Teva cozaar tablets

Nearly 98% of patients experience quality of life impact as a result of tardive dyskinesia (TD) including social, psychological, physical and recreational aspects of daily living
Data highlight for the first time that TD has a multidimensional impact on patients including those with mild TD severity
IMPACT-TD Registry is the largest-ever study of its kind evaluating the holistic effects of TD over three years along with real-world treatment patterns and outcomes with once-daily AUSTEDO® XR (deutetrabenazine) extended-release tablets and twice-daily AUSTEDO® (deutetrabenazine) tablets
TEL AVIV, Israel & PARSIPPANY, N.J.--(BUSINESS WIRE)-- Teva Pharmaceuticals, a U.S. affiliate of Teva Pharmaceutical Industries Ltd. (NYSE and TASE: TEVA), today announced new patient- and physician-reported interim results from the Phase 4 IMPACT-TD Registry study, reinforcing that TD has a wide-reaching, multidimensional impact on patients’ quality of life. These interim findings from the IMPACT-TD study were presented at the 2024 Psych Congress Elevate Annual Meeting, taking place from May 30 – June 2 in Las Vegas, Nevada.
“TD can be a devastating setback for those who have achieved mental stability with their psychiatric medication,” said Eric Hughes, MD, PhD, Executive Vice President of Global R&D and Chief Medical Officer at Teva. “These interim findings from IMPACT-TD Registry, the largest study of its kind, reveal the profound effect that TD can have on a patient’s life, beyond the clinic. Understanding the full impact of TD and how approved treatment options for TD, like once-daily AUSTEDO XR and twice-daily AUSTEDO, can help treat the condition is critical to improving outcomes for patients and is a driving force in our unwavering commitment to developing meaningful solutions for them.”
The two-part IMPACT-TD study is a 3-year longitudinal observational study evaluating how TD progresses over time and impacts a patient’s quality of life (Part A), as well as outcomes related to treatment with once-daily AUSTEDO XR and twice-daily AUSTEDO (Part B).
Clinician-reported TD severity and impact is assessed using the IMPACT-TD scale, the AIMS (Abnormal Involuntary Movement Scale) and the CGIS-TD (Clinical Global Impression of Severity of TD) scale. The interim analysis includes 286 patients with varying levels of TD severity and highlights, for the first time, that clinicians reported that TD has a multidimensional impact, even on patients with mild TD severity. Clinician-reported IMPACT-TD findings show:
98% of patients experience the impact of TD in some aspect of their quality of life
83% of patients experience moderate to severe impact across various quality of life domains, including social (59%), psychological/psychiatric (70%), physical (53%) and vocational/educational/recreational (57%)
54% and 61% of patients with “very mild” and “mild” TD severity based on CGIS-TD, respectively, experience moderate to severe impact on their quality of life
Patient-reported TD impact is assessed using the novel IMPACT-TD PRO (IMPACT-TD Patient-Reported Outcome) scale. Patient-reported findings, as assessed with the IMPACT-TD PRO, show:
59% and 57% of patients reported that TD caused embarrassment in social situations and impacted their ability to enjoy the things they do for fun, respectively
43% of patients reported that TD impacts their sleep
38-42% of patients reported experiencing the physical impact of TD, including on their ability to hold things, do chores and exercise
“These data provide a clearer understanding as to how the abnormal movements of TD significantly impact the daily functioning of patients that cannot be gleaned from looking solely at the severity of the movements,” said Richard Jackson, MD, an Assistant Clinical Adjunct Professor in the University of Michigan School of Medicine’s Department of Psychiatry and the study’s lead investigator. “TD can impact all domains of daily functioning including social, psychological, physical, occupational and recreational aspects of daily living even when the abnormal movements appear to be mild. This emphasizes the need for all clinicians to assess not only the severity of a patient’s TD movements but the impact those movements can have on all aspects of life. Continuing to understand the multifaceted impact of TD and finding ways to alleviate these burdens is crucial to supporting patients on their TD journey.”
Also presented at Psych Congress Elevate 2024 were data supporting:
The development and internal validation of the IMPACT-TD PRO scale, suggesting that the questionnaire can effectively and reliably characterize the multidimensional impact of TD in adult patients.
Final results from the TD cohort of the Phase 4 START study, which investigated real-world treatment outcomes for patients starting AUSTEDO with the 4-week Titration Kit. These full START results show that the titration kit successfully helped patients with TD find individualized therapeutic AUSTEDO doses with effectiveness similar to that observed in the pivotal clinical trials, with high adherence and patient satisfaction rates.
Findings from a retrospective study comparing healthcare resource utilization (HCRU) in patients with TD treated with benztropine versus non-treated patients with TD suggest that benztropine can result in potential harm and increased cost for the patient if used off-label for the treatment of TD.
FULL RELEASE: https://ir.tevapharm.com/news-and-events/press-releases/press-release-details/2024/Teva-Presents-First-Real-World-Data-from-the-IMPACT-TD-Registry-Study-at-Psych-Congress-Elevate-2024/default.aspx

I'm not one to carry a GoPro, take many pictures, or train for an event, but I like writing things up after. It's old school, but the stream-of-consciousness, no edits style can be fun and raw. An old, broken body will always voice it's displeasure, and that's part of the fun too.
Wednesday, May 22nd , 2024 to Thursday, May 23rd, 2024
45.3 miles
10,710 feet of descent (that be the downhill parts)
10,310 feet of ascent (that be the uphilly parts)
Route: start on South Rim,
down South Kaibab (7.4 miles, 4,700’ descent)
up North Kaibab (13.6 miles, 5,695’ ascent) arriving at North Rim
down North Kaibab (13.6 miles, 5,695’ descent) (wow, you go back and forth on the same trail and the distance and elevation match)
Up Bright Angel (9.5 miles, 4,314’ ascent, arriving back at the South Rim
Don’t @ me that those numbers are a little off… I used Phantom Ranch as my trail start/terminus because that’s where I stopped.
A little background, in 2019 I did Rim-to-River-to-Rim with my good friend. At Phantom Ranch, I seriously asked if we could just keep following the North Kaibab trail and do what we really wanted to do: Rim-to–Rim-to-Rim, but wiser heads prevailed. That was my friend, not me. Ever since, I’ve been thinking about doing the double crossing of the Canyon in a non-stop, or non-camping, manner. Why? Because that’s how I wanted to do it.
Wednesday I caught a flight into Phoenix, grabbed my rental car and shot north to the Canyon, arriving around 5pm at my hotel in Tusayan, the hotel and restaurant town a few minutes outside of the park. Check in was easy. I had stopped on the way to get a couple gallons of water and a Subway sandwich for the trail, so I did not need to grab dinner. After loading, and weighing, my pack (new CamelBak Octane with my old 3 liter reservoir) I ate ½ of the sandwich and made a few calls. Yes, my pack was definitely overdone. There was no need for 13 pounds.
Thanks subway staff! They got the bread wrong, and it tasted terrible. Of course I would still carry the other ½ sandwich into the Canyon with me, but I knew I wouldn’t eat it.
After closing the blinds and setting an alarm, I laid out for a little pre-event sleep. Thankfully I was able to get an hour or so of a nap in before my alarm barked at me at 8:50pm. By 9:15 I was on my way into the Park, and by 9:30 I had parked, walked to Bright Angel Lodge and called the park taxi. I’d recently learned that there was a Park taxi (only one of them), and they can take directly to the South Kaibab trailhead which is not accessible to normal vehicles. After waiting a while to get slotted, I was given a “be ready in 20 minutes” from the dispatcher. Inside the hotel lobby it was warm and not windy (that’s what real authors call “foreshadowing”).
A guy about 10 years older than me was in the lobby waiting for his daughter to drive her car up and get him. They had done Rim-to-Rim that day (North to South), and he was hurting bigtime. He mentioned more than a few times how the footing on the North Kaibab trail was terrible. Yes, backcountry trails on steep terrain are always pretty terrible. It’s ain’t a bike path. They rolled out, and I waited a bit longer until I saw the taxi arrive.
As is always the case, delays are real and always happen. There were supposed to be 2 other people being picked up, but they were nowhere to be seen. We waited, the taxi driver ranted, until I suggested we had waited long enough and hit the road. Driver guy had had one hell of a full-moon night and we chatted while he observed the speed limits of 15mph and 25mph very carefully. The roads were deserted at 10:15pm, but he said he was GPS monitored on speed which I can understand. He rolled right up to the trailhead, dropping me off, and picking up another hiker up who had been waiting for up to an hour. It was very, very windy, lots of dust in the air, a bit of sandblasting, but such is life. I had my Marmot rain shell on which I always wear or carry and headed straight for the trailhead.
I had turned on and started the GPS tracker that I had borrowed, so the only pause was to take a picture of the trailhead.
Hoping to get out of the wind, or that it might slack off the lower I got I started heading down the trail. SK is pretty steep, but the wind was not quick to abate. During my last trek here, I had shed my rain shell very early. Today I was going to keep it on for protection from the flying dust and debris.
A few switchbacks down I spotted some lights below me. Cool, someone to catch. Yes, I’m externally motivated. It’s not the best way to live, but it’s who I am.
The switchbacks kept coming, as did the log ladders and mixed trail terrain. Some sections were runnable, so I did. The switchbacks that hit at exposed peaks were definitely a sketchy. With massive dropoffs on either side and wind gusts that rocked the body, these points required some thought. Mainly that thought was “crouch down, so that you don’t get blown over the side to your death.” The darkness exacerbated the fear of falling to my demise. It wasn’t that bad, but mentally, and being alone, it was a thought I couldn’t shake.
At some point I caught up to the couple ahead of me, said a few greetings and scooted past. They had trekking poles and were navigating the uneven trail a bit slower than I was. In the darkness I missed Ooh-Ahh point and it’s famous view. Granted, there’s not much to see in the dark anyway. I had picked a full moon for my trek, but it was not illuminating much. I tried turning my headlamp off a few times because I love trekking by moonlight, but the shadows were too dark and hid critical details that could easily lead to a twisted ankle or maybe worse (steep terrain, dropoffs, ….. You get the picture). I wanted to get rid of my jacket, but was getting buffeted still and decided it was not quite the right time even though I was heating up.
I was doing my usual sipping frequently from my camelbak reservoir and it felt like I was stopping to pee every 5 minutes. That was concerining because it was coming out very clear which is a sign that fluids are passing right through.
At some point, I braked to a complete stop, having spotted a HUGE scorpion just resting in the middle of the trail. I am no fan of those critters, but it was easy to step over. Back to losing elevation I went. I don’t know where I was exactly, I had shot through Cedar Ridge and around Skeleton point where it opens up a bit I noticed a Katadyn 1 liter Be Free water pouch with filter. Both to keep the trail clean and, why not, I picked it up, drained it, and stuffed it in my pack. I already had one just in case I needed to filter water, but a spare doesn’t hurt. Whoever had lost it was well off trail by then and not coming back for it.
Finally I was able to shed my jacket, while moving, which felt amazing.
Turning one corner, I noticed even more lights below me that led to believe there were a few more people on trail below me. There was not, as I’d learn later, but it would have been nice had there been.
Soon I hit the junction with the River Trail which felt pretty soon. Then I was really shocked to come up to the tunnel at Phantom Ranch Bridge (or black bridge as some call it). I was really shocked. I’d been on trail for about 2 hours but didn’t think I’d come this far as mainly I’d just been putting one foot in front of the other and and making forward progress. This was a cool boost!
I crossed the bridge and headed with the flow of the river toward Bright Angel Campground and Phantom Ranch. At Phantom, I topped off my water reservoir and hopped back on trail within a few minutes. It was dark, the air was cool, and life was good. Why not make time?
Heading out of Phantom the trail did what it does and started moving upwards again. About the first half (7’ish) miles of North Kaibab trail are more gradual with 4% to 7% grades which is where one can put some miles in. The longest section of the trail without services is between Phantom Ranch and Cottonwood campground which are a little less than 7 miles apart. This is also the hottest part of the trail during the day. Several miles are in between towering cliffs where the heat has nowhere to go, this section is called “The Box.” Of course, at 1am, it wasn’t hot at all. The full moon was providing some super cool illumination on the cliffs, but I still needed my headlamp for trail details. Just above the box, there was a stream in the middle of the trail which I avoided. Wet feet can be the end of a hike. A few hundred feet up, it was clear that it wasn’t a stream but a break in the water line.
Uh-oh. The water line supplied the North side water stops. Would they now be shutoff?
I was still making good time and decided that, even with the waterline break, I would skip refilling at Cottonwood and go the next 1.4 miles up to Manzanita rest stop to refill. Made it to Manzanita and the water was still on, so I quickly refilled my reservoir and got back on trail. Now it was steep again with an 11% grade. I was thinking longingly of the 7 mile stretch between Cottonwood and Phantom Ranch and how nice it would be to jog that section once I returned to it later in the day. I still think it would be nice to jog that section someday.
I was starting to see headlamps above me from the people who had done an early start on their Rim-to-Rim treks staring from the North Rim. I loved the solitude of being alone in a very popular national park, but it’s also good to know that a few people are around.
I have read different numbers, but it is said that out of 4.75 Million people who visit the Grand Canyon every year, only 5% go below the rim (at all) and less than 10% of those folks make it to the river. That would be about 0.5% of visitors make it Rim-to-River-to-Rim or Rim-to-Rim. I can’t find any data on who many people do double that up and do Rim-to-Rim-to-Rim on any given year.
Let’s divert a bit and talk about how this can be done… Yes, there are many options. Some people hike straight through, they leave the North Rim in the dark and traverse to the South Rim over the course of 10-20 hours. Another choice is to overnight camp along the way at one of several campgrounds (reservations REQUIRED). I’m not against the concept, but the thought of carrying a tent and sleeping bag up the other side of the canyon sounds way too hard to me. Yet another choice is to reserve a cabin at Phantom Ranch where you can also get dinner and breakfast. Because it is a cabin, you don’t have to haul camping gear.
Speaking of Phantom Ranch, they do sell a few things to hikers including ice cold lemonade. A lot of people talk about it like it’s an elixir from the gods. Personally I would prefer to keep walking and not waste time stopping, buying and drinking something that needs to have it’s cup recycled at the location.
Back on trail, it was good to see people. Most honored trail etiquette - whoever is going uphill has the right of way, so I got to keep plugging along. It was finally light, and I was able to ditch my headlamp finally which was lovely. Up, up, up, I went. Seeing many folks who had questions, “when did you start?” “how are you doing?” and the obligatory “You’re ALMOST there!”
Note to the trail gods, I was NOT “almost there.” It was nice for folks to say it, but after every group said it, and I could see at least 1,000’ vertical to gain I started thinking “Do they think that I am almost there, or are they being incredibly nice?”
Answer: they were being nice.
At this point, the trail had more and more major step ups and log ladders, and my left knee was really hating me. Over the years, my patella, which does not track correctly, has ground away the cartilage from my femur, so any 90deg bend with force causes a massive stab of pain. OK, step ups would only be with my right leg from now on. Plus, as I was gaining altitude it was getting a bit chilly. Keep moving. My sleeveless t-shirt does not provide a ton of warmth.
I had tried to use one of the long-sleeve sun protecting hoodies, but I really didn’t like it. It just wasn’t for me. Another tangent, so much of this stuff is personal. What gear do you bring, what shoes do you wear, how many layers do you bring, what do you eat? It’s all a matter of trial and error.
At some point, I came across a group of Chinese couples who were descending for their R2. The guy at the lead of their pack asked me a few questions and finally asked “are you doing R3?”
“Uhhhh, yeah. At least I’m hoping to. Need to finish Rim-to-Rim first.”
For years I did not bring people in. I had a “NOBODY CARES. WORK HARDER” sticker in huge letters on my handstand pushup wall. After a lot of work on myself, it turns out that A LOT of people care. Even strangers from another country can care. The lead guy yelled back to the rest of their crew who congratulated me with every person I walked past. It was pretty cool.
The trail though? It didn’t care. It just kept going uphill.
Not too far from what really was the end, there was crew of about 5 guys who took up most of the trail and refused to share. There are always those folks out there. Everyone else was cool as heck.
And then… the final stretch, well, for this section, and I was at the North Rim. It was cold. I didn’t need water, so I took my selfie at the North Rim sign, used the GPS personal locator to send an “I’m OK” message and went back down the trail.
Unfortunately, my legs were more than a bit wrecked. That I could only step up with my right leg meant I could also only lower myself with my right leg when there were rocks and logs to step down from, and the muscles along my left shin were screaming in pain too. I was good and assessed if this meant I should call it a day and try to get a shuttle to the South Rim, but I could still move even if only slowly.
Down we go again… Step downs were not fun. Plant right foot, pivot on it, lower left leg to the ground below, repeat, repeat, repeat. Oh, and blisters were cropping up too. There is a water filling stop at Supai tunnel which I targeted for my refill and blister treatment. Once I covered the 1.7 miles to the tunnel, I took a break, pulled off my pack and dug out my blister kit.
I say “dug out,” but the Octane pack is pretty well organized. I simply located the blister kit in the little internal pouch, pulled out the tiny scissors and started lancing blisters. One circled the back of my heel where the insole ended. 20 miles to go and now my shoes finally show their true colors. After refilling my water and bandaging my blisters, I got back to what needed to be done, losing elevation. Damn I was going slow though. Way too slow but having to walk differently to avoid pain was a slow process.
I’ve done it many times before in many situations. There was no danger, I had food and water and was regularly ingesting salt tablets. It’s a mind-game now. The plans I had roughly sketched out where out of the window, and it would be a day of slow and steady progress.
The trail and terrain look so different coming down than going up and not just because there was now light to see.
As with all alpine type trails, distances are weird. I saw a building below me which I thought was the Manzanita rest stop, and it looked very close. Problem was, it was not the Manzanita rest stop, and to get to it required a lot more switchbacks and uneven terrain. It’s almost sad when you realize it’s a building I couldn’t have seen in the morning on the way up.
Around now, more people were coming up the trail too, doing a South to North version of Rim-to-Rim, with a few doing R3. Also came across a guy lugging a mountain bike across the Grand Canyon, because the Canyon is part of the Arizona Trail. You can’t ride a mountain bike through the canyon, so, if you are doing the AZ trail by mountain bike, you have to carry it across. That’s hardcore.
I passed a few R2 hikers, even in my slow state there are always folks moving slower, and heard some people talking behind me. I have a fragile ego and didn’t want to get passed this close to Manzanita rest stop, so I picked up the pace a bit. By “a bit” I only mean 1-2%. I wasn’t winning any prizes today. Thankfully, Manzanita appeared, and I was able to hop off the trail before getting passed. I said it, and I meant it. I have a fragile ego.
The two guys also hopped in to the rest stop. One taking the seat next to me at the picnic table and immediately pulling his pants off.
OK, he had running shorts underneath, but that did not stop me from remarking “it’s not everyday a guy I don’t know takes his pants off next to me.”
I didn’t need water, but I did use the time to apply a nice layer of sunscreen. The slurry of sunscreen, trail dust, and salt crystals is probably a great sun protection, but it’s kind of gross too. 10 minute break over it was time to get back on trail. I was not happy at this point. I should be able to run some of this, but my legs were not allowing any of that. The 1.4 miles to Cottonwood took just as long going down as they had going up in the morning.
Actually, it was still morning, around 9am or so (?), but I had been going since 10:30pm last night. At Manzanita I used the GPS to message that I was safe (have to say that or people freak out) but struggling and plans have changed. I’d probably be stopping for a while once I got to Phantom Ranch. That lemonade that I had distained earlier was sounding pretty darn good.
It’s pretty wide open at this point with the nothing to block the sun. My boony hat with neck guard was doing a great job of keep my head, neck and face protected, but nothing was protecting me from my slow progress. There were a lot more northbound folks on the traill, and they looked a LOT fresher than I felt. They kept saying “good morning” too which was incredibly surreal. Didn’t they know it was late afternoon already? Except it was not late afternoon.
They guys who had been behind me at Manzanita would leap frog me. They walked faster but took frequent breaks. Soon enough I hit Cottonwood Campground. No need to stop for water, so I kept going. There are a few uphills in this section, and those did not feel fantastic. Again, no danger, no worries, just keep moving the legs.
When I hit the part of the trail with the water line break I knew I was close to the heat of the box. It wasn’t the heat of the day, but it was later than I had hoped to be there. Drink, talk salt tablets, eat as I could, keep plugging.
My only thought when entering the Box was to get through the Box and into Phantom Ranch, which is really close to the end of the Box. The only way to get out of the box is to keep walking, and, at some point, instead of seeing canyon walls, the sky will open up to show the South Rim. Oh hey, the South Rim is 4,000’ vertical above, and will need to be dealt with at some point today. All in it’s time though.
My history of epic events has taught me some very critical lessons: I’m not very smart, and I can dig deep and grind out distance when most people can’t. It’s about turning inward and just making progress when the only thing you can do is make incremental progress.
I was probably down to 1.5 miles per hour now, and that was downhill. Ugh.
Every corner revealed a new section of canyon walls instead of open sky, and the Box was getting warm. Even with the roaring creek beside us this section just held a lot of heat. The trail varied sides of the creek as the 7 bridges criss crossed it. One more bridge down meant a little closer to a long break. More canyon meant another corner to hope to see the South Rim. By now, I was sitting regularly for a break. My legs wanted it, so I gave it to them.
The first deep drink from my camelbak was inevitably hot, and the 2nd and 3rd, which had not been exposed to the sun, were delightfully cool. I was cherishing those 2nd and 3rd sips.
Another corner, and still more canyon walls. In the distance I would see the 2 guys who I’d talked with earlier. They weren’t making that much headway in comparison. At some point, the canyon walls fell away and Phantom Ranch appeared. I really wanted that lemonade.
The steps up to the window counter at Phantom were not nice to me, but I got my lemonade, 2 ice cold apples, and a small bag of peanuts (more salt for the fluid absorption). There was a picnic table, in the shade, so I took it. Sipping lemonade and enjoying a couple of lovely apples.
Given that I had been on trail for 12 or so hours, with no sleep, I decided to set an alarm and take a 30 minute nap. You know you’re tired when you are old and immediately all asleep while laying the bench of an old picnic table.
I woke up when my person lightly scratched their nails on my shin to get my attention.
Except I was doing this solo, how they hell did they get here? Oh, it was a squirrel trying to climb me to get to my apple core. The mind is an amazing thing.
The Chinese crew was at Phantom too, and they were very interested in my condition. They were expats living in Toronto, and we had a nice chat.
After an hour at Phantom it was time to move on again. I wanted to soak my feet and legs in the cold Colorado river, but the Phantom access was upriver, so I targeted the river access that was across the Silver Bridge and up the trail a ways. As I left Bright Angel campground, the “pants off” guy from the duo asked if I had seen his buddy. They had gotten separated.
“You mean your friend with the blue shirt?”
“ummm, I have no idea what color shirt he has on, I’m color blind”
“oh hey! Me too… the dark shirt?”
“Yeah him. He went back to the store for something and hasn;’t come through”
“No, I haven’t seen him”
Crossing the Silver (OK, the “galvanized”) bridge, a couple of motor rafts drifted below. Maybe they had the better way of seeing the Canyon.
I wasn’t emotional at all, no frustration or anger. I knew that my plans were out the window, but the true nature of all of this was in dealing with what is versus what one wanted things to be. The section between Silver Bridge and the river access (before the trail turns left and heads up again) is pretty mellow. The section where the trail is beach sand is a bit challenging. Mainly it was all just warm. Very warm.
At the river access, a construction crew was working with some type of cable. I assume it was massive power cables, so I chose not to do my soak there. I know there are a few places where a creek crosses the trail up ahead. Thankfully there was one just a few yards up, so gladly stopped and dropped my pack. The cold water felt great on my feet and knee, and I took the time to do some more blister surgery.
Unfortunately, as I put on fresh socks, which I had debated about carrying, I knocked my sunglasses into creek which swiftly took them away. It was getting into later afternoon, still sunny, but I hoped I could get by with lowering my hat.
Back on trail, up I went. If I haven’t said “stead motion” a hundred times by now, just wait, I’ll easly get to 100 by the time this over.
The two guys came through this section and rested for a bit and headed out before me
Bright Angel trail is about 10 miles, and it’s roughly divided up into sections. It’s about 5 miles from Phantom to Havasupai Campground (the only water source turned on today), then it’s 1.5 miles to 3 Mile Resthouse, 1.5 miles to Mile-and-a-Half Resthouse (quick, do the math on that…) and then another 1.5 miles to the South Rim. The section to Havasupai was a slow slog. Somewhere on the Devil’s Corkscrew, which is a series of switchbacks that is really visible from above, a guy flew past me wearing full pants, boots, and a firefighter helmet while also holding a radio. It was impressive and disheartening.
The two guys were ahead of me, and I could see them on occasion, never catching up to them.
During the section where the creek runs in the middle of the trail, another shirtless firefighter blew past me. “How far is he ahead of me?” he asked, “I have to catch him.” You go bro.
Surprisingly I caught up to the two guys. We chatted for a bit wondering how much farther Havasupai was. We estimated at last another mile or mile and a half. This is where there is a creek on the South side, and the greenery and animal sounds were amazing. They kept me company as I moved along at my 1.5 mile per hour pace. Then I hit Havasupai, took a seat, took off my hat and pack, and rested.
The Chinese crew was here too as they had left Phantom well before me. The duo arrived too. I rested, filled my water reservoir, ate a little, and rested some more. By now I was using a stop watch to keep track of my stops. I will look at my watch but never remember the time. Seeing “10 minutes” on a stopwatch is much more effective. At 5:40pm, the duo and I pulled on our packs to leave and discussed how much time we had left.
“It’s about 1 ½ miles between each next stop (3 mile, 1 ½ mile, South Rim), with about 1,000 feet of vertical between each. At my pace of 1.5 mph, that’s roughly 3 hours plus stops, so I’m saying 9pm on the Rim”
Hey, I sounded like I knew what I was talking about. Confidence when speaking is critical.
I pulled on my pack and started up the trail. It was now early evening, it was cooling off, and the sun was not beating down. If you are paying attention, I wasn’t, you’ll notice that I forgot something.
About 20 minutes later I realized I had forgotten my hat. Oops, but there was no way I was going back for it. Somebody can get some use out of it. Instead I started thinking about hat shopping. What kind would I replace it with?
I had forecasted an hour of hard hiking between each waypoint, so I used time as my measurement. I should get to 3 Mile at 6:40pm, and I kept looking at my watch as I walked about. 6:01pm. 6:07pm, 6:20pm. Etc. etc. It was my way to guage progress. I also caught and passed the Canadian Chinese crew. 4 married couples who adventured together and trained together. We chatted for a while, but I need to keep my pace. After leaving them a French guy caught up to me “excuse me, did you leave a hat at the water stop?”
Yes, yes, I did.
“My friend is carrying it…” OK, I waited a minute for the friend who handed me my hat and scooted up the trail. No way I was taking my pack off, so I rolled it up and held it in my hand. I really didn’t pause in hiking, did take a short seat a time or two, and at 6:30 the 3 Mile Resthouse’s beauty appeared before me.
Normally when I hike long, my fingers swell significantly. It’s not sodium, it’s that edema pools in my fingers. I had noticed it for most of the day, but it, very surprisingly, had gone away in my right hand. Holding onto my had cleared the edema from my hand. Maybe I should look at getting some decent trekking poles with large grips in order to force my hands to hold something and reduce the swelling?
OK then, making good time all things considered. I went past the resthouse and took a seat on a rock. A young couple I’d been leap frogging with ended their break at the resthouse and started up ahead of me. There was no way I’d be catching them.
Throughout the day, I had noticed one set of shoe prints with a distinct “Adidas” logo, and I started seeing it again. Was it him or her? The dust of the trail held perfect shoe impressions, but only briefly, so it became a game to track the Adidas logo and guess which one of them it was.
You have to do something to pass the time.
It was coming on to to sunset, but this section of the trail isn’t the best aligned for sunset views, so I admired the vistas and searched for shoe prints wil also looking at my watch to see how much of the next hour I had left before I reached Mile and a Half Resthouse.
If you have never done it, pushing forward for literally hours on end is a reward unto itself. It takes WORK to gain 1,000’ of vertical in a mile and a half (approximately an 11% grade). This trail section is better than most with several decent sections, but there are alway log ladders and step ups to overcome. My left leg felt a lot better since soaking in the creek, and I was able to judiciously use in on smaller step ups to save my right leg. For the bigger step ups it was “adjust stride to put left foot at the base of the step up, step up with the right leg, then push myself up and over.”
At 7:30 I hit the Mile and a Half Resthouse, right on my adjusted schedule. After a brief sit, it was time for the final push to the Rim.
I had not seen the duo since Havasupai, and I had managed to catch a couple of people. It wasn’t a lot, but it was still a nice mental boost.
The Bright Angle Tunnel came out of nowehere much to my joy, but I forget that it’s further down trail than I want to admit. There was still time left in my day. Right about then I heard strong footsteps behind me. It was a guy I’d seen a time or two during the day in a party of four. One of their team was hurting, so he was charging ahead to get some food for the guy and bring it back down. That’s impressive.
He also told me that Maswik Lodge has a food court. By now, my thoughts had turned to “what am I going to eat when I’m off this trail, and where can I get some LEMONADE?”
Food court you say??? Hmmmmm.
The guy said we were 3 switchbacks away from the end. Granted, the last switchback is a haul from the trailhead, but it was good info. I came across two women, one of whom had pushed it too hard sensing the end, and was heaving at the side of the trail. They assured me that they had what they needed. OK, the woman who was not heaving assured me that they have fluids and clothing and headlamps after I had checked to see if they needed any help, so I kept moving forward.
Then, there it was, the buildings at the edge of the Rim! 20 hours to the minute instead of what should have been about 17, but life is what you make of it.
I didn’t see the big Bright Angel sign and wanted to get to my car, so I took at quick selfie at the trailhead sign and hoofed it to my rental SUV. it felt sooooooooo nice to take off my running shoes, socks and gaiters and put on my Teva’s. Pure bliss.
Of course I was shivering uncontrollably in the wind and from the exertion. After changing shoes, notifying everyone I was OK, and texting Monika and my kids, it was time to roll. My intent was to get out of the park, but, driving past Maswik, which looked open, I had to stop in. After acquiring 4 slices of cheese pizza I was on my way to my hotel. Stopping at the minimart in Tusayan, I scored a lemonade, a coke, and a Double IPA. All sounded delicious.
The parking lot was full, so I did the back lot which required a set of downstairs to get to my room. That was a challenge.
In my hotel I made a few calls. My 89yo mother had been more than a little worried. My person was incredibly happy for me and also no fan of the GPS tracking software. My kids were cool that I was still breathing. I enjoyed the lemonade and coke, AND the pizza. It wasn’t that great to be honest, but I loved it.
Then I hopped in the showing to erase 20 hours of trail dust and grime. I’m sure the hotel is used to it, but I felt bad that the washcloth was far from white when I was finished. At least I was clean!
And then I slept, and a good sleep it was. So good. 11 hours of bliss.
The next morning I took my time, packed up while drinking coffee, and walked over to the Mexican place next door. It was only 4.0 on Google, but I have rarely met a chimichanga that I don’t like. Deep fried is amazing.
Then I headed back into the park. The line took a bit, but it wasn’t too bad. Plus, my free veteran park pass meant I didn’t have to pay. The main lots were full, so my goal of getting a picture at Mather Point wasn’t going to happen. I was feeling pretty good but not like walking a mile or two. Nor was I interested in riding the park shuttle. A quick stop at the Market Plaza allowed me to find a replacement pair of sunglasses for the drive to Phoenix. Then I drove over and found a hidden parking spot near Bright Angel. I might not have been able to get to Mather Point, but I wanted a couple of daytime pictures.
After that, I pointed the car south, and then west for a visit with my friend Mark and their partner in Prescott. Based on their suggestion, I was able to book a short massage the next day also. Seeing their town, laughing about life, and explaining the fun I had had the day before was a fantastic detour. After my massage, Mark and I grabbed lunch, we were able to swing by Beth’s shop for a goodbye, then I was off for the 2 hour drive to Phoenix airport and my flight home.
Rim-to-Rim-to-Rim is now done.
Will I go back again? Probably. I know a couple of people who are interested in doing Rim-to-Rim, and, well, though the experience has been achieved, and in my core I am entirely an experience junky, there’s that little thing about doing Rim-to-Rim-to-Rim with style, and speed, that is brewing at the back of my mind.
It’s just a little thought though.
At least it’s a little thought for now….
45.3 miles
10,710 feet of descent
10,310 feet of ascent
19 hours and 51 minutes

• U.S. FDA approves new one pill, once-daily AUSTEDO XR tablets (30, 36, 42, 48 mg/day)
• AUSTEDO XR offers more flexibility with the most once-daily doses of any vesicular monoamine transporter 2 (VMAT2) inhibitor for effective and tolerable tardive dyskinesia (TD) and Huntington’s disease (HD) chorea control¹
• Patients with TD taking AUSTEDO XR can expect symptom improvement as early as two weeks while patients with HD chorea may experience a significant reduction in Total Maximal Chorea (TMC) score, with three years of the longest TD and HD chorea clinical trials and sustained results to date ^1,2,3,4,5

TEL AVIV, Israel & PARSIPPANY, N.J.--(BUSINESS WIRE)-- Teva Pharmaceuticals, a U.S. affiliate of Teva Pharmaceutical Industries Ltd. (NYSE and TASE: TEVA), today announced that the U.S. Food and Drug Administration (FDA) has approved AUSTEDO XR as a one pill, once-daily treatment option, now with four new tablet strengths (30, 36, 42, 48 mg) indicated in adults for TD and HD chorea.
“Since our launch of AUSTEDO^® in 2017, we have been committed to helping people living with TD and HD chorea treat these chronic, involuntary movements,” said Dell Faulkingham, Senior Vice President, Head of U.S. Innovative Medicines at Teva. “AUSTEDO, backed by the longest efficacy and tolerability data to date, has continued to evolve – having received approval for AUSTEDO XR, our once-daily extended-release formulation in February 2023. This latest milestone offers a streamlined treatment regimen for clinically therapeutic doses with the broadest dosing flexibility.”
Currently more than 57 million Americans are living with a mental illness, 14 million of whom are living with a serious mental health condition.⁶ For those taking certain mental health medications, one in four may experience the onset of TD, an often-overlooked chronic movement disorder that can have a physical, emotional and psychological impact on patients.^7,8 HD is a fatal neurodegenerative disease characterized by cognitive deterioration, behavior and/or psychological problems and uncoordinated and uncontrollable movements known as chorea – a symptom that affects 90% of patients.^9,10 Both conditions can pose significant challenges to patients’ everyday lives as simple tasks like eating, talking and walking can be impacted.
“Knowing patients living with TD and HD chorea are also managing other underlying concomitant conditions, it is important that treatment options for these chronic movement disorders are not only effective, but keep the patient experience in mind,” said Dr. Rakesh Jain, Clinical Professor of Psychiatry, Texas Tech University School of Medicine. “This latest AUSTEDO XR approval provides patients with the same proven efficacy, but now with the convenience of a one pill, once-daily option for clinically therapeutic doses as established by the pivotal clinical trials to help control involuntary movements that can make carrying out basic daily activities difficult."
Patients with TD taking AUSTEDO XR can expect symptom improvement as early as two weeks while patients with HD chorea may experience a significant reduction in TMC score, with three years of the longest TD and HD chorea clinical trials and sustained results to date.^1,2,3,4,5 AUSTEDO XR, along with its twice-daily counterpart, AUSTEDO (deutetrabenazine), are the only VMAT2 inhibitor treatments with no restrictions for use with CYP3A4/5 inducers or inhibitors, an important consideration for patients who take a variety of concomitant medications to manage their underlying conditions.^11,12
Approximately 90% of patients with insurance coverage are expected to pay $10 or less for their prescription with financial assistance offerings.¹ Teva is committed to helping eligible patients who have been prescribed AUSTEDO XR access their medication. Teva continues to support with access, reimbursement, prescription pull-through and patient assistance. Savings on out-of-pocket costs may vary depending on the patient’s insurance provider and eligibility for participation in the co-pay assistance program. For more information regarding cost and coverage options for AUSTEDO XR through Teva Shared Solutions, visit MySharedSolutions.com.
About Tardive Dyskinesia (TD) Tardive dyskinesia (TD) is a highly debilitating, chronic movement disorder that affects one in four people who take certain mental health treatments and is characterized by uncontrollable, abnormal, and repetitive movements of the face, torso, and/or other body parts, which may be disruptive and negatively impact individuals. ^13,14,15
About Chorea Associated with Huntington’s Disease (HD) Huntington’s disease (HD) is a fatal neurodegenerative disease characterized by uncoordinated and uncontrollable movements, cognitive deterioration and behavioral and/or psychological problems. Chorea – involuntary, random and sudden, twisting and/or writhing movements – is one of the most striking physical manifestations of Huntington’s disease and occurs in approximately 90% of patients. Chorea can have a significant impact on daily activities and progressively limit peoples’ lives. ^9,10
About AUSTEDO XR Extended-Release Tablets and AUSTEDO Tablets AUSTEDO XR and AUSTEDO are the first vesicular monoamine transporter 2 (VMAT2) inhibitors approved by the U.S. Food and Drug Administration in adults for the treatment of tardive dyskinesia and for the treatment of chorea associated with Huntington’s disease. Safety and effectiveness in pediatric patients have not been established. AUSTEDO XR is the once-daily formulation of AUSTEDO.
FULL RELEASE: https://www.businesswire.com/news/home/20240425312754/en/

Since February I was tryingto fill my prescriptions in the Boots pharmacy in London. I was told they don’t have Teva brand Dexamfetamines in stock and their supplier also doesn’t have anything in the warehouse so they can’t even order them for me. I was advised to check out independent pharmacies and so I did check a couple of them but without any luck.
Is there really shortage of these meds currently, or maybe I’m just looking in wrong pharmacies? I am prescribed 20mg dex 3x daily and usually with Teva brand I was given plenty of boxes of 5mg tablets (so one dose for me was 4 tablets), as these were the only ones available. They said the 20mg Teva tablets are not available at all, I was fine with the 5mg tablets in higher amounts. However; last time I was given Amfexa which I don’t tolerate quite well. I really need the Teva brand meds. Anybody knows what’s going on and where I should try my luck??? 🍀

Hi guys,
I took Wellbutrin for a brief period of time 5 years ago. The stuff changed my life, but after the prescription ended I decided to try to raw dog life. I unfortunately have found myself in another depressive state and have had to resort to anti depressants once more to keep myself stable, safe and afloat. My doctor prescribed me Wellbutrin, and on the prescription it said the words “Wellbutrin”. No other name, nothing. I even have a picture of it on my phone.
I go to fill out the prescription and the pharmacist asks me if I have any health insurance. I don’t, but I was willing to pay up front for it no matter how much it was. I get my prescription and take it…. 8 hours in I felt like I was going to simultaneously have a heart attack and vomit. I had hot flashes, an accelerated heart beat and nausea with stomach pains and had an anxiety attack.
This was an immediate red flag to me because Wellbutrin has never made me have side effects like that ever in the time I was on it. I read the bottle and realize the word “Wellbutrin” isn’t on it at all. Instead, it read “Teva bupropion”. I search it up and it’s the generic brand.
I was absolutely pissed the pharmacist did this without consulting me or without my consent. I called the pharmacy and asked why I was having all these side effects and the answer I got was “well you shouldn’t be having those side effects”. Great answer, Jack ass. I did some more research and found that these side effects are consistent with Teva Bupropion and that a lot of other people on Wellbutrin haven’t been able to handle the generic brand because it also gives them wierd side effects too.
I just want to know if the pharmacist was gaslighting me because he was a Jack ass for not warning me ahead of time and did this without my knowledge and he’s trying to save his own ass, or if anyone else has had the same experience. It honestly feels like I’ve taken 9 tablets of adderall and I feel like I’m going to die. Is this common?

I take PREP via the 211 method because I only have unprotected sex (top) like 4 to 6 times a year. (I need a bf and am sick of hookups as you can see)
Problem is, PREP 211 is trusted with Truvada but not Descovy quite yet. My PREP seems to be generic, so I can't tell what brand it is.
The bottle says "emtricitabine and Tenofovir Disoproxill Fumarate Tablets" 200 mg/300 MG. From the company Teva.
Is this PREP safe for 2-1-1?

The global buccal drug delivery systems market was valued at approximately USD 3 billion in 2020 and is projected to experience a notable compound annual growth rate (CAGR) exceeding 9% during the forecast period to 2027. A key driver of this growth is the rising population of geriatric patients, alongside an increasing demand for convenient drug delivery methods. Moreover, the growing preference for buccal drug delivery systems, coupled with ongoing research and development efforts in the field, are anticipated to further propel market expansion throughout the forecast period.
To know more about this study, request a free sample report @ https://www.researchcorridor.com/request-sample/?id=54366
Market Trends:
· Growing Preference for Non-Invasive Drug Delivery: There is a rising preference for non-invasive drug delivery methods among patients and healthcare providers. Buccal drug delivery systems offer a non-invasive route of administration, avoiding the need for injections or swallowing pills. This trend is driving the adoption of buccal drug delivery systems, particularly for patients who have difficulty swallowing or are averse to needles.
· Expansion of Drug Formulation and Delivery Technologies: Advancements in drug formulation and delivery technologies are expanding the capabilities of buccal drug delivery systems. Novel formulations such as mucoadhesive films, gels, and tablets are being developed to improve drug absorption and bioavailability through the buccal mucosa. Additionally, innovative delivery devices and technologies, such as patches and sprays, are enhancing the ease of administration and patient compliance.
· Increasing Focus on Patient-Centric Healthcare: There is a growing emphasis on patient-centric healthcare, with healthcare providers prioritizing treatments that offer convenience, comfort, and improved quality of life for patients. Buccal drug delivery systems align with this trend by providing a convenient and patient-friendly alternative to traditional drug delivery methods. This trend is driving the development of patient-friendly buccal dosage forms and user-friendly delivery devices.
· Expanding Applications in Chronic Disease Management: Buccal drug delivery systems are finding expanding applications in the management of chronic diseases such as diabetes, cardiovascular diseases, and neurodegenerative disorders. These systems offer controlled and sustained drug release, allowing for better disease management and improved patient outcomes. As the prevalence of chronic diseases continues to rise globally, the demand for effective and patient-friendly drug delivery systems like buccal delivery is expected to increase.
Market Opportunities:
The buccal drug delivery systems market offers significant opportunities for growth and innovation. Firstly, there is a growing demand for non-invasive drug delivery methods among patients and healthcare providers, presenting an opportunity for the expansion of buccal drug delivery systems. Additionally, advancements in drug formulation and delivery technologies enable the development of novel buccal dosage forms with improved drug absorption and bioavailability, further driving market growth. Moreover, the increasing focus on patient-centric healthcare creates opportunities for the development of patient-friendly buccal drug delivery systems that offer convenience, comfort, and improved treatment adherence. Expanding applications in chronic disease management, particularly for conditions requiring controlled and sustained drug release, present another avenue for market expansion.
According to the recent report published by RC Market Analytics, the Global Buccal Drug Delivery Systems Market is expected to provide sustainable growth opportunities during the forecast period from 2023 to 2030. This latest industry research study analyzes the buccal drug delivery systems market by various product segments, applications, regions and countries while assessing regional performances of numerous leading market participants. The report offers a holistic view of the buccal drug delivery systems industry encompassing numerous stakeholders including raw material suppliers, providers, distributors, consumers and government agencies, among others. Furthermore, the report includes detailed quantitative and qualitative analysis of the global market considering market history, product development, regional dynamics, competitive landscape, and key success factors (KSFs) in the industry.
Browse the Full Report Discretion @ https://www.researchcorridor.com/buccal-drug-delivery-systems-market/
Geographically, the buccal drug delivery systems market report comprises dedicated sections centering on the regional market revenue and trends. The buccal drug delivery systems market has been segmented on the basis of geographic regions into North America, Europe, Asia Pacific, Latin America, and the Middle East & Africa. Buccal drug delivery systems market estimates have also been provided for the historical years 2020 & 2021 along with forecast for the period from 2023 - 2030.The report includes a deep-dive analysis of key countries including the U.S., Canada, the U.K., Germany, France, Italy, China, Japan, India, Australia, Mexico, Brazil and South Africa, among others. Thereby, the report identifies unique growth opportunities across the world based on trends occurring in various developed and developing economies.
The Buccal Drug Delivery Systems Market Segmentation:
By Type:

• Sublingual Films
• Buccal Tablets and Lozenges
• Oral Sprays

By Application:

• Pain Management
• Smoking Cessation
• Angina Pectoris
• Others

By End-User:

• Hospitals
• Ambulatory Centers
• Others

By Region:

• North America
• Europe
• Asia Pacific
• Latin America
• Middle East & Africa

Key players in the global buccal drug delivery systems market include Pfizer Inc., Teva Pharmaceutical Industries Ltd., Indivior Pharmaceuticals, GlaxoSmithKline plc., and Catalent, Inc. These companies are strategically navigating the market landscape through various approaches such as expansion, new investments, the introduction of innovative services, and collaboration. In their pursuit of a competitive edge, these entities are venturing into new geographical regions via both expansion and acquisition, aiming to harness joint synergies and bolster their market positions.
To know more about this study, request a free sample report @ https://www.researchcorridor.com/request-sample/?id=54366
Key Questions Answered by Buccal Drug Delivery Systems Market Report:

• Product popularity and adoption based on various country-level dynamics
• Regional presence and product development for leading market participants
• Market forecasts and trend analysis based on ongoing investments and economic growth in key countries
• Competitive landscape based on revenue, product offerings, years of presence, number of employees and market concentration, among others
• Various industry models such as SWOT analysis, Pestle Analysis, Porter’s Five Force model, Value Chain Analysis pertaining to Buccal Drug Delivery Systems market
• Analysis of the key factors driving and restraining the growth of the global, regional and country-level markets from 2020-2027

About Us: RC Market Analytics is a global market research firm. Our insightful analysis is focused on developed and emerging markets. We identify trends and forecast markets with a view to aid businesses identify market opportunities to optimize strategies. Our expert’s team of analysts’ provides enterprises with strategic insights. RC Market Analytics works to help enterprises grow through strategic insights and actionable solutions. Feel free to contact us for any report customization at sales@researchcorridor.com.
​
Media Contact:
Company Name: RC Market Analytics Pvt. Ltd. Contact Person: Vijendra Singh Email: sales@researchcorridor.com Visit us: https://www.researchcorridor.com/