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Are you the proud owner of this beer belly?While you must have earned a lot of 'brownie pints', a beer gut is not quite something one can be awfully proud of, as it is positively dangerous for your health. Well for one this condition seems to be a common affliction amongst men more than women (though it isn't entirely unknown for women to guzzle beer). A beer gut is normally found in middle aged men as a token for services rendered to a sedentary lifestyle and hours spent accumulating empty calories. How is a beer belly formed? A protruding mid-section in men is generally formed when they consume more than they burn off. So given a busy lifestyle with very little exercise and discretion one generally can end up consuming lot many calories than one is willing to toss out. According to Dr Michael Jensen MD, endocrine and obesity expert at the Mayo clinic, the liver burns calories earned from alcohol instead of the existing fat. So say, if an average beer is around 150 calories plus all the tiny appetizers one has along with the beer (Pizzas, cuts, chips etc.) one can easily understand how these go about accumulating around the belly area in to a paunch. And because the liver was all too busy burning the calories guzzled from the beer, the rest finds a cozy place to settle around the tummy. This is exactly what gives majority of men and some women the infamous paunch or beer gut! GIVE YOUR PAUNCH A PUNCH IN THE FACE Well for starters be a giver and not a taker. Which means give more time to exercise like running, cycling, swimming, skipping, dancing or aerobics which should take care of visceral fat (which is easiest to shake off, by the way). As one ages their calorie needs go down, but then so do their physical activity levels and this is where the fat creeps in. Stick to light beer if you must but do not miss your exercise regimen for anything in the world.  
Absent father, violent kids!When children are growing up, they undergo a lot of hormonal changes and have varying emotional requirements. If these requirements are not fulfilled by the presence of both parents, they can develop into violent adults. Single parenting for a mother, is extremely difficult; it is simply impossible for her to fill the void left behind by an absent father. When a couple cannot live under the same roof due to major differences, they separate or get divorced. However, the requirements of the children remains the same; they still need the care and love of their mother and the support and guidance of their father, to grow up without any complications or insecurities. Children usually look up to their father as a symbol of strength and security and in his absence, they might not receive the same support and may feel inadequate and insecure. If during their childhood kids do not get the support and security that only a father can provide, they might bottle up the feelings inside; and these feelings usually explode when they grow into violent adults. A Father's Absence is Critical Due to whatever reasons, if the father is not present in the family during the most important growing periods of the kids, they have more chances of turning to crime and drugs, than the children who have a father by their side. According to a research conducted by the Research Institute of the McGill University Health Center located in Quebec, a father's absence, especially during the child's prime growing period, can lead to behavioral problems when they grow into adults. The research was carried out on mice raised only by their mothers and showed that the mice that were brought up in the absence of their fathers, were  abnormal and aggressive in their social interactions. Gabriella Gobbi, who is an author and a senior associate professor at the McGill University - Faculty of Medicine, says that even though the experiment was carried out on mice, the findings are highly relevant to the behavior of humans, under similar circumstances. Role of Fathers and Fatherhood Another research carried out by Dr. David Popenoe, a renowned sociologist, throws light on the role of fatherhood and fathers. According to Popenoe, fathers should not be treated as mere second adults in the family. Fathers, who are more involved in their family, have a certain positive impact on the children, which no other person is capable of. Fatherhood is an important responsibility and the presence of fathers in a family, directly influences the well-being of the growing children. In the absence of fathers, mothers may try their level best to provide their children with the right kind of upbringing and education. However, they might fail to give the kids the support and strength that only a father can provide. Due to this, children fail to face the challenges of life head on and are unable to handle their problems with an open mind. When a lot of emotions get bottled up inside, in most cases, they find their release in the form of violence. Sometimes, children also lack the right kind of guidance in their growing years and mothers fail to handle their changing emotional requirements, due to which these kids become increasingly frustrated and violent as they grow up.  
Hairy tale: Hirsutism in womenThe condition is called Hirsutism where women grow coarse hair just like males on the face, chest or elsewhere. The primary cause for Hirsutism is hormonal imbalances by the over stimulation or excess production of male hormones (present in minute quantities in females too). The thickness of hair that grows largely depends on our genes and at times Hirsutism in women may be just a hereditary trait rather than an imbalance. Self care and medication can take of it in such a case. Idiopathic Hirsutism is a type of this condition where there is no possible cause for the male type hair growth. These women have regular menstrual cycles and no Androgen excesses, yet they have Hisrutism. Hirsutism with excessive bodily and facial hair, usually in a male pattern, in women may be present in normal adults as an expression of an ethnic characteristic or may develop in children or adults as the result of androgen excess due to tumors, or of non-androgenetic or other drugs. Hirsutism can make its appearance at menopause or soon after as there are a lot of hormonal changes that occur in the female body, and in certain cases women grow hair even on the lip, nipples, abdomen and upper shoulders. And just as men go bald there can also be a receding hairline and baldness in women accompanied by a deepening of the voice and enlargement of the clitoris. If the hair growth occurs at puberty then a doctor's evaluation is most essential as it could be more than just Hirsutism.
Dilemma of a working woman - How to stay healthy!Women want to be healthy and beautiful. But most of us are not able to find the time to exercise or plan our meals. We pay more attention and money on therapies to look good externally. But good looks come from good health, and good health is an outcome of a healthy lifestyle. Healthy lifestyle helps in preventing illnesses and makes us more efficient. Improper and irregular diet, lack of physical activity, and stress are the chief causes of poor physical and mental health. Most working women today are occupied with their desk jobs, and as a result have a sedentary lifestyle. Eating junk food most of the times makes the matter worse. So if you want to stay healthy, here are some changes you can make. Add movement to life. Activities like walking, gardening, swimming or aerobics help build endurance and relieve stress. Choose something which you think you can consistently - Yoga, aerobics, cycling or even dancing. Balanced diet plays a pivotal role in fitness. Fruits, vegetables, and whole grains are a must in your diet. Antioxidants in fruits have an anti-ageing effect. Choose to eat in order to satisfy hunger and build healthy body, and not to feed your emotions. Avoid junk and processed food. They are empty calories. Drink water. Dehydration affects metabolism. Drink 8-10 glasses a day to flush out the toxins. Add liquids like milk, fruit juices to your diet. Positive thoughts help build a healthy mind and a healthy mind ensures healthy body. Do not smoke cigarettes or drink alcohol to deal with stress. Try yoga, meditation, listen to music, or take a nice shower to relax. Rest and relaxation helps to cope with daily stress. Making these lifestyle changes as a regimen will surely help working women to live a life of health, wellness and fitness.  
Activities to help your toddler talkWe understand how eager parents are to talk to their kid. They want to hear their soft voice and babble talks. So start teaching them as soon as possible to help them to speak fast and clear. Here are some activities which will help you to teach your kid to talk. The playful ways: The best way of teaching your kid to speak is to, well,play. Most of the learning is done through playing. Be a child with your child. Act playfully foolish --kids enjoy that a lot. And when the kid is happy and in playful mood, they try to talk. Building vocabulary: Use a word in more than one sentence to make them understand the meaning of the word. For example, 'The color of leaves is green' and 'Your father is wearing a green colored shirt.' If the kids hear a word used often in different sentences, it becomes a permanent part of their vocabulary. Give them practical examples: Teach them the names of the things they see around. Or get actual objects and be descriptive to teach them the name of the object and talk about the object's features. Use a toy phone: You must have seen kids trying to talk over phone to their dads or friends. They try to copy you the way you talk over phone. It can be a great way to teach them to speak. Pretend that you are talking to the kid's dad or grandparents, and pass over the phone to the kid and encourage them to chitchat over the phone. Story telling: Kids listen to the stories very carefully. Show them the pictures in the storybook and describe them with the story. Then repeat the same story the next day. Ask your child if she/he remembers what was there in the story by showing them the picture. Help them if they get stuck. Sing together with the child: Music is another amusing way to teach the child to speak. Listen to a song, sing and dance along. Encourage the child to dance and sing with you. Children are great at learning lyrics of a song. Reward the child on completing a task: When you reward the child with his/her favourite toy or snack, they understand the benefit of performing the task. And they take effort to get the reward. Ask your child to recite a poem for you, or speak a certain word or sentence and entice the child by showing him the reward he will get on completing the task.  
Is circumcision a healthy ritual?Religious rituals and practices have been carried out since ancient times. Circumcision is a religious ritual that involves surgical removal of the prepuce of the human penis. Prepuce is the foreskin of the penis and during the procedure; the person performing the ritual opens, inspects and separates it from the glans. The process is painful and hence local or topical anesthesia is used to reduce physiological stress and pain. Circumcision is performed for religious as well as personal reasons and many times recommended medically for prophylactic or therapeutic reasons as well. Today's medical science makes use of this treatment for treating chronic urinary tract infections, refractory balanoposthitis and pathological phimosis. Circumcision is performed as ritual in many parts of the world. However, it is also recommended medically as protection against HIV infection. Circumcision-Is it Legal and Ethical? In the world over, the ritual or practice of circumcision is carried out on all types of people from neonatal stage to adulthood. While no significant risks have been noticed due to the practice of this ritual, rather some modest health benefits have come to the fore. The World Health Organization has recommended circumcision for male infants in parts of Africa where the children are more vulnerable to urinary tract infections. However, no other medical organization in the world has supported or banned the procedure. Over past few years, legal and ethical questions have been making rounds and many believe that consent should be taken before carrying out neonatal circumcision. HIV and Circumcision Benefits A Cochrane meta-analysis conducted in 2009 on sexually active African men have revealed that the ritual of circumcision reduces the risk rate of HIV infection by 38 to 66 percent among heterosexual men in a period of 24 months. That is why WHO has recommended circumcision in sub-Saharan African areas having high rates of HIV infection as a part of the comprehensive HIV program. Moreover, this process is more cost-effective as compared to other treatments and preventive measures recommended for HIV. Circumcision reduces the risk rate of HSV-2 infections and oncogenic HPV prevalence along with the risk of penile cancer and UTIs. Until now, there have been no concluding reports on the protective effects circumcision offers against other types of sexually transmitted infections. Circumcision is also recommended medically to children suffering from pathological phimosis and refractory balanoposthitis. Contraindications The literature worldwide review conducted in 2010 reveals that around 1.5 percent of the newborns face median complication when the process of circumcision is performed by trained medical providers. Only 6 percent children face severe complications with the common complications being infection, bleeding or removal of too little or too much of foreskin. However, the process does not cause any negative impact on the sexual functioning of an individual. Contraindications due to circumcision are also cited in infants having genital structure abnormalities right from the birth such as misplaced urethral opening, ambiguous genitalia or chordae. In such cases, the foreskin may require reconstruction through surgery.  It is contraindicated in premature babies and clinically unstable infants and it should also be avoided in children with family history of hemophilia (bleeding disorders). In such patients, it is important that the blood should be checked for its coagulation properties before attempting the procedure.
Faking illnesses - An illness in itself?In 2008, a 28 years old woman in the US shared some shocking news with her friends. She had been detected with cancer. She posted updates on social networking sites and wrote blogs on her illness. Sympathy poured in from all corners. Some even sent in monetary help to cover her expenses. The saddest part of the incident though was not her cancer; it was the fact that she had faked it! Police investigations revealed her little trick when no evidences or records were found at the hospitals! Apparently, this isn't a unique case;  faking illnesses or malingering is a very common occurrence. All of us have done it at some point in our lives. While we may have done it to escape a school punishment or to take undue advantage of the office 'sick leaves' for personal purposes, it is usually done on a harmless level. But faking illness can be a chronic disorder too and  medical professionals even have a name for it-; Munchausen's Syndrome. People suffering from this syndrome fake illnesses that they don't actually have, to gain sympathy or simply to be the center of attention. Usually gaining sympathy is the main reason why people fake illnesses. It gives them a chance to be in the spotlight. Everyone calls and visits, expresses concern and fusses over them. Lots of love is showered upon them. Another common reason for faking illnesses, is money and at times, the monetary benefits are higher than the emotional ones. No one hesitates to fulfill the last wish of a dying person, however expensive it may be. Often there are mixed motivations and the person faking an illness has many reasons to keep up the pretense of being sick, for as long as possible. Some people really do have a disease — a mental illness known as a factitious disorder. People with this disorder pretend to have an illness, which is usually a terminal one and often go to great lengths to maintain their hoax. Munchausen syndrome by proxy, is another form of faking illness. People with this disorder, fake illnesses of people under their care; and they usually do this, for monetary benefits. Children are the most common victims in this disease. When you tell someone that your child has cancer, you will receive a great amount of sympathy and all the money you want, no questions asked! People with these disorders are extremely cunning. They go to great extents to maintain their lies. They will build grand stories, complain of fake pains and aches, get admitted to hospitals and undergo a battery of tests, numerous times. Interestingly, they never allow and frequently discourage medical professionals, from talking to any of their family members. Since they know they are faking the illness, they will refuse to undergo treatment, for obvious reasons. . If you think a loved one may be exaggerating or faking their health issues, attempt a gentle conversation, voicing your concerns. Avoid anger, judgment or confrontation, while offering support and care and if possible, help them in finding a treatment. Treatment includes empathy, helping in identifying feelings and issues that led to the development of the disorder and finding  alternative healthy ways to deal with those feelings and issues.
10 best and worst appetizersWhen you are munching on appetizers before your meal, the idea is to eat something that can trigger off the production of your digestive juices in the intestine, so that what you eat next, the food is easily digested. However sometimes, the appetizers are much more complex and heavier on your tummy and can actually reduce the metabolic activity and imbalance the digestion process. Here are some of the best and worst appetizers that are commonly served: Best Appetizers Vegetable Kababs: These highly nutritious and low calorie appetizers are a good alternative to fried items. Grilled vegetables or kababs are prepared by skewering red and green bell peppers, onions, tomatoes, mushrooms and zucchinis. To add to the taste, you may brush over some low-fat herbs and even garlic marinade. Two delicious vegetable kababs, will get you only 75 calories. Crab Cakes: Seafood offers you high nutrition and the best way to include the properties of seafood in your diet, is by choosing crab cakes as appetizers since these offer only 20gms of fat and 300 calories, while providing you with a high level of sodium (960mg). Spinach Salad: The best thing about good appetizers is that they are low calorie foods and provide great flavor and satisfaction while eating. One such fulfilling appetizer, is spinach salad. You can also use other green leafy vegetables to add more nutrition to the recipe. If you eat this appetizer before your meal, chances are, you will eat 10 to 15 percent less of the main course, which is certainly a great way to cut down on the calories. A cupful of fresh salad gives you only 80 calories. Beef Skewers: If you are in the mood to pamper your taste buds, but still want to stick to eating healthy, then beef skewers is the right option for you, in the appetizers section. These are usually served with peanut sauce in restaurants. You can opt for lean beef along with soy, garlic, hoisin, onions and barbeque sauce to make this dish yourself. Quarter to the pound is the recommended serving, which consists of 5 gms of fat, 130 calories and a high sodium content of 803 mg. Stuffed Mushrooms: Potato skins are a common appetizer people go in for, but these add more calories. Instead, you should opt for stuffed mushrooms that are way more delicious. The caps of mushrooms are stuffed with breadcrumbs and the cheese of your choice; and they provide only 50 calories per cup. This means that even if you eat six stuffed mushrooms, you are still within the limit of 300 calories. The worst appetizers are deceptive yet tempting in their looks and taste. But you should always keep a check on the ingredients before gorging on them, for your own benefit. Worst Appetizers Onion Blossom: Fried onions are certainly bad for your waistline. It is always better to eat a starter stuffed with more vegetables, instead of fried things. A restaurant preparation of onion blossom consists of 161 gms of fat, 1,049 calories and around 4100 mg sodium, which is more than double the limit required by an adult, making this appetizer a completely unhealthy choice. Cheese Fries: Cheese fries are one of the worst appetizers; these can be even more overwhelming than your meal itself, which is why health experts advise not to include this appetizer in any type of menu. Sometimes cheese fries actually come with more melted cheese on top, which is obviously worse. Spinach Artichoke Dip: Although this starter starts with the word 'Spinach', it is in no way a healthy appetizer. One dip of spinach contains loads of calories-1600, fat-100 g and 2500 mg sodium. It is certainly not the spinach but the cream base that is rich in saturated fat. Potato Skins: Potato skins have all the high calorie foods such as meats, sour cream and cheese. When you take one pop of these, you will be adding 150 calories, which is quite a big number. Moreover, these appetizers are not filling. A plateful of potato skins adds 1,340 calories, 1,850 mg sodium and 94 gm fat and yet leaves you hungy. Cheeseburger Skins: Although these appetizers look small, there are loads of calories packed in them. One order of Cheeseburger skins can total up to 1270 calories, with an added 2310 mg sodium and 82 gm of fat.
Common causes of allergic reactionsAllergic reactions, most of the times, do not warrant immediate medical attention. But never ignore or take any allergic reaction lightly! Allergic reactions include itching or a puffy face or swollen red blotches all over your body or a fit of sneezing.  If we know what allergies have, we can avoid the triggers. So, here is a list Soaps and detergents: Are your palms are all rough and peeling off in patches and it doesn't seem to go away? Time to do a check on the dish-washing soaps and the detergents you may be using. Most of the brands contain harsh chemicals that burn while you use them. Medically known as Contact Allergic Dermatitis, this is one of the most common allergic reactions. Artificial Jewellery: Even the best looking jewellery can, at times, trigger allergic reactions. Another common type of Contact Allergic Dermatitis, this happens when you wear artificial jewellery. Most of the jewellery of this variety contains Nickel which is the main cause for this type of allergic reaction. Clothes: Clothes can be a cause for allergic reaction. While synthetic fibres like nylon and polyester are common factors, at times, the chemicals used in the dyeing can also be a reason for allergy. Add to it the perspiration and the constant friction between the skin and the clothes, and you have a severe allergic reaction guaranteed! Latex: Latex is also a very common cause for allergy. Commonly found in condoms, gloves and certain medical devices, allergy to latex can range from minor itching and redness, to a serious life-threatening anaphylactic reaction. Milk and milk products: The symptoms for this source of allergy include loose motions and stomach, among other things. Medically called as Lactose intolerance, it occurs in people who do not have the necessary enzymes in their bodies to digest milk and milk products. Food allergies: Peanuts, brinjal, fish etc can also trigger allergic reactions. Food reactions are specific to individuals. One may suffer from an allergic reaction to almost any kind of foodstuff. Beauty products: From shampoos and creams to nail paints and lipsticks, every cosmetic you use is a potential allergic trigger. Molds: These are microscopic fungi found in damp and moist places.. Allergic reactions to molds are pretty common and seasonal. Cockroach: The proteins secreted by the glands and the saliva of the cockroach can be allergic to humans. Sneezing, itchy and watery eyes are common symptoms. Insects: Insect stings can lead to burning and stinging pain with redness and a slight swelling around the bite/sting area. In some people though, insect bite/sting proves to be life threatening. Symptoms as severe as difficult breathing, rapid pulse, severe drop in blood pressure and swelling of face and throat may occur!
Bile block - Understanding gallbladder problemsRavi was a young intern working the night shifts in a government hospital when he was asked to examine a patient who had just been brought in. The patient was a 45-year-old, a fat man, who was complaining of pain in the right side of the abdomen along with nausea and vomiting. On inquiry it was revealed that he had eaten a very heavy fat-laden dinner. Remembering what his surgery professor had taught him about cholelithiaisis, Ravi immediately guessed what the diagnosis could be. He, however, sent the patient for a blood test and an abdominal scan. The reports confirmed Ravi’s suspicions- cholelithiasis, gallstones. The gallbladder is a tiny pear shaped organ that lies just below the liver. It is responsible for storing the bile that is produced by the liver for digesting food. It ensures the smooth outflow of the bile from the bile ducts. When the bile components aggregate in the gallbladder, they build up to form gallstones, similar to kidney stones. The gallstones are usually small enough to pass on to the intestines and be eliminated without causing too much trouble. At times, these stones may be big enough to block the outflow of the bile and give rise to a variety of symptoms depending on the size of the stone and severity of the block. The symptoms include -  Intermittent colic. A bloated sensation with constant nausea. Inability to tolerate fats. Vomiting.  Fever with chills if the stone becomes infected. Gall stones though found in both sexes, is more common in females. The risk factors for developing gallstones include - Diabetes. Organ transplant. Diseases like hemolytic anemia, sickle cell anemia. Liver cirrhosis. Failure of the gallbladder to empty properly, e.g., during pregnancy. Rapid weight and nutrition loss due to any reason. Gallstones are confirmed by a blood test to check the liver function and by an abdominal scan. Medications to dissolve the stones, and surgery in case of large stones that do not dissolve with medications, are the treatment options.
Sex at 50 for womenAs you age, your reflexes slow down. The passion to love and to be loved is never dying and just because you have grown in age, you should not stop enjoying sex. The body, especially in case of women also undergoes many changes after the menopausal period. Although it may take you more time to become aroused but the desire to have sex is always there. Moreover, with no children and no worry of getting pregnant you can enjoy sex uninterrupted without any tension. Women who continue to remain sexually active after their menopause retain their ability for enjoying normal orgasms. But this does not mean that there is no difference in the enjoyment factor. Several factors can be detrimental in continuing sex activity. However, there are solutions that can help the couple in their fifties still enjoy sex. Better sex can be possible even during the fifties but for this, you should be ready to take some extra efforts and make your body more comfortable for sex. Using lubrication After the menopause, the body of a woman starts producing less female hormone-estrogen. Lower estrogen level leads to physical changes such as less elasticity of vagina, dryness in vagina and so on. Your vagina may also take more time to swell and lubricate; in turn making intercourse painful or uncomfortable. Instead of getting discouraged by such occurrence, you should try to find out a remedy for it. For overcoming the dryness of vagina, you can use different sexual lubricants that are specifically prepared for the older women. You get them in suppositories or gel forms, which you apply liberally to the vaginal area before having sex. There are certain vaginal moisturizers also available in the market that makes vaginal penetration easier by maintaining elasticity and lubrication. Increase the frequency The more often you have sex, the easier it is for you to maintain elasticity and lubrication. So, go for it more often to enjoy it more now. Hormonal therapy treatment If you are suffering from distressing menopausal symptoms like hot flushes, you can opt for hormonal therapy treatment. This will help to relieve the vaginal dryness. Some doctors also suggest local intra-vaginal therapy to avoid discomfort and dryness during penetration. Application of local estrogen into the vagina enhances the blood flow to this area and ensures more sensation and lubrication. Intra-vaginal estrogen treatment This treatment is carried out in three different ways: A small ring of silastic is inserted high inside the vagina and is kept there for three months. This ring release estrogen in right amount to promote optimum vaginal health. A small tablet of estrogen is inserted inside the vagina twice in a week. Conjugated estrogen cream is applied with small applicator twice in a week. So, there are different methods for increasing responsiveness, vaginal lubrication and elasticity that help you enjoy sex better even in your fifties. Overcome awareness about your body The body of women in fifties is saggy and wrinkled. However, if you have a young heart and passion for sex, you should not let the body image spoil your enjoyment. It is your response towards your partner that matters the most as both of you are going to age slowly and get more wrinkles as the age progresses. Like someone said, it's the imperfections and not the perfections that we fall in love with.
Female circumcision - Health EffectsThe procedure is carried out by either snipping off a piece of the clitoris or removal of all external genitalia for non-medical reasons. The procedure is carried out outside hospitals and the environment may not be effectively clean and could lead to infection. The painful procedure causes a lot of fear and distress. Some countries have begun to use healthcare personnel to cut the genitals, which reduces pain, bleeding and infection but it does not mean that it is acceptable by the United Nations. Even though the United Nation has termed female circumcision as a violation of human rights, there are millions of girls suffer because it is a requirement for girls so that they remain pure. It is supposed to lower female libido so that they do not indulge in any kind of sexual activity before marriage. Immediate complicationsGirls are likely to suffer severe pain besides the fear that accompanies such a procedure. It can cause them more pain when they try to urinate. If there is severe bleeding, it can lead to haemorrhage. The tissues that form the genitals are severely damaged and healing may not take place immediately and sores can form leading to more pain. Girls can retain urine for fear of the pain. There is always a chance of contracting tetanus or other bacterial infections like sepsis which lead to formation of pus. Besides cutting, procedures can include pricking, piercing, incising, scraping, and cauterizing the genital area. Long term health problemsBesides the immediate problems, female circumcision can lead to long term effects including infertility. The girls can be subjected to urinary tract infections and bladder infections that can recur again and again. Sometimes cysts may also form. There are chances that there could be increased risk of problems during childbirth which could in extreme cases result in the death of the newborn baby. According to UN estimates more than 125 million girls and women are living with female circumcision. Women may be subjected to continuous surgeries especially in those cases where the vagina has been stitched to make it narrow as part of the circumcision process. Once the girls are married, the vagina is unstitched to have sexual intercourse. During childbirth, the vagina may need to be cut again to deliver the child and then stitched up again. This is a continuous problem and women should be spared from this pain and trauma.
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