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Weight gain and prostate cancerOne of the hormone therapies involves increasing the production of LH-RH. Luteinizing Hormone-Releasing Hormone (LH-RH) is a hormone which is produced by your body. This lessens the production of testosterone. The drug given induces the generation of this hormone. One of the side effects of this therapy is weight gain. Along with this, breast pain, hot flashes, nausea, and growth of male breast tissue might occur. Apart from hormone therapy side effects, the presence of fatigue can also stop a patient from regularly exercising, thus, resulting in gaining weight. However, it is important that this weight gain is averted as the chance of cancer returning is a possibility. You can keep your weight in check by following these tips: Ask your doctor if your hormone therapy can lead to weight gain. If you receive an affirmative answer, then ask for a diet chart to be followed. You can also keep a food and activity journal to get an idea of how your body is reacting to the treatment. Inculcate physical activity in your schedule. This will not only help to reduce fatigue, but also keep at bay the chances of becoming constipated or feeling nauseous. Medical studies have shown that cancer patients must have at least 2-1/2 hours of moderate physical exercise per week. Have about 2.5 cups of fruits and vegetables every day. Also, shift to whole grain food items. You should also consume at least a cup of legumes, for example, beans, to keep up your protein levels. It is best to opt for lean protein snacks like yogurt and chicken. You must stay adequately hydrated during your treatment. Drink about 10 to 12 glasses of water everyday. Do not consume excessive amount of sweetened beverages like coffee and cola. Have a small portion of nut and nut seeds. If you feel distressed due to the therapy, go for a massage. These have been proved to reduce anxiety and stress caused during the treatment of cancer. Most importantly, keep up with your appointments with the doctor and convey the bodily changes that you may notice. Have an optimistic outlook towards the treatment and do not repress any emotional disturbance. Weight gain in men who had been previously healthy often leads to depression regarding weight issues. Being proactive and focusing on keeping your weight under check is the key here. You could also approach a psychologist if you have been feeling low. The LH-RH therapy is also known as Androgen Deprivation Therapy (ADT). This therapy leads to a weight gain of around 9 pounds within a year of starting treatment. You can make sure that your weight is controlled by altering your lifestyle and getting adequate physical exercise everyday.
The post-delivery bluesA baby being born is cause for celebration. Especially in a country like India, where the family ties tend to be close, there is a festive atmosphere at home. However, sometimes the mothers may not share the same enthusiasm. This wave of negative emotions in the middle of what is clearly a happy occasion can be confusing for the new mother. Interestingly these feelings are not abnormal, as many new moms face postpartum depression, which is also called baby blues. It is an emotional reaction that begins a few days after delivery and lasts not more than 2 weeks. What are the symptoms of postpartum depression? Feelings of anger or irritability. Lack of interest in the baby. Lack of appetite and sleep disturbance. Crying and sadness. Irritability or hypersensitivity. Feelings of guilt, shame or hopelessness. Loss of interest, joy or pleasure in the things you used to enjoy. Possible thoughts of harming the baby or yourself. What are the causes of postpartum depression? Postpartum depression can occur due to a combination of factors. Hormonal changes: Changes in the level of hormones can leave you feeling tired, sluggish and depressed. Changes in your blood volume, blood pressure, immune system and metabolism can contribute to fatigue and mood swings. Emotional factors: Feeling overwhelmed with the new arrival in the family, and taking care of the baby day and night, may leave you sleep deprived, overexerted, and anxious. New mothers also feel that they look less attractive after pregnancy. You may feel that people around you are concerned with the baby more than you, and that you are being neglected. All these emotional factors may lead to postpartum depression. Other factors: Issues like breast feeding, financial strain, and relationship troubles can also contribute to postpartum depression. How does one deal with postpartum depression? Take complete rest and sleep for sufficient hours Spend quality time with your husband Go for healthy diet Take morning or evening walk for fresh air Try to follow yoga or other exercises Share your feelings with your husband or friends Do not overexert Join some groups for new moms Go for individual therapy or counsellors Remember, postpartum depression is not an incurable problem. It is just a temporary state of mind, which can be overcome if you are sufficiently aware of the problem.                
Ageing gracefully and happilyEverywhere we look there are constant reminders that we are growing old each passing day. There are creams that tell us that will make our wrinkles vanish and make us look younger. There are hair care products dyes that claim to cover our grey hair so that we can look and feel young. Our doctors tell us about how we have to take care of all our body parts to keep several diseases at bay in the old age! It is a rare and difficult attainment to grow old happily and gracefully. Is there anything good about old age? It doesn't seem so, going by the look of things. Here we give you 5 reasons that will make you look forward to old age! Old age is the happiest time in life: You are constantly living life to the fullest when you are young. Survival is your prime priority. You work hard to keep yourself and your family happy and financially stable. Too many responsibilities bog you down. Old age is the time when there is nothing of this sort. You are retired, free from all responsibilities. You have passed the baton to the younger lot. Now is the time to sit back and enjoy. Now is the time to relax and do the thing you always wanted to do. Imagine living with not a care in the world? That is old age for you. Old age is when the brain functions the best: It is a proven fact now. It was believed that we lose more brain cells as we age. Now it has been proven that our cognitive functions peak between the ages of 48 to 60. Old people make the wisest and toughest decisions quickly. People may call them worldly wise. Have you ever given a thought to how all the judges are old men? And how when someone says the word 'wise' the picture formed is usually of an old man with a beard? No more fashion policing: When you are young, there is a lot of stereotyping involved! Going to a board meeting, wear formals? Going for a lunch meeting, wear something that is suitable keeping in mind the place. Are you at a certain position in life? Dress accordingly! So many restrictions! Old age comes with none of this. You can wear what you please and no one will really mind! Only when you actually get to do it will you realize how much f a relief it is! Relationships improve: According to a 2011 study; married oldies are more satisfied and positive about their marriages than young couples are. Arguments involve less anger, and senior spouses show more positive emotions and affection than middle-aged couples. It's not only marriages, however, that benefit in older age. Seniors also seem to be happier with their other social relationships too. They have a smaller but closer circle of friends and gain more benefits from these close, emotional bonds. Old Age makes you feel better on the whole: You have lived life to its fullest, your kids have now flown the coop and you have seen it all. As you age, you start feeling better about things in general. You look at things more positively and make the fullest of every situation presented to you. You live in the moment and are not worried about future repercussions. Old age is a happy place to be. Look forward to aging positively.
Exercise to fight off depression in school kidsBefore concluding on the effects of different forms of exercise on children, it is important to note the distinction between fitness and exercise. Fitness encompasses most importantly a healthy lifestyle of which exercise forms a part. For this reason, when researchers examined the impact of fitness on emotional being of a child, most of them covered three main determining factors, namely the body mass index, the child's feeling about fitness, and a shuttle-run test. Depression is characterized by recurrent feelings of despair and hopelessness. The main symptoms of depression include sensations of unworthiness, dysfunctional thinking, lack of concentration, low level of sleep, anger, social isolation, crying, physical grievances like headaches which do not react to treatments, reduced interest in social activities, and thoughts on suicide. It is not necessary that every child will undergo all the symptoms. If most of the symptoms recur continuously, then it is a warning sign. The propensity towards chronic depression is higher in those who suffer from depression during childhood. A healthy lifestyle is accompanied by a range of psychological benefits. When you exercise, your body produces endorphins which stimulate positive sensations about the self. Produced by the brain, they also reduce the sensation of pain. A healthy lifestyle boosts the sleep cycle and helps in coping better with tough situations. A medical study conducted by University of Texas revealed the positive effects of physical activity on middle-school graders. It was found that there is a robust link between depression and fitness in girls. Even though boys show association, it is not explicit.  Conclusively, it was pronounced that exercise helps in reducing the chances of depression in school-going children. The best way to help your child is by introducing activities that she or he finds interesting. Initially, you might face resistance. The most important task is to communicate with your child. In the face of such resistance, you can attempt to find a hybrid therapy to reach out to your child. Apart from scheduling appointment with a child psychologist, you can also meet up with a physical health advisor. Emphasize on activities which will also help your child to meet new people. According to the Center for Disease Control and Prevention, one of the main benefits of physical activity is betterment of academic achievement and conduct in children.
Bonding with the babyIt is an immense pleasure to hold a baby in your arms, isn't it? The bonding between amotherand her baby starts within the womb itself. When the baby is born, a few parents bond with the baby within minutes. But for others this may take some time. If the baby is taking time to respond to your affections, don't worry, here are some tips to help you with the bonding. Babies respond to the mother by making sounds, grasping, smiling, or crying. Touching, holding, kissing, cuddling, talking and singing help build a bond with your child. Infants prefer a human face to any other stimuli. So face your child as much as possible. The attention span of a new born baby is quite short. Hang a colorful object on top of the pram, cradle,or cot. Your baby already likes toys of different shapes. Various reflexes develop by the fourth week after birth. These include sucking, grasping, searching for the nipple and blinking. Baby may gaze at you some time. Respond by nodding, smiling, and talking to the baby. Babies are sensitive to their surroundings. They respond to music or the phone ringing by staring at it quietly. They observe toys keenly, spot colours and become happy at times. These are heart warming moments for the parents. Father's care usually builds a protective and secured feeling in a child which he carries for life and prevents building of any unreal fears in him in later life. So dads should care for and make their babies feel secure. You love to touch your bundle of joy, right? Babies love, enjoy, and need it as well. Skin-to-skin touch helps growth and development of the child. Mom's touch soothes the baby when he is irritated. Start reading to your child. It is never too early. It helps the development of reading skills and language. Babies enjoy pictures in the book. Even if baby can't understand words, they love to hear the parents' voices. During the first few months, they understand little of it, but they are thrilled by listening to you. Have a short reading session with your child daily.Dads can try this trick to make the baby sleep. Carry her around while patting her very gently on back.
Not very chummy! Menophobia - The fear of periodsMenstruation or periods begin as female reaches puberty. This is the time when there are hormonal changes which occur in the body as nature takes the girl and makes her ready for womanhood. The onset of periods can be distressful with lots of mood swings accompanied by abdominal cramps, bloated feet as the menstrual blood flows. This is also a time when the girl needs to be comforted and educated the most, as it can be truly a terrifying experience. Normally mothers or elder women in the family ensure that they take complete care of the girl in this transition phase. For some women, their initial experience with periods may not have been particularly pleasant, causing them to actually dread those 4 days and this fear can then take the shape of a full blown phobia -Menophobia! The reason could vary. For some the pain factor could be the reason for menophobia, while for others, it could be the memory of embarrassing red stains on the clothes which could set it off. In menophobia, just before the onset of the periods, the person starts getting anticipatory anxiety and the pain which could be normal period pain, is then imagined to be ten times worse. This brings on panic attacks and feeling of utter dread which while is entirely psychological can be utterly distressful and downright crippling. Counseling can help greatly along with pain medication to manage the pain and the fear of this natural phenomenon called periods. In therapy, this is what is iterated. That menstruation is a completely natural process and if there is a fear of menstrual blood then gradually, the woman is encouraged to accept it as a natural body function which plays a major part of her being a woman.
Afraid of the dark? understand your fear and cure it!Scotophobia, more commonly known as Nycotophobia, is a psychological illness, where the patient is afraid of the dark. Children are more prone to this fear, though it does affect quite a few adults as well. The dark often represents insecurity and uncertainty to children, and it symbolizes their entrance into an unknown territory. If the children are alone during their first few encounters with darkness, the absence of parents (who exemplify safety), tends to amplify this crippling fear. While most of us do actually possess this fear in relatively small amounts, as we grow up the fear diminishes. However, there are those of us who might carry this fear of the dark into their adulthood and in such cases, the fear is usually accompanied by quite a few intricate issues. People often tend to externalize a set of conflicting feelings about a certain situation, towards something else. For instance, you might be worried about your children; but your mind may externalize this fear, via your inefficiency at work. This process is called externalization. So, when it comes to the root of your fear of darkness, it is possible that at some point in your past, you experienced something untoward, which through externalization, inculcated this fear of darkness, deep into your psyche. Evolutionary Ties to Darkness: Many scientists have pointed out that this phobia might be linked to the process of evolution. Since predators hunt for their prey at night, we might have inherited this fear of darkness from our ancestors, who believed that darkness was a space where they could be attacked by wild animals. However, recent studies have shown that  Scotophobia begins at approximately the age of two in children, and thus, it cannot be said to be innate to us. In a study done by Ryerson University involving over 90 students, it was found that people who are afraid of the dark, are more likely to be poor sleepers, than those who are not afraid of it. More interestingly, it was discovered that any kind of noise made while the people with this phobia were asleep, frightened them the most.. Symptoms of Scotophobia: The first symptoms of this fear are the resistance to visit dark places and the yearning for company when such situations arise. However, many a times adults who are suffering from this fear, do not reveal it due to the added fear of embarrassment and this, sometimes, results in outbursts of rage when they are forced to go out for an event at night, or to confront the dark under any such circumstances. A person battling this fear may experience panic attacks, sweating and trembling prior to, or while staying in the dark. The blood pressure also rises, accompanied by chest pain and lastly, a difficulty in breathing. Diagnosis of Scotophobia: In children, this fear can be easily verified by their behaviour. However, adults might require further assistance, due to their natural resistance to openly admit to such a fear. Scotophobia can be diagnosed through a comprehensive psychiatric evaluation. Following this, your psychologist would be able to give you an idea of the source of your fear as well. Pursue a course of treatment immediately after the discovery of the phobia, which will ensure a faster and more effective recovery. Treatment of Scotophobia: The process of 'desensitization' is most commonly used to help with such a phobia. In this form of treatment, the patient is slowly exposed to the object of fear, in a situation where she/he will not feel vulnerable. This is done by asking the patient to confront the dark along with another individual who symbolizes safety for him/her. This could be a parent or a friend. Night lights can also be installed to gradually reduce the fear. You may try certain breathing exercises, which will reduce the panic attacks that accompany this fear. Hypnosis has also been said to be very effective in dealing with this phobia. If your psychologist sees fit, you might be also prescribed some medicines; antidepressants are given in some cases. Joining a self-help group is also a good option, in addition to your psychological treatment.  
Good and bad calories-How do they affect weight loss?Not all calories are bad calories. Surprisingly very few people are aware that good calories are quintessential for burning fat and can rather help you in losing weight. So, it's very important to know how to differentiate between good calories and the bad ones. What is a Calorie? In scientific terms, one calorie equals to one unit of energy. When the term calorie is being used in relation to nutrition, it means consumption of energy through what you drink and eat and use of energy for carrying physical activity. Many people think that in nutritional terminology, calories are only associated with drink and food; but the truth of the matter is that everything has energy is calories. For example, since coal provides you energy it contains calories. 7,004,684,512 calories are equal to energy produced by 1-ton of coal. Coming back to weight loss, 100 calories of fiber and protein is not similar to 100 calories of a cake. This is because there are good and bad calories and much like us humans all calories are not equal. Calories are the measuring units of energy that are produced by the food once it reaches your body. This energy works on the law of physics and hence less energy intake leads to weight loss and vice versa. Varying types of Calories Different types of food provide varying calories or energy amount to the body. The analysis of a tightly scrutinized weight loss experiment has revealed that when people of two different groups were fed the same measure of calories albeit from varying food sources, the weight loss was almost similar. However, the effects of weight loss were variable; like uncontrolled emotions, cravings, hunger and more. This happened for the same reason that some calories are good and some calories are bad. Good and bad calories Sugar is a powerhouse of energy. But if you keep on eating only sugar all day long it will be suicidal. This is because; the calories present in the sugar are devoid of any nutrients and your body cannot function without the right balance of different minerals, nutrients and vitamins. Most food not only carry calories but they also constitute a complex mixture of additives, fiber and nutrients. These mixtures of varying components directly affect the leptin hormone that controls the hunger trigger in your body. These hormones tell the body to either burn the fat or store it. The process of weight loss is made complicated by the fact that biologically our body is programmed to protect the fat stores so that they can be utilized during starvation. So, the question remain, which calories should you eat to lose weight but still keep on getting the required amount of energy? Eating lean protein, healthy fats and unrefined and unprocessed carbohydrates such as fruits, beans and vegetables are the best for losing weight. Calories with more nutrients are the best The foods that do not store fat and make us eat again and again, are the ones you should eat as good calorie food. Choosing them is simple. These are the same food that humans used to eat before processed food was invented. For example; avoid using the processed whole grains and switch over to brown rice instead of the polished white rice. Also, stone-ground whole wheat, oats or quinoa bread is much better than the white bread. Replace the processed carbohydrates from your platter with whole grains and vegetables to lose weight, control hypertension and blood sugar. Use fats derived from plant sources such as olive oil or nut oil. Eat lean protein more such as chicken and fish.
Beating the weight loss plateauThere comes a stage when you stop losing any weight in spite of strict exercise and diet regimen. This is called as weight loss plateau. When calorie intake is reduced along with exercise, the energy required is obtained from stored fat which eventually leads to weight loss. This rate of weight loss slows down and eventually stops once body reaches its set point of metabolism. This set point varies from person to person. So what can you do next? Here are some easy ways to get the weighing scale budging: Modify diet pattern: Metabolism slows down with lowering calorie intake. To reset metabolism, you need to have an adequate amount of calories. This can be done by including fruits and vegetables, whole grains, and proteins in diet. More energy is needed to burn proteins than carbohydrates or fats. Eat within half an hour or hour after exercising. Add proteins and carbohydrates to diet. Sip water: Increase total water intake in a day. Drink water before, during and after exercise and throughout the day. Change the workout: Change the exercises you do daily. Muscles get accustomed to a routine workout. Switching exercises and continually challenging helps burn more fat and build lean tissue. Change the type and time or duration of exercise. Try cycling instead of running if you have been doing it for long. Running, swimming, dancing, and Pilates too are good options. Skipping and brisk walking help in burning calories too and break the plateau. In the gym, change the exercise or number of repetitions. If you have been working on machines for long, try weight training or floor exercises. Take rest: Adequate rest is essential for the body to rejuvenate. Muscles, tendons, and ligaments get slight internal and external injuries which can be healed by rest. Proper rest helps repair and regenerate the tissue and makes them strong. Make these changes and get the needle on that weighing scale to budge.
How to communicate with a patient who has a strokeThe first and the most important thing to communicate with the patient, is to give undivided attention. Give attention to his activities, gestures, his facial expressions through which he may try to communicate so his feelings could be understood. Eye contact is also important but the patient having stroke may look at you square in the eyes but he may not respond to your conversation. While communicating with the patient you should always stand in front and tune out all the other sights and sounds in the room. Maintain full silence around the patient in the room, turn down the volume of the television, radio and ask other people in the room to be silent. You may communicate with the patient by making contact by touching the hand, chin, cheek or areas which are not affected by stroke. As the side which is affected by stroke, does not have any sensations. You may communicate with the patient through his family member by telling the family member to communicate with patient by saying, "Look at my face"; through this we can gain the patient's concentration. You should always speak clearly with the patient in a normal soft volume. Express your ideas in simple terms, form simple sentences, do not use complex words. You may repeat the sentences or an important term again. For example to ask if the patient wants tea, repeat the word 'tea'. More complex thoughts can also be similarly conveyed and repeated. You may also use hand gestures with clarification like doing Hello by waving your hand or through your hand action, you may ask questions like, How are you? Are you ok? What do you want? Through this both caregiver and stroke patient can benefit. You may ask your patient to point out whatever he wants or if he needs anything. And gradually he will develop the habit of pointing the daily items like television, newspaper, remote, eyeglasses radio, drapes an uncomfortable foot, the patient can indicate any pain or headache. Through this communication we can make the patient learn, use mechanical lifts to get in and out of the bed, and with the help of the attendant by demonstrating the patient how to use it. Sometimes when the communication does not work, take a break, give it time and try again, do not get frustrated and reassure the patient that yes, he or she can do it. Good communication with the patient is very important as they cannot speak their basic wants and needs clearly. The patients suffered a stroke also have slurred speech. There is a deviation of the angle of mouth. They are mostly bed ridden and could not carry out the routine activities.
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.
Smoking causes impotence!Men who smoke heavily are twice as likely to suffer from impotence or erectile dysfunction. The link between smoking and ED has been established beyond reasonable doubt. Smoking causes a hardening of the arteries or blood vessels. For a penis to grow erect or tumescent there has to be a healthy blood supply. Now imagine the cross-section of a smoker's penis where there are plenty of blockages and hardening of the blood vessels. Can the penis then grow erect with so many hindrances to the blood? There is also an acute loss of sensitivity to the penis which is a direct contribution of smoking! Previously, alcohol was a hot favorite of the medical lobby when it came to 'impotence.' Wish smokers could say the same thing about moderate smoking! Even moderate smoking can make an existing condition of impotence worse. One could make changes to one's lifestyle and diet and curb stress to treat ED (erectile dysfunction), but all these will come to naught unless one really resolves to give up smoking permanently. Just within a few hours of kicking the butt, the body starts to repair itself. Of course, it may take longer for the blood vessels to actually undo the blockages and have a free run for the penis, but it will certainly happen, slowly and surely. Smokers may have an underlying condition of anxiety, which is made worse by nicotine, which in turn causes performance anxiety, not greatly helped by blocked blood arteries. So smoking not just makes you physically impotent, but also mentally impotent too. It is a powerful narcotic which is hateful to the body and spiteful to its salubrity. Please enroll into a 'stop smoking now' campaign with the help of friends or family. Check for any 'nicotine anonymous' programs in your neighborhood or just do it all by yourself. Otherwise, the only thing hard about your penis will be hardened arteries and lots of hard luck!
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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