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Leaning close to the baby, her face nearly touching his, the nurse pressed a finger to her lips and tried softly to quiet him so that his twin brother could sleep. Not about to be hushed, 14-month-old Mohamed Ibrahim flashed a devilish grin, let out a yell and stomped his feet on the mattress.
His brother Ahmed dozed anyway -- even though the boys are conjoined twins, joined at the crown of the head. Attached so closely that just a fringe of curly hair divides their foreheads, they nonetheless have separate brains and minds of their own, and they often nap at different times.
Mohamed and Ahmed, born in a remote Egyptian village 500 miles south of Cairo, have been in Dallas since June, having tests at Medical City Dallas Hospital to determine whether they can be safely separated.
Their plight is daunting. If they are not separated, they have little chance of ever being able to move about on their own. Because of the position in which their skulls are fused, they cannot sit, stand or crawl.Continue reading the main story
But doctors acknowledge that the surgery to separate them could kill one or both of these bright-eyed, lively boys, or cause brain damage that might cripple them, physically and mentally -- in essence, trading one lifelong disability for another just as profound.
Because of shared blood vessels in their brains, separating Ahmed and Mohamed would be even more difficult and dangerous than the 22-hour operation performed at the University of California at Los Angeles on Aug. 5 and 6 to separate Guatemalan sisters who were also joined at the head. [The girls are still in serious condition, and on Friday, one required additional surgery to drain blood after she developed a bacterial infection in the lining of the brain.]
''It is a challenge whether we'll wind up with two children with two good brains, or even a portion,'' said Dr. Kenneth Salyer, the surgeon who arranged to bring the Egyptian babies to Dallas and who is directing their care. ''It's horrendous.''
Mohamed and Ahmed lie on their backs much of the time, even while being fed. They cannot see each other's faces. Together they are at least five feet long, and it already takes two people to pick them up.
Even so, they are cheerful, squealing and bouncing with delight when visitors arrive at the apartment where they are staying in Dallas, cared for by two nurses from Cairo, Wafaa Dardir and Naglaa Mahmoud. Except for being conjoined, they are normal and healthy.
The twins' parents are in Egypt with their other children, a son, 6, and a daughter, 4. Arrangements are being made to bring the father to Dallas, Dr. Salyer said.
It is by no means certain that doctors will be able to help the boys. In a similar case at a hospital he declined to name, Dr. Salyer said surgeons considered plan after plan, finally deciding not to operate because they could not find a safe way.
In addition to the ethical dilemma posed by the risks of surgery, the twins' case raises questions about the fairness of spending up to $2 million to help two children when the same amount, spent on food, vaccines or sanitation, could potentially save many more lives. The medical costs are being paid by the hospital and a charity created by Dr. Salyer, the World Craniofacial Foundation.
Neither Dr. Salyer nor anyone on his team of craniofacial and neurosurgeons has ever separated twins joined at the head. The condition is so rare -- one in 2.5 million births -- that only a handful of surgeons have operated on more than one set. But Dr. Salyer, described by colleagues as energetic and determined, said he and his team had had enough related experience to do the surgery.
As a craniofacial surgeon, he said, he has operated on thousands of children with severe skull and facial deformities and reconstructed the skulls of one pair of twins who were joined at the head and separated by other surgeons. He said he and his colleagues had already spent hundreds of hours, and would probably spend hundreds more, trying to map out an operation -- or, more likely, a series of operations -- to separate Ahmed and Mohamed.
The boys share some brain tissue, but Dr. Salyer said it could probably be divided without lasting harm, because very young children's brains have tremendous potential to recover from injury.
But while their brains are separate, their blood vessels are not. Of particular concern are large veins, called venous sinuses, that carry blood away from the brain. Each twin has vessels that drain into the other's head. The veins cannot be cut or tied off; doing so can cause brain swelling and strokes. And the venous sinuses are fragile; if one is torn, a child can quickly bleed to death.
''Our concern with these twins is that the veins are so interdependent that separation is almost impossible, if not impossible,'' Dr. Salyer said.
''Ahmed has better circulation, and more circulation than Mohamed,'' he said. ''But Ahmed's circulation goes out through Mohamed's brain. And Mohamed is even more dependent on Ahmed.''
He said a possible strategy was to try to redirect blood flow in the veins so that the twins are no longer dependent on each other. In theory, that might be accomplished by a series of operations in which the vessels are slowly blocked off -- not abruptly clamped or cut -- to redirect the blood flow gradually into other vessels, called collaterals.
''I have to bring the pediatric neurosurgeons along with that, to be honest with you,'' Dr. Salyer said. ''I don't have a clear-cut plan.''
Conjoined twins are always identical, the type of twins that develop from one egg that splits into two complete embryos shortly after being fertilized. How the twins become conjoined is not known. It was long assumed that the egg failed to split all the way. But some researchers say that with twins joined at the head, it is more likely that the egg did split completely and that the two embryos later became stuck back together and their rapidly developing tissues intermingled.
The history of efforts to separate twins joined at the head has been bleak. In 30 attempts around the world since 1928, according to an article published in 2000 in the journal Neurosurgery Quarterly, only 7 of the 60 children came through the surgery without brain damage; 30 died, 17 were neurologically impaired, and the remainder of the cases were reported before the ultimate outcome could be determined.
But advances in imaging and computing may make success a bit more likely now than when surgeons had only X-rays to work from.
Life-size three-dimensional models of the twins' skulls have been essential in the planning, Dr. Salyer said, adding that he uses such models for nearly all the craniofacial surgery he performs. The U.C.L.A. team also used them. The models are made from the information in the twins' CT scans and magnetic resonance images.
The information, in digital files, is processed and used to guide a machine that makes the models by putting down a fine layer of liquid plastic, hardening it with a laser and then applying another layer. That process goes on for 20 to 30 hours, gradually building up and shaping the model. Each model costs $2,000 to $3,000, said Andy Christensen, the president of the manufacturer, Medical Modeling L.L.C., in Golden, Colo., but he said the company had provided the twins' models at no charge.
The models are a pinkish, translucent plastic, with a bewildering tangle of veins. On a recent morning, Dr. Salyer had one on his desk, marked up in pencil, with arrows showing the direction of blood flow in different vessels, and the twins' initials here and there to show which vessel belonged to whom.
''I think there are options,'' he said, adding that craniofacial surgeons often have to improvise solutions to unique problems.
In 1997, Dr. Benjamin S. Carson, director of pediatric neurosurgery at Johns Hopkins Hospital, performed a 28-hour operation to separate a pair of twin boys in South Africa who were joined at the head, facing in opposite directions. He said it was the first time twins of that type had been separated without suffering brain damage.
Dr. Carson's earlier efforts on other twins did not go as well. A set of sisters he separated in South Africa died soon after the surgery. Twin boys brought from Germany to the United States for surgery in 1987 survived but were later reported to be living in a home in Germany for disabled children.
A spokeswoman for Johns Hopkins said Dr. Carson was ill and could not be interviewed for this article.
Dr. Alice Dreger, who is writing a book about conjoined twins, said in an interview that she questioned the widely held assumption that all conjoined twins should be separated.
''Some think conjoinment is such an awful condition that it justifies any attempt, and it doesn't matter if they're damaged physically or mentally,'' said Dr. Dreger, an associate professor of science and technology studies at Michigan State University. ''But what are the costs of the separation? Do they outweigh the benefits?''
Dr. Dreger said some twins who remained conjoined into adulthood led full lives. She mentioned Lori and Reba Schappell, 40-year-old sisters in Reading, Pa., who are joined at the head. The sisters have been told separation would be extremely risky and say they would never chance it.
But the Schappell sisters are mobile, unlike the Guatemalan and Egyptian twins, and Dr. Dreger said immobility was a ''serious issue'' making separation more desirable.
''There might be no way to get around except on an enormously large stretcher,'' she said. ''How would you even set up a house around that kind of body?''
Acknowledging that it might sound ''curmudgeonly,'' Dr. Dreger also questioned the enormous publicity and millions of dollars spent on risky operations to help just a few children when so many others also have unmet needs. Conjoined twins are no more deserving of help than other children, she said, adding, ''The difference is that we're seeing these kids' faces.''
Addressing those issues, Dr. Salyer said, ''How can you value one life as being more important than another?'' He added that his expertise is in fixing skull and facial deformities, so that is where he can help.
The twins are growing fast, and those who spend time with them say that hints of frustration are beginning to break through the babies' usual good cheer. Mohamed sometimes flips his startled brother as he rolls onto his belly and tries to raise himself on all fours.
''It breaks your heart when you see them try to walk and sit and move and they cannot do it,'' said Dr. Mamdouh Aboul-Hassan, a pediatric surgeon from Cairo University who is staying in Dallas to help care for the twins. ''This is the normal time for them to sit and move.''
He said that a visitor had suggested setting up a mirror so they could see each other. But Dr. Aboul-Hassan resisted the idea, he said, fearing that if one boy died after the surgery, the memory of his face from the mirror might be too painful for the survivor. There is no mirror.
If the twins cannot be separated, Dr. Aboul-Hassan said, they will be taken back to Egypt to live with their parents and their brother and sister. But the family has never taken care of them, he said; the babies were taken to a hospital in Cairo shortly after being born and spent their first year there.
Dr. Salyer said that if his team could not find a way now to separate the twins, it might still become possible in the future. It might even be easier to solve the vein problem when the twins are bigger.
''If the decision were at this moment in time not to do it, I don't think that would close the door,'' Dr. Salyer said. ''My goal is successful separation. And I'll pursue it as an ongoing goal. I can't imagine these children in a primitive setting in Egypt, attached to each other, doing well.''Continue reading the main story


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Lots of little bowler hats linked together make up this gorgeous formed red jasper and sterling silver bracelet.
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With Houston Texans defensive end J.J. Watt undergoing sport hernia surgery in Philadelphia with Dr. William Meyers, he will miss the Pro-Bowl game and be replaced by Minnesota Vikings defensive end Everson Griffen.
Watt has been selected to the Pro-Bowl in four consecutive seasons and this will be the first Pro Bowl game he missed due to an injury. Watt was dealing with a groin injury for about half the season and a broken hand he played with for the final month of the season. A healthy Watt is the priority for the defensive end and the Texans for 2016.
Also, left tackle Duane Brown will miss the game with a torn right quadricep he suffered in week 17 and he would have been the replacement for Philadelphia Eagles offensive tackle Jason Peters, who will too miss the game due to injury.
The lone representative for the Texans in Hawaii will be DeAndre Hopkins who is making his first appearance at the end of the season annual game.


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A US jet was forced to make an emergency landing after horrified passengers discovered a hole in the plane's fuselage.
The football-sized hole appeared during a Southwest Airlines flight from Nashville to Baltimore on Monday, prompting the cabin to depressurise and forcing the plane to land.
"All 126 passengers and crew of five onboard landed safely," the firm said in a statement.
An investigator examined the hole on top of a Southwest Airlines plane.
US carrier Southwest Airlines is inspecting nearly 200 of its aircraft after a hole in the fuselage of a plane forced an emergency landing.
"The aircraft cabin depressurised approximately 30 minutes into the flight, activating the passengers' onboard oxygen masks throughout the cabin.
"According to initial crew reports, the depressurisation appears to be related to a small-sized hole located approximately mid-cabin, near the top of the aircraft."
Charleston Airport spokesman Brian Belcher said passengers on the 737 aircraft could see the outside through the hole in the rear of the plane.
The hole was position just above passenger Michael Cunningham, who had been sleeping in seat 20-C.
"All of a sudden, the loudest noise I ever heard came out of nowhere. There was no pop, no creak, no explosion like noise. There was just a loud roar," said Cunningham.
He said it took him a few seconds to realise what had happened after the noise woke him up.
"I got the baseball cap out of my face and I looked up and there's the sun coming through the ceiling," he said.
The loss of cabin pressure caused the oxygen masks to deploy. Cunningham said some people weren't sure if they were working.
"They were asking me is it working, is the bag inflating? And I was like, if you can feel your fingers and you're conscious by this point, the bag's working," he said.
The airline said it would inspect all its 737-300s.


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- M J Werebe
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The focus of this study is to analyse, within the same population, the specificity of friendship in comparison with dating relationships among French adolescents. The subjects interviewed (63 boys and 82 girls, aged 15 to 19 years), all volunteers, were recruited from three "classic and modern" senior high schools and three vocational high schools. The data… (More)
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In order to determine how adolescents perceive their relationships, a set of eight drawings representing one, two or three characters, whose sex and relationships where not clearly defined, were shown to 403 Parisian adolescents (227 girls and 176 boys) aged 15 to 19. The majority of data converge for all subjects, regardless of the sex, curriculum or… (More)
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So Mitt Romney put his big foot in his mouth again, as he has done so often recently. Last week it was Libya, this week Palestine, and along the way he insulted half the US electorate. His campaign now appears to be in freefall.
This time he stirred things up by saying that he was writing off 47 per cent of US voters who were "victims" and didn't pay taxes as they would never vote for him. He also made it clear he is against redistribution: the poor are on their own.
Well, actually he didn't exactly say it publicly, he said it behind closed doors at a fundraising dinner with a few well-heeled supporters at the residence of a wealthy donor, but was caught out because one of the waiters apparently filmed him on their iPhone.
Mr Romney had to backtrack a little when it was pointed out that this actually includes lots of Republican voters. Many Americans receive help from the federal government in the form of social security and Medicare (which they pay for through payroll taxes), veterans' benefits (which they often obtain through service in the military), college loans, food stamps or other support.
But Mr Romney hasn't backed down, despite being lambasted by critics including a number of well-known Republican supporters such as Peggy Noonan and Bill Kristol. Even Paul Ryan said he didn't agree with Mr Romney's comments. Dumb and dumber.
That brings me to George Osborne, who apparently has also written off a big chunk of the British electorate, who presumably will also never vote for the nasty party. Recall this is the guy who cut the top rate of tax for his rich pals, but introduced pasty and granny taxes. There have been all those cuts in frontline services, with so many more to come, big job cuts, and a pay freeze in the public sector. Now Slasher has a plan to squeeze the pips out of the poorest of the poor by freezing the increase in welfare benefits, by ending the automatic annual increase in benefits in line with inflation. That really is going to solve the country's fiscal problems at a stroke, I don't think. I don't know how he sleeps at night. Not a great idea to write off the poor and the disabled.
The fact that the Government is relying heavily on monetary policy to provide stimulus means it has essentially abandoned regional policy, especially given that it has abolished Regional Development Agencies. Plus a disproportionate chunk of public spending cuts are occurring north of the Watford gap. So I am rather surprised that there hasn't been more public outcry in places like the North-west, the North-east and Yorkshire and Humberside, where unemployment rates are 9.1 per cent, 10.4 per cent and 9.8 per cent respectively, compared with 6.3 per cent in the South-east. The North-east is the only region where inactivity rates are over 25 per cent. House price declines have also been greatest in these areas where there is little Tory representation.
So what exactly is the Government doing to help the poorer regions? As far as I can see, close to zippo. The tiny enterprise zones have only a minor impact. It's probably not a good idea to write off big chunks of the country.
On top of this, the Government has decided to take on workers' rights, including moves announced by Vince Cable to make it less costly to fire people. This is also ideological, as there is no evidence at all to suggest that labour market inflexibility in the UK is constraining growth; in fact, exactly the opposite is the case. David Davis and Liam Fox have absolutely no basis on the evidence to argue that de- regulating the labour market is a problem or that removing workers' rights would bring significant benefits. Wages have been flexible downwards, and firms have hired temporary workers and reduced hours at will. The Coalition made a big deal of the fact that the World Economic Forum in its Global Competitiveness Report 2012-2013 moved the UK up the world competitiveness rankings to 8th from 10th the year before. We were beaten by, in order, Switzerland, Singapore, Finland, Sweden, Netherlands, Germany, and the US. What the Coalition failed to mention was that the UK ranked 5th in labour market efficiency behind only Switzerland, Singapore, Hong Kong and Canada. Of interest is that the countries that Mr Cameron and Mr Osborne frequently compared us to when they imposed austerity rank somewhat lower: Greece is 133rd and Spain 108th. The Dominican Republic is ranked 107th. Not a great idea to write off the workers. No wonder there were rumblings of discontent at the TUC last week.
Then there was Sir John Major's claim of green shoots. Not according to the Bank of England's agents, whose report suggested no evidence of any improvement. They reported that the level of investment would be broadly unchanged over the coming 12 months. Export growth continues to slow, reflecting weakening conditions throughout the euro area. Manufacturing growth had slowed further, and was broadly flat on a year earlier. Construction output continued to fall, largely due to cuts in work for the public sector, along with some weather-related disruption.
The cost of borrowing was creeping up as lenders passed on higher funding costs, although many banks were preparing to make use of the Funding for Lending Scheme. Employment intentions indicated little job creation in the private sector over the coming six months. Consistent with that, the minutes of the MPC's September meeting suggested signs of "some modest underlying expansion. Set against that, the more forward-looking components of the business surveys were weaker, and the rise in energy prices would mean that the squeeze on real household incomes would not ease further in the short term". So little sign of green shoots any place. Borrowing in August hit a record £14.4bn, pushing Slasher's ex-growth strategy to cut the deficit even further on to the rocks.
The next round of spending cuts is about to come. Who is watching out for the meek and the mild? Certainly not the Coalition here, or Mitt over the pond.Reuse content


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What do clients say about working with you?
Cheryl Palmer, M.Ed., CECC, CPRW is a certified career coach and a certified professional resume writer. She holds a Master's degree in counseling and has a certificate in career coaching.
As a career expert Ms. Palmer has been quoted in articles in media outlets such as Forbes, The Wall Street Journal, CNN, MarketWatch, The Ladders, ExecuNet, and HotJobs.
She has also been a guest on Fox Business News where she discussed how job seekers can use their alumni associations to assist them with their job searches, and she appeared on Maryland Public Television to discuss how job seekers can improve their resumes.
Ms. Palmer has been featured in articles in Associations Now where she has given tips on improving your LinkedIn profile, demonstrating your worth on your resume, negotiating salary, and knowing when it's time to move on from your current position. She has also conducted webinars that have been well received by the ASAE community on topics such as online and offline job search strategies, using Twitter and LinkedIn, and current trends in resume writing. And she has been invited every year since 2011 to participate in ASAE's annual meeting as a career coach where she counsels clients confidentially on moving up in the organization, finding new opportunities, and maximizing job satisfaction. In addition, she coaches association executives and professionals in her private practice.
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Thanksgiving Travel Rush: What to Expect
One of the busiest travel days of the year is upon us.
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Traffic reports, live traffic cameras for all Connecticut's Major Roadways. Check out our real time interactive traffic map to help you plan your commute, avoid delays and get where you need to go quickly and safely.
One of the busiest travel days of the year is upon us.
Millions of Americans are heading to their holiday destinations Wednesday.
Officials at the Metropolitan Transportation Authority announced Monday that extra trains will be available before and Thanksgiving and thro…
Federal regulators are urging railroads across the country to test train operators for obstructive sleep apnea after the engineer in Septemb…
The Gold Star Memorial Bridge in New London has reopened after the bridge was closed on both sides due to the icy conditions Monday morning.
The Metropolitan Transportation Authority is considering two proposals that would raise fares and tolls system-wide by about 4 percent on av…
Governor Dannel Malloy is set to make a major announcement about the future of the Pearl Harbor Memorial Bridge project Thursday.
A rollover crash closed part of Interstate 91 southbound in Hartford Wednesday afternoon.
A section of Interstate 91 was closed in North Haven late Wednesday morning after a boat fell off of a trailer and on to the highway.
U.S. Senator Richard Blumenthal is using the final two months of the Obama Administration to push for advancements in railway safety.
A deadly car fire closed part of Route 15 in Hartford Sunday afternoon.
I-95 southbound has reopened in Clinton after a box truck fire closed the highway Thursday morning.
Route 101 was closed for several hours Thursday morning after a 46-year-old Thompson woman was killed in a crash on Wednesday evening.
Rescue crews have responded to a vehicle vs utility pole accident in the Elm City.
Part of 9th District Road in Somers is closed following a crash Thursday morning.


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Daviess County Farm Service Agency (FSA) Executive Director Kirby Payne, reminds producers to review available USDA crop risk protection options, including federal crop insurance and Noninsured Crop Disaster Assistance Program (NAP) coverage, before the deadline of March 15. This deadline applies to forage and pasture, as well as spring-seeded crops, including most produce.
Federal crop insurance covers crop losses from natural adversities such as drought, hail and excessive moisture. NAP
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The five-time champion is an amazing 11 years older than the previous oldest major winner and after falling from two ahead to one behind with three holes of his third round to play Watson produced more moments of inspiration to regain the lead.
In went a 30-footer on the 16th, the green where he had holed from 60 feet the previous day, and a kindly bounce at the par five next set up a two-putt birdie and a par on the last saw him sign for a 71 to give him a one-shot lead at four under.
His closest challengers are now Tasmanian Mathew Goggin and England's Ross Fisher, for whom a first major title may yet come on the day his wife Jo gives birth to their first child.
She was due on Tuesday and he has been saying all along he will pull out if she goes into labour - even if he has a six-shot lead.
As it is, birdies on the 16th and 17th like Watson meant a 70, while Goggin, who has not won a tournament anywhere since 1999 and was first reserve for the tournament until Wednesday of last week, moved up from joint ninth with a 69.
Joint fourth only two back are Fisher's compatriot Lee Westwood and South African Retief Goosen, while American Ryder Cup pair Jim Furyk and Stewart Cink are the only other two players under par.
Westwood had joined Goggin and Watson out in front with a birdie on the long 17th, but from the centre of the last fairway he came up short in the bank of dense rough.
His first chip snagged in the grass and the ball hardly moved, but while a double bogey would have left a horrible taste in his mouth he then got up and down to drop only one stroke.
- More about:
- Golf
- Lee Westwood
- Ryder Cup
- US Open- Golf


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Disclaimer; I don't own Advance Wars
It was a glorious day. The sun shone through a large round window and brightly lit the high up office. The office had a view over a huge expanse of forest leading to picturesque mountains in the background. The office was a large circular room, decorated with long hanging tapestries, all showing Blue Moon troops crushing their enemies, all of which were part of the Black Hole alliance. A single desk, positioned just in front of the window was completely empty, except for a few discarded notes. Struggling as best he could to sit in the most dark and shaded corner of a bright and round room was a boy wearing slightly overly formal military dress.
Colin stood up from his small plastic chair, feeling that the large executive chair at the desk was far too luxurious for anybody except Grit and Olaf. He strolled around the room and, as he enjoyed to do immensely, saluted at the various scenes on the tapestries. Colin reached the one that represented the final battle with Sturm in the Second Black Hole War, and saluted through a small frown. The scene showed Olaf, approximately seven feet tall and with perhaps slightly exaggerated muscles, standing with one of his feet on Sturm's fallen body, who was begging for mercy as the Orange Star COs looked on in admiration, especially Nell. As Colin had remembered the battle, Sturm's death had had slightly more to do with Hawke, but given that the defeat in battle had been very much to do with Olaf's impeccable planning and organisation followed by an inspired execution of exceptional tactics, then Colin supposed that the imagery was fairly apt.
Colin suddenly looked up and his eyes widened. He ran across the room back to his plastic chair. Commander Olaf's instructions had been clear; he was to stay there and not touch anything. Colin had been unsure exactly to what extent he was to 'stay there'. Did that mean he was stay in the building, the office, or the chair? Just in case, Colin was going to fulfil all three criteria, by staying in the chair. He then remembered Commander Grit's instructions, and, after all, Commander Grit had equal authority to Olaf as he was just as intelligent, skilful, qualified, proficient, practised and certified. Commander Grit's words had been, Colin believed exactly,
"You just relax boy, and be taking no notice of Frosty. He's just in a huff because things ain't going so well up north "
Colin decided that, though to disobey or, far worse, take no notice of Commander Olaf was unthinkable, Commander Grit's words did authorise Colin to take a brief walk if he felt it was necessary. Colin thus stood up again and walked over to the large window. The view was exceedingly beautiful, however, the sound was not. The rumbling of ever moving tanks was a faint drone in the background, often drowned out for a moment by thunderous crash of tanks firing. The trees largely shielded the view of the combat. In such heavily forested areas, trying to figure out who was winning was completely pointless, as Colin knew well. Firstly, it was impossible to tell the size of either army, so speculation was pointless, and secondly, Commander Olaf was leading the Blue Moon offensive, so of course he was winning. The grim reality of the scene was reinforced by the occasional volley of artillery fire that rose up over the trees and then fell to Earth and shook the ground with its impact. Nonetheless, Colin had faith in his commanders and his own safety, being in the Blue Moon HQ for the local area.
Colin sat back down and, deciding that he would act in as productive a fashion as he could given the situation and save Commander Olaf the time of dealing with administration later, thus allowing him to enjoy his victory party. Colin got out his journal and began to write, as he had been doing since the beginning of Black Hole's latest invasion,
"Day 27 since first encounter with third Black Hole army, battle continues in the central areas of Blue Moon territory. Battle is joined in deep forest, preventing estimation of enemy numbers. Commander Olaf in local area, leading vehicular direct combat units against unknown enemy, thought to be Hawke. Commander Grit approximately 120 miles east in mountain ranges with indirect combat units, attempting to prevent a significant group of tanks from surrounding the local area. Last communication suggested a temporary stalemate as enemy held position out of range, reason unknown. Final units arrived from the northern front. All resistance there has formally collapsed. Conservative estimations of infantry units in area suggest that the north sea naval forces have fallen into Black Hole hands without a significant fight. Many infantry units were able to safely return south, largely due to a well organised T-copter evacuation. Taking this into account, Blue Moon would appear to have lost over 200,000 G of military equipment through the hasty retreat and another 140,000 G through units destroyed in battle. Value of enemy units destroyed in battle unknown, but thought to be lower than this."
Colin put his pen into his pocket. He had been at the northern front when the Black Hole fleet was first seen in the distance. His command had been simple, to draw up all available indirect combat units in the defensive cover of the city, with tanks on the beaches, preventing any force landing. The enemy had been overwhelming. Despite a significant level of missile support, the air force had torn through the tanks. The landers had Neotanks aboard. There had been no method of resistance. Though Commander Olaf and Commander Grit had initially been critical, their anger softened, or rather melted away leaving only despondency, when they had their first battles against the new Black Hole army.
Colin was disturbed from his thoughts by the sound of footsteps outside the door. The door swung open without a knock and banged quietly against the wall to reveal Grit, with a rather laboured smile on his face. Colin saluted, and Grit awkwardly saluted back out of politeness. Colin stood to attention and failed to say anything, seemingly awaiting orders. Grit gave him a dour gaze and added,
"Now what did I tell you about relaxing a little there Colin?"
"Yes sir!" replied Colin, adopting a well practised 'casual slouch' before daring to say to the mildly amused Grit, "Commander, how goes the eastern front, if it is permitted to talk about it?"
"Things ain't exactly going to plan, Colin. I've got to admit, I don't like the way things look like they might be turning"
"Commander, what happened? Where are the indirect fire units?"
"Now don't you worry about them. They're heading down south now"
"Commander, what exactly happened? Did Olaf recall you?"
"Ah," said Grit with a sigh, "there's a point. I'd better be telling old Captain Snowflake what's happened out there. C'mon, boy, I'll fill you when I've got in contact with Olaf"
Grit sauntered towards the communications office, and Colin took this as an order to follow him. Grit entered the darkened room, lit only by a large number of screens showing various technical readouts and messages, being dealt with by blue clad experts in this field, each trying to synchronise individual unit's need to advance or retreat as appropriate and then relay this information to Olaf to keep him well informed of what was happening at each end of the battlefield, allowing him to make the executive decisions far more easily. Grit walked to the end of the room and tapped one of the men on the shoulder. The man gave a quick nod to Grit before handing over a receiver to him. Grit held down a button on the front of the device and began,
"Come in, Frosty the Snowman, Frosty, do you read me?"
"Grit!" came the exceedingly angry sounding reply, "You impudent excuse for a Commanding Officer! Use the official code names!"
"You got it Aurora Blade, this is indeed Sniper Dragon"
"Grit! Where are you?"
"Closer than you'd think Olaf, I'm right here with Colin"
"Incompetent fool! Why aren't you at the mountains in the east?"
"Well, I know why those tanks were just playing wait and see with me anyway. The lot of them were waiting for some air support. Soon as I saw a few bombers gathering on the horizon, there was no way I could have stayed. There weren't enough missiles to hold them off. If I were still there, the whole lot of them would be destroyed by now, as it is, they're all heading down south to the southern ports. Face it, Olaf, we can't keep doing all this"
"Well…" Olaf grunted and fell silent for a moment
"Anyway boss, where are you?"
"Heading back to you now"
"How's it going?"
"There are too many of them, and thanks to your cowardice we're going to be encircled before long! Idiot!"
"Now don't you worry, you just tell our boys to head south 'til they get to the next town. There should be a good group to join up with there. You head back here"
"What are you planning?"
"Now don't you get your beard in a knot worrying all about it"
"Grit! You're lucky I don't exile you this instant, you impertinent rogue!"
"Olaf, we've all got bigger things to be worrying about now. Face it, if we keep fighting this war like this, the whole army might as well give up now. We can't take on these boys face to face. We need to fall back and consider our options"
"What are the odds of some help?" said Olaf sulkily
"Not great," admitted Grit, "Yellow Comet's busy with its own battles and Green Earth has formally surrended"
"And Orange Star?"
"Busy with preparations of their own. They recommend that we evacuate to their soil immediately. The Green Earth lot are already there, apparently"
"Grit, why do you want me to come back to the HQ?"
"Over and out, Snowy" Grit then turned to the man sitting in front of the transmitter, "If he rings back, tell him I'm not in. I think our boys are on the move now, you get your men on the next APC heading south, and take any staff you can find with you, you got it?"
As the man gave a clear nod and began collecting files scattered throughout the room while his fellow officers did the same, Grit walked briskly out of the office without offering Colin any explanation, who followed anyway. Grit walked as fast as Colin could run behind him, and got to the main stairway for the building, which a large number of people were running down in a panic now, before stopping and turning to Colin, looking deadly serious,
"Listen Colin, you remember how you asked me to teach you how to be a good CO?"
"Yes sir!"
"Then ignore what I'm about to do. A good CO would get out of here now. Remember, without a CO in charge, the troops have no direction, there's no synchronised attack, it all falls apart. A good CO has to know when it's time to leave a few men behind for the good of the rest. Well, I never did buy into the whole good CO thing, Colin. Now, here's the problem. There are too many units advancing too fast outside, and we're going to be surrounded and hit by an air force. We're getting out of here by T-copter. There are two up on the roof, so you head up there now. There should be a unit of infantry up there, get them into one of the T-copters with you and tell the pilot to take off and head south"
"Commander, what about you?"
"Olaf's still out there, son, and I don't fancy his chances alone. Anyway, there's still a unit of mechanised infantry out front. Me, Olaf and them will get out in the second T-copter"
"Commander, it's too risky! There's too much indirect fire being launched!"
"Sorry, Colin, but this is how it's got to be. Now head up to the roof and that's an order"
"Yes sir!"
"Colin!" yelled Grit over his shoulder as he hurried down the stairs, " Just Remember, you are a CO of the Blue Moon, same as any of us. Whatever happens, from here on in, you're going to have to be making decisions"
"What if I make the wrong decisions, sir?"
"Colin," said Grit as he stopped as looked up at Colin from below, "never judge a CO by his right decisions. Any fool can get lucky. It's the good COs that can make bad decisions and win in the end anyway, ok?"
"Yes sir!"
"Then get going, Colin, and good luck"
Grit ran downstairs and through the corridors to the deserted front lobby of the HQ. The only movement was a few papers rustling from the breeze coming through the open front door. Grit walked to the wall with the door in it and peaked his head out quickly, and again for slightly longer. The dirt paths that passed the HQ were all full of units, most of which were badly damaged and moving quite slowly, as Grit could see from the top of the stairs that led up to the HQ main building. As he looked forwards down onto the expansive courtyard, he saw what he was after. The mechs were drawn up behind an improvised barricade made of some desks that they must have borrowed from inside. Grit ran down to them and crouched alongside them. There were only three men left. Each had a look of solemn concentration, though their eyes seemed empty and dull, as they never took their eyes off the gateway, the gates themselves having long since been destroyed by a tank unit that had been dealt with appropriately. Grit turned to the captain,
"Has Olaf checked in yet?"
"Yes sir," replied the captain without shifting his gaze, "He'll be here shortly"
As if agreeing, an APC came clearly into view out of the shadows of the forest, clearly having sustained a great amount of fire. As the APC drew into the courtyard, Olaf's head appeared out of the hatch, sour disapproval of the situation in general quite evident from his face. He somewhat inelegantly pulled himself out of the APC and jumped to the ground and immediately began vocally attacking Grit,
"Unbelievable! Just as I start making some progress, you go and dismiss half the army and force us to abandon a triumphant battlefield to avoid being encircled! Not only that, but with such shortages of men on my front, I find out that you've been sunbathing with who knows how many troops without even firing a shot!"
"Now now, Olaf," interrupted Grit, "You'll have plenty of time for all that later. Right now, we've got to get out of here. You guys come with us" added Grit, turning to the mechs
"We can't" replied the captain, "We're here to cover your escape"
"That's an order, captain" replied Grit bluntly, "and get the crew of that APC as well, I'm not leaving anyone behind"
"Grit! Don't be more of a fool!" exclaimed Olaf, "I've got word that Hawke himself is leading the attack on the front lines! He'll be here to personally ensure that the HQ is captured any second!"
"I thought as much" replied Grit with a half smile
"Grit! What are you planning?" growled Olaf
"Olaf, do you want to be standing here when Hawke himself arrives, or do you want to heading to the evacuation copters that are waiting for us right about now?"
"Fine… Everyone follow me, and, if it means anything to you Grit, then that's an order!"
Olaf, Grit and five men ran back up the steps and into the main building. As Grit entered the building, he looked back to see Hawke stroll calmly through the open gateway, his face giving nothing away, surrounded by five Black Hole mechs. Grit smiled as Olaf yelled something at him from the far side of the hall. He drew his infamous revolver, casually slid one bullet into the chamber, held the gun steadily with his right hand at arm's length, breathed deeply, and fired. The deafening bang echoed around the cavernous entrance hall that he was still just inside, and drowning out any noise in the background. As the Black Hole unit froze in the courtyard, Grit lowered his gun and watched. The mech standing immediately to the right of Hawke bent over and, as his knees and legs started shaking uncontrollably, fell to the ground. Hawke didn't look down at him, but rather up at the source of the shot. Another one of the mechs raise his machine gun towards the building and Grit, but Hawke immediately grabbed the gun and lowered it himself. Hawke, still glaring intently at Grit, gave two quick hand signals and the remaining mechs ran into smaller side buildings. As soon as they were out of sight, Hawke himself began moving towards the main building, straight towards Grit. He walked slowly but purposely, and was completely unarmed. Grit smiled and turned and find Olaf yelling at him,
"Grit! Are you listening? What just happened?"
"I got one of the mechs, let's go"
"Why didn't you shoot Hawke!"
"That one's got strange powers, Olaf, beyond what either of us know. I reckon it'll take more than a bullet to put him down"
"Grit! Stop being so ridiculous!
"Olaf, if a single bullet could stop him, do you honestly think he would personally lead an assault against an enemy HQ with unknown resistance inside?"
Olaf didn't reply as the pair of them ran across the hall. Just as they were about to leave through the glass doors towards the stairs to the roof, Olaf stopped and looked like he was about to speak. Grit didn't let him start, and, while effortlessly reloading his revolver, replied in advance,
"Fine, Olaf, let's just see shall we?"
Grit pressed himself against the wall outside the entrance hall and stared intently at the wall opposite the door. Olaf soon realised what he was doing as Hawke's shadow appeared against the wall. Grit breathed deeply, threw himself out from his cover and fired, shattering the closed glass doors. Hawke calmly stopped and raised his hand unnaturally fast. A strange shadow appeared in the middle of his palm. The bullet hit the middle of his hand, not seeming to pass or make any impact upon the shadow. As Grit dived back behind the wall to safety, Hawke closed his eyes. The shadow over his outstretched palm began to shake exceedingly fast, before suddenly exploding outwards in a wave of shadow. The darkness seemed able to effect the physical world as the doors collapsed from the overwhelming force, stone walls cracked and large sections of the ceiling fell onto the floor. Grit and Olaf, seeing part of the wave come through the door and break through the thin wall opposite them, ran without a word. As they got to the stairwell and began running upwards, closely followed by the five men, Grit breathlessly mentioned,
"That, I do believe, was Black Wave, the lesser of Hawke's two powers"
Olaf didn't reply. As they approached the final door to the roof, the distinctive sound of Hawke's hard boots against the HQ's marble floor made it clear that Hawke knew where they were. Another wave of shadow passed by them, terrifying the soldiers. The wave passed by like a fine black haze, silent and almost beautiful, before striking the ceiling and sending more falling stone towards the COs. As the men briefly took cover in a small corridor off the stairwell, the sound of Hawke's continuous approach forced to brave the failing roof. Grit kicked open the door and waved the men past him, ordering them to instruct the pilot to start up the T copter, before going back in briefly to help the quite out of breath Olaf.
Olaf and Grit rushed out to the helicopter and ordered the pilot to take off at once. As they began to ascend away from the building, Hawke emerged from the door and looked up at them, with almost a look of anger on his face, much to Grit's delight. Grit then leaned out of the T copter, gave a clear salute to Hawke and, while still in full sight of him, picked up the transmitter's receiver from beside the door and casually said,
"This is Grit, Squadron 27, you are free to go, repeat, free to go"
At the same moment Grit put the receiver back, as Hawke finally turned to go back down the stairs, an unusually loud series of explosions unmistakably came from the far side of the mountains, almost all at the same moment. Olaf staggered over to the door and looked out. A vast explosion suddenly consumed part of the HQ that they had been in so recently. A series of equally immense explosions began pounding the very building, tearing it apart as the outer walls collapsed. With a huge groan, the HQ began to lean over to one side while flames consumed the offices. With a final volley of artillery blows, the building surrended and fell inwards on itself, leaving a burning ruin alone, smashed by the occasional rocket. Olaf, pure horror and disgust visible on his face, turned to Grit and began stuttering madly,
"My… my, my tapestries! Do you have any idea how long it took for those to be made! You'll be paying for those for a long time!"
"Yeah, I admit it was that one with Sturm that made me originally think of that plan, but I never thought it might actually be useful for something or another"
"Grit! You had all this planned? What if something had gone wrong! We could both be dead! More importantly, I could be dead! Did it never cross your carefree little mind to run this over with the Commander in Chief of Blue Moon!"
"To be honest, no, because you'd have probably forbidden the idea. Anyway, it all worked out fine. A bullet, probably not, but if it's enough to goad him into the blast of a full artillery barrage, then that might do the job"
"All that was part of your plan! You were gambling with our lives!"
"Yeah, but it all worked out fine, didn't it? Hawke's dead, Olaf, and things will be a fair bit more simple with no CO in the south. Might just give us a chance"
"Sir," said the pilot nervously, "there's another Blue Moon T-copter nearby, it seems to be circling"
"Put me though to it" said Grit as he picked up the receiver, "Colin, now what do you think you're doing here? I thought I ordered you to head south"
"Yes sir," came the reply, "but you also ordered me to relax and take it easy. Given that the two orders seemed contradictory, I thought it better to wait for further instructions before following either course of action"
Grit smiled as Olaf grabbed the receiver and yelled,
"Colin! You are hereby banned from obeying any order given by Grit, do you hear me?"
Grit casually took the receiver off Olaf and said,
"It's good to see you Colin, now follow us"
He then put the receiver back against the transmitter. Olaf began to come up with more problems with Grit's plan, still failing to acknowledge that it had achieved anything. Grit wearily sat down and muttered,
"It's going to be a long flight"
Just at that moment, a frantic beeping came from the front of the cockpit as the T-copter began to shake. The pilot yelled back,
"Something's firing at us! I think there might be some anti air units in the forests, commander, what should we do"
"Increase altitude" came Grit's instant and confident sounding reply, his calm face betrayed by the sweat drops on his forehead. As both the T-copters pulled up, Grit was terrified by the risks. He knew well enough that too low and anti air units tear you apart, but increase your altitude and missiles can pick you off like flies. Grit's worries were answered soon enough. Another alarm from the front sounded. The pilot resignedly turned around and quietly said that a missile system had locked onto them. There was nothing to be done. Try to drop altitude and it just hits the rotors, then you're guaranteed to die. Try to raise altitude and you just fall further. As the beeping got faster and then became a drone, Grit and Olaf both grabbed onto something and nodded at each other once, brave determination on both their faces.
Colin looked out from the other T-copter. Grit's tactics had been certainly unconventional, but they had certainly worked. He looked forwards immensely to arriving at the southern ports to congratulate him properly on his crushing victory over Hawke. He looked on and could have sworn that he caught Grit's eye for just a second, a strange despondency seemed to be there. Less than a second later the T-copter was catapulted forwards, its nose thrown into the air, before wildly swinging and trying to regain a level course with only one rotor. Colin felt sick, mute, unable to move. Two men were in that T-copter who couldn't die, they just couldn't. The other T-copter continued to lose altitude, now in a downward spiral. The back half was completely missing, blown away by the devastating missile strike. Colin, feeling completely detached from the world, totally helpless, stumbled to the cockpit and yelled,
"Pilot, go after that T-copter! Land wherever it does!"
"I'm sorry sir, I can't"
"That is an order, pilot"
"Grit's orders were clear, sir, if anything were to happen to him or Olaf, I am not to set down under any circumstances before we reach the south ports"
"That…" Colin began. That made sense, and Colin knew it. As he sat down slowly, and stared at the T-copter, it finally disappeared underneath the trees, leaving only smoke behind it


text:
Ed Cabellon and Josie Ahlquist have been selected to serve as Co-Editors for an upcoming "New Directions for Student Services" (NDSS) sourcebook, to be published in 2016, tentatively titled, "Engaging the Digital Generation." Find out more!
Student Affairs and Information Technology Partnerships
How intentional is your Student Affairs division in creating meaningful partnerships with the Information Technology division at your institution? Today, Ed shares some ideas on how this can take place based on his recent attendance at the EDUCAUASE Annual Conference.
Exploring EDUCAUSE's Annual Conference
Ed is heading to his first EDUCAUSE Annual Conference in Orlando, FL next week, and has a lot of questions as he prepares for his first Higher Education, Information Technology event!
Advice for New Doctoral Students
As Ed begins his second year in his doctoral program, he shares advice for first year doctoral students that may help demystify being back in the classroom.
Summer Technology and Social Media Projects in Student Affairs
The summer months will fly by. As a Higher Education administrator, how will you spend them learning about technology and social media use in Higher Education?
8 Leadership Lessons as a Student Center Director
As Ed makes his transition out of the Campus Center and up to Student Affairs division leadership, he shares 8 leadership lessons for those who work in Higher Education administration.


text:
REIN Team
Co-founders Rebecca Morter and Gemma Vanson of REIN.
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Previous: Ane Aneli A Next: Aneli B
AKA:Aneli, Aneli A
Born [dd-mm-yyyy]:
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text: EL COCO - Let's Get It Together (1976) • Genre : Italo Disco HiNrg / Funk Soul Disco Jazz • Year : 0 • Label : • On demand! (album available 128-320kbs)* #/by GROVER Release code: ODI114711 Added on 27-10-2014, 19:33 You want this album? link doesn't work? report us from your account! Release Info: EL COCO - Let's Get It Together (1976) 1. Just Be You2. Quiet Village3. Let's Get It Together4. Choka Ma Love5. Mr. Lucky6. Love Vaccine7. Under Construction8. Love Vibrations9. Fait le Chat10. Put on Your Jeans11. Gimme Some This album(s) is currently available for download only with a Premium account. To get a premium account, click here


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Shenzhen Training School, 15,000, ASAPPELCC Education & Legal Consulting Co. Published: May 1, 2015
Job 530: Shenzhen Training Schools
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- M B Kemper, R J Hagerman, R S Ahmad, R Mariner
- American journal of medical genetics
- 1986
We investigated the possibility that fra(X) heterozygotes had a distinct or specific set of mental deficits ("cognitive profile") which would allow for accurate diagnosis. Wechsler Intelligence Scale for Children-Revised (WISC-R) subtest scores obtained on 8 fra(X) school age girls were compared with similar scores obtained on 8 "learning-disabled" non… (More)
- Rabia Shabir Ahmad, Masood Sadiq Butt, +5 authors Muhammad Zia-Ul-Haq
- Journal of Translational Medicine
- 2015
During the last few years, scientific investigations have proposed diet based regimens to prevent several health ailments including obesity, hypercholesterolemia and diabetes. In this regard, a promising tool is the use of functional foods/nutraceuticals. Present research project was an attempt to explore nutraceutical worth of locally grown green tea… (More)
- Roesnita Ismail, K. Jusoff, T. Ahmad, S. Ahmad, R. S. Ahmad
- Computer and Information Science
- 2009
Fuzzy State Space Model (FSSM) is a new modeling technique, which was developed for solving inverse problems in multivariable control systems. In this approach, the flexibility of fuzzy modeling is incorporated with the crisp state space models proposed in the modern control theory. The vagueness and uncertainty of the parameters are represented in the… (More)
- R J Hagerman, A E Chudley, J H Knoll, A W Jackson, M Kemper, R Ahmad
- American journal of medical genetics
- 1986
We present two women with the fragile X syndrome (Martin-Bell syndrome) and autism. Both are mentally retarded, one mildly and one severely. Cytogenetic studies showed a high percentage of lymphocytes with the fragile X chromosome and inactivation occurring preferentially in the normal X chromosome. Autism is shown to be a severe behavioral and cognitive… (More)
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wikiHow to Get Rid of External Hemorrhoids Fast
Three Parts:Relieving Hemorrhoid PainImproving Your Diet and LifestyleTreating External HemorrhoidsCommunity Q&A
Hemorrhoids (piles) can happen to anyone at any age. These uncomfortable enlarged veins can be found inside or externally around the anus. Hemorrhoids are caused by increased pressure on your pelvic and rectal veins, usually linked to constipation, diarrhea, or straining to pass a stool. In some cases, hemorrhoids can be caused by obesity, lifting heavy objects, or from the strain of pregnancy which applies pressure to the veins of the lower abdomen. Fortunately, external hemorrhoids can usually be taken care of without seeing a doctor. There are several things you can do to help relieve the pain, discomfort, and itching of hemorrhoids.
Part 1
Relieving Hemorrhoid Pain
1Take a warm bath. Soaking in warm water can relieve hemorrhoid pain. Run a full bath or sitz bath (a small basin that fits over your toilet, allowing you to soak your anal area). Keep the water warm and add 1 cup of epsom salts to a full bathtub or 2 to 3 tablespoons of salts to the sitz bath. You can soak two to three times a day.
- If you have hemorrhoids, you need to keep the area clean. Be gentle when showering, bathing, or using the toilet. You don't need to use soap, since it may irritate the area.[1] Pat yourself dry with a clean towel.
2Use a compress. To numb the pain, apply a cold ice pack or cold compress. Take a clean cotton washcloth and soak it in cold water. Apply the compress to your hemorrhoid for about 10 to 15 minutes. You can do this frequently throughout the day.[2]
- If you're using an ice pack, place a cloth between the ice pack and your exposed skin.[3] Applying ice directly to the skin can damage your tissue.
3Use pain and itch-relieving gels or lotions. After soaking and drying the hemorrhoid, apply a small amount of aloe vera gel, or anti-itch lotion.[4] Look for something containing petroleum jelly, mineral oil, shark liver oil and phenylephrine. The phenylephrine acts as a decongestant and helps shrink the hemorrhoid. Aloe vera gel can prevent infection and help in healing minor wounds.
- If the hemorrhoids are very painful or uncomfortable, apply a bit of baby teething gel to the area. Teething gels contain a local antiseptic that can reduce pain and discomfort.
- Avoid using steroid creams because they can damage the delicate tissue around a hemorrhoid.
4Shrink the hemorrhoids with an astringent. Take a cotton pad and soak it in witch hazel. Place it on the hemorrhoid after you have a bowel movement. Repeat this as often as you need to, at least four or five times a day. Or, place it on a pad in your underwear for longer lasting relief.[5]
- Witch hazel is a natural astringent and can reduce the swelling of your hemorrhoid.
Part 2
Improving Your Diet and Lifestyle
1Eat more fiber. Slowly add fiber to your diet (since it may cause gas or bloating). Try to get 25 to 30 grams of fiber a day. Fiber will soften your stools, making them easier to pass. Fiber supplements can reduce hemorrhoid bleeding, irritation, and inflammation. If you feel bloated or gassy, you may be eating too much fiber.[6] To get fiber from your diet, eat:[7]
- Whole grains: brown rice, barley, corn, rye, bulgur wheat, kasha (buckwheat), bran cereals, and oatmeal
- Fruits: (especially with the rinds) prunes, apples, peaches, grapes, nectarines, figs, dates, apricots and plums
- Vegetables: especially leafy vegetables like Swiss chard, collard greens, spinach, lettuces, beet greens. Include a variety of vegetables of various colors.
- Beans and legumes
- Yogurt with active cultures and probiotics: These may help support normal bowel function.[8]
2Eat smaller meals and drink water. Choose more nutritious, smaller meals and eat throughout the day. This will give your digestive system a chance to process the food and give your body the nutrition it needs to heal the hemorrhoid. Drink plenty of water throughout the day.
- Fluid keeps your stools softer making them easier to pass.[9]
3Exercise regularly. Do any kind of exercise: aerobic, endurance, cardiovascular or just walking. The idea is that body movement can help keep your bowels moving by essentially massaging them. As your body moves, internal organs move and get massaged as well.
- Exercise also reduces pressure on your veins which may be contributing to hemorrhoid pain.[10]
4Reduce the pressure when you sit. It may be helpful to purchase a foam cushion or a doughnut cushion to sit on. This can help relieve some of the pressure. Avoid sitting directly on hard surfaces.
- Direct pressure on the hemorrhoid can increase swelling and even cause new hemorrhoids.[11]
5Use the restroom on a regular basis. If it's possible, try to use the bathroom without interruptions at the same time every day. If you pass bowel movements regularly, it will reduce your need to strain.[12] Regular bowel movements are a great indicator of overall good health.
- Don't strain or push too hard. Let gravity help, but allow your bowels to do most of the work. If nothing happens, wait an hour or so and try again.
- It may also help to place your feet on a small stool so that your knees are higher than your hips.[13]
Part 3
Treating External Hemorrhoids
1Choose the correct laxative. Passing stools regularly is important when you have hemorrhoids. Avoid straining since this commonly causes hemorrhoids. Instead, choose a bulk laxative or stool softener to temporarily use. Bulk laxatives can soften your stools and reduce the pressure needed to pass the stool which will help the hemorrhoid start to shrink. While your stools should be regular because of the fiber in your diet, you can choose one of the following laxatives:[14]
- Bulk laxatives: These contain fiber (usually psyllium) to increase the mass or weight of the stool, helping it move through the bowels.
- Stool softeners: These soften the stools by adding moisture which should make them easier to pass. Most stool softeners contain docusate, which is what adds the moisture to soften the stool.
- Lubricant laxatives: These lubricate the walls of the intestines and rectum, making the stool pass easier. Most lubricant laxatives contain mineral oil. They are usually safe when taken for short periods of time, but are not recommended for long-term use.
- Avoid stimulant laxatives that include senna, cascara, aloe, or bisacodyl. They work by irritating the interior of the bowel, which is not helpful when you have hemorrhoids.
2Look for signs of external hemorrhoids. The most common symptom of external hemorrhoids is bleeding and discomfort during a bowel movement. You may first notice external hemorrhoids when you clean yourself after using the restroom. A hemorrhoid will be a tender swelling around your anus often about the size and shape of a grape when it first appears. It can also be itchy and painful. Commonly, people notice blood on the toilet paper or in the toilet bowl.[15]
- If you're unsure if you have internal or external hemorrhoids, consider what you can feel. You won't usually feel internal hemorrhoids, but they can bulge through the anal opening. Typically internal hemorrhoids have few symptoms other than bleeding with bowel movements.
3Know when to see a doctor. Most external hemorrhoids go away or at least shrink within two to three days. If you still have hemorrhoids after three to five days, call your physician. You should also contact your doctor if the area is painful or bleeds. Your doctor can diagnose internal or external hemorrhoids by doing a rectal exam.[16]
- If rectal bleeding is not caused by a hemorrhoid, your doctor will probably recommend a more extensive test called a sigmoidoscopy or a colonoscopy because one of the symptoms of colon cancer is rectal bleeding.[17]
4Get medical treatment. If your hemorrhoids don't respond to basic home care or resolve on their own, your doctor may recommend a minimally invasive surgery. The most common approaches include:[18]
- Ligation: A rubber band is tied around the base of the hemorrhoid to cut off blood flow.
- Injection (sclerotherapy): A chemical solution designed to shrink the hemorrhoid is injected.
- Cauterization: The hemorrhoid is burned away.
- Hemorrhoidectomy: The hemorrhoid is surgically removed in this outpatient procedure (although it sometimes requires an overnight hospital stay).
Community Q&A
I've had swelling at my anus, but it comes back when I start going to the gym again. What should I do to get rid of it?If your anus swells to the size of a cherry, soak it in cool spring water and the swelling will stop. If it grows to the size of a small radish, seek medical help. If it grows to the size of a tennis ball, go to the ER. If it's the size of a melon, SEEK HELP NOW!
- Use baby wipes instead of toilet paper to clean yourself after using the restroom.
- Ice packs can reduce swelling, but don't use them for too long. Stick to 5-10 minutes maximum each time.
- Stimulant laxatives can be habit forming and can also weaken the bowels, potentially leading to chronic constipation.[19]
Sources and Citations
- ↑ http://www.mayoclinic.org/diseases-conditions/hemorrhoids/basics/lifestyle-home-remedies/con-20029852
- ↑ http://www.mayoclinic.org/diseases-conditions/hemorrhoids/basics/lifestyle-home-remedies/con-20029852
- ↑ https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=4483
- ↑ http://www.mayoclinic.org/diseases-conditions/hemorrhoids/basics/lifestyle-home-remedies/con-20029852
- ↑ http://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/hemorrhoids-during-pregnancy/faq-20058149
- ↑ http://www.health.harvard.edu/diseases-and-conditions/hemorrhoids_and_what_to_do_about_them
- ↑ http://www.foodpyramid.com/healthy-eating/foods-that-soften-stool-11276/
- ↑ https://nccih.nih.gov/health/probiotics/introduction.htm
- ↑ http://www.mayoclinic.org/diseases-conditions/hemorrhoids/basics/prevention/con-20029852
- ↑ http://www.mayoclinic.org/diseases-conditions/hemorrhoids/basics/prevention/con-20029852
- ↑ http://www.health.harvard.edu/diseases-and-conditions/hemorrhoids_and_what_to_do_about_them
- ↑ http://www.health.harvard.edu/diseases-and-conditions/hemorrhoids_and_what_to_do_about_them
- ↑ http://www.nhs.uk/Conditions/Constipation/Pages/Treatment.aspx
- ↑ http://www.mayoclinic.org/diseases-conditions/constipation/in-depth/laxatives/art-20045906
- ↑ http://www.health.harvard.edu/diseases-and-conditions/hemorrhoids_and_what_to_do_about_them
- ↑ http://www.mayoclinic.org/diseases-conditions/hemorrhoids/basics/symptoms/con-20029852
- ↑ http://www.mayoclinic.org/diseases-conditions/hemorrhoids/basics/tests-diagnosis/con-20029852
- ↑ http://www.mayoclinic.org/diseases-conditions/hemorrhoids/basics/treatment/con-20029852
- ↑ https://www.nationaleatingdisorders.org/laxative-abuse-some-basic-facts
Article Info
Categories: Hemorrhoids | Conditions and Treatments
In other languages:
Italiano: Sbarazzarsi Rapidamente delle Emorroidi Esterne, Español: deshacerte de las hemorroides externas con rapidez, Português: Se Livrar Rapidamente de Hemorroidas Externas
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text: We had the Godfather pizza without black olives. All of the ingredients on the pizza were bake just right and had a nice crunch when I bit into them. However, the pizza dough seemed to be plian flour and water. It also was baked just right and had a nice crunch to it, but the dough had little flavor. The... More


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Justin Trudeau visits Fort McCurray for the first time!
After severe damage caused, Fort McCurray for the first time gets to see Justin Trudeau. The current Prime Minister Justin Trudeau has assessed the damage, has effective plans for them and will come up with something effective for all victims very soon. (more…)