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  MEN`S HEALTH MORE
Are you ready for the healthy year ahead?
The mystery of the male mind revealed!
Broad chest, weak lungs - Are men more prone to respiratory diseases?The long-standing, chronic afflictionof the respiratory disease is called as COPD, i.e., Chronic Obstructive Pulmonary Disease. COPD is the obstruction within the lung tissue, causing improper circulation and entrapment of air. This limits the space for air to move in and out, directly affecting the quality of inhalation. A small reminder here may be necessary - breathing is synonymous with life, why? Because that's how we get oxygen, which is vital for the functioning of each and every cell within the body. With COPD, the ability to take in oxygen gets compromised increasingly. Continued cough, sputum, and shortness of breath are the main symptoms. COPD is more common in men. Does it have to do anything with being a male? Not necessarily. No specific link has been established to say that COPD risk is higher for you solely because you are a man. Then, what could it be? A study conducted in 2011 in USA showed that the number of men who smoke is 5% more than the women who do. To understand the reason behind this, let us see the primary causes of this disease. Air pollution, some genetic predispositions, frequent acute infections, exposure to harmful chemicals for a long time (usually occupational) - are some of the main causes, and the number one cause is smoking, owing to almost 80-90% of the cases. Park this thought. Next piece of information is simply revisiting some facts you may already know: #The gender classification ofsmokers - Men are known to smoke more than women all over the world, not only in numbers, but also in quantity. Whether it is a developing country or a developed one, 2011 studies say there are more male smokers everywhere than female smokers. Not only there are more men who smoke, they smoke for longer periods and more number of cigarettes than female smokers. This may vary from country to country, like India has much less women smokers than USA does, but the difference between the two genders holds true everywhere, only the ratios differ. #Occupational exposure to harmful chemicals and gases - These are industries of mining, textile, chemical engineering, welding, etc. The number of men working in such industries is way higher than women. #Air pollution - Men are more exposed to air pollution since they are outdoors more than women. This may not apply to all countries and societies, but is generally true. Now, we can put the pieces together and understand why COPD is more common in men? Yes, they are at a higher risk because of higher exposure to smoking, pollutants and irritants. Cigarette smoking is the leading cause of lung diseases and male smokers outnumber women across the world. You can figure out the math here!
Health check up checklist for men Prostate Cancer - Prostate cancer is the lesser known killer in men. It is a slow growing cancer, but at times, its symptoms can be aggressive as well. Detecting prostate cancer at its onset can help in treating it effectively. Tests include a digital rectal exam and a blood test for Prostate Specific Antigens (PSA). Testicular Cancer - This uncommon cancer can affect any male between the ages 21 to 55. A physical exam during yearly medical checkups is recommended for all men. Men having a higher risk, with family history, should speak to their doctors regarding additional tests for screening. Self-examination through regular gentle palpation of the testicles to notice any change in shape or size, presence of lumps is also suggested by doctors. Colorectal Cancer - This is the second most common cancer in men. Men over 50 and younger, if they have a familial risk, are suggested to get a screening colonoscopy done to detect this cancer. It usually starts as a polyp that grows and invades the nearby areas to develop into a full-blown cancer. The polyps, if detected early, can be removed and cancer prevented. A CT scan or a double barium enema can also help in detecting polyps. High Blood Pressure - With the kind of lifestyle men lead today, almost every other man is bound to have BP issues. Regularly checking the BP is essential as it helps detect high BP which may lead to a variety of other problems including stroke and heart attacks. The sooner the detection, the sooner the measures for control. Cholesterol Levels - Bad eating habits, sedentary lifestyle, and mental stress can all lead to lots of cholesterol roaming around in your arteries. This will eventually clog the arteries and cause diseases like high blood pressure and atherosclerosis which can be life-threatening. Get your total cholesterol, LDL, VLDL, HDL, and triglyceride levels checked regularly and initiate timely interventions to bring them under control. HIV - This is the most commonly spreading STD among men. Due to its chronic nature, HIV is often detected accidentally when it may be too late. Regular tests for HIV detection are essential if one is physically active with multiple partners. Be safe though and use a condom. Glaucoma - It is extremely common and is one of the leading causes of blindness. Glaucoma has no cure, but it can be controlled well with timely detection. Screening tests should be undertaken by men under 40 years at an interval of 2 to 3 years after 35. A yearly test is recommended for older men.
  WOMEN`S HEALTH MORE
Five fitness flaws by females
3's of Premenstrual syndrome
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.  
Mammary duct ectasiaSigns and Symptoms In most of the cases, female patients do not have any symptom. In few cases, women may present with nipple discharge, tenderness or inflammation of the surrounding region. In some cases, there may be a lump over the breast or the nipple may get inverted. Causes Exact cause of mammary duct ectasia is unknown. But few possible cause or risk factors have been proposed by the doctors : Increasing age - Probability of developing mammary duct ectasia increases with age. With ageing, the breast changes its nature. Glandular tissue is replaced by fatty tissue. This change may lead to duct ectasia. Smoking- Milk ducts are widened due to smoking. This increases risk of inflammation which may lead to duct Ectasia. Inverted nipple - Inverted nipple obstructs the milk duct. It may lead to inflammation followed by duct ectasia. Complications Complications of duct ectasia may be may be of varying severity. They are usually minor, but sometimes become serious. Localized discomfort- Discomfort occurs due to pain and swelling around the nipple. Nipple discharge - Ectasia is frequently associated with discharge of thick and sticky fluid from nipple. Infection- Bacterial infection may develop due to stagnation of fluid in the milk duct. If it is neglected, it may lead to localized collection of pus known as abscess. Abscess requires surgical treatment. Abscess is drained surgically. Diagnosis The doctor usually diagnoses duct ectasia by clinical examination. However, few investigations may be required. Mammography- X-ray of the breast tissue is known as mammography. It helps the doctor to evaluate the breast tissue. Ultrasound- Ultrasound enables the doctor to evaluate milk ducts beneath the nipple. Treatment Duct ectasia is usually relieved by treatment. Following are the treatment options : Medications: The doctor prescribes antibiotic therapy for 10 to 14 days. It may be accompanied by mild painkillers like ibuprofen, etc. for initial few days till the remission of the disease sets in. Most of the cases are usually relieved by medications. Surgery: If duct ectasia is not controlled with medications then the doctor chooses to remove the duct ectasia surgically. Surgery is required very rarely.  Self care measures Following self-care measures often provides relief to the patients. These remedies can be adopted at home. The patient may wear a breast pad or support bra. The patient may apply warm compression to the affected region. The patient must stop smoking. The patient may be advised to sleep on the opposite side of the affected breast. Female patients should be educated regarding mammary duct ectasia so that they can detect possible symptoms of duct ectasia themselves. This will help to prevent possible complications of mammary duct ectasia and early diagnosis will provide early cure.
  KIDS CARE MORE
7 Tricks to keep kids away from tv
A ready reckoner on age - Apt diet for kids
Your child is ready for school... but are you?It was still okay. Just 2-3 hours which you could utilize for other things while your child was away briefly. Now you will have to compete along with teachers, textbooks and homework for your child's attention. Well Mother, we know this is going to be difficult for you, but let's see if we can try and make it any easier. Think of school as an extension of the tender loving care that you provided. The only difference is that the TLC will go towards nurturing and developing his/her brain and help it learn important skills which will help gain a balanced development. At this point your child feels bad and completely unsafe in this new hostile world of teachers and uniforms and what not! If you weaken at this point your child will cop on and then will come the emotional blackmail. So explain the importance of school to your child as it will make the transition easier. It is always good for mothers to accompany their children to school but imagine watching mother walk away and all hell can break loose. So if your child's school has a school bus facility you can walk him to the bus stop and then say your goodbyes there. A lump in the throat at the bus stop is preferable any day than a scene at school with a child holding on to mother for dear life. Do not criticize your child's school or assignments given by them as children can catch on quite quickly and that can be reason enough for them not to concentrate on school activities. Always encourage your child to talk about what he did at school and ask him questions about his friends and teachers. This gives the impression that school is as important as home and gradually even you will reconcile yourself to the fact that school is here to stay.
High blood pressure in the little onesIf you are asked to paint a picture of a patient of hypertension, how would it look? Leave the details aside, would you paint an old person, a young person or a child? Most likely, you will paint an old person or may be a middle-aged person. But a child, who would think of a child to have high blood pressure! It may be difficult to believe for most but not only is it possible, its incidence is also increasing gradually. In fact, hypertension in kids is becoming quite common. Studies in USA show that up to 5% children and adolescents have hypertension. What is it? High blood pressure in children and adolescents is also called as pediatric hypertension. Pediatric hypertension is defined by the blood pressure recorded on the mercury, in comparison to the given standard range. As a child grows, there is rapid development in all the milestones. For children, there are percentiles defined for all parameters for various age groups. In children, when the blood pressure is above the 90th percentile but below the 95th, it is called prehypertension. When it is above 95th percentile, it is diagnosed as hypertension. There are no distinguishing symptoms of pediatric hypertension, so it may easily be missed. Please make it a practice to get your child's blood pressure checked on routine visits for medical examination. Why does it happen? High blood pressure in children under ten years of age is usually secondary to some other health condition. It could be due to an underlying heart disease, kidney disease, hormonal disorders or genetic abnormalities. This demands treatment of the main problem. Primary hypertension is noted in older children, over 6-10 years of age and adolescents. There is no specific cause identified for this, other than lifestyle, obesity, rich foods and family history. How bad could it get? Children may show a disordered sleep pattern when they have hypertension. They may suffer from sleep apnea, reflected by snoring or abnormal breathing. Besides sleep, the other effects of hypertension are the known ones. In the long run, it could lead to heart disease, stroke or kidney disease. What to do? It is very important to control the blood pressure from a young age. Regular check-ups and monitoring of the BP is needed. Thorough examination is a must to identify whether the hypertension is primary or secondary. Treatment by medicines is recommended in secondary hypertension, where the underlying condition is to be tackled along with the management of blood pressure. In cases of primary hypertension, medication is suggested only in extreme cases. Otherwise, lifestyle management is the key. It is not a healthy option to start anti-hypertensives this early in life. Give your child healthy food, help him/her maintain the ideal body weight and make sure he/she gets enough exercise physically. The sooner we identify the problem, the better are the results with a disciplined lifestyle. The unhealthy lifestyle is creating chaos in all our lives. How long the kids would have escaped? Our lifestyle reflects on our kids. Follow a healthy routine and keep the family healthy!
  MENTAL HEALTH MORE
Meditation - A perfect way for mental hygiene
10 Tips to build a better body image
Anxious about anxiety?Anxiety disorder is a term that almost everyone has heard and experienced in some form or the other. It is a generic term used to describe different forms of a mental disorder wherein those afflicted show typical characteristics of great apprehension, fear and trepidation. The symptoms, of course, vary depending on the severity of the affliction. So you can have 'anxious moments' when you narrowly escape an accident while driving - that's temporary and natural, while some others might have chronic anxiety which might need medical aid. Types of anxiety disorders Generalized anxiety disorder: There is no specific reason for the symptoms of anxiety i.e. restlessness, apprehension, worry, and panic. Thus the term general anxiety disorder (GAD) is any irrational worry which is disproportionate to the source of anxiety. GAD is a state of perpetual irrational and persistent fear which absorbs a person's time or can disrupt his normal functioning. The symptoms of GAD are light headedness, sweating, difficulty breathing, nausea, and numbness. Phobias: Phobias are an irrational morbid fear for certain things or objects. The list of phobias is exhausting as it is anything that a human being is capable of being afraid of. Thus you have arachnophobia which is the fear of spiders, homophobia, which is the fear of homosexual people orxenophobia,the fear of foreigners. Phobias can completely paralyze and terrorize a person and is a form of anxiety disorder. Obsessive compulsive disorder: This is the classic loop where a person is afraid of certain situations arising constantly and thus takes precautionary measures to ensure that it won't. Only thing is that this turns in to a compulsive ritual which can throw her in a loop. Thus a person can be said to have OCD if she persistently checks to see if the gas valve is off as she has a fear that she will set fire to her home. It is a particularly distressful anxiety disorder. Post-traumatic stress disorder: This is anxiety arising out of a traumatic incident which the person undergoes. It could be a horrific accident or an extremely brutal incident which the person has witnessed. The trauma is revisited again and again in the mind and manifests as anxiety. This disorder is based on real events that the person has experienced or undergone and can take a long time to heal. Panic disorder: This is characterized by panic attacks or episodes where great terror or discomfort is experienced. It is a very unsettling experience as the patient feels he is about to go unhinged or something dangerous or embarrassing is going to happen to him. Thus the sensation or feelings of panic build up and reach a crescendo resulting in a panic attack. Sometimes in a panic attack, the patient's reality and perceptions are distorted and blurred and can thus put him in danger. According to the National Institute of Mental Health there could be a number of reasons for anxiety disorders. They vary from early childhood environment to lifestyle causes, heredity and even environment.    
Meditation and relaxationProcess of meditation: It entails three stages:  Concentration Meditation Enlightenment or absorption Meditation is a fantastic relaxation tool that comes for free. Today, we need relaxation because of our hectic lifestyles. In today's world the most of the people have a lot of ambitions and goals which they want to achieve as fast as possible in no time. This doesn't have to be the case because meditation not only increases energy level and efficiency but also clears the clutter of one's mind and helps accomplish one's goals with less efforts, leaving more time for the person to enjoy recreation, leisure and entertainment that life has to offer. Characteristics of Deep relaxation: When a person has a relaxation response, several physiological changes occur -  Decrease in heart rate Decrease in respiration rate Decrease in skeletal muscle tension Decrease in metabolic rate and oxygen consumption Decrease in analytic thinking Increase in skin resistance Meditating one of several activities that produce the relaxation response for 20-30 minutes a day, over time, can lead to a generalized feeling of relaxation. Benefits of Deep Relaxation are: Reduction of generalized anxiety Preventing stress from building up Increased energy and productivity Improved concentration and memory Reduction of insomnia and fatigue Increased self-confidence and reduced self-blame Increased availability of feeling
  BEAUTY AND FITNESS MORE
Dark chocolate
Boost your digestive system
When the grey matters!Greying of hair happens to all of us at some point in life. Some may get it early and other fortunate ones may get it when they are 50. Premature greying and hair fall is a common problem faced by 70% of females in India these days. What are the causes of greying of hair and what can be done if your hair starts to go grey early? What are the probable causes of grey hair and hair fall? Deficiency of nutrients in diet. Excessive stress. Dandruff. Diseases like thyroid disorders, anemia, and vitiligo. Side effects of certain medication. Hair problems are seen more in women who smoke or drink. Childbirth and menopause are the periods of life when most of the women invariably have hair loss. Hereditary pattern of premature greying. Today's beauty procedures like coloring, bleaching, dyeing, perming, and straightening cause hair problems at a young age. Environmental pollution. Treatment and prevention Have a balanced diet. Ensure proper nutrients reach your body in every meal. If you are anemic, treat it with proper medication. This can be an underlying cause. Have a good sleep. Avoid tension and stress. Apply oil regularly and massage. Drink lots of water. Avoid exposure to chemicals. What can be done to hide the grey hair? Apply amla oil to your hair to make it healthy. Apply henna, lemon juice, fenugreek seeds paste, made in an iron container, on your hair to give them a color and reduce greying. Boil gooseberry pieces in coconut oil. When they turn black apply it on the hair. If you have 45-50% grey hair then you can use a permanent hair color.
Exercise, a healthy way to deal with hypertensionYou have not exercised for a long time. You took it easy when it came to physical activity. Now that you are diagnosed with high blood pressure, you will do anything to control it. Even exercise! Exercise, weight management, and a healthy diet are important ways to help prevent high blood pressure and lower the blood pressure that is already high. Benefits of exercise for people with hypertension include: Improve blood and oxygen circulation in the body Promotes sound sleep Improves stamina and endurance Keeps heart healthy Reduces stress and promotes mental health Exercise enhances the effectiveness of medication So how much should one exercise? An exercise session of atleast 30 minutes per day is important. Get started Start slowly and increase gradually. Start with 10 to 15 minutes of exercise and increase it, as youget comfortable. Choose exercises you enjoy and will do consistently. Avoid sudden vigorous activities; they can cause injuries and hamper the routine. Warm up Warming up helps the body adjust slowly from rest to exercise. A warm-up will reduce stress on the body muscles, increase heart rate and respiratory rate, and body temperature slowly. It will also decrease soreness of muscles. Best exercises for lowering blood pressure Stretching: It is the best. It relaxes and helps prepare the body and muscles for activity and prevents injury and muscle strain. Stretching regularly will make you flexible and improve motility. Aerobic exercise: This helps to improve circulation to the entire body. It improves heart function. It gives maximum benefits to the heart. They also help to reduce heart rate and blood pressure by improving breathing pattern thus lowering blood pressure. Walking, swimming, jogging, and skipping are all aerobic activities. Do aerobics for at least 30 minutes three times a week. Strengthening exercises: These include exercises that have repeated muscle contractions till the muscles are tired. These include side balance crunch, climbing a rope, and push-ups. Join a gym. Here are some  exercise guidelines for a better exercising routine in the gym:  Schedule a fixed time for exercise. Find a buddy to exercise with you. Select an exercise that you like. Make variations to avoid getting bored. Boredom can make you stop exercising. Start slowly and increase gradually, especially if you do not exercise regularly. You should wait for an hour after eating before you exercise. Ten minutes of warm up and ten minutes of cool down sessions are must Keep a record of daily exercise.
  LIFESTYLE PROBLEMS MORE
Causes and treatment of electrolyte imbalance
Dizziness
Hypertension and Vitamin DVitamin D is one of the essential vitamins that are required for strong and healthy bones. The body synthesizes it in the skin from cholesterol when there is adequate exposure to sunlight. Over the past decade, vitamin D has been intriguing medical researchers the world over. Several studies were conducted and interesting results found. One of them being that vitamin D may be implicated in influencing blood pressure levels. As per studies conducted, it was found that low levels of vitamin D lead to high blood pressure levels. People living in high altitudes where sunlight is at a minimum level were found to be hypertensive. Also, the winter season showed an increase in hypertension cases which was again attributed to the low sunlight levels. What exactly does vitamin D do to affect the blood pressure? Renin is an enzyme secreted by the kidneys that constricts the blood vessels and increases the blood pressure. Vitamin D acts by inhibiting this renin. Insulin resistance causes high blood pressure, which is why hypertension often has co-morbidity with diabetes mellitus. Vitamin D helps in improving the body's sensitivity to insulin. Calcium deposits on the arterial walls harden them and make them lose their elasticity leading to an increase in the pressure of blood flowing through them. Vitamin D helps the body to better absorb and metabolize the calcium. The role of vitamin D in strengthening bones is very clear. Though the studies have shown that people having deficiency in vitamin D tend to develop hypertension, the role of vitamin D in this case is still not very clear. Also, whether vitamin D supplements help in lowering blood pressure levels is still to be found out! But all said and done, the research findings cannot be ignored. Moreover, a morning walk is beneficial in many other ways as well! So, get up early, put on your walking shoes and say Hello to the sun! Vitamin D alone will not help you control your BP. You need to keep taking the medications along with the other dietary and life-style changes! An early morning walk is a blessing for the whole day!
A ready reckoner on obesityObesity is a condition of excessive accumulation of body fat to the point that it has adverse effects on health. People with body mass index (BMI) more than  30% are considered as obese. Indians are turning obese at an alarming rate and obesity has spiked epidemic levels in India. The causes of obesity are: Lack of exercise and low level of physical activity. Irregular and improper eating habits.  Eating a lot of junk food, high calorie food, that too, at wrong timings. Emotional factors like stress and depression. Hormonal imbalances and disorders like polycystic ovarian disease. Genetic disorders. The symptoms of obesity are: Low energy levels Shortness of  breath Disinterest in physical activities Pain in the back and joints. Obesity can lead to: Gout Hypertension Diabetes Heart diseases Sleep apnea - Breathing problems while sleeping Arthritis High cholesterol levels Obesity can be dealt with by taking following steps: Eat less and exercise more Adapt to healthy food and eating habits Avoid sedentary life; incorporate some physical activity in the daily routine Treatment of medical conditions responsible for obesity like hormonal imbalances, polycystic ovarian disease, and depression Surgeries like liposuction So ascertain your ideal weight as per Body Mass Index, and start working towards achieving it.
  Sexual Health MORE
Spice up your sex life - Aphrodisiacs at home
Famous 5 kissing crimes
Psychological impotenceSex is not just physical but just as equally mentally involved. Mental stimulation and response are responsible for arousal and overall enjoyment; and therefore any sort of psychological disturbance or mental issues like stress, tension, or anxiety can lead to psychological impotence. Stress or exhaustion are most possible explanations for psychological impotence. Depression and post-traumatic stress disorder also may result in impotence. A mental trauma of sexual or physical abuse, guilt due to sexual relationship, problems amongst partners contribute too. Confusion over one's sexual identity is also a major cause for impotence. Impotence results from underlying physical disorders, especially if the people choose to stay unaware of it. Absence of knowledge of this disorder leads to anxiety and stress building up over a period of time.  So when determining factors rule out physical causes first and then go for identifying mental causes. Psychological impotence can be sometimes situational or only with a particular partner and the treatment approach differs with the cause. Counseling works wonders in the case of psychological impotence. For example, depression or anxiety may require treatment to improve condition. Post-traumatic stress disorder or abuse needs therapy on coping skills. Sometimes simply explaining underlying cause of physical condition resulting in impotence and comfort and reassurance are sufficient. So don't hold back, share to get your mojo back!!
Painful intercourseSome of the causes affecting women can be: Going too fast, penetrating from an awkward position. Do not hesitate to tell your partner that it hurts and he needs to slow down or change position in order to make you comfortable and prevent pain. Dry vagina or lack of natural lubrication in the vagina. This dry vagina is caused due to some medications, changes at the menopause. Sometimes just increasing the time of foreplay can help vaginal lubrication. Use water-based lubricant to reduce pain. Failure to fire off. Sometimes failure of the vagina and uterus to respond to sexual arousal can lead to irritation and tenderness. The vagina may be too tight for the intercourse sometimes or the uterus may not be raised so that the penis comes in contact with the cervix during penetration. Using other penetration methods can be helpful to explore the level of arousal before engaging in intercourse. Vaginismus can be the cause of discomfort. Muscles surrounding vagina are sometimes very tight and lead to pain and intercourse to be painful. Woman can examine herself with her fingers to see if vaginal walls are tighter than normal. It can be vaginismus. Normal cause is nervousness or anxiety. It is reversible. Good foreplay before intercourse will help to relax the muscles and help lubricate. Just relaxing before the act can be helpful. Vaginal infection and inflammation due to yeast, herpes, etc. can make intercourse uncomfortable. Fabrics, creams, perfumes may cause irritation in area in some women. Avoid these. First-time sex can be a little painful. Rupture of the hymen can cause discomfort during penetration. Start slowly or begin with forms of penetration other than intercourse. Psychological pain. Sexually traumatic experiences or feelings of guilt associated with sex can make the act painful. Consult a sex therapist or psychiatrist. Discomfort during intercourse is experienced by men too, various causes affecting this outcome for men are: Tight foreskin. During first attempt at intercourse, tight foreskin will make retraction painful. After sometime, the foreskin will become loose and make intercourse comfortable. Any lesion on the penis skin can make intercourse painful. These may result from non-lubricated masturbation or rapid intercourse or STDs. The blisters due to herpes infection can make intercourse extremely painful.
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