal uk# View larger version (67k): [in this window] [in a new window]   figure 1. A, preoperative transthoracic echocardiogram (parasternal long-axis view) showing centrally directed jet of mitral insufficiency (arrow) with color doppler flow mapping. Viagra patent expiration date usa B, postoperative image showing no mitral insufficiency (arrow). buy cheap viagra   the patient was referred for cardiac catheterization before mitral valve repair. viagra for sale online At the time of cardiac catheterization, it was not possible to pass a guide wire across the aortic arch through a right femoral approach. buy cheap viagra The right brachial artery was then used to successfully access the ascending aorta. buy viagra online legally An aortogram revealed evidence of an aortic arch coarctation involving all 3 arch vessels (figure 2, a ) in association with an innominate artery aneurysm. viagra for sale The mean gradient across the coarctation was 44 mm hg. cheap no prescription viagra There was no evidence of aortic valve insufficiency. purple pill viagra The coronary arteries had minor luminal irregularities, and the left ventricular wall motion was normal, with evidence of moderate-to-severe mitral insufficiency. buy viagra online It was recommended that this patient undergo aortic arch and innominate artery replacement in conjunction with mitral valve repair or replacement. On discussion of the risks and benefits of this procedure, the patient provided informed consent. viagra dosage time View larger version (112k): [in this window] [in a new window]   figure 2. A, preoperative aortogram showing arch coarctation and innominate artery aneurysm (arrow). viagra dosage time B, reformatted 3-dimensional reconstruction of postoperative computed tomographic scan showing intact aortic arch repair. where to buy viagra online The cannulation graft site is seen as a small out-pouching on the anterior surface of the graft. viagra young people   at the operation, a right infraclavicular incision was used to obtain proximal and distal control over approximately 2. viagra online 5 to 3 cm of the axillary artery. A median sternotomy was then performed, and the skin incision was extended to the anterior right neck overlying the lower third of the right sternocleidomastoid muscle. cheap viagra online The innominate vein was divided to obtain appropriate exposure of the aortic arch. viagra young Careful dissection was undertaken to expose the aortic arch coarctation and great vessels, including the aneurysmal innominate artery to its bifurcation. viagra on women Both the left and right recurrent laryngeal nerves were identified and preserved. Generic viagra or viagra The patient was systemically heparinized, and a 14f arterial cannula (dlp; medtronic, minneapolis, minn) was placed in the right axillary artery. A 7-mm, 65°, angled soft flow cannul. viagra dosage time Welcome

I offer individual counselling/psychotherapy and group therapy in Jersey, Channel Islands.  To get in touch with me, please send me an email.

It is very common to experience psychological difficulties

People often feel embarrassed or ashamed about the problems they are experiencing, and this can make it harder to seek help.

You may feel that you are alone with your problems, but research shows that psychological difficulties are extremely common:  1 in 4 people - 25% of the adult population - will experience a mental health problem in the course of a year.  The most common mental disorders are anxiety and depression.

Research shows that therapy is helpful for:

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  • Depression
  • Anxiety, including panic attacks, phobias & performance anxiety
  • Stress
  • Self-awareness/personal development
  • Low self-esteem/lack of confidence
  • Mood swings
  • Eating disorders
  • Self-harm
  • Physical or sexual abuse
  • Bereavement
  • Obsessive behaviour
  • Addictions (drugs, alcohol, gambling, sex, internet - and more)
  • Sexual difficulties
  • Adjusting to life changes (divorce, retirement, middle-age, parenthood, adolescence)
  • Relationship problems (including difficulties making/sustaining relationships; and becoming involved in destructive relationships)

Choosing a therapist

The titles ‘psychotherapist’; ’therapist’; or ‘counsellor’ are not protected titles, so anyone can use them.

Ensure that the therapist you choose is registered with either the UKCP, the BACP the BPC or the BABCP

If your therapist is registered as a fully accredited member with one of these organisations, you can be sure that they have completed a reputable training and have sufficient experience to help you - and that they will abide by a code of ethics.

For more information on looking for a therapist, have a read of the FAQ page.

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