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What causes male balding?They say there are 3 types of men: the ones that go bald at the top are thinkers, the ones who go bald at the back are lovers, and the ones who grow bald at both places... only think they are lovers. If pregnancy and menstruation are a female's burden, then baldness is a great inconvenience to men. Some men lose their hair in their youth and thus lose their confidence along with their hair. So what is with baldness and men? Men start having a receding hairline by the time they hit 30, though it could begin in their 20s as well. The most common type of baldness is the mid-frontal type resembling a horseshoe. Earlier it was thought that baldness is caused only by genetic factors, but apparently emotions, lifestyle and diseases also contribute largely to hair loss and baldness. This hair loss can be temporary or permanent. Some medications like anticoagulants, antidepressants, antifungal medicines, chemotherapy etc can cause baldness. Certain diseases like thyroid disease, Crohn's disease, lupus can cause hair loss and baldness. Poor nutrition is an important factor in hair loss. Vitamin and mineral deficiencies along with poor nutrition can pave the path sooner than most other things. Then there are some conditions like Alopecia Areata which cause baldness in patches -- on the head or beard. It is temporary and the hair grow back in about 6 months to 1 year. Corticosteroid injections are used to treat the condition. Air and water pollutants, environmental toxins, conventional styling products have the potential to build up on the scalp. These affect hair cuticle, cause dryness, and weaken the hair causing them to easily break off before their natural lifecycle has ended. If you notice your hairline receding more than usual, then check if you are getting enough nutrition. Exercises like the headstand and handstand send the blood rushing to the scalp and can help with hair growth. Massaging the head with warm oil helps to increase blood circulation as well. Use a shampoo that suits your hair along with a conditioner. Oil your hair overnight at least thrice a week. Keep yourself well hydrated and try vitamin C which can help arrest hair fall. Use a clean comb and ensure that you sun your scalp, as vitamin D is an essential tonic for skin, bones, teeth and even hair.    
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.                
Teenage troubles for autistic kidsTeenage brings along with it a lot of physical and psychological problems. Your body undergoes a lot of changes, the way the world looks at you is changing and you are not in the position to accept all this. Teenage is one of the most painful periods in one's life.  For an autistic child teenage can be compared to living a nightmare day in and day out. Here is a look at the problems of teenage from an autistic kid's point of view: Social Interaction The ability to interact socially is absent in autistic kids. They are loners who prefer to be left alone and undisturbed in their own worlds. Such a child is a natural target for bullying and ragging by other kids of his age group. At times even if the autistic child wants to come out and make friends, he is not able to do so due to lack of the required skills. Teenage is a period where you need at least one friend to confide in. It can be an extremely difficult phase when you are all alone. Puberty This is the dramatic time in life dilled with hormones and emotions. Your body undergoes lots of changes and you are confused about so many things. You don't know whom to ask or whom to turn to for guidance. Autistic children do not have the maturity to understand this phase. Special issues for autistic teens and sexuality include: Knowledge of physical changes in body. Knowledge of 'good' and 'bad' touch. Ability to communicate about a 'bad' touch or action. Keeping 'safe' distance from others. Handling menstrual cycles. Avoiding 'self-touch' in public. It can be a phase of emotional turmoil for the parents. They need to work closely with their child's special teachers to chalk out a plan that will be best suited to the child in handling puberty successfully. Self-help skills Simple self-help skills like hygiene can be a challenge for teenagers with autism. Improper motor skills, compliance, and sensory problems may interfere with a teen's progress. The proper training of hygiene and grooming can help to add these elements into the daily routine. The right approach is to simplify each task into simple small steps. The positive reward system is a great source of encouragement, as positive motivation always help the teenagers. Higher Functions Autistic teenagers are socially awkward. They lack the power to comprehend and process complex social cues which includes sarcasm, body language, humor, emotional responses and facial expressions. What complicates the problem is that the autistic child lacks empathy and hence may appear rude. Such kids are likely to be teased a lot in school settings.
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.
Cleanliness - A clean body, clean mindPhysical Benefits: Killing of Germs: Disinfecting your living area allows negligible scope for breeding and spreading of germs and bacteria. Though not visible to your eyes, many of these can cause severe illnesses. Prevention of Food Contamination: Clean cooking utensils and counter tops allow for low risk for contamination of food. The parts of the utensils which have come in contact with fish, raw meat, or eggs are recommended to be washed with hot water and soap. Make sure you wash your hands to avoid spreading of any bacteria in your house.  Keeps Illnesses and Allergies at Bay: Many allergies could be caused due to dirty mattresses, carpets, sheets, walls, and furniture. In order to keep away mold, dust mites, cobwebs, and mildew, make sure you dust, mop, and vacuum the house on a regular basis. The sheets should be washed at least once a week with hot water and detergent. Floors and walls, wardrobes, and refrigerator should be cleaned using disinfectant sprays up to 2 to 3 times per month. Thoroughly clean your carpet and upholstery at regular intervals. Psychological Benefits: Association of Non-Cleanliness with Moral Lapse: In a review by Current Directions in Psychological Science, it has been found that physical cleanliness does not only physically benefit a being, it also results in weighing the person on a moral radar. When we perceive a physical contamination, we respond in the same way as we would in case of an act of moral disobedience. This response includes repulsion and disgust accompanied by their behavioural components like scowling and frowning. Sense of Accomplishment: Those who clean their house and living space have been found to have a consequent sense of accomplishment that adds to the way one feels about oneself. Clarity and Organization of Thoughts: It has been discovered that those living in a clean and neat environment tend to have a greater capacity to think than those who live in a messy and unclean atmosphere. Proactive Sanitation Teaching for Children: Start with your own home. A child emulates its parents, and if the parents practice cleanliness as part of their lives, children would notice and follow suit. Children tend to connect who they are with their home environment and as they grow up they ensure that such a cleanliness of their world around is maintained.  towards their immediate surroundings, thus ensuring that they do not contribute towards pollution and environmental degradation, at least on an individual level.
Communicate to strengthen the family tiesA family that talks to each other stays together. Sounds easy? But how often does your family sit down together in the week to spend time with each other? How about breakfasts and dinners? Are you all able to match your meal times or are you catching each other by the end of the coats in the fast paced world that has us spinning us on our heels constantly? As the family members run in and out of the house, like in a hotel, engulfed in their daily routines they slowly start drifting away from each other. Somewhere pushed to the depths of the heart are old connections and affections with the family. Ideal conversations during childhood, encouragements received during tough times, sibling squabbles in adolescence and many a wonderful memories tug at the heart keeping the family from disintegrating altogether. On the contrary, improper communication and bottled feelings singe the heart in such circumstances and lead to the tumbling of the family ecosystem. Understanding how to build effective communication within the family is important as it helps build a stronger, inseparable family. Here are some effective practices: Communicate Frequently:With the limited time that you have with your family, make communication a common and frequent activity.  While traveling in the car, during meal times, replace TV time with talking, talk to your young ones at bedtime. Keep designated time for informal family meetings and encourage conversations among the family members. Keep the cell phones and laptops in the other room when the whole family is sitting together. Communicate Clearly and Directly:Develop an environment where the family members feel okay to communicate clearly and directly. Allow them to express their thoughts and feelings without having to mask and filter them. This is important in a parent-child relationship and sibling-sibling relationship. It also helps build confidence, family intimacy and bonding among the family members. On the other hand, veiled, indirect or vague communication is ineffective and harmful as it increases confusion and communication gaps. Active Listening:Open and free communication flows only when it is received well and the other person's perspective is acknowledged and respected. Active listening is the cornerstone of effective communication. Whether listening to your partner or child, it is necessary to pay attention to not just the words but tell-tale signs in the tone of communication and non-verbal messages too. Nodding of the head, or words of acknowledgment like, "I understand" make the other person feel that what they are saying is valued and received. Asking questions and requesting clarifications for the parts of the message you do not understand is a very important part of active listening. Trust and Honesty:Only when the family members feel that they can trust each other, can they communicate honestly. Trust is the key for strong familial relationships. Trust is propagated through openness and honesty. Understanding the Individual:The way each individual of the family feels and communicates is different. The way you communicate with the different family members should vary accordingly. Especially in case of young children, as their maturity levels are different than the young adults and adults in the family. The unspoken messages:Not everything might be said in words. Learning to read non-verbal communication such as expressions and body language are very important in understanding the entire message being conveyed to you or the parts being held back. Stay Positive:Many complications and problems between family members can be avoided or solved by effective communication. When dealing with undesired or negative situations, it is important that the words and tonality of the communication is positive. Avoid engaging in negative communication like criticism, defensiveness or contempt. Such negative communication patterns discourage communication.Communication is essential to successful family functioning. Taking inventory of how well the family is doing and readjusting course and practices will help improve the family environment and build a happy family that shares openly and honestly with each other.
5 Muscle building smoothiesProtein is highly important for muscle building as it repairs the muscles and help in their rapid recovery after a workout. That is why most of the trainers recommend taking protein smoothies after workouts. Generally, banana and peanut butter alternatively, are used to add the protein content to the smoothies. Apart from these, Chocolate is a hot favourite as well. But if these do get boring, here are some smoothie ideas, only for you. Hot Cocoa (bed-time and post workout) Ingredients: 1-cup milk (fat-free), 1 scoop whey protein chocolate, 1 packet Swiss Miss Diet hot Cocoa and ½-cup cottage cheese (low fat). Recipe Heat the milk and just when it gets to the boiling point, blend it in the blender with the protein, cottage cheese and cocoa until smooth. Ensure that the mixture has mixed well. This protein smoothie can be taken just before bedtime as well, because the cottage cheese contains slow digesting proteins that are great for overnight muscle repairing. Each glass of the Hot Cocoa smoothie contains: Calories-275 Protein-44 gms Carbs-20 gms Fat-1 gm Fiber-0gm Root Beer Float (post-workout) Ingredients: 1 scoop vanilla flavored whey protein, ½ cup vanilla yoghurt (fat free(, 1 scoop vanilla casein protein and 1 ½ cup root beer Recipe In a bowl mix all the protein powders into the yogurt slowly and stir well to avoid clumps. Now, pour the root beer in a large beer glass and add this mixture of yoghurt carefully, without stirring. Since the root beer starts carbonation process, the shake becomes quite frothy without having to use a blender for mixing. Each large glass of the Root Beer Float smoothie contains: Calories-443 Protein-48gms Carbs-61 gms Fat-1 gm Fiber-1 gm Post workout or pre-workout smoothies provide the necessary protein to the body that contributes in rapid muscle recovery and growth. Peach Cobbler (pre-workout) Ingredients: 1-cup water, ½ can of sliced peaches with juice, 1 scoop vanilla whey and 1 packet Quakers Instant Oatmeal (lower sugar maple and brown sugar) Recipe Mix all the ingredients in a blender and serve. Use an immersion blender for this one, to get a finely mixed smoothie. Each glass of the Peach Cobbler smoothie contains: Calories-305 Protein-24 gms Carbs-49 gms Fat- 2 gms Fiber-3 gms Orange Creamsicle (pre-workout) Ingredients: 1-cup orange juice, ½ cup fat-free yoghurt (vanilla flavor) and 1 scoop vanilla whey protein Recipe Mix all the ingredients in the blender and enjoy your smoothie. Ensure that you use real orange juice and not the flavored orange drinks for this one to get the desired result. One glass of the Orange Creamsicle smoothie contains: Calories-280 Protein-27gms Carbs-43 gms Fat-1 gm Fiber-2 gms Chocolate Almond Brownie (pre workout or early morning) Ingredients: 1 cup milk (fat-free), ¼ cup almonds (chopped), ½ Clif brownie bar (chocolate flavor-chopped finely) and 1 scoop of chocolate flavored whey protein Recipe Mix the milk and the flavored protein in the blender and serve with almonds and Clif bar topping. Use a spoon as you will be eating as well as drinking the shake, because the almonds and the bar chips can settle to the bottom. One glass of this Chocolate Almond Brownie smoothie contains: Calories -457 Protein-39 gms Carbs-41 gms Fat-17 gms Fiber-8 gms
21 foods for a healthy heartFollowing is a list of heart-healthy food substances: Garlic: Did you ever think that the commonly available garlic in your kitchen can be heart healthy? It may be smelly for some, but for the heart it is a soothing substance. Garlic is known to control blood pressure, serum triglyceride level & cholesterol level. Carrot: Carrots, though taste sweet, have the ability to control blood sugar levels because of high level of antioxidants in them. So include carrots in your diet, especially in salads. Orange: This juicy fruit has cholesterol-lowering ability because of fibre pectin in it and also helps control blood pressure. Almonds: Though all nuts are believed to be nutritious, almonds are considered to be heart healthy. Almonds are rich in vitamin E, calcium, plant sterols, fibre and antioxidants. Almonds help in lowering LDL cholesterol and reducing risk of diabetes. Walnuts: Walnuts are rich in omega 3 fatty acids, monounsaturated fats which help in lowering cholesterol levels.  Oatmeal: Oats are very healthy & help in lowering the bad LDL cholesterol. You can have one bowl of oatmeal mixed in milk along with nuts as breakfast. Flaxseed: This honey coloured shiny seeds contain substances which are heart healthy, such as lignans, ALA and omega 3 fatty acids. It helps in lowering cholesterol level and controlling diabetes. Tofu: It is a type of soybean protein which can be replaced with paneer. Tofu is rich in fibre and polyunsaturated fats which prevent clogging of arteries.  Barley: The fibre in barley is believed to lower cholesterol and blood glucose levels.  Tuna fish: Tuna fish is rich in omega 3 fatty acids which helps in lowering cholesterol levels.  Salmon: It is very good for heart as it is rich in omega 3, EPA and DHA. It lowers and reduces the risk of inflammation in arteries. It is also believed to maintain the ratio of good cholesterol to bad cholesterol. Red wine: Red wine contains catechins and resveratrol, good for heart health.  Black beans: They are a rich source of magnesium which helps in lowering blood pressure. It also contains folate, antioxidants and fibre which is helpful in controlling blood sugar and cholesterol levels. Fresh herbs: If you are hypertensive and want to control your salt intake then try using fresh herbs as a substitute for salt. It also contains antioxidants which are good for heart. Herbs include rosemary, sage, oregano and thyme. Extra virgin olive oil: This is rich in heart-healthy polyphenols & monounsaturated fats. As it's very costly you can use it as a topping for bread or salad. Sweet potatoes: White potatoes are believed to increase glycemic index so you can replace them with sweet potatoes. It is heart healthy as it has low glycemic index and also contains fibre, vitamin A and lycopene. Low fat yoghurt: You can include this in your breakfast safely as it contains calcium & potassium which helps in lowering blood pressure. Dried cherries: They are rich in anthocyanins and antioxidants which help in neutralizing the action of enzymes which cause plaque formation. In winter you should opt for strawberries, blueberries for a healthy heart. Cayenne chili pepper: Your blood sugar normally increases post a meal. By sprinkling cayenne chili pepper over your food can help preventing insulin level spike post meals. Hot cocoa: Coffee helps in patients with type 2 diabetes. Hot cocoa contains antioxidants helpful for heart. Kosher salt:  This is very beneficial for heart patients as it contains half the amount of sodium as compared to table salt and thus helps in controlling high blood pressure.
A guide to earwax impactionBiologically, the earwax which builds up over time moves through the ear canal from movement caused by chewing or other jaw motions. It is also extricated through the inside-out motion of the skin of the ear canal - it reaches the outer ear and peels away. The cerumen is produced in the outer regions of the ear and not in the inner recesses. Earwax impaction refers to the condition where the ear wax builds up to such an extent or in such a manner that it causes discomfort to the entire body. In many cases, earwax impaction occurs when patients use cotton swabs or safety pins to clean their ears, only causing the wax to drop deeper into the ears. The main symptoms of earwax impaction include difficulty in hearing, faintness, ache in the ear, foul smell in the ear region, ringing or sound in the ear (also known as tinnitus), a sensation of fullness in the ear, and lastly, discharge from the affected ear. The most vulnerable groups for this condition include those who use hearing aids or ear plugs, elderly people, and those who insert cotton swabs or other items into their ears, as well as those who have an odd ear shape which could negatively affect the discharge of the earwax and those suffering from development incapacities. Did you know that one of the most common methods used by people to clear excessive earwax is ear candling where a candle (in shape of a cone) is placed inside the ear canal and set alight to warm up and remove the wax? This is one of the most dangerous methods causing burns, worsened blocks, and damaged eardrums; this should be clearly avoided. The diagnosis of this condition can be done by an ear specialist using an instrument called otoscope. Earwax impaction is treated in many ways. While at home, you could try to clean the outer region of the ear by wiping with a cloth, the physician could irrigate or syringe the ear to wash out the ear canal with saline. This procedure is generally done once the wax has been softened by the use of cerumenolytic solutions aimed at dissolving the wax like mineral oil, peroxide-based ear drops, and hydrogen peroxide. Physicians also use special instruments to remove the built-up earwax like forceps, cerumen spoon, and suction tool. The best way to prevent cerumen impaction is by not inserting anything into the ears to clean it up. Cotton swabs should only be used in the outer part of the ear. In case you feel that the buildup is regular, then you can fix an annual appointment with your physician for cerumen removal.
Some tips to prevent night blindnessHere are some foods and eating tips, which will help improve vision and prevent night blindness: Eat dark green leafy vegetables like spinach and collards. These contain high amount of lutein and zeaxanthin, the nutrients for healthy eyes. Do not smoke. A glass of red wine daily is fine but drinking is not. Stay away from hydrogenated oils, refined carbohydrates and sugars in excess. Always wear sunglasses while going out in bright light to avoid potential sun damage to eyes.  Amber and grey-coloured lenses are effective against ultraviolet rays. See an eye specialist and get prescription glasses for driving at night, if required. Do not ride in dim light at night and see if you can postpone the work until next day. Even good lighting conditions at night even in a big city, can be troublesome to someone with night blindness. Vitamin A rich foods like spinach, carrot, papaya, broccoli, and mangoes should be added to your daily diet. Fish oil is a great source of vitamin A. Cod-liver oil is used as medicine too. Some wild plants are said to be rich in vitamin Abut they are seasonal, available in small quantities and there isn't much known about them. Beans are another fairly common source of vitamin A. These are consumed especially during autumn. Eggs are a good source of vitamin A. Eat eggs daily. People with high cholesterol should, however, limit their egg intake. Hot pepper is contains vitamin A too, but the preservation method, sun-drying, decreases the vitamin A content. Carrots are another good source. They are high in vitamin A and arenot expensive as well.
Your questions about contraception, answeredFew couples want to have babies as soon as they are married. Most want to enjoy their sex life without having to worry about conceiving a child in the process. If you are in this group, then here are answers to the most commonly asked questions about contraception. What is contraception? Contraceptionis use of various methods to control and prevent the pregnancy. It allows you to choose when you want to have a baby. What are the various methods of contraception? There are two main methods. Temporary contraception: Caps, combined pills, male condoms, female condoms, contraceptive implant, contraceptive injection, contraceptive patch, diaphragms, intrauterine device (IUD), intrauterine system (IUS), natural family planning, progesteron-only pill, vaginal ring. Permanent contraception: Female sterilisation(tubectomy), Male sterilisation (vasectomy). No contraceptive is 100% reliable and some can have side effects. Find out about all the methods listed here, so you can decide which method is right for you. How soon can I conceiveafter stopping the birth control pills? It is difficult to predict exactly how long it will take for a woman to start ovulating again. Some women are fertile as soon as the pills are stopped and others might take couple of months. Once the periods return and are normalised with normal ovulation, you can conceive a child. What if my period doesn't resume after I stop taking oral contraception pills? If you don't get your periods for several months, you may have what's known as post pill amenorrhea. The pill prevents your body from making hormones involved in ovulation and menstruation. When you stop taking the pill, it can take some time for your body to return to normal production of these hormones. Normally, periods should start again within three months of stopping the pill. But some women, especially those who took the pill to regulate their menstrual cycles, may not have periods for many months. If you don't have a period within three months, take a pregnancy test to make sure you're not pregnant, and then see your doctor.
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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