My Uncle's Story of Defeat....

Stories hadn't moved me to an edge for some time now. And then I met my uncle, a very close relative. I surprisingly hadn't heard his complete story till date, although people jibed bits of their own versions.

It was the story of his youth, of fairytale success & crumbling demise of dreams. I knew footballers & musicians who plummeted to glorious fame and spiralled into dark vanquish. But his story was almost my own, of our own family, of my cousins born to him...

I still remember a photo of him in khaki green Army uniform, holding a red headshield right after landing from a helicopter. He looked no less than a protagonist from a romantic english novel,  his life no less than fiction, like undulating seawaves.

Since early childhood, studies weren't his expertise. But he was gifted. He played volleyball & was exceptionally phenomenal at it. He played under clubs. People back home in Gorkha, knew him for his game.

He was perhaps eighteen when he entered Kathmandu, stepping in his elder brother's shoes, who was already a government official. Goverment service was prestigious, highly revered and acclaimed. My uncle had similar big dreams. Given his extraordinary skills, he was offered an army position. He enrolled in sports quota. He had only two hours of service per day
Unlike fellow cadres, he was exempted of arduous army rountine. Other cadres were vexed of the liberty he was granted.

In his glory days, he never lost a game. And that picture of khaki dress with red headshield was taken in one such sunny day....

He was paid very well both by the army and his club. People knew him. No one forgot his name after watching his game. He had the same name as our late King. And he played like one.

Times were promising. And someone advised him to join a bank job. Those days, government and bank jobs were prized. He initially declined but since his army trainings were only two hours a day, he had abundant time for a fulltime job. Little did he know, that it was the herald of an ominous downfall...

He was juggling two jobs, and still playing well when he met another player Hari. Hari was a big bull from Kathmandu valley and reigned volleyball arena of Patan.

He met his nemesis.

Their egoes wrestled, both claiming the title over some verbal spat. The challenge was very serious for both. One afternoon, they confronted each other in a volleyball match.

Like every other time, my uncle won!!

But that defeat stirred fire in Hari's soul. His ego collapsed and he seeked revenge. As they say, you need only one matchstick to set an entire stockpile of straw on fire. Hari was a snowball of venegeance...

He found about my uncle's jobs through some dissatisfied fellow cadres in the army. Someone filed a complaint that he was working two jobs. My uncle didn't know he could be punished for taking dual jobs simultaneously. His knightly castle of armors, badges, stars and brooches suddenly fell apart. He lost both jobs, was fined heavily and even threatened to be jailed. He couldn't play from his club... One angry defeated volleyballer ruined his reputation as well as life.

After some time, army offered his position back as a sportsman. But his sportsmanship spirit was trampled. He was terrified. He succumbed to the illfated twist of time. Too many things changed. Only he can narrate the hailstorm of emotional rollercoster he experienced.

Days months and years passed in unemployment. He found solace in alcohol. His wife and children suffered heavily with and because of him. Children missed schools due to unpaid dues, wife worked through odd jobs to make ends meet and he lost his identity even in front of his family. 

If only he had lost that one game. If only Hari had won. Even Hari perhaps wasn't aware that an act of wrath would devastate many lives. It wasn't my uncle's fault. He was extraordinarily blessed, but with a different fate.....

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So much respect for this man who would've otherwise represented Nepal in International platform. He would've been an Army Major now... and his talented kids would have had a different life!


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Doctors for Society or versus them??

I feel very sad about this bilateral pull between medical fraternity & consumer right advocates. I want to start with my small story. I clarify beforehand that me & my story is just the tip of the iceberg, in terms of medical scenario in Nepal.

I am a married, female, doctor, who lives with her in-laws, with my two kids. Please read about my obligations in between the lines. And I went to China at 6th month of 2nd pregnancy all alone, to a city where I didn't know anyone before, only to learn something called Fat graft. It was something new & something I really really wanted to learn. I chose to go there in such a vulnerable stage of pregnancy because I knew, if I didn't take that opportunity, I probably wouldn't get a second chance.

This is the state of learning or training opportunities in Nepal. I cannot imagine  hardships faced by thousands others, who live in foreign countries for years before completing eight grueling years of medical education until MD degree. And despite that, these same thousands of doctors are working day & night, with monthly income similar to or even less than that of clothing stores, wholesale vendors or slaughter houses, leave aside fashion boutiques, parlors, restaurants, etc. In the United Kingdom, junior doctors, took to the streets, to increase remunerations in the past. In Nepal, if we did the same by talking about wages, it would trigger another moral debate and catch meaty headlines in our newspapers.

Before reinforcing "blind-folded" legal system, create opportunities, scholarships, trainings, promote research, grants. Make doctors resourceful, trained and experts. Create environment for growth & positivity instead of making doctors hunker down for justice. We are breeding a society of distrust, of malice, threat & fury. If patients are consumers, then doctors must be goods that can be bought, things, or materials. I don't understand how to bridge this huge loop hole between doctors & patients.

Yes we are moms!

Motherhood, so sacred and powerful.... yet the world has so little time to glorify it. I cannot speak for all but I deeply admire all women who become mothers. As routine as it may seem, every woman has risked her life and body to nurture another being.... a boy or a girl, both loved and nourished unaminously, before either is received partially by this world. What a pity that a girl child is still belittled, a pregnant woman is still judged, disparaging their worth at work, devalued coz their time is divided between work and child.  The world is blurring into emotionless incompassionate emoticons, where new beings find themselves in the lap of babysitters, because the world couldn't spare their moms at work. This subconcious shift to workaholic robotics, scares me. As a mother of two, a boy and a girl, I love them both. As about my work, its my third child, I love it almost obsessively. But how to find that balance, is complicated. More than often, I struggle to meet two full time jobs. I cannot accomplish both, without pushing myself beyond nerve-wrecking limits.

Another painful truth, moms are again judged insensibly for their bodily changes, prompting them to despise the mirror. This social media whim, singing tales of reverence of zero-sized moms, is inflicting grave hazards on the minds of the young. 

Motherhood is so so beautiful, so divine.. no Shakespeare could scribble words of wisdom about it... coz he is a man. Only that woman, can jot down this celestial feeling. But alas! she's been busy rearing the new one. Thats why there is so less written about it, while there are volumes about another kind of love. Man and woman might have flimsy, superfluous or momentary glimpses of fleeting joy. Parenting is such sturdy feeling with robust roots, that won't wither with time. Its like that untainted lake, that doesn't shrink like a spring river. My deepest gratitude to all women, who are mothers, are reeling thru two full time jobs and finding joys to rejoice and recapitulate thru their lifetime.

Pollution in Kathmandu and brunt on our skin

Unabated pollution and deteriorating air quality of Kathmandu has been in news for all the wrong reasons lately. Due to rapid urbanization, people from all over the country throng to the capital for of education, employment, entrepreneurship etc. With annual population growth rate of 4.7% and motorization rate of 12%, Kathmandu has fast become overpopulated as well as polluted. Contributors of environmental pollution are vehicle emission, open air waste burning, industrial smog, brick kiln smoke, river sewage, construction work, etc. Scarcity of natural sinks such as forests, ponds, grassland and greenery has catapulted this damage in the valley.

In 2017, Kathmandu ranked as 5th most polluted city in the world according to Pollution index survey. In 2018, Environment Performance Index(EPI) had Nepal at the bottom among 180 countries in the survey. EPI was measured considering various indicators such as household solid fuels, sanitation, heavy metal and lead exposure, air quality, water quality, etc. Air quality of Nepal was worse than its neighbouring countries India, China, Bangladesh, etc. Ultraviolet Index (UVI) of major cities such as Kathmandu and P0khara are usually at the worst daily, with scores of 9-10 every day. UV Index depends on ozone layer, cloud cover, environmental pollutants, etc. Pollutants in the air are nitrogen oxide, sulfur dioxide, carbon monoxide, particulate matter smaller than 2. 5 Microns(PM2.5), ground level ozone, hydrocarbons, methane, etc. Amount of particulate matter in the air (PM2.5) has reached more than four times that of WHO guidelines in Kathmandu.

So what are the health implications of such chemicals, indices and scores? Pollution is a major health hazard causing asthma respiratory difficulties, heart disease and cancers. WHO has reported death rate of 0.036% from air pollution in Nepal. Globally, more and more researches are attributed to links between pollution and health. In the same realm, skin health is hugely impacted by environmental pollution.

Skin is the largest and outermost organ of the body which acts as a barrier against external harm. It is the first line of defense that fights these chemicals, but ultimately succumbs to their detrimental effects in long term. Skin, hair and oil glands bear the brunt of environmental pollutants, which get absorbed into skin directly or indirectly, causing oxidative stress and inflammation.  Many studies show that skin quality is altered, leading to dry, rough, dull and reactive skin that has redness, itching, burning and stinging. Content of the skin changes. Major studies in Shanghai and Mexico showed decrease in vitamin C, Vitamin E, squalene and linolenic acid content. Pores get clogged causing acne. Decrease in oiliness of skin makes it dry and easily attacked by allergens leading to eczema, itching, sun allergy and rashes. Gases such as nitrous oxide coming from vehicle emission cause pigmentation and black spots. Increased humidity and temperature leads to excessive sweating, clothing dermatitis and flexural dermatitis. Environmental factors also trigger chronic skin diseases such as psoriasis and atopy. Interaction of sunlight with different pollutants cause pigmented spot, keratosis and skin cancers.  UV irradiation coming from the sun can have many effects on skin, most of which are harmful. UV rays reach the earth surface at various intensity during different time of the day and seasons. Compound effect of UV irradiation and toxic gases in atmosphere increase many skin diseases.

Depletion of ozone layer in atmosphere is another imminent threat. Photochemical smog, supersonic aircrafts and gases deplete ozone layer in the sky, increasing UV rays reaching earth surface. For every 1% decrease in ozone layer, there is 2% in UVB intensity and 2% increase in skin cancers.   

Cumulative effect of the pollutants, UV radiation and ozone layer depletion amount to an array of skin diseases that are exponentially rising. Hence urgent measures to curb the pollution and environmental damage in Kathmandu is of paramount importance.

Can we do anything to save ourselves and save our skin from the premature uninvited turmoil?? Skin is a large organ and it isn’t possible to completely cover all areas of skin. Wearing full sleeves can curb the direct exposure to some extent. Since these pollutants get absorbed through exposed skin, washing our face, hands and feet should be a regime. While outside, wearing protective moisturizers and sunscreen  act as barrier as well as fight sundamage. These products form films on the surface of skin and protect from instant damage but not long term protection. A medical study has revealed that Dead Sea minerals rich water (DSW) and Pollustop creams attenuates damage by UVB. They act as physical barrier and protect against carbon and heavy metals induced damage. But they are not readily available in common cosmetic market. Besides these, minimal endeavors can be done on personal front to control health implications of pollution. 

In summary, impact of global warming, pollution and sun damge can be seen on skin as pimples, sunallergy, rashes in short term while wrinkles and cancer in the long run.

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Food Allergy: What are problem foods??

Food allergy is on the rise, and someone with food allergy can present to a skin specialist, physician, child specialist and sometimes even a surgeon. Urbanization, environmental pollution, promoting caesarian delivery, changing food habits, etc. contribute to sharp rise in food allergy in recent past. Being a less discussed entity, patient might be unaware of the actual cause of this distressing health issue.


What is food allergy!
Food allergy is an abnormal reaction to food, triggered by our immune system. Immune system is our body’s defense mechanism against harmful threats such as bacteria, viruses, etc. When this defense system reacts against certain food components, it manifests as allergy. Common symptoms of food allergy are stomach upset, pain abdomen, itchy skin rash, blood in stool, diarrhea, difficulty breathing, swelling of face, unexplained fatigue, irritability, etc.  Symptoms of food allergy usually begins in childhood, but can also start later in life.

There are range of delayed onset food allergies that appear as late as one week after food intake. It is difficult to point at the triggering agent in such situations. Moreover, some people show symptoms without an actual allergy. It is due to intolerance to certain food components. For example, intolerance to lactose component in milk, manifests as diarrhea within few hours of milk consumption. Also, some foods directly produce chemicals such as histamine, mimicking symptoms of allergy. Foods such as wine and pickles cause itchy mouth, sneezing or difficulty breathing promptly. This reaction is dependent on amount ingested. This is not exactly food allergy. Your doctor will be able to tell you precisely.


Foods associated with allergy
Common food allergens in our circumstance are cow milk, egg white, peanuts, fish, wheat, soy bean, dairy products such as cheese, etc. Other allergens are raw fruits and vegetables, tomatoes, chocolate, legumes, lemon, etc. Some foods such as meat, vegetables and fruits can be rendered harmless via cooking, because their allergenic components are destroyed by cooking. Food products such as preservatives, colorants, flavor enhancers such as cinnamon, menthol, vanilla, food additives, wine, dried fruits, pickles, strawberry, etc can directly stimulate symptoms similar to food allergy.


Who gets food allergy??
Small infants and children are more prone to food allergy. Some foods such as cow milk and egg white cause specific symptoms from early childhood. Early introduction of solid foods or formula milk products before six months of life has been associated with development of allergy. Children with history of allergy in family members are at more risk.
Adults can also commonly develop specific food allergies later on.
Generally, someone with one food allergy might also have other food sensitivity. Having said that, all potential food allergens do not cause symptoms in everyone.


COW MILK PROTEIN ALLERGY

Cow milk protein allergy is common in developed world, while it is rising in our part of the globe. It is not always diagnosed as we do not suspect food allergy frequently in our scenario.

It usually begins within first year of life, and occurs within a week of introducing foods containing cow milk protein. Children typically present to a doctor with diarrhea, vomiting, bad stomach ache or blood in stool within few hours of consuming cow milk or formula feed. Other symptoms are crying inconsolably, irritability, skin allergies, such as itchy hives and eczema, swelling of eyes and lips, shortness of breath, etc.

Children who are not exclusively breastfed for at least first four months of life are at more risk. Components of cow milk protein are present in common formula feeds available in the market, affecting children who are put on these feeds. Cow milk protein is also present in skimmed milk, butter, curds, cheese, yogurt, beverages, burgers, etc. Older children may have eating difficulties, avoiding certain foods, poor weight gain, etc. Do not force your child to eat foods he denies or refuses consistently. Children are often unable to express the discomfort or symptoms accurately.

A doctor makes a diagnosis based on patient’s complaint, previous episodes and careful examination of the patient. Tests such as skin prick tests, specific blood tests (IgE antibodies) help in confirming cow milk protein allergy. These tests are available in few hospitals and laboratories in Nepal. It is not always mandatory to have tests for the diagnosis.

Treatment is avoidance of the food trigger. Exclusive breastfeeding for at least 4 months, and preferably 6 months seem to be protective. In circumstances where exclusive breastfeeding is not possible, it is important to choose formula feed vigilantly. Common formula feeds are not recommended. Partially hydrolyzed infant formula or “hypoallergenic” formula milk should be chosen. Soy formula or litho can be a reassuring alternative in our scenario. However, 10-30% children with cow milk protein allergy also cross react to soy proteins. Replacing cow milk with goat or sheep milk isn’t recommended. On brighter side, cow milk protein allergy generally improves by 6 years of age. But there is no specific age for reintroducing cow milk in diet.

Other food allergies common in childhood are egg white and peanut allergy. While peanut allergy is a menace, children might develop tolerance to egg whites similar to cow milk. Doctors usually advice patients to avoid problem foods, however, a recent study showed that exposing young child with small amounts of culprit foods, eg peanuts, help them develop tolerance to that specific allergenic food.
Another aspect of food allergy is whether we can predict them before they happen. The answer is no, except in few instances, where parents or other family members have similar problems. Children with dry skin, reactive skin and asthma have increased likelihood of developing allergies as adults. But no one can exactly anticipate it before it happens. Parents have to be alert and cautiously follow their child’s relevant symptoms in relation with food intake.
Hence, food allergy is less commonly discussed, not so uncommon health problem.

Birth of a girl child...

After five beautiful years with my daughter, I was in operating room again, ready to bring my second borne into this bittersweet world.
He was borne at fifteen hundred hours, as the day was exhausting into soothing twilight...  An anesthesist friend brought him to me, as I lay in OT table. I noticed his nose, similar to mine. I smiled. My pediatrician husband then took charge of the baby.

I was taken to postoperative room for the night. Two patients were already there, I was placed on the third bed. I was well acquainted with pain, from my previous caesarian section. As a doctor, I also knew I could comfortably rely on analgesics.  However, other two ladies were winching, carefully fidgeting, so that any movement wouldn't throb their raw wounds.

Midnight passed. I was dozing off to sedative-induced drowsy sleep, when a wheeler rolled in. It carried a teenage newmom, after emergency operation. Her babygirl was put to her side. Some hospitals bring baby to mother's side immediately after operation, while others wait 24hours.

As the newborn started crying out of hunger, her mother didn't seem keen to feed her. At first, I thought it was probably because of pain and apprehension immediately atfer operation. Her mother in law was summoned for help. It was then, that I was astonished beyond words. Both women started cursing the newborn. They were so upset that it was a girlchild. They called her names, in harsh cruel offensive language. Mother-in-law angrily vanished out of the room into the darkness, blabbering all the while..... I sank in my bed in horrid disbelief. I found it brutal, close to barbarious. But it was kind of routine for caretaking nurses and obstetric staffs. They didn't react.

The baby was still howling, unaware of the harrowing cruel world she just came into. All she wanted... was her mom's suckle and granny's snuggle or her father rocking her to sleep.... :(

Nursing staff fetched the father in, hoping he could assist the new mom. This first time father was just a boy, perhaps in his late teens. He gently asked his wife to feed the child, but she started ranting again, vehemently. He seemed more level headed than both the ladies. He sat silently for few minutes. It seemed he wanted to help but had no idea what nursing or breastfeeding meant. Their first born was wailing all the time. But her mom was deafmuted to maternal emotions. After few requests, he gave up attempts of coaxing his wife and walked out of the room.

Meanwhile, baby seemed exhausted from crying. Her shrill screams became whimpers and then periodic sobs. Morning was less than hours away when she sobbed herself to sleep.

As the dawn pierced the gloomy dark night, bringing in pale yellow rays through the curtains, I woke up. To my surprise, my fellow mate was feeding her child. Even the granny had mellowed down a bit. She was spreading the light meal hospital allowed for the patient. It was as if the soft morning breeze had lightened their hearts. I understood they had finally amicably accepted the birth of a girl child. Then I heard the teenage mom talk to her child, a hint of tenderness in her voice. Love had sprouted amid the bitterness, anxiety and laments....

My heart crushed for them all. They were mere victims of a mindset, of social preference for a male child.

Why I didn't gain weight??

Everyone has been asking why I haven't gained weight after delivery or during pregnancy.
Its actually a long story, that I didn't wanna whine about in social media. Yes, our lives aren't exactly what we potray in facebook n instagram. We don't look as good as our pictures. I have dark circles, bags and perhaps much more. I haven't slept more than two hours in one stretch of a time in last two months, coz that's how frequently I need to feed my newborn.
Coming back to weight gain, my pregnancy and puerperium were more stormy than I ever imagined.
Pregnancy pukes were so horrible, I landed in ER and took IV drips. I had ketonuria, ie frequent vomiting made me pass glucose in urine. I had hyperemesis for first 4 months.
 During last 3 months, I had severe iron deficiency n anemia. In my final month, I was bedridden coz of my preexisting illness, fibromyalgia. I couldnt eat, I couldnt sleep.

At 36 weekd, a random ultrasound showed that my uterus was just about to erupt or dehisce. Uterine wall thickness was less than 4 mm.  I had to rush for emergency caesrian section. Operating gynecologist ma'am later informed that my uterus was plastic thin and baby's hair had already protruded out of the defect. I was rescued right before uterine rupture threatened both me and my baby's lives. Hubby told me later that day, that it was my second life.
But it was only the beginning of my countless sufferings....
My baby was taken to neonatal ICU for first 24 hours for TTN. My hubby informed me that my boy had heart murmur, a suspected VSD. I was petrified. Amidst so much pain,  all I could think of, was my little boy's VSD. I cried, whined, sobbed and prayed. An ECHO revealed that the defect was small, which would most likely, close spontaneously. But only time would tell.

On the 3rd night, while still in the hospital, I got fever from breast engorgement. Severely painful milk expressions, day and night, for 4-5 days, and it dwindled a bit, only to be followed by wound infection, urinary tract infection and uterine wall infection. There was fluid collection(seroma) at wound site, which was drained via syringe.
At the end of second week, my wound hurt so bad that I couldnt empty bladder or bowel. It went on for a week before a senior gynecologist at Grande Hospital detected the source of infection. I took my third course of antibiotics. I was so weak, I couldnt eat or sleep well.
Just when the wound infection abated, and I thought all was well, I woke up in the middle of the night with fever, rigors and excruciating breast pain. Next day, I was told I had second bout of breast engorgement involving entire lower zone and risked forming an abscess. There I was, getting IV antibiotics again, fourth course. Running to hospital four times a day, as I refused admission coz I couldn't risk exposing my baby to hospital acquired infections. I was five weeks postpartum by then.
As that episode subsided, I had vestibulitis along with aphthae and dental impingement. I couldn't eat, again. My dose of antibiotics were escalated, as they feared my nasal infection had risks of passing into the connecting brain linings. With treatment, my swollen nose and eroded tongue was beginning to wane, and I had severe gastritis, forcing me to stop all antiobiotics.
Between all this, my wound pain had revived. And my gynecologist said I had scar adhesions, probably connecting to the uterus. He was apprehensive that I might need laparoscopic surgery for breaking adhesions if my pain won't subside. Maybe after 6months or so. But for me, any more surgery sounded like death sentence. I had suffered so much, any surgical intervention scared me.
Thankfully the wound pain vanished. And now, my baby is two months old, thriving well, with remarkable weight gain. And his murmur has disappeare. He has embraced my genes wholeheartedly, his light brown eyes, sharp nose, full lips and the dimples that light my world when he smiles.

During all the chaos, my baby's healthy weight gain was my only pride. And I learnt two things, pain is a constant, yet nothing lasts forever. I survived and I conquered.

Happy Sixth

My dear daughter,
You are six now. You are this beautiful chirpy little thing that warms my heart and life.
Your shoes are getting bigger. And suddenly, I realise that one day you will out grow us and this house, to build your own shelter, or to find your own world. So I ask, why you can't be six forever?? Coz these are the best years of "you and me", coz you are innocent yet mischevious. Your pour your questions at us with utter amusement, and your little games add music to our souls.
Your father loves you, very deeply. As you will always fondly remember, he takes you places, shows you happiness and beauty. What you might not reckon, is that he subtly makes sure that sadness doesn't hover around you. He wants to protect you from the universe, from its chauvenism, judgements, patriarchy, etc. He acknowledges the charm of a girl child. At the same time, he understands the challenges of being a woman. and wishes so hard, that you don't encounter them. It makes him love you more everyday. That....  makes him the best father you could ever have. Happy Sixth Birthday.

So far.. in Nanjing

A petite brown-skinned woman in her early thirties, donning a blue long floral dress, has a backpack on her tiny shoulders, and an incubating pot-belly, protruding out of her rounded waist. She's at the airport, nervously fidgeting with her air-ticket, so uncertain of herself, for the first time in her life, daunted by fears of plausible upcoming challenges. At sixth month of pregnancy, she is traveling alone, to a place where English is an estranged language, where traffic signs, food menu and everything else is in Chinese. She can stutter few incoherent Chinese words, but her vocabulary is limited to countable ramblings. She looks at her five year old, one last time, shuddering at the thought of missing her desperately. Her daughter looks at her with piercing hopefulness, but in vain. With tearful sunken heart, she takes aching strides to the departure gate... "

This journey is a memoir I have to scribble about... too important a life event, too many memories to recount in years to come. I came to China for a training course of one month, all by myself, to a city I had never been to, without a single soul to call my acquaintance. It may not sound so unnerving, but my guts failed me because I was in vulnerable stage of life. I had lost my pace, recently overcame hyperemesis with ketonuria, and was regaining my health and stride back....

But the most striking part of my journey was the eager generosity people bestowed upon me. Be it random Chinese passerbys, handful Nepali students at the dorm or doctors at the hospital. I was greeted with exceptional kindness and love. Everyday I travel alone, to my faraway hospital, to shopping centers, electronic stores, groceries, and far off. I somehow find my way, without the google map, amid illegible Chinese signs, hoarding boards and bus routes. My full belly turns a lot of heads, and many helping hands too. Some instances are surreal and too-good-to-be-true. My beliefs of benevolence are reaffirmed very strongly in this presumed outlandish city...

... to be continued

DAYCATION

A trend has set in. Any employee working under someone else in Nepal, literally goes gaga over holidays during the weekend. Although it may sound bizzare to Westerners, for whom two days long weekend, isn’t a luxury but a norm. More than 40 hours of work week is overtime. But not in our country. So how do we handle this exhilaration of a stretch of 48 hour long break? We go crazy, we run to nearest staycation or daycation spot. And our facebook and instagram scroll busier than usual, with photographs and captions.... of outings and contemplations of life etc.

In such similar strive, we drove to Namobuddha, an outing closest to our abode. Beauty of this place cannot be confined to words. It’s enrapturing placidity mirrors peace, stillness, faith and warmth. It has an aroma of sophisticated mysticism and spirituality, as if an answer to all human frailties, gluttony and malice. However, the last few strides to reach this sanctuary is obnoxiously unpleasant. Our vehicle suffered bumps, curves, caves and thuds along with sheets of mud. My four month old belly cramped all along the unruly lane. We loathed the incompetence of our unstable government, which gobbles hefty taxes from us, but is unable to suffice its obligations. 

Just as we reach the destination, our disappointments of the stumbling journey mists into breezy air. The spotless restfulness ripples at Namobuddha. The yellow-capped hermitage rests at the hills of Kavre, various wings of the monastery is terraced along its stairs. This place wasn’t a stranger though.... We had hiked to this picturesque site, more than a decade ago, in first year of med-school. We were teenagers, freshly paired up with each other, and quite naïve about one another.... one of the fondest memories of maiden years of love. Time has taken its swift flight, and here we are, a family of three.

Our family trip was one of its kind this time, coz we had packed home food with us. Sausages, cheese, bread, juice, papadum, vegetables, etc were in the list. In a cozy nook of this peaceful hilltop, we spread our lunch-pack enjoying the beaming sunshine. Aaliyah was especially elated, as it was so refreshing. There were throngs of visitors from near and far off places, from cities and villages alike. All of them were amusingly busy, taking pictures of themselves, mostly selfies. Women and girls seemed more aware of their dresses and makeup, than the serene scenery. An irony. Changing times. Men on the contrary, were more self-reliant, absorbing the stunning backdrop contently.

The site-seeing lasted a brief hour, and we were heading back sooner than we had reached. Those sixty minutes were cleansing, purgatory and delightful. We were weary but content. Gleeful. Happy. And just like every tour, the journey back home seemed shorter. We were home before twilight guzzled the Dhulikhel sky. 

Vitiligo: The scourge and the stigma- how the battle can be won

Humans are enthralled by the concept of beauty. And in our pursuit of vanity, mankind has many a times, rebuked any contrary to the norm. Be it leprosy, syphilis or tuberculosis, diseases have been loathed and ostracized ruthlessly since primeval times. How could vitiligo escape this coercive subjugation. Since its first documentation in Egyptian medical papyrus in 1550 BC, vilitiginous white spots have been noted by Indians, Japanese and Latins alike. The journey of demystifying vitiligo traverses almost four thousand years in time. And the path to unfurl its scientific genesis is still in progress....  Vitiligo stood apart from other diseases due to its deceitful appearance, despite naive harmlessness. An innocuous disorder raised such harsh abhoration in communities in the eighteenth and ninteenth century! Hence baptized "historical curse of depigmentation"  Unlike our veteran vitiligans today, patients suffered despondent segregation from the society in the past. This stark stigma has aroused curiosity, resentment, distaste and sympathy across generations. Vitiligo patients are still divaricated from social throngs, as ugly ducklings. In our times, Michel Jackson catapulted the social standing of this disease to jolting acceptance. His unmatched contribution is etched in history. Vitiligans like Winnie Harlow, Lee Thomas further eased the battle by embracing their depigmented bodies, and shedding light on the disorder. Therefore, I believe that blemishes of vitiligo shall fade with time.
However, in developing countries like India and Nepal, the task of generating awareness about this disease is herculean. We lack vitiligo societies or foundations unlike in the West. It is still hurtful to disclose to a 10 year old that he/she has vitiligo, as it brings disgrace not just to the child, but the entire family. The prognosis maybe brighter in an adolescent, but the excruciating agony caused by the diagnosis, is hard to dampen, even with elaborate counseling. Hence, clarity about the disease and stupendous treatment efficacy will be the unwavering weapon against this discriminative illness.
The scientific task of delineating the etiopathogenesis has been arduous. Wide array of clinical causes have been postulated time after time, with newer theories emerging every now and then. As dermatologists, we are aware of the lists of various hypothesis. So lets take a brisk walk, down the lane of known etiopathogeneic factors. Autoimmunity, oxidative stress, cytorrhagia, traumatic, neural, genetic, biochemical factors are snippets of the dice we have yet to complete.  Oxidative stress and autoimmunity are the titans that have had paramount significance. Others fall out in the fringes. Recently genetic linkage and associations are surfacing as strong determinants of both the onset and severity of the illness. Various susceptibility genes have been identified. Unfolded protein response(UPR), melanocortin and Raper mason enzyme related genes, genome with linkage and association studies are rising as susceptibility indicators. More concrete impact of gene analysis on disease predictability and prognosis, is yet to be disclosed.
Coming back to autoimmunity, tremendous association of vitiligo with other autoimmune conditions such as thyroid disorders is unputdownable. Studies show thyroid association in quarter of the childhood cases, and more than half of adult vitiligo cases. A study conducted in our center, have also reaffirmed the coexistence of thyroid disorders with vitiligo. Newer studies reveal autoantibodies and T cells predomination in diffuse and localized vitiligo. CD8T cells were positive in lesional skin in localized vitiligo. Depending on whether the cellular or the humoral response is predominant, extent of the disease maybe predictable in future.
My concern for autoimmune association, is regarding thyroid autoantibodies. To me, thyroid disorders and their treatment guidelines, are biased against cutaneous disorders. Thyroid associations in the West, specifically advocate against treating mild thyroid alterations despite cutaneous manifestations. Their cut off for thyroxine supplementation is TSH>10. We frequently witness patients with vitiligo, who have moderately increased TSH and positive Thyroid peroxidase (TPO) antibodies. Will autoimmune vitiligo improve as long as TPO remains escalated? Does mild TSH alteration shift the balance of skin homeostasis? Do we wait for endocrine storm to abate or we intervene? These questions need to be addressed in order to find a solution for autoimmune skin conditions.
In regards to management, counselling has a tremendous role. It is encouraged to make intelligible leaflets in patient’s language. For me, it is heart-crunching to see patients willing for painful surgeries for this asymptomatic condition. Hence, generating awareness in our community should be our prime priority.
Treatment modalities in vitiligo have metamorphosed over centuries, as we unravel this enigmatic condition. Treatment guidelines have been simplified, and rendered more precise in recent times. Dichotomy of segmental and nonsegmental vitiligo, treatment modalities according to body surface areas and stability of lesions are primary considerations for choosing treatment modalities.
Conventional treatment modalities such as steroids, are the veteran warhorse that still reign supreme in vitiligo. Oral steroids are the most potent tool to halt disease progression. Immunomodulators such as azathioprine, tacrolimus and phototherapy are prevailing steroid sparing alternatives. Phototherapy is an irrefutable asset. NB-UVB is superior to PUVA, with excellent color matching and minimal adverse effect profile. However, we have found rewards in Bath PUVA, turban PUVA and bathing suite PUVA in our vitiligo patients.
Newer molecule Tofacitinib has grabbed limelight of late. Tofacitinib inhibits the IFN-Y signalling via Jak pathway, hence halting progression and maintenance of vitiligo. Multiple clinical trials hint towards excellent potential role of Janus kinase inhibitors in near future.
Adjunctive or alternative therapies are topical gingko biloba, levamisole, latanoprost, vitamin D analogues, topical ruxolitinib and antioxidants.
Selenium in the form of selenomethionine or sodium selenite, has shown promise in cutting off the TPO levels. Selenium improves TPO profile, and also directly quenches the oxidative surge. Hence, it might emerge as a robust tool in autoimmune vitiligo. Some studies have shown the linkage between vitamin D deficiency and vitiligo. Vitamin D accentuates photo-induced melanogenesis and hinders cytokines linked to vitiligo via immune-modulating properties. Vitamin D deficiency related vitiligo might be more important in our skin types, as some reports have shown significant role of Vitamin D induced repigmentation with NB-UVB. Role of micronutrients such as selenium, zinc and copper should be further extrapolated.
Interventional strategies have gained momentum for some time now. Experts are fanatic about surgical grafting in patients with stable lesions. However, surgery maybe double edged sword, because of debacle of stability. Scoring these lesions, serial photographs and performing test grafts may aid in warranting stability. In test grafts, unequivocal repigmentation beyond 1mm from the border of the test graft is said to indicate stability. Individual lesional stability is cardinal before holding a scalpel. Evidence based practice will further uplift the surgical results in vitiligo patients. However, the despairing fact of failure of surgical grafts should be counselled even in the most promising patient.
Punch grafts were the harbinger of surgical interventions in vitiligo, and mini punch grafting still remains one of the most common surgeries. However, threats of cobblestone, lopsided repigmentation and anatomic restraints limits its utility.
Epidermal suction blister grafts, split skin grafts and tissue grafts are met by their rewards and hindrances. At present, non cultured epidermal cell suspension and cultured melanocyte suspensions are at the heart of vitiligo surgeries, as they address large recipient areas, provide excellent response and admirable color matching.
Hair transplantation, excision of small lesions have all been done with variable results. Nonsurgical interventions such as lasers and home-based phototherapy may prove to have snowball effect, as they gain momentum among patients with localized disease. Neon lasers, fractional lasers, microfocused bioskin phototherapy are glimmering in the horizon as promising innovations. In recent past, Mosenson et al. showed that vitiligo can be reversed through immune targeting with mutant  Heat shock proteins(HSP70), given the evidence of association of Heat shock proteins (HSP) in depigmentation.
In conclusion, patient specific and lesion specific individualized approach in vitiligo management can defeat this colossal stigma. Unambiguous patient counselling at first patient visit should follow individual targeted therapy at achieving disease control and repigmentation. We stand at this glorious era in the history of vitiligo, where we have defined many uncharted spheres in etiogenesis and management. Future gleams in delight, as we discover newer prospects in battling this ancient disease.

Journey with Fibromyalgia

I was just tender 22. One sunny summer noon, frens at med school planned an outing by the river-side of Dolalghat. We swam all day under the dazzling sun. And when I woke up next morning, i couldnt move. It was as if I was trapped in a casket. My hands and body crunched in pain. Oblivious to the source of pain, my friends tried giving me painkillers, massage and hotbags. None of that worked however. I was bedridden. 
That was my first attack of fibromyalgia. ...

But it was only a harbinger of the upheaval.. that was about to turn my life upside down!

My hands and back felt foreign to me. I sat stiff, days after days, writhing, hurting, crying and devastated. Disabling pain pinged into my bones. I still sorely remember sitting by my hostel window, wearing jacket in summer heat, and trying to read my course books. I almost flunked my third year final exam. My friends were lost in their own stress of med-school. But i was at war, war i lost everyday. My dreams were thwarted, I sank in my wretchedness. I woke up every morning just to find the demons stronger and fiercer than the day before. I couldn't eat, dinner table sobs became a mundane routine. I was entangled in a vicious web of vexation. Thoughts of ending my sufferings constantly plagued me, and wished for euthanasia back then. My then boyfriend, and now spouse, was the only person who encouraged me to move on.

It took me more than a year to demystify the source of pain. I was temperature sensitive. I had allodynia and hyperalgesia. Temperature changes and wind triggered my attacks. But I didnt know how to avoid or abate it. Desperate for answers, I knocked all doors... specialists, traditional healers, fortune tellers and who not. Renouned orthopedician misdiagnosed me with arthritis and prescribed Methotrexate for a year, with no improvement. Rheumatologist at AIIMS Delhi, brushed off my condition as not arthritis, but wonder what...

Years passed, harrowing pain became a bitter constant. However, I didn't let it forestall my life goals. It wasnt one particular day or event, but when I looked back after 6-7 years of affliction, I realised I had won the battle. I wasn't cured, it still followed me like dark shadow. The disability still tainted my brightest days. During MBBS finals, MD finals or pregnancy, pain would shoot up, forcing me to immobility. But I worked. I worked when I was fine, I worked when it hurt. I worked when I was unable to hold a pen, I paddled through choppy waters. Now I am a proud  Derm graduate. Despite days of bedlock right before MD finals, I am Kathmandu University's first distinction holder in Dermatology. Even today, my hands hurt during every hair transplant, while holding laser probes, in household chores and as I carry my daughter on my hips. But I do all of that, and the triumph is priceless.

I am sharing my journey because I know, there are so many others who live this chronicity, shunned and dejected. Life is a battle, one way or the other.  Fibromyalgia is a havoc, it engulfs you if you succumb. You have to fight, you cant give up, just cant give up.

A fish trying to climb up the shore.. a woman in Nepal

Sometimes I feel like a fish trying to climb up the shore... with my powerful feeling of womanhood, strong views on freedom and deeply opinionated persona!

A woman rather be a femme-fatale, than an aficionado here. Her strength of thoughts, are vilified than respected. How many women do we actually know, to have made a mark in Nepal politics?? Is it my feeble memory or we actually have none!

We had Pasang Lamhu, who combated and conquerred the Everest. We had Parijit, who enriched our literature with her imagination. Of late, CNN heroes who shone brighter in international arena. Ladies like Bidhya Bhandari, to whom politics was gifted in lineage. I cant think of many.

A country with polemic and gibberish politicians, Nepal stands at crossroads today. It may either veer off a sharp cliff into despondency or rise like a phoenix, like South Korea, Japan and Singapore. Illuminated hopes come with this budget and other amendments. But with ropes of power scattered in many hands, so many mushrooming heads of prominence, its hard to fathom which way we progress.

And in this mix-bag of ethnic, dogmatic and ethical dichotomy, where exactly do women stand? In this league of patriarchial politics, legislation have been rectified. Property inheritence, citizenship claims to name a few. But will people embrace them without prejudice? Our social framework is structured in a way where women have a weaker hand. More so after marriage. She cannot pursue her goals and aspirations passionately, when she has to live in subordination.

Women from different ethnic and cultural backgounds are living in completely different era. Rural women still live in primitivity.  Their dreams are thwarted, shelved, because of their male siblings, husbands and children.

And women like me, seemingly liberal and independent, we live in a mirage. We are customed to believe we are equals. We got similar education, similar job opportunities, even similar pay. But there are obligations that pulls us down. Little routines like cooking, bathing the children, making the shelves, closet, homeworks, linens, and cleaning consumes our leisure time. There is immense gratification in home-biding. But it overshadows our career and blurs our social stand in the long run.

This gap will probably end, only when gender based roles end, right from early childhood. A seismic shift cannot be anticipated!

A Ride To Revel... one such happily everafters.... :)

Last month, we made a quick trip to Bandipur and Pokhara. It was sort of a getaway, with bits of government paperworks too.

Up the winding roads of lush green Bandipur, sun had climbed its tallest. Mint green freshly blooming crops of leaves capped the mountains. Breezing skittish winds bantered with flowery trees. Spring gleamed in pious delight.

But the government paperwork snarled at our vacation spirit. Asim had to xerox the documents so many times. He was annoyed at the tenuous redundancy. To further excruciate our disappointment, we were told we had to go to Damauli to complete the procedure. We hissed... Its stifling that a snippet of government work requires so much travel.... :(

We drove back hurriedly coz we ran short of time. Aaliyah was however excited despite the rush. She savoured every bit of the sunshine and ride. Outdoor trips are revelous for kids. It inculcates love for nature in them!

But we were still gripped, coz more work waited us. As we expected, Damauli was another damp squib. We went through tedious form-filling again! And our job was finally done by late afternoon.

Then....we headed for Pokhara for a real vacation. It was a lavish treat! Unhindered straight highways promised a jolly staycation. It was a beautiful sight... barren soil, pretty girls on the sidewalk, twin toddlers, rain trickling down the arid roads... Twilight embraced us along the way, the fervent dipping sunrays threw patronizing glare at the rising pale moonlight!

And we arrived! The roitous conundrum of city life seemed like a carousal. The nimbus of light at lakeside was invigorating. It felt so special..."you and me, in this paradise" :) :)

Contrary to banal rush of urgency in kathmandu, Pokhara was laid back, inviting, tempting and soothing. Lofty soft winds greeted us in summer. Air wasn't thick with smoke, and sky wasnt clouded. Stars had already woken up, flashing their silvery grin. Music enlivened our tired bodies.

We explored the bright lanes on flipflops. There were crowds... couples, teens and salmon-skinned travellers, perhaps bloggers, singers and dreamers too. We were elated. Watching people is always captivating. They remind of simple joys of life... a new mother proudly carrying her cheruby cub on her love handles, her smile priceless... a gorgeous teenager on windowseat with plugged earphones, lost in the world of musical fantasy... a young couple awkwardly holding hands, still trying to figure each other out... that moment seemed to ooze happiness..

Restaurants offered foods to drool for. After enriching our tastebuds, we took to a friend's hotel for the stay.

Next morning, breakfast at Himalayan coffee beans was delightful. It reminded so much of Starbucks. Really! We then paddled the concrete roads in bicycles. It had been a long long time, since I actually got to take on the roads. I was pleased. And after an hour of sweaty cycle-ride, we strolled along lakeside, went food hunting. We found some awesome korean food to satiate our growling tummies.

In the afternoon, we decided to find "Paame" as it sounded like a tourist destination. We drove along lakeside on our four wheeler. But it was a little disappointing coarse ride. Tracks were muddy and bumpy. We gave up midway and instead, landed at a paragliding site. The airglider lands at that small piece of land leftover by the huge lake. Both of us were fascinated at the actual gliders and their flight. While we couldnt decide whether to give it a try, time had ran out for the day. They wouldnt embark the glide after 3pm. Interestingly, we met the last two people who came down that flight. They were couples and they flew in two parallel crafts. The fascinating part was that they were almost 50 years old. Wow. That was quite a sport to choose at 50! With promise of doing it ourself next time, we headed back HOME. :) :)

Thoughts... they cant be random, however bizzare!

One gloomy day, I slip into retreat. I feel sore. I hunker down my scrawny bones on crusted-creaky floor. Usually, I slid into warm memories when I'm blue. But tonight, my thoughts traverse elsewhere. I am confused. I wonder about human behaviours... how we constantly exude, potray and flaunt "positivity". These days, social media has become a perfect "hide-out". We quote the redundant tropes... about life, love, etc. We hardly admit our fervent inadequacies in those scrolls. But, all of us acquiesce to our demons sometimes, dont we? Sun doesnt always shine. It rains, it hails, it snows. So, I juggle my mental volleys.... I wouldnt be me, without my negativity.... my fusillades, trailblazing anger, my woes, aches, some lies, insecurities, etc. :) :) So why shouldnt I heartily embrace my flipsides?
Of course, I keep straddling to cultivate healthier thoughts. We always should. But I also know, old habbits die hard, wonder if they really do!

Tips for good skin... cosmeceutical facts!

Smriti Shrestha

Cosmeceuticals is one of the most rapidly expanding $280 billion global industry, growing steadily at the rate of 10% per year. Cosmeceuticals include all cosmetics, foods and chemicals that enhance beauty. Signs of ageing - dull, tight, rough skin, pores, spots, yellowness, wrinkles and sagging. Smoking, mental stress, excessive dieting, wrong food habits, excessive sun exposure, lack of exercise and pollution lead to premature ageing and skin disorders. People using excessive heavy make-up all day suffer from pigmentation, pimples, contact allergy and sensitive/reactive skin. Reactive skin is sensitive to heat, cold, wind, topical creams leading to itching, burning, tingling, redness and dryness. Both reactive or aged skin can be prevented and controlled by disciplined dietary habits and proper skin care.

Here, I discuss how to eat your way to fabulous skin and how to choose your skin care products wisely. Don’t miss out on my recommended food journal.

SKIN CARE: Basic skin care products are sunscreens, moisturizers, use of umbrella and appropriate day and night creams. Moisturizer: Moisturizers are key ingredient in beauty care. Effective moisturizer must decrease water loss from the skin surface, known as transepidermal water loss (TEWL). Their job is to create an environment for healing. Our skin is constantly undergoing minor unnoticed trauma due to external factors. Therefore, healing is essential for healthy skin. Petrolatum(vaseline jelly) is an ideal moisturizer that decreases TEWL by 99%, creating effective occlusion, thus promotes healing. Other moisturizers are mineral oil and vegetable oil. Glycerine holds water like a sponge, and prevents TEWL by 50%. Sorbitol, uear, lactic acid, NMF (natural moisturizing factor), gelatin, hyaluronate are other constituents of moisturizers to look for. However, any rehydration caused by moisturizer is temporary and works for around half an hour. Therefore, it should be reapplied frequently in copious amount. Sunscreen: Rays from the sun such as UVA, UVB and infrared radiation amounts to upto 70% of external ageing. Application of liberal amount of sunscreens every 3 to 4 hourly is essential to prevent sun-induced damage. Meticulous care is needed while swimming, at beaches, deserts and snow as they reflect more sunlight onto our skin. Gel based solutions work well on oily skin and lotions/creams are preferable for dry skin. Sunscreens containing titanium dioxide or zinc oxide provide better protection as they are physical blockers. For our skin, spf 15 is recommended for daily use and spf 30 preferred during outdoor activity. Kathmandu has one of the highest UV index (intensity of UV rays) in the world, hence, we are highly susceptible to damage.

Retinol: It is a synthetic form of vitamin A, most widely used by all A-listed cosmetic brands worldwide. Pro-activ is one such example. Retinol works by binding to skin and repairing virtually all age related changes in skin. It enhances layers of skin and its components. But it needs to be applied for a long time to appreciate visible change. Expected side effects are discomfort, burning, stinging, sun-sensitivity when applied inappropriately. Strict sunprotection is advised during its use.

Others: Vitamin C, Vitamin E are antioxidants that fight free radicals responsible for skin damage. But very few products actually contain adequate amount of these chemicals. Rice ceramide, rice germ, bran, litche extract, grape extract, flavonoids, zinc, selenium are natural components of beauty products that have scientifically proven benefits.

DIETARY CHOICES Eating right is a lifestyle and you are what you eat. Eating smart is an intelligent way to attain healthy lifestyle. Gastrointestinal maintenance positively influences skin health directly and indirectly. Lately, the concept of “functional food” is on the rise. Functional food are ingredients (natural or added) that provide health benefits beyond their traditional value. Example, fortified food containing vitamins and minerals.

Here is the list of beneficial food:

SOY: Soy is available in the form of soy milk, soy beans. It acts on skin, hairs and nails when consumed or applied to skin for 3 to 6 months. Variety of soy milk with added nutritives are available in stores these days. It contains carbs, fat, protein and essential nutrients such as calcium, zinc, iron, vitamins, etc. Dietary soy improves obesity, bone health, alleviates menopausal symptoms and decreases risk of breast and skin cancer. It protects the skin against solar damage, allergy, skin swelling, DNA damage.

PROBIOTICS: Probiotics are fermented food products that contain bacteria beneficial for human body. Probiotics are found in yogurt, enriched milk and various formulated functional food. They were initially used for diarrhea. Now, their use has extended to various skin allergies and sensitive skin. They also enhance absorption of dietary nutrients.

OLIVES: Consumed as olive oil or olives, these are one of the most trending health food. They protect against heart disease, various cancers and skin ageing.

OTHERS: Green Tea, carotenoids (carrot), broccoli, lemon, nuts, pumpkin seed, fish oil are other antioxidants that fight skin ageing. Red wine contain resveratrol, which acts as a defense against skin damage. Tropical fruits such as berries(strawberry, blueberry, cranberry), pineapple and papaya are low calorie antioxidants.

YOUR DAILY FOOD JOURNAL: Breakfast: Soy milk/Green Tea. Cornflakes/oats(fortified) Lunch: Use olive oil instead of mustard or vegetable oil. Eating carrots/ cucumber before big meal reduces calorie intake and supplements antioxidant requirement. A fist/palmful of rice with green vegetables, soybeans and pulses. Finish your meal with yogurt. Afternoon snack – replace your afternoon junk food with fresh fruits, berries, fruit juices and mixed fruit salad. Dinner – Whole grain pasta/ brown bread. Peanut butter. A glass of red wine. “Breakfast like a king, lunch like a common-man, dinner like a beggar” “Cleanse your skin and remove the last bit of make-up. Apply generous amount of moisturizer to let your skin heal while your body rejuvenates through the night”

LOVE

LOVE...such a simple word with so much gravity, so much to talk and feel about .. defined and redefined time and again, day after day, and time after time. As much as it can fill your life with unbound joy and liberation, it can bring you down with unmatched pain and heartache... just met a couple, who'd recently separated. Reasons were many, forthem to trace their own individual path. But the pain of detaching yourself from long-loved and heartily-embraced mate, is definitely not easy. Being an emotional person myself, i couldnt help notice and even, feel the gush of pain racing through their bruised hearts. She seemed so delicate and fragile, drowned in the ache of a fleeting relationship. As much love as he gave her in the last three years, i bet, no one has and will ever crush her soul in years that she lives... i have seen them play, watched them giggle, heard them fight, but cant explain how a piece of my own heart smashed, to see them struggle to hide the storm of emotions wrestling in their minds. LOVE.. indeed tricks us sometimes, fools our hearts and scars the soul, forever to be mended... :')

Yay! My new Blog! xcited!!